Departmentul de Gastroenterologie, Institutul Clinic Fundeni, Bucuresti Context

Corelatia dintre masuratori obtinute prin ecografia transabdomiala si markeri biologici de activitate la pacientii cu boli inflamatorii intestinale

Autori: Anda Les, C. Gheorghe

Departmentul de Gastroenterologie, Institutul Clinic Fundeni, Bucuresti

Context: Ecografia intestinala devine o investigatie paraclinica importanta in managementul bolilor inflamatorii intestinale (BII). Valorile obtinute prin masuratori ecografice se coreleaza cu observatiile endoscopice si cele imagistice (CT, IRM). Cateva studii au incercat sa demonstreze o legatura intre grosimea peretelui intestinal (GPI) si activitatea bolii exprimata prin markeri biologici (proteina C reactiva (CRP), viteza de sedimentare a hematiilor (VSH), fibrinogen) insa acestea au esuat in a demonstra corelatii inalte, dar au sugerat existenta unei corelatii semnificative statistic, mai ales in cazul colitei ulcerative.

Cuvinte cheie: Ecografie, boala inflamatorie intestinala, markeri biologici.

Metode: 23 de pacienti au fost inclusi in studiu (4 diagnosticati cu colita ulcerativa iar 19 cu boala Crohn) cu boala activa sau aflati in remisiune endoscopica. Diagnosticul acestor pacienti a fost stabilit endoscopic si histopatologic. Au fost exclusi pacientii cu alte cauze de sindrom inflamator (infectii cu Clostridium Difficile, cu rotavirus sau infectii de tract respirator superior). Studiul a presupus evaluarea ecografica prospectiva a subiectilor folosind sonda cu frecventa de 5 Mhz. Pentru fiecare pacient s-au obtinut 3 masuratori ale grosimii peretelui intestinal localizat in regiunea corespunzatoare leziunilor observate endoscopic. Ulterior a fost calculata o valoare medie a acestora. S-au prelevat markeri biologici de activitate a bolii de la fiecare pacient (CRP, VSH, fibrinogen). Examinatorul nu a cunoscut valorile acestora.

Rezultate: O corelatie buna s-a observat intre 2 din cele 3 masuratori ale GPI ( Spearman’s equation, r=0.609 and r=0.671, p<0.003, p<0.002) si CRP insa, nu si cu cea de-a 3-a (r=0.452, p<0.035), aceasta fiind cea mai apropiata de valoarea normala. Media calculata dintre cele 3 se coreleaza puternic cu valoarea CRP (r=0.642, p<0.001). Acelasi calcul statistic a fost aplicat si pentru fibrinogen cu o valoare usor mai scazuta a corelatiei dintre acesta si una din masuratori (r=0.567, p<0.005 ) pe de alta parte, celelalte masuratori s-au corelat slab si fara valoare statistica (r=0.384, p<0.07, r=0.506, p<0.032). In ceea ce priveste VSH-ul, s-au observat corelatiile cele mai puternice atat in privinta valorilor masurate ale GPI (r=0.771, r=0.782, r=875, p<0.003), cat si a celei calculate (r=0.812, p<0.001).

Concluzii: Masuratorile obtinute prin ecografia intestinala se coreleaza cu indicii biologici de activitate a bolii, ecografia fiind o examinare de ajutor in managementul pacientilor cu BII.

Correlation Between Sonographic Measurements in Inflammatory Bowel Diseases and Biological Markers of Disease Activity

Authors: Anda Les, C. Gheorghe

Department of Gastroenterology, Fundeni Clinical Institute, Bucharest

Background: Bowel ultrasound is becoming a useful tool in managing inflammatory bowel diseases (IBD). Sonographic measurements correlate well with endoscopic findings and other imagistic methods (MRI, CT) . Several studies attempted to demonstrate a link between bowel wall thickness (BWT) and disease activity expressed by biological markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen). Data from those studies failed to demonstrate a strong correlation but suggested a significant one, especially in ulcerative colitis.

Key Words: Ultrasound, Inflammatory bowel diseases, biological markers.

Methods: 23 IBD patients were included in the study (4 diagnosed with ulcerative colitis, 19 with Crohn’s disease). Diagnosis was established endoscopically and histologically and both patients with active and inactive disease were included. Patients with other causes of inflammatory syndrome were excluded (Clostridium Difficile and rotavirus infections, upper tract respiratory infections). Subjects were prospectively evaluated sonographically using a 5-MHz linear array transducer. The examiner was blinded to biological data. Patient were examined in supine position with no special preparation before. For each subject 3 sonographic measurements of bowel wall thickness were noted from the areas corresponding to disease localization observed endoscopically. Mean value of BWT was calculated. Biological markers of inflammation were obtained: CRP, ESR and fibrinogen.

Results: A strong correlation was detected for 2 of the measurements regarding the BWT ( Spearman’s equation, r=0.609 and r=0.671, p<0.003, p<0.002) and CRP, but not for the third measurement (r=0.452, p<0.035), this measurement being the closest to normal value. A mean calculated value of the 3 measurements of BWT was correlated with CRP, observing a strong correlation too (r=0.642, p<0.001). Same statistics were applied to fibrinogen with a slight lower value of correlation (r=0.567, p<0.005 for fibrinogen) in one measurement, but the other 2 were weekly correlated and with no statistical significance (r=0.384, p<0.07, r=0.506, p<0.032). Regarding the ESR, stronger correlations were obtained (r=0.771, r=0.782, r=875, p<0.003). Mean value was strongly correlated as well (r=0.812, p<0.001)

Conclusions: Sonographic findings seem to correlate well with biochemical markers of inflammation, making this technique a good option in managing IBD patients.