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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

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
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

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
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

More Information
  • 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。
    利益冲突  无
  • 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

    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

    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 P
    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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  • 收稿日期:  2018-12-28
  • 刊出日期:  2020-09-18

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