标题：多排螺旋CT测量肠壁厚度对溃疡性结肠炎病情活动及预后的临床评估价值

      作者：苏越 1，冯璐 2，蒋蕾蕾 1，许芳 1，陈玉洁 1，杨少志 1，郭志国 1    苏越 1，冯璐 2，蒋蕾蕾 1，许芳 1，陈玉洁 1，杨少志 1，郭志国 1安徽医科大学附属宿州医院/宿州市立医院消化内科 1、影像科 2，安徽 宿州 234000

      卷次： 2023年34卷20期

      【摘要】 目的 探讨多排螺旋CT测量肠壁厚度评估溃疡性结肠炎病情活动及预后的临床价值。方法 回顾性分析2017年7月至2023年4月安徽医科大学附属宿州医院确诊的58例溃疡性结肠炎(UC)患者的临床影像资料，所有患者均接受全腹部多排螺旋CT检查，测量病变最严重处结肠壁的最大厚度，比较不同病情程度患者、手术与非手术患者及不同复发患者的肠壁厚度，通过受试者工作特征曲线(ROC)分析肠壁厚度诊断UC患者活动度、预后不良及复发的最佳临界值。结果 轻度13例，平均厚度(6.03±0.80) mm，中度26例，平均厚度(7.00±0.99) mm，重度19例，平均厚度(8.48±1.13) mm，三者的肠壁厚度比较差异具有统计学意义(P<0.05)，即活动程度越高，肠壁厚度越厚；手术患者的肠壁平均厚度为(8.23±1.19) mm，明显高于非手术者的(7.09±1.28) mm，差异具有统计学意义(P<0.05)；偶发者和频发者的平均厚度分别为(7.18±1.32) mm，(7.23±1.32) mm，差异无统计学意义(P>0.05)；经ROC分析结果显示，肠壁厚度判断患者处于重度活动期的曲线下面积(AUC)为 0.879，最佳临界值为 7.85 mm，敏感性为78.9%、特异性为89.7%；肠壁厚度判断患者预后不良的AUC为0.747、最佳临界值为7.40 mm、敏感性为 83.3%、特异性为61.5%。结论 多排螺旋CT测量肠壁厚度可以更好地判断UC病情程度及远期预后，有助于个体化治疗。
      【关键词】 溃疡性结肠炎；肠壁厚度；多排螺旋CT；病情活动；预后；复发
      【中图分类号】 R574.62 【文献标识码】 A 【文章编号】 1003—6350（2023）20—2986—05

Clinical assessment value of bowel wall thickness measurement by multi-slice spiral CT on disease activity andprognosis of ulcerative colitis.
SU Yue 1, FENG Lu 2, JIANG Lei-lei 1, XU Fang 1, CHEN Yu-jie 1, YANG Shao-zhi 1, GUOZhi-guo 1. Department of Digestive Medicine 1, Department of Radiology 2, Suzhou Hospital of Anhui Medical University/Suzhou Municipal Hospital of Anhui Province, Anhui 234000, Suzhou, CHINA
【Abstract】 Objective To investigate the clinical value of measuring bowel wall thickness usingmulti-slice spiral computed tomography (CT) in assessing disease activity and prognosis of patients with ulcerativecolitis (UC). Methods Clinical imaging data of 58 UC patients diagnosed at Suzhou Hospital of Anhui MedicalUniversity from July 2017 to April 2023 were retrospectively analyzed. All patients underwent full abdominalmulti-slice spiral CT scans, and the maximum thickness of the bowel wall at the most severe lesion site was measured.Bowel wall thickness was compared among patients with different disease severity, surgical and non-surgical patients,and those with different recurrence patterns. Receiver operating characteristic (ROC) curve analysis was used to deter-mine the optimal critical value of bowel wall thickness for diagnosing disease activity, adverse prognosis, and recurrencein UC patients. Results Thirteen cases were classified as mild, with the mean thickness of (6.03±0.80) mm; 26 cases asmoderate, with the mean thickness of (7.00±0.99) mm; 19 cases as severe, with the mean thickness of (8.48±1.13) mm.There were statistically significant differences in bowel wall thickness among the three groups (P<0.05), with thickerwalls indicating higher disease activity. The average bowel wall thickness in surgical patients was (8.23±1.19) mm, signifi-cantly higher than (7.09±1.28) mm in non-surgical patients (P<0.05). The average thickness for occasional and frequentrelapsers was (7.18±1.32) mm and (7.23±1.32) mm, respectively, with no statistically significant difference (P>0.05).ROC analysis showed that the area under the curve (AUC) for bowel wall thickness in determining severe disease activi-ty was 0.879, with an optimal critical value of 7.85 mm, a sensitivity of 78.9%, and a specificity of 89.7%. The AUC forpredicting adverse prognosis based on bowel wall thickness was 0.747, with an optimal critical value of 7.40 mm, a sensi-tivity of 83.3%, and a specificity of 61.5%. Conclusion Measurement of bowel wall thickness using multi-slice spiralCT can better assess the severity and long-term prognosis of UC, aiding in personalized treatment.
      【Key words】 Ulcerative colitis; Bowel wall thickness; Multi-slice spiral computed tomography; Disease activity;Prognosis; Recurrence