Almer S, Bodemar G, Franzén L, Lindström E, Norén B, Ström M
Department of Internal Medicine, Faculty of Health Sciences, Linköping University, Sweden.
Digestion. 1995;56(6):528-33. doi: 10.1159/000201287.
In a prospective study of 34 patients with active ulcerative colitis, the findings of inflammation on plain abdominal films and air enema films were compared to those at colonoscopy including biopsy within 10 days. The degree of inflammation on X-ray films was graded independently by two radiologists, at colonoscopy by one gastroenterologist and from histological slides from 6 different colon segments by one pathologist for each patient. Air enema films had a high sensitivity for endoscopically confirmed friable or ulcerated mucosa (0.91). There was a high specificity (0.86) when excluding inflammation in individual colon segments. Absence of fecal residue as an indication of active inflammation had the same positive predictive value, 0.95, as an abnormal air enema film, 0.98 for endoscopically confirmed inflamed mucosa. The presence of fecal residue or a normal air enema film excluded a friable or ulcerated mucosa at endoscopy with negative predictive values of 0.83 and 0.86, respectively. Patients who had had a complete colonoscopy (n = 16) were divided into groups with total, extensive or distal colitis. Air enema films underestimated the extent of inflammation in 8 of 16 patients compared to colonoscopy. Of 6 patients with distal disease only on air enema films, 5 had disease above the splenic flexure at endoscopy. In patients with ulcerative colitis (1) the presence of fecal residue and a normal air enema film exclude a friable or ulcerated mucosa with a high degree of certainty, and (2) the absence of fecal residue and an abnormal air enema film are predictors of the presence of endoscopically confirmed inflammation.
在一项针对34例活动性溃疡性结肠炎患者的前瞻性研究中，将腹部平片和气钡灌肠片上的炎症表现与10天内结肠镜检查（包括活检）的结果进行了比较。两位放射科医生独立对X线片上的炎症程度进行分级，一位胃肠病学家对结肠镜检查结果进行分级，每位患者的一名病理学家对来自6个不同结肠段的组织学切片进行分级。气钡灌肠片对于内镜确诊的黏膜易碎或溃疡具有较高的敏感性（0.91）。排除单个结肠段的炎症时，具有较高的特异性（0.86）。无粪便残留作为活动性炎症的指标，其阳性预测值与气钡灌肠片异常相同，均为0.95，对于内镜确诊的炎症黏膜，阳性预测值为0.98。粪便残留或气钡灌肠片正常可排除内镜下黏膜易碎或溃疡，其阴性预测值分别为0.83和0.86。进行了全结肠镜检查的患者（n = 16）被分为全结肠炎、广泛性结肠炎或远端结肠炎组。与结肠镜检查相比，气钡灌肠片低估了16例患者中8例的炎症范围。在仅气钡灌肠片显示远端病变的6例患者中，5例在内镜检查时病变位于脾曲上方。对于溃疡性结肠炎患者，（1）存在粪便残留和气钡灌肠片正常可高度确定地排除黏膜易碎或溃疡；（2）无粪便残留和气钡灌肠片异常是内镜确诊炎症存在的预测指标。
