摘要
目的研究克罗恩病（CD）与肠结核（ITB）的临床、内镜及病理特征，为两者的鉴别诊断提供依据。方法回顾性分析武汉大学中南医院2011年1月-2012年1月收治的107例CD及69例ITB患者临床资料，并评估新近制定的临床及内镜评分系统对CD与IT13的诊断价值。结果（1）临床表现及实验室检查结果：与ITB相比，CD患者男性更多见，确诊时间长，肠道手术率高，腹泻、血便、腹部包块、肠梗阻、肠出血、肛周病变及肠外表现更常见（P值均〈0．05），血小板计数及红细胞压积更高，血白蛋白更低，c反应蛋白（CRP）升高的比例、核周型抗中性粒细胞胞浆抗体（pANCA）、抗酿酒酵母抗体（ASCA）及粪潜血阳性检出率更高（P〈0．05或P〈0．01）；而低热、盗汗、肠外活动性结核、红细胞沉降率升高、x线胸片异常、精制结核菌素试验（PPD）阳性及T细胞斑点试验（T—SPOT）阳性在ITB患者更多见（P〈0．05或P〈0．01）。（2）小肠影像学：CD病变多累及小肠，出现肠腔狭窄及腹腔脓肿（P〈0．05）；肠系膜淋巴结增大多见于ITB（P〈0．05）。（3）内镜下表现：与ITB相比，CD患者纵形溃疡[41．12％（44／107）比5．80％（4／69）]、鹅卵石征[15．89％（17／107）比4．35％（3／69）]、阿弗他溃疡[23．36％（25／107）比10．14％（7／69）]、病变≥4个节段[24．30％（26／107）比7．25％（5／69）]、累及直肠[17．76％（19／107）比5．80％（4／69）]、回盲瓣口狭窄『21．50％（23／107）比8．70％（6／69）]及黏膜桥形成[5．61％（6／107）比0（0／69）]更多见（P〈0．01或P〈0．05）；ITB患者环形溃疡[37．68％（26／69）比9．35％（10／107）]、鼠咬状溃疡[24．64％（17／69）比12．15％（13／107）]、回盲瓣口固定开放[39．13％（27／69）比19．63％（21／107）]、结节样及息肉样病变[36．23％（25／69）比20．56％（22／107），37．68％（26／69）比22．43％（24／107）]较CD患者常见（P〈0．05或P〈0．01）。（4）病理组织学：透壁性炎[5．61％（6／107）比0（0／69）]、裂隙状溃疡[14．02％（15／107）比4．35％（3／69）]、非干酪样肉芽肿[5．61％（6／107）比0（0／69）]、淋巴小结形成[16．82％（18／107）比5．80％（4／69）]及隐窝脓肿[9．35％（10／107）比1．45％（1／69）]检出率在CD组高于ITB组（P值均〈0．05）。（5）应用临床及内镜评分系统对全部病例进行评分，以总分≥3分诊断CD54例，占确诊CD患者的50．47％（54／107），以总分≤一3分诊断ITB46例，占确诊ITB患者的66．67％（46／69）（P〈0．05）。结论CD与ITB鉴别诊断时需重视临床、内镜及病理结果的综合判断，应用临床及内镜评分系统有助于答别诊断。
Objective To investigate the clinical, endoscopic and pathologic features in the differential diagnosis between Crohn＇ s disease （ CD ） and intestinal tuberculosis （ ITB ） . Methods The complete clinical data of 107 patients with CD and 69 patients with ITB in our hospital from January 2011 to January 2012 were retrospectively analyzed. The diagnostic value of the clinical and endoscopic scoring system was evaluated. Results CD occurred mainly in male. The salient features of CD included long duration of disease high incidence of colectomy. Comparing with patients with ITB, patients with CD have more cases of diarrhea, hematoehezia, abdominal mass, intestinal obstruction, intestinal hemorrhage,perianal lesions, and extraintestinal manifestations （all P 〈 0. 05）. It＇s more frequent to have positive results of anti-Saccharomyces cerevisiae antibody （ASCA）, perinuclear antineutrophil cytoplasmic antibody （pANCA） and fecal occult blood in CD patients, as well as low albumin, high C-reactive protein （ CRP）, elevated platelet count and hematocrit （ P 〈 0. 05 or P 〈 0. 01 ）. The salient features of ITB included low fever, night sweats, active parenteral tuberculosis, increased erythrocyte sedimentation rate （ESR）, chest X-ray abnormalities, the positive PPD （ purified protein derivatives tuberculin） and T-SPOT （P 〈 0. 05 or P 〈 0. 01 ）. Based on the imaging, CD often involved the small intestine, such as the intestinal stricture and abdominal abscess （P 〈 0. 05 ） , while mesenteric lymphadenopathy was more common in ITB （ P 〈 0. 05 ）. The endoscopic examination showed that some patterns of disease involvement such as fissure-shape ulcer [41.12% （44/107） vs 5.80% （4/69） ], cobblestone sign [ 15. 89% （ 17/107 ） vs 4. 35% （3/69） ], lesions over four segment [ 24. 30% （26/107） vs 7.25% （5/69） ~, rectum involvement [ 17. 76% （19/107） vs 5.80% （4/69） ], ileocecal valve stenosis [21.50% （23/107） vs 8.70% （6/69） ~ and mucosal bridge [5.61% （6/107） vs 0（0/69）] were more frequent in CD patients than those in /TB patients（P 〈0. 01 or P 〈0. 05）. However circular ulcers[37.68% （26/69） vs 9.35% （10/107） ], rat-bite-like ulcers[ 24. 64% （17/69） vs 12. 15% （13/107） ], persistent open ileocecal valves [ 39. 13% （27/69） vs 19.63% （21/107） ], tuberous and polypoid lesions [ 36. 23% （25/69） vs 20. 56% （22/107）, 37.68 % （ 26/69 ） vs 22. 43% （24/107） ] were more common in ITB （P 〈0. 01 or P 〈0. 05）. In terms of pathological findings, certain characteristic features such as transmural inflammation 5.61% （ 6/107 ） vs 0 （0/69） ], fissure-liked ulcers [ 14. 02% （15/107） vs 4. 35% （3/69） ], non-caseous granulomas [5.61% （6/107） vs 0（0/69） ], lymphoid hyperplasia [ 16. 82% （ 18/107 ） vs 5.80% （4/69） and crypt abscess [ 9. 35% （10/107） vs 1.45% （1/69）] were more common in CD than those in ITB （P 〈 0. 05 ）. According to the clinical and endoscopic scoring system, the positive diagnostic rate of CD was 50. 47 % （54/107）and of ITB was 66. 67 % （46/69） （P 〈 0. 05）. Conclusions The differential diagnosis between CD and ITB should be considered carefully based on clinical, endoscopic, pathological characteristics. The clinical and endoscopic scoring system may contribute to distinguish CD and ITB.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2013年第11期940-944,共5页
Chinese Journal of Internal Medicine
关键词
CROHN病
结核
胃肠
诊断
鉴别
Crohn disease
Tuberculosis, gastrointestinal
Diagnosis, differential
