肠结核与克罗恩病的鉴别诊断研究

摘要

目的 对比分析肠结核(ITB)与克罗恩病(CD)的临床、内镜及病理特征,探讨结核杆菌特异性T细胞检测(QFT-GIT)在ITB与CD鉴别诊断中的应用价值.方法 选择2010年12月～2012年2月在浙江省温州市中西医结合医院就诊,明确诊断为ITB(ITB组,n=30)或CD(CD组,n=20)的患者50例.分别行结核菌素皮试(TST)及QFT-GIT检测,同时观察患者临床表现、内镜表现、病理学特征.结果 ①两组在充血水肿、糜烂、节段性改变、肠腔狭窄、息肉增生比例等方面,差异无统计学意义(P＞0.05)；但ITB组裂隙状溃疡、鹅卵石样变比例[0.0％(0/30)、0.0％(0/30)]低于CD组[30.0％ (6/20)、15.0％(3/20)],差异有统计学意义(P＜0.05).②两组肠全壁炎症、淋巴细胞聚集、非干酪性肉芽肿所占比例差异无统计学意义(P＞0.05)；但ITB组裂隙状溃疡[0.0％(0／30)]、隐窝脓肿[0.0％(0／30)]比例低于CD组[25.0％(5/20)、15.0％(3/20)],ITB组干酪性肉芽肿比例[23.3％(7/30)]高于CD组[0.0％(0／20)],差异有统计学意义(P＜0.05).③QFT-GIT敏感性优于TST(83.3％比46.7％),特异性优于TST(95.0％比75.0％),差异有统计学意义(P＜0.05).结论 ITB与CD的内镜及病理表现相似,差异较少且不常见,易出现误诊.QFT-GIT敏感性好特异性高,有助于提高肠结核检出率,可作为临床鉴别ITB与CD的重要辅助诊断方法,具有一定的临床推广价值.%Objective To investigate the clinical,endoscopic and histological pathologic features and to evaluate the value of QuantiFERON-TB Gold In Tube (QFT-GIT) assay in differential diagnosis between intestinal tuberculosis (ITB) and Crohn disease (CD).Methods 50 patients diagnosed with ITB (ITB group,n =30) or CD (CD group,n =20)in Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou City from December 2010 to February 2012 were selected.The patients were treated with TST and QFT-GIT detection,the clinical,endoscopic and histological pathologic features were analyzed.Results ①The differences of proportion on hyperemia edema,erosion,segmental changes,lumen stenosis,hyperplasia polyp between ITB group and CD group were not statistically significant (P ＞0.05); the proportion of fissuring ulcers,cobblestone appearance in ITB group [0.0％ (0/30),0.0％ (0/30)] were lower than those in CD group [30.0％ (6/20),15.0％ (3/20)],the differences were statistically significant (P ＜ 0.05).②The differences of proportion on bowel wall inflammation,lymphoid aggregates,non-caseous granulomatous between ITB group and CD group were not statistically significant (P ＞ 0.05); the proportion of fissuring ulcers,crypt abscess in ITB group [0.0％ (0/30),0.0％ (0/30)] were lower than those in CD group [25.0％ (5/20),15.0％ (3/20)],the proportion of caseous granulomatous in ITB group [23.3％ (7/30)] was higher than that in CD group [0.0％ (0/20)],the differences were statistically significant (P ＜ 0.05).③Susceptibility of QFT-GIT were better than that of TST (83.3％ vs 46.7％),specificity of QFT-GIT were better than that of TST (95.0％ vs 75.0％),the differences were statistically significant (P ＜ 0.05).Conclusion Endoscopic and pathological manifestations of ITB and CD are similar,differences are less and uncommon.QFT-GIT has better susceptibility and specificity,it is helpful to enhance the detection rate of ITB,it is an important auxiliary diagnostic method for the differential diagnosis of ITB and CD; it is worthy of clinical promotion.