结肠憩室病内镜分类的开发与验证：DICA分类
Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification.
作者信息
Tursi Antonio, Brandimarte Giovanni, Di Mario Francesco, Andreoli Arnaldo, Annunziata Maria Laura, Astegiano Marco, Bianco Maria Antonietta, Buri Luigi, Cammarota Giovanni, Capezzuto Erminio, Chilovi Fausto, Cianci Massimo, Conigliaro Rita, Del Favero Giuseppe, Di Cesare Luigi, Di Fonzo Michela, Elisei Walter, Faggiani Roberto, Farroni Ferruccio, Forti Giacomo, Germanà Bastianello, Giorgetti Gian Marco, Giovannone Maurizio, Lecca Piera Giuseppina, Loperfido Silvano, Marmo Riccardo, Morucci Piero, Occhigrossi Giuseppe, Penna Antonio, Rossi Alfredo Francesco, Spadaccini Antonio, Zampaletta Costantino, Zilli Maurizio, Zullo Angelo, Scarpignato Carmelo, Picchio Marcello
机构信息
Gastroenterology Service, ASL BAT, Andria, Italy.
出版信息
Dig Dis. 2015;33(1):68-76. doi: 10.1159/000366039. Epub 2014 Dec 17.
BACKGROUND
A validated endoscopic classification of diverticular disease (DD) of the colon is lacking at present. Our aim was to develop a simple endoscopic score of DD: the Diverticular Inflammation and Complication Assessment (DICA) score.
METHODS
The DICA score for DD resulted in the sum of the scores for the extension of diverticulosis, the number of diverticula per region, the presence and type of inflammation, and the presence and type of complications: DICA 1 (≤ 3), DICA 2 (4-7) and DICA 3 (>7). A comparison with abdominal pain and inflammatory marker expression was also performed. A total of 50 videos of DD patients were reassessed in order to investigate the predictive role of DICA on the outcome of the disease.
RESULTS
Overall agreement in using DICA was 0.847 (95% confidence interval, CI, 0.812-0.893): 0.878 (95% CI 0.832-0.895) for DICA 1, 0.765 (95% CI 0.735-0.786) for DICA 2 and 0.891 (95% CI 0.845-0.7923) for DICA 3. Intra-observer agreement (kappa) was 0.91 (95% CI 0.886-0.947). A significant correlation was found between the DICA score and C-reactive protein values (p = 0.0001), as well as between the median pain score and the DICA score (p = 0.0001). With respect to the 50 patients retrospectively reassessed, occurrence/recurrence of disease complications was recorded in 29 patients (58%): 10 (34.5%) were classified as DICA 1 and 19 (65.5%) as DICA 2 (p = 0.036).
CONCLUSIONS
The DICA score is a simple, reproducible, validated and easy-to-use endoscopic scoring system for DD of the colon.
背景
目前缺乏经过验证的结肠憩室病（DD）内镜分类方法。我们的目的是开发一种简单的DD内镜评分系统：憩室炎和并发症评估（DICA）评分。
方法
DD的DICA评分是憩室病扩展范围、每个区域憩室数量、炎症的存在及类型、并发症的存在及类型的评分总和：DICA 1（≤3）、DICA 2（4 - 7）和DICA 3（>7）。还进行了与腹痛及炎症标志物表达的比较。为了研究DICA对疾病结局的预测作用，对50例DD患者的视频进行了重新评估。
结果
使用DICA的总体一致性为0.847（95%置信区间，CI，0.812 - 0.893）：DICA 1为0.878（95% CI 0.832 - 0.895），DICA 2为0.765（95% CI 0.735 - 0.786），DICA 3为0.891（95% CI 0.845 - 0.7923）。观察者内一致性（kappa）为0.91（95% CI 0.886 - 0.947）。发现DICA评分与C反应蛋白值之间存在显著相关性（p = 0.0001），中位疼痛评分与DICA评分之间也存在显著相关性（p = 0.0001）。对于回顾性重新评估的50例患者，29例（58%）记录到疾病并发症的发生/复发：10例（34.5%）分类为DICA 1，19例（65.5%）分类为DICA 2（p = 0.036）。
结论
DICA评分是一种用于结肠DD的简单、可重复、经过验证且易于使用的内镜评分系统。
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