肠结核与克罗恩病的鉴别诊断研究

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。

Research on differential diagnosis between Crohn disease and intestinal tuberculosis

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 histolog ical 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）.② The 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 promo tion.