摘要
目的:筛选鉴别诊断克罗恩病和肠结核的CT小肠造影指标。方法:回顾性分析2008年5月1日—2018年9月1日所收治的243例克罗恩病患者和106例肠结核患者的CT小肠造影表现,筛选出能区分克罗恩病和肠结核的CT小肠造影单因素指标,而后进行多因素二元logistic回归分析,建立回归方程(数学模型),采用ROC曲线分析回归方程的诊断效能。结果:鉴别诊断克罗恩病和肠结核CT小肠造影指标的数学模型为P=1/[1+e-(-1.630+7.923X16+3.451X37+4.546X33-2.874X25-5.378X18-4.279X19-5.126X30)],其中X16、X37、X33、X25、X18、X19、X30分别代表肠管非对称性受累、脓肿、梳状征、淋巴结分布在回结肠动脉引流区、回盲瓣挛缩变形、回盲瓣固定开口和淋巴结中央坏死。其诊断的灵敏度为97.8%,特异度为94.2%,准确度为96.3%,阳性预测值为98.2%,阴性预测值为89.9%,诊断预测值为0.783,AUC值为0.989。结论:筛选出的CT小肠造影指标对克罗恩病和肠结核的鉴别诊断具有较高的准确度。在鉴别肠结核和克罗恩病的流程中,CT小肠造影应作为首选的检查方法。
Purpose:To screen CT enterography parameters for differential diagnosis of Crohn’s disease(CD)from intestinal tuberculosis(ITB).Methods:CT enterography manifestations of a cohort of 243 cases of CD and 106cases of ITB from 1st May 2008 to 1st Sep 2018 were retrospectively reviewed.Univariate parameters were screened for differentiation of CD and ITB,then statistically significant variables were screened by binary logistic regression analysis and the regression equation(mathematical model)was established.Furthermore,the diagnostic efficacy of screened parameters was analyzed by regression equation(mathematical model)and ROC curve.Results:The regression mathematical equation was:P=1/[1+e-(-1.630+7.923X16+3.451X37+4.546X33-2.874X25-5.378X18-4.279X19-5.126X30)],and X16,X37,X33,X25,X18,X19,X30 represent asymmetric pattern of involvement and abscess,comb sign,distribution of the lymph nodes along the ileocolic artery,contracture of ileocecal valve,fixed patulous ileocecal valve and lymph nodes with central necrosis respectively.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of regression mathematical model established by CT enterography parameters were 97.8%,94.2%,96.3%,98.2%and 89.9%respectively.A predictive diagnosis point of the clinical regression mathematical model in discriminating CD from ITB was 0.783 and the area under the ROC curve was 0.989.Conclusion:The screened CT enterography parameters would improve the accuracy in differentiating CD from ITB,which indicated that in the diagnosis flow sheet of differentiating CD and ITB,CT enterography should be considered as the first modality.
作者
赵雪松
缪飞
徐嘉旭
范婧
严福华
ZHAO Xuesong;MIAO Fei;XU Jiaxu;FAN Jing;YAN Fuhua(Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2022年第3期276-280,共5页
Chinese Computed Medical Imaging
基金
国家自然科学基金(62133012)
关键词
克罗恩病
肠结核
小肠CT造影
鉴别诊断
回归方程
Crohn disease
Intestinal tuberculosis
Computed tomography enterography
Differential diagnosis
Regression equation
