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CT评分系统对系统性红斑狼疮胃肠道受累的评估价值:单中心回顾性研究

李皎宇,  陈志威,  李磊,  叶霜

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文章导航 > 协和医学杂志  > 2019 >  10(3): 231-236
李皎宇, 陈志威, 李磊, 叶霜. CT评分系统对系统性红斑狼疮胃肠道受累的评估价值:单中心回顾性研究[J]. 协和医学杂志, 2019, 10(3): 231-236. doi: 10.3969/j.issn.1674-9081.2019.03.008
引用本文: 李皎宇, 陈志威, 李磊, 叶霜. CT评分系统对系统性红斑狼疮胃肠道受累的评估价值:单中心回顾性研究[J]. 协和医学杂志, 2019, 10(3): 231-236. doi: 10.3969/j.issn.1674-9081.2019.03.008
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Jiao-yu LI, Zhi-wei CHEN, Lei LI, Shuang YE. CT Scoring System for the Assessment of Systemic Lupus Erythematosus Associated Gastrointestinal Involvement: A Single-center Retrospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(3): 231-236. doi: 10.3969/j.issn.1674-9081.2019.03.008
Citation: Jiao-yu LI, Zhi-wei CHEN, Lei LI, Shuang YE. CT Scoring System for the Assessment of Systemic Lupus Erythematosus Associated Gastrointestinal Involvement: A Single-center Retrospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(3): 231-236. doi: 10.3969/j.issn.1674-9081.2019.03.008
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CT评分系统对系统性红斑狼疮胃肠道受累的评估价值:单中心回顾性研究

doi: 10.3969/j.issn.1674-9081.2019.03.008
  • 1.

    上海交通大学医学院附属仁济医院南院 风湿科, 上海 201112

  • 2.

    上海交通大学医学院附属仁济医院南院 放射科, 上海 201112

基金项目: 

国家重点研发项目精准医学专项 2017YFC0909002

详细信息
    通讯作者:

    叶霜 电话:021-34506393, E-mail:ye_shuang2000@163.com

  • 中图分类号: R593.24;R445

CT Scoring System for the Assessment of Systemic Lupus Erythematosus Associated Gastrointestinal Involvement: A Single-center Retrospective Study

  • 1.

    Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201112, China

  • 2.

    Department of Radiology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201112, China

More Information

    摘要
  • 摘要:   目的  通过分析系统性红斑狼疮(systemic lupus erythematosus, SLE)胃肠道受累患者腹部CT的特征性病变, 建立CT评分系统并分析其临床评估价值。  方法  回顾性分析2013年9月至2018年5月上海交通大学医学院附属仁济医院风湿科收治的SLE胃肠道受累患者的临床资料, 记录患者CT影像学下的肠壁厚度及肠内外受累部位, 建立CT评分系统, 分析CT评分系统与患者肠道功能恢复时间、住院天数、系统性红斑狼疮疾病活动指数(systemic lupus erythematosus disease activity index, SLEDAI)及实验室观察指标的关系。  结果  共63例SLE胃肠道受累患者纳入本研究, 其中女性60例, 男性3例, 平均年龄(36.7±13.1)岁, SLE病程4(1~8)年; 54例(85.7%, 54/63)患者存在胃肠道病变, 31例(49.2%, 31/63)出现肠外脏器受累, 肠壁厚度平均(7.8±3.7)mm。CT评分与肠道功能恢复时间呈正相关(r=0.365, P=0.003);低分组(CT评分≤ 2)与高分组(CT评分>2)相比, 肠道功能恢复时间更短[(7.9±6.2)d比(15.8±13.8)d, P=0.006)], 住院天数更短[(17.1±9.0)d比(25.7±20.5)d, P=0.043)], SLEDAI更低[(7.6±4.4)分比(12.2±7.2)分, P=0.004], 接受大剂量激素治疗的患者数量更少(60.7%比88.6%, P=0.010)。  结论  CT评分系统可用于评估SLE胃肠道受累患者疾病严重程度。
    Abstract:   Objective  The aim of this study was to develop a CT image-based evaluation system for systemic lupus erythematosus(SLE)associated with gastrointestinal involvement.  Methods  The clinical data of SLE patients with gastrointestinal(GI) involvement from September 2013 to May 2018 were retrospectively analyzed. The bowel wall thickness and extra-GI organs involvement were recorded by CT imaging. A new CT scoring system was established. Then the relationship between the CT score and the time to GI functional recovery, the length of hospital stay, the systemic lupus erythematosus disease activity index (SLEDAI), and laboratory findingswere analyzed.  Results  A total of 63 SLE patients with GI involvement were enrolled, including 60 females and 3 males with a mean age of (36.7±13.1)years and SLE duration of 4 (1-8) years; 54 patients (85.7%, 54/63) had GI tract thickness/edema; 31 patients (49.2%, 31/63) had extra-GI involvement; the average intestinal wall thickness was (7.8±3.7)mm. CT score was positively correlated with the time of GI functional recovery (r=0.365, P=0.003). Compared to those with a CT score >2, patients with a CT score ≤ 2 had a shorter time of GI recovery[(7.9±6.2)d vs. (15.8±13.8)d, P=0.006)], a shorter length of hospital day[(17.1±9.0)d vs. (25.7±20.5)d, P=0.043)], a lower SLEDAI(7.6±4.4 vs. 12.2±7.2, P=0.004); and were less likely to receive higher dose of corticosteroids (60.7% vs. 88.6%, P=0.010).  Conclusion  The CT scoring system can be used to assess the severity of SLE in patients with GI involvement.
    利益冲突  无
    • HTML全文

  • 图  1  CT评分与肠道功能恢复时间(A)、住院天数(B)及SLEDAI(C)的相关性

    下载: 全尺寸图片 幻灯片

    图  2  CT评分高分组与低分组肠道功能恢复时间(A)及住院天数(B)比较

    下载: 全尺寸图片 幻灯片

    表  1  肠道受累的CT评分系统及评价指标(0~6分)

    评价指标 评分标准
    0分 1分 2分
    肠壁最大厚度(mm)
     回盲部以上 ≤3.0 3.1~7.9 ≥8.0
     回盲部以下 ≤3.0 3.1~7.9 ≥8.0
    肠外脏器
     胆胰 无累及 累及 -
     泌尿 无累及 累及 -
    下载: 导出CSV

    表  2  63例SLE胃肠道受累患者一般临床资料

    临床资料 数值
    基本资料
     年龄(x±s，岁) 36.7±13.1
     女性[n(%)] 60(95.2)
     病程[M(Q)，年] 4(1，8)
    临床表现[n(%)]
     腹痛 59(93.7)
     恶心呕吐 51(81.0)
     腹泻 42(66.7)
     发热 13(20.6)
     尿路症状 11(17.5)
     便血 3(4.8)
     静脉血栓 2(3.2)
     活动性肾炎 21(33.3)
     狼疮脑病 4(6.4)
    SLEDAI(x±s，分) 10.2±6.5
    抗凝脂抗体阳性[n(%)] 2(6.9)
    治疗[n(%)]
     大剂量激素治疗 48(76.2)
     羟氯喹 43(68.3)
     环磷酰胺 28(44.4)
     吗替麦考酚酯 13(20.6)
     环孢素 1(1.6)
     利妥昔单克隆抗体 3(4.8)
     全肠外营养 37(58.7)
    死亡[n(%)] 1(1.6)
    SLE:系统性红斑狼疮; SLEDAI：系统性红斑狼疮疾病活动指数
    下载: 导出CSV

    表  3  63例SLE胃肠道受累患者腹腔脏器累及情况 [n(%)]

    累及部位 数值
    胃肠道
     胃十二指肠 31(49.2)
     空肠 50(79.4)
     回肠 53(84.1)
     结肠 42(66.7)
     直肠 21(33.3)
    肠外脏器
     胆道系统(胆囊/胆管) 19(30.2)
     胰腺 7(11.1)
     肾盂/输尿管 18(28.6)
     膀胱 11(17.5)
    下载: 导出CSV

    表  4  CT评分高分组与低分组临床指标比较

    指标 低分组(n=28) 高分组(n=35) t值/χ2值 P值
    年龄(x±s，岁) 35.5±14.6 37.6±11.9 0.638 0.526
    女性[n(%)] 27(96.4) 33(94.3) 0.393 0.842
    病程[M(Q)，年] 2.5(0.9，8.8) 5.0(2.0，7.0) - 0.446
    活动性肾炎[n(%)] 5(17.9) 16(45.7) 5.432 0.020
    SLEDAI(x±s，分) 7.6±4.4 12.2±7.2 2.980 0.004
    红细胞沉降率(x±s，mm/h) 28.8±27.8 30.6±25.7 0.264 0.793
    白蛋白(x±s，g/L) 31.3±4.1 28.1±5.4 2.492 0.015
    谷丙转氨酶(x±s，IU/L) 41.5±75.1 31.7±52.8 0.610 0.544
    淀粉酶(x±s，U/L) 101.1±51.6 123.5±110.2 0.994 0.324
    C3(x±s，g/L) 0.51±0.21 0.41±0.15 2.159 0.034
    双链-DNA(x±s，IU/ml) 40.50±41.7 72.6±103.1 1.548 0.127
    大剂量激素治疗[n(%)] 17(60.7) 31(88.6) 6.654 0.010
    全肠外营养[n(%)] 13(46.4) 26(74.3) 5.119 0.024
    SLEDAI：同表 2
    下载: 导出CSV
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