协和医学杂志

2019, v.10(03) 231-236

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

李皎宇;陈志威;李磊;叶霜;
LI Jiao-yu;CHEN Zhi-wei;LI Lei;YE Shuang;Department of Rheumatology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;Department of Radiology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;

摘要(Abstract):

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。
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 findings were analyzed. Results A total of 63 SLE patients with GI involvement were enrolled,including 60 females and3 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.

关键词(KeyWords): 系统性红斑狼疮;胃肠道;CT;胃肠道功能
systemic lupus erythematosus;gastrointestinal tract;CT;gastrointestinal function

Abstract:

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基金项目(Foundation): 国家重点研发项目精准医学专项(2017YFC0909002)

作者(Author): 李皎宇;陈志威;李磊;叶霜;
LI Jiao-yu;CHEN Zhi-wei;LI Lei;YE Shuang;Department of Rheumatology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;Department of Radiology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;

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