Evaluation of the feasibility and safety of capsule endoscopy in newly diagnosed Crohn's patients
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摘要:
目的 探究胶囊内镜在新诊断克罗恩病患者中作为诊断工具的可行性与安全性。 方法 选择2019年8月—2023年8月杭州市西湖大学附属第一人民医院新诊断的60例克罗恩病患者为研究对象，均接受胶囊内镜检查。对受试者的临床特征及胶囊内镜的观察结果进行统计，通过该检查的完成率以及不良临床事件的发生率反映其临床应用的可行性和安全性，同时分析胶囊内镜阳性检查结果的病变特征、影响因素及患者年龄对内镜检查结果的影响。 结果 60例患者年龄为(37.0±14.2)岁，CE检查前35.0%(21/60)的患者确诊为克罗恩病，21.7%(13/60)的患者伴随肛周病变和肠外并发症，以腹痛和腹泻为主要临床症状。胶囊内镜检查结果阳性率为80.0%(48/60)，小肠通过时间为(258.5±128.2)min。59例患者顺利完成检查，1例患者发生胶囊滞留(滞留率1.7%, 1/60)。CE检查发现本病最常见的病变为糜烂、溃疡、狭窄，72.9%(35/48)的患者在小肠下段病变相较于上段明显。年轻患者(≤30岁)出血、小肠上部病变为主的比例高于年龄＞30岁的患者(P＜0.05)。C反应蛋白(CRP)是胶囊内镜阳性结果的影响因素(P＜0.05)。 结论 胶囊内镜在新诊断的克罗恩病患者中的应用是可行并且安全的，特别是在年轻、小肠上段病变的患者中更易检出，CRP是影响胶囊内镜阳性结果的相关因素。 Abstract:Objective To explore the feasibility and safety of capsule endoscopy as a diagnostic tool in newly diagnosed Crohn's patients. Methods From August 2019 to August 2023, 60 patients with Crohn's disease newly diagnosed at the First People's Hospital Affiliated to West Lake University in Hangzhou were selected as the research subjects, and they all underwent capsule endoscopy. Statistics were made on the clinical characteristics of the subjects and the observation results of capsule endoscopy. The completion rate of this examination and the incidence of adverse clinical events reflect the feasibility and safety of its clinical application. Simultaneously analyze the lesion characteristics and inflence infactor of positive capsule endoscopy result, and effect of patient age on capsule endoscopy result. Results The mean age of the 60 patients was (37.0±14.2) years, and 35.0% (21/60) of the patients were diagnosed with Crohn's disease before CE examination. 21.7% of the patients were accompanied by perianal lesions and parenteral complications, with abdominal pain and diarrhea as the main clinical symptoms. The positive rate of capsule endoscopy was 80.0% (48/60), and the mean passage time of the small intestine was (258.5±128.2) min. 59 patients successfully completed the examination, and 1 patient had capsule retention (retention rate 1.7%, 1/60). CE examination found that the most common lesions of this disease were erosion, ulcer, and stenosis, and 72.9% (35/48) of patients in the lower small intestine lesions than the upper segment. The proportion of bleeding and upper small intestine lesions in young patients (≤30 years old) was higher than that in patients >30 years old (P < 0.05). CRP is a significant factor affecting the positive results of capsule endoscopy (P < 0.05). Conclusion Capsule endoscopy is feasible and safe in newly diagnosed patients with Crohn's disease, especially in young patients with lesions in the upper small intestine. CRP is a related factor affecting the positive results of capsule endoscopy. -
Key words:
- Capsule endoscopy /
- Small intestinal lesions /
- Crohn's disease /
- Safety /
- Feasibility
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表 1 60例CD患者的临床特征
Table 1. Clinical characteristics of 60 CD patients
项目 数值 性别(男/女, 例) 39/21 年龄(x±s，岁) 37.0±14.2 CD(检查前确诊/ 高度疑似, 例) 21/39 肛周病变[例(%)] 8(13.3) 存在肠外并发症[例(%)] 5(8.3) 研究前接受的检查[例(%)] 回肠结肠镜 54(90.0) 腹部CT 52(86.7) 胃镜 47(78.3) 腹部MRI 9(15.0) 确认肠道通顺方式[例(%)] 完整排出体外 48(80.0) X线下未显示胶囊 8(13.3) CT检查查找 3(5.0) 患者就诊症状[例(%)] 腹痛 34(56.7) 腹泻 21(35.0) 腹胀 7(11.6) 消化道出血 9(15.0) 发热 2(3.3) 
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表 2 CE操作与临床发现
Table 2. CE operation and clinical findings
项目 数值 总小肠完整观察[例(%)] 50(83.3) 小肠通过时间(x±s，min) 258.5±128.2 不良临床事件[例(%)] 1(1.7) 胶囊滞留[例(%)] 1(1.7) 阳性发现[例(%)] 48(80.0) 回肠末端阴性[例(%)] 30(50.0) 病变特征[例(%)] 糜烂 44(73.3) 溃疡 40(66.6) 鹅卵石征 7(11.6) 出血 8(13.3) 狭窄 11(18.3) 息肉样增生 5(8.3) 主要小肠病变位置[例(%)] 上段＞下段 13(27.1) 上段＜下段 35(72.9) 结肠镜检查阴性 30(50.0)
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表 3 阳性病例中的CE发现(例)
Table 3. CE findings in positive cases (cases)
项目 例数 ≤30岁(n=18) ＞30岁(n=30) χ2值 P值 糜烂 44 17 27 0.291 0.590 溃疡 40 13 27 2.560 0.110 不规则型溃疡 22 6 16 1.813 0.178 卵圆形溃疡 26 8 18 1.097 0.295 纵行溃疡 7 3 4 0.100 0.751 环形溃疡 11 4 7 0.008 0.929 鹅卵石征 7 4 3 1.349 0.245 出血 8 6 2 5.760 0.016 狭窄 11 4 7 0.008 0.929 息肉样增生 5 3 2 1.206 0.272 主要小肠病变位置 上段＞下段 13 8 5 4.396 0.036 上段＜下段 35 10 25 注：溃疡分类之间存在部分交叉。
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表 4 CE检查病变阳性/阴性结果影响因素
Table 4. Influencing factors of positive/negative results of CE examination
项目 胶囊内镜阳性(n=48) 胶囊内镜阴性(n=12) 统计量 P值 年龄(x±s，岁) 35.56±13.30 42.75±16.86 1.586a 0.118 性别(男/女，例) 31/17 8/4 0.018b 0.892 胆固醇(x±s，mmol/L) 4.39±0.97 3.72±1.05 2.106a 0.059 白蛋白(x±s，g/L) 39.40±6.76 39.84±5.51 0.223a 0.821 白细胞(x±s，×109/L) 5.71±1.72 6.10±1.46 0.722a 0.470 血红蛋白(x±s，g/L) 128.28±23.95 134.25±17.57 0.809a 0.422 血沉[M(P25, P75)，mm/h] 7.18(3.40, 56.29) 5.05(1.66, 32.05) 1.349c 0.177 CRP[M(P25, P75)，mg/L] 39.24(33.22, 47.35) 2.84(1.60, 11.26) 4.306c ＜0.001 钙卫蛋白(x±s，μg/g) 472.12±116.15 449.74±143.04 0.570a 0.289 注：a为t值，b为χ2值，c为Z值。
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