摘要目的 探讨Clermont分数在检测克罗恩病肠道黏膜溃疡中的价值.方法 回顾性分析东部战区总医院2015年5月至2017年8月经内镜和病理检查确诊为回结肠克罗恩病行磁共振肠道成像(MRE)和扩散加权成像(DWI)检查的45例患者,其中男28例、女17例,中位年龄25岁.以患者肠段为研究对象,根据内镜下肠道黏膜表现分为无溃疡组、浅溃疡组和深溃疡组.通过常规MRE测量肠壁厚度、评估肠壁水肿及溃疡情况,同时观察各肠段DWI表现,测量表观扩散系数(ADC)值,综上计算得到Clermont分数.采用单因素方差分析比较3组不同肠段间Clermont分数、ADC值,采用受试者工作特征(ROC)曲线分析Clermont分数、ADC值评价克罗恩病肠道黏膜溃疡的效能.结果 本研究共纳入137个肠段,其中无溃疡组、浅溃疡组和深溃疡组肠段分别为30、37、70个.深溃疡组Clermont分数(22.5±4.5)高于无溃疡组(10.2±1.3)及浅溃疡组(15.8±3.5)(F=179.935,P＜0.01).深溃疡组ADC值[(1.34±0.17)×10-3 mm2/s]低于无溃疡组[(2.07±0.52)×10-3mm2/s]及浅溃疡组[(1.52±0.23)×l0-3mm2/s](F=83.822,P＜0.01).采用Clermont分数和ADC值鉴别肠道深溃疡的ROC曲线下面积分别为0.887和0.733.结论 Clermont分数和ADC值均可用于评估克罗恩的黏膜溃疡,Clermont分数检测深溃疡的效能优于ADC值.

abstractsObjective To explore the value of Clermont score in the detection of intestinal mucosal ulcer in Crohn's disease (CD).Methods From May 2015 to August 2017,45 patients (28 males and 17 females;median age was 25 years) were confirmed to have ileocolic CD by endoscopic and pathological examinations at Nanjing General Hospital.All patients underwent MRE and DWI examinations.Based on the appearance of intestinal mucosa endoscopically,intestine segments from 45 patients were divided into three groups,namely,no ulceration group (NU),superficial ulceration group (SU),and deep ulceration group (DU).Several factors contribute to Clermont score calculation.These included the measurement of intestinal wall thickness using MRE,evaluation of intestinal wall edema and ulceration by MRE,DWI performance and ADC value of each segment.One-way ANOVA was utilized to compare the Clermont scores and ADC values of the intestine segments among the three groups.The efficacy of the Clermont scores and ADC values in evaluating intestinal mucosal ulcer in CD was verified using ROC analysis.Results A total of 137 intestine segments were included in the study with 30 cases in NU,37 cases in SU,and 70 cases in DU.DU had the highest Clermont score (22.5±4.5),following were SU(15.8±3.5)and NU(10.2± 1.3)(F=179.935,P＜0.01).The ADC values of DU ((1.34±0.17)× 10-3mm2/s)was lower than NU ((2.07±0.52)× 10-3mm2/s) and SU ((1.52±0.23)× 10-3 mm2/s) (F=83.822,P＜0.01).The AUCs of using Clermont score and ADC value in differentiating deep ulcerations were 0.887 and 0.733,respectively.Conclusions Either Clermont score or ADC value can be used to evaluate mucosal ulcer in CD.Clermont score demonstrates a better efficacy than ADC value in detecting deep ulcerations.