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中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (6): 428-435.DOI: 10.3969/j.issn.1673-5501.2024.06.004

• 论著 • 上一篇    下一篇

疑似儿童炎症性肠病患儿经腹肠道超声诊断准确性研究

吴海霖1a,2，张源1b,2，秦小娇1b，唐子斐1a，王玉环1a，黄瑛1a   

  1. 1 复旦大学附属儿科医院上海，201102，a消化内科，b超声科；2 共同第一作者
  • 收稿日期:2024-11-28 修回日期:2024-12-14 出版日期:2024-12-25 发布日期:2024-12-25
  • 通讯作者: 第一通讯：黄瑛；共同通讯：王玉环

The diagnostic accuracy of transabdominal intestinal ultrasound in children with suspected inflammatory bowel disease

WU Hailin1a,2, ZHANG Yuan1b,2, QIN Xiaojiao1b, TANG Zifei1a, WANG Yuhuan1a, HUANG Ying1a   

  1. 1 Children’s Hospital of Fudan University, Shanghai 201102, China: a. Department of Gastroenterology, b. Department of Ultrasound；2 Joint First Authorship
  • Received:2024-11-28 Revised:2024-12-14 Online:2024-12-25 Published:2024-12-25

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摘要： 背景肠道超声（IUS）是一种无创、无辐射的方法，在评估肠道炎症方面具有重要价值，但在儿童炎症性肠病（IBD）诊断中的应用数据较为有限。 目的评估IUS及其与生物标志物联合对IBD的诊断和筛查效能。 设计诊断准确性研究。 方法招募复旦大学附属儿科医院（我院）收治的疑似IBD患儿，年龄>2岁且<18岁，主要表现为反复腹痛、排便习惯改变、便血或肛周脓肿。入院1周内先后接受IUS和结肠镜检查，以Porto标准综合判断作为IBD诊断的相对金标准，以IUS为待测标准（IUS由同一名连续2年每年完成＞200例IUS检查的我院超声科医生完成），采集和组合IUS检查指标、生物标志物（ESR、CRP、FC、ALB）指标，分析各指标在诊断IBD中的诊断效能。 主要结局指标肠壁厚度（BWT）、肠系膜脂肪爬行、肠壁分层紊乱或消失、Limberg评分的诊断效能。 结果2023年3月至2024年3月我院消化科收入院具有IBD临床表现的儿童582例，排除年龄<2岁19例，已接受IBD诱导治疗42例，患有可解释症状的器质性疾病98例，拒绝接受IUS或结肠镜检查211例，212例疑似IBD患儿进入本文分析，年龄2.3~16.2(10.0±3.4)岁。IBD组58例，其中45例（77.6%）为克罗恩病，13例为溃疡性结肠炎；非IBD组154例，主要为功能性胃肠道疾病和过敏性肠炎。AUC显示，BWT＞3 mm［80.4%(95%CI：74.2%~86.5%)］截断值优于＞2.5 mm［71.6%(95%CI:65.3%~77.8%)］和＞4 mm［75.1%(95%CI:68.5%~81.7%)］；BWT>2.5 mm在敏感度60.4%(95%CI：52.7%~68.1%)，特异度82.8%(95%CI：73.0%~92.5%)，BWT>3 mm和Limberg评分>1特异度均＞83%，敏感度为77.6%；肠壁分层紊乱或消失、肠系膜脂肪爬行特异度＞96%，敏感度<30%；Limberg评分>1+ESR或+FC敏感度＞60%，特异度＞96.8%。 结论对于疑似IBD患儿，BWT＞3 mm的截断值适用于儿童IBD的诊断；BWT>3 mm和Limberg评分>1有助于儿童IBD的早期筛查和加速内镜病理诊断，肠壁分层紊乱或消失、肠系膜脂肪爬行、Limberg评分>1+ESR或+FC对儿童IBD的诊断价值较高。

关键词: 肠壁厚度, 儿童, 炎症性肠病, 无创

Abstract: BackgroundIntestinal ultrasound (IUS) is a non-invasive, radiation-free method with significant value in assessing intestinal inflammation. However, its application in diagnosing pediatric inflammatory bowel disease (IBD) remains limited. ObjectiveTo evaluate the diagnostic and screening efficacy of IUS and its combination with biomarker analysis in the diagnosis IBD. DesignDiagnostic accuracy study. MethodsChildren aged 2-18 years old, admitted to the Department of Gastroenterology at Children's Hospital of Fudan University with suspected IBD (presenting with recurrent abdominal pain, altered bowel habits, hematochezia, or perianal abscess) were recruited. Within one week of admission, each patient underwent both IUS and colonoscopy. The diagnostic gold standard was based on the Porto criteria for IBD diagnosis. IUS was performed by the same ultrasound physician, who had conducted over 200 cases of IUS annually for the past two years. IUS indices and biomarker levels (ESR, CRP, FC, ALB) were collected and analyzed for their diagnostic efficacy in IBD. Main outcome measuresThe diagnostic efficacy of bowel wall thickness (BWT), mesenteric fat creeping, bowel wall stratification disruption or disappearance and Limberg level. ResultsFrom March 2023 to March 2024, 582 children with suspected IBD were admitted. A total of 212 children were included in the analysis after excluding 19 children under 2 years old, 42 children who received IBD induction therapy, 98 children with organic diseases that explained their symptoms, and 211 children who refused IUS or colonoscopy. Their ages ranged from 2.3 to 16.2 years (10.0 ± 3.4 years). The IBD group included 58 children, with 45 (77.6%) cases of Crohn's disease (CD) and 13 cases of ulcerative colitis (UC). The non-IBD group consisted of 154 children primarily diagnosed with functional gastrointestinal disorders and allergic colitis.The AUC analysis showed that BWT cutoff of >3 mm ［80.4% (95%CI: 74.2-86.5)］ performed better than >2.5 mm ［71.6% (95%CI: 65.3-77.8)］ and >4 mm ［75.1% (95%CI: 68.5-81.7)］. For BWT >2.5 mm, sensitivity was 60.4% (95%CI: 52.7-68.1) and specificity was 82.8% (95%CI: 73.0-92.5). Both BWT >3 mm and Limberg Level >1 demonstrated specificity >83% and sensitivity of 77.6%. Bowel wall stratification disruption or disappearance and mesenteric fat creeping showed specificity >96%, but sensitivity was <30%. The combination of Limberg level>1 with ESR or FC demonstrated sensitivity >60% and specificity >96.8%. ConclusionFor children with suspected IBD, BWT cutoff >3 mm is suitable for the diagnosis of pediatric IBD. The combination of BWT >3 mm and Limberg level >1 is useful for early screening and accelerated endoscopic pathological diagnosis of IBD. The presence of bowel wall stratification disruption or disappearance, mesenteric fat creeping, and the combination of Limberg score >1 with ESR or FC provides significant diagnostic value for pediatric IBD.

Key words: Bowel wall thickness, Children, Inflammatory bowel disease, Noninvasive