克罗恩病和肠结核的组织病理学研究

目的：明确克罗恩病和肠结核的组织病理学特征，找出异同点。方法：利用手术切除的肠结核和克罗恩病理标本，观察其组织病理学特征并比较。结果：克罗恩病的特征为裂隙性溃疡、非干酪样坏死性肉芽肿、肿膜下层增宽；肠结核的特征为干酪样坏死、粘膜下层闭锁，肉芽肿融合，组织切片有许多相似之处，如微肉芽肿，全层炎症等，结论：典型的肠结核和克罗恩病易于鉴别，但二者组织病理学的相似性，给部分病例的鉴别诊断带来困难。     

内镜及活检病理对回盲部溃疡的鉴别诊断

目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡，结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌（溃疡型）进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断；对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明：异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义（P〈0．05）；单纯类上皮结节（即结节样肉芽肿）见于克罗恩病和肠结核病，若未发现肠结核干酪样坏死，两者不易鉴别；隐窝脓肿多见于溃疡性结肠炎，但该病理特征诊断意义不强，可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的，综合分析其结果可进一步提高诊断准确率。     

克罗恩病与肠结核鉴别诊断方法的评价

目的　对克罗恩病与肠结核的鉴别诊断方法进行评价 ,寻找更好的鉴别诊断策略。方法　采用回顾性方法 ,将 1990～ 2 0 0 4年武汉大学人民医院既往确诊的克罗恩病与肠结核病例资料各 30例进行复习 ,分析其临床表现、放射影像学、内镜和组织病理学特征的异同之处 ,其结果行Pearson相关分析。结果　克罗恩病的内镜表现以铺路石样改变、节段性病变及非对称性的纵行溃疡为主 ,其病理表现主要是裂隙样溃疡、非干酪样肉芽肿、淋巴细胞聚集。肠结核的内镜表现以溃疡和假息肉为主 ,其病理表现主要是肠壁和淋巴结的干酪样坏死、黏膜肌层的破坏。两组病例的主要临床表现、系统钡餐和 (或 )钡剂灌肠检查和内窥镜表现呈正相关 ,γ分别为 0 .976、0. 975和 0 .96 1。两组病例的病理学特征无相关性 ,γ为 0. 12 9。两组病例在确诊前容易相互误诊 ,误诊率分别为 36. 7%和 5 0 . 0 %。结论　内镜和病理检查对于CD和肠结核的鉴别作用较大 ,临床表现和放射影像学检查可起到协助鉴别作用。     

内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值

目的评价内镜及病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值.方法回顾性分析161例溃疡性结肠炎和89例克罗恩病的临床资料,对其病变分布、内镜结果及病理检查进行了分析.结果克罗恩病好发于末段回肠、右半结肠及上消化道,而溃疡性结肠炎好发于直肠.克罗恩病的病理特征有非干酪样肉芽肿、裂隙样溃疡、淋巴细胞聚集、全层炎;溃疡性结肠炎的病理学特征有弥漫性或灶性黏膜炎症、隐窝脓肿、黏膜糜烂及溃疡.结论内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中起到决定性作用,尤其手术标本的病理检查对CD诊断价值较大.     

肠结核与克罗恩病的鉴别诊断

在诸多肠道炎症性病变中,肠结核和克罗恩病是两大重要的疾病,近年来两者的发病率均呈上升趋势。肠结核与克罗恩病的临床、影像学、内镜和病理学表现均十分相似。肺结核的存在和结核杆菌的发现有利于肠结核的诊断,但克罗恩病误诊为肠结核的概率仍很高。本文就这两种疾病的诊断和鉴别诊断作一综述。 一、诊断标准 1.肠结核:符合以下任何一项标准即可确诊:①肠壁或肠系膜淋巴结找到干酪样坏死性肉芽肿;②病变组织病理检查找到结核杆菌;③病变处取材培养结核杆菌阳性;④病变处取材动物接种有结核改变。一般病例根据临床症状、体征以及X线检查有典型结核改变、肠外找到结核灶和抗痨试验治疗6周病情有改善,便可作出临床诊断。     

肠结核和克罗恩病的鉴别诊断

肠结核（IT）和克罗恩病（CD）的鉴别诊断一直是临床难题。临床研究显示内镜检查和手术标本组织病理学在两者的鉴别诊断中具有重要价值，而临床特征、放射影像学、结核杆菌抗酸染色、结核杆菌培养、结核杆菌聚合酶链反应（PCR）以及血清标志物（血管紧张素转换酶和抗酿酒酵母抗体）的价值有限。     

肠结核与克罗恩病的临床鉴别及肠黏膜结核分枝杆菌聚合酶链反应检测的意义

目的总结肠结核与克罗恩病临床症状、内镜、病理表现的差异及肠黏膜组织结核分枝杆菌聚合酶链反应（polymerasechain reaction for Mycobacterium tuberculosis,TB-PCR）对二者鉴别诊断的意义。方法回顾分析1994年1月-2006年2月于我院确诊的42例肠结核和60例克罗恩病病例,记录患者的临床、内镜、病理表现特点及肠黏膜TB-PCR检测结果。结果克罗恩病患者临床表现为消化道出血者占56.9%（33/58）,较肠结核（16.1%,5/31）多见（P〈0.001）;29.3%克罗恩病患者有肠外表现（口腔溃疡、皮疹、关节痛、肛周病变）,而肠结核患者未见;内镜下克罗恩病表现为纵行/裂隙样溃疡（44.9%,22/49）、卵石征（28.6%,14/49）、节段性病变（51.0%,25/49）多于肠结核（7.7%、3.9%、0）（P值分别为0.001、0.011、0.000）;克罗恩病患者肠黏膜组织病理表现为淋巴细胞聚集占34%（18/53）,小血管炎占26.4%（14/53）,明显较肠结核多见（0%、3.8%）（P值分别为0.001、0.016）。82.4%（14/17）的肠结核患者试验性抗结核1-2周症状改善,而5例克罗恩病患者试验性抗结核治疗4-8周均无效。肠黏膜组织TB-PCR检测阳性率肠结核组为11.5%（3/26）;与CD组（14.3%,3/21）比较无显著差异（P〉0.5）。结论肠结核与克罗恩病鉴别需结合临床表现、内镜、影像学表现综合判断;肠黏膜TB-PCR对肠结核与CD鉴别诊断的意义有限;试验性抗结核治疗及内镜随访仍是鉴别肠结核与克罗恩病的有效方法。     

回盲部溃疡228例的回顾性分析

目的探讨内镜及病理检查对回盲部溃疡的鉴别诊断价值.方法 收集我院2006年至2010年肠镜检查中检出的228例回盲部溃疡病例,就其临床特征、内镜及病理检查、治疗及随访情况进行总结分析,并比较克罗恩病及肠结核内镜下的形态特征.结果 (1)溃疡性结肠炎及回盲部肿瘤结合内镜及活检组织病理检查通常可明确诊断,回盲部的非特异性溃疡局部溃疡整齐或局限,多数经抗生素及培菲康等对症治疗后症状缓解,克罗恩病及肠结核只有少数通过内镜及病理活检确诊,多数经试验性治疗后随访明确诊断.(2)克罗恩病的溃疡多呈纵形或不规则形伴黏膜卵石征和肠腔狭窄,而肠结核溃疡多呈环形或环周分布伴息肉样变.结论 回盲部溃疡病变诊断主要依靠反复的病理检查及试验性治疗,尤其是肠结核和克罗恩病的诊断,因此寻找一种特异性血清或免疫组化的指标鉴别诊断回盲部溃疡是非常必要的.     

结核杆菌DNA检测在肠结核与克罗恩病鉴别诊断中的价值

目的：探讨聚合酶链反应（PCR）技术对肠结核和克罗恩病（Crohn's disease,CD)的鉴别诊断价值。并对其内镜活检组织的病理改变进行比较,方法：C地38例肠结核和30例CD活检组织进行病理分析、抗酸染色镜检和PCR技术检测结核杆菌DNA。结果：（1）淋巴细胞聚集在CD远较肠结核多见（P＜0．05）;而肉芽肿,尤其是干酪样肉芽肿和肉芽肿的融合在肠结核却更多见（P＜0．05）。两者其他病理特点的差异在活检组织中不明显或难以发现;（2）PCR技术检测结核杆菌DNA总阳性率为63．2％（24／38例）;在与CD肉芽肿形态相同的肠结核组中阳性率为71．4％（10／14例）;在无肉芽肿瘤变的肠结核组中阳性率为64．7（11／17例）。而该技术在CD组无1例阳性。抗酸染色镜检总阳性率为21．1％（8／38例）。结论：内镜活检病理对肠结核与CD的鉴别诊断有一定局限。PCR技术是鉴别肠结核和CD极有价值的一种新方法。     

肠结核误诊为克罗恩病2例分析

肠结核与克罗恩病在临床表现、内镜下所见及病理学改变等方面可极为相似,因此,两者的鉴别诊断十分困难,是临床上的一大难题^[1]。最近,我们收治了2例误诊为克罗恩病的肠结核患者。现报道如下：     

The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis]

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.     

Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis

BACKGROUND: Intestinal tuberculosis and Crohn's disease are chronic granulomatous disorders that are difficult to differentiate histologically. AIMS: To characterise distinctive diagnostic features of tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy. METHODS: Selected histological parameters were evaluated retrospectively in a total of 61 biopsy sites from 20 patients with tuberculosis and 112 biopsy sites from 20 patients with Crohn's disease. The patients were chosen on the basis of clinical history, colonoscopic findings, diagnostic histology, and response to treatment. RESULTS: The histological parameters characteristic of tuberculosis were multiple (mean number of granulomas per section: 5.35), large (mean widest diameter: 193 microm), confluent granulomas often with caseating necrosis. Other features were ulcers lined by conglomerate epithelioid histiocytes and disproportionate submucosal inflammation. The features characteristic of Crohn's disease were infrequent (mean number of granulomas per section: 0.75), small (mean widest diameter: 95 microm) granulomas, microgranulomas (defined as poorly organised collections of epithelioid histiocytes), focally enhanced colitis, and a high prevalence of chronic inflammation, even in endoscopically normal appearing areas. CONCLUSIONS: The type and frequency of granulomas, presence or absence of ulcers lined by epithelioid histiocytes and microgranulomas, and the distribution of chronic inflammation have been identified as histological parameters that can be used to differentiate tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy.     

克罗恩病与肠结核临床及病理特征的对比研究

目的 探讨克罗恩病(CD)与肠结核(ITB)临床与病理特征,为两者鉴别诊断提供依据.方法 对1996-2007年四川大学华西医院临床、病理资料完整的33例CD和34例ITB的临床及病理资料进行同顾性分析.结果 CD出现症状到确诊的时间明显长于ITB(P<0.05),CD多因肠梗阻或诊断不明而手术,CD的便血、肠梗阻、肠外表现明显多于ITB(P值均<0.05),而盗汗、合并肺结核、低白蛋白血症和ESR升高、血清结核抗体阳性则更常见于ITB(P值均<0.05),CD患者仅累及空、回肠的情况明显多于ITB(P<0.05);CD患者内镜下纵形溃疡及鹅卵石样外观明显多于ITB(P值均<0.05),而ITB组环形溃疡更多见(P<0.05);ITB组的肉芽肿检出率(70.6%)明显高于CD组(29.4%)(P<0.05),且肉芽肿的位置有助于两者的鉴别;CD的手术标本的固有层底部/黏膜下层淋巴细胞聚集现象明显多于内镜活检标本(P<0.05).结论 尽管CD与ITB临床表现极其相似,但各自仍有一定的特征性,诊断需结合临床及病理资料进行综合分析.肉芽肿出现的几率、位置及炎症细胞分布范围与深度可作为两者病理鉴别要点.     

Gastric T-cell lymphoma presenting with epithelioid granulomas mimicking tuberculosis in regional lymph nodes

In patients with malignant lymphomas, a sarcoid reaction is occasionally observed. However, lymphoma-related granulomas with caseous necrosis are rare. We describe such a case of T-cell gastric lymphoma that was difficult to diagnose. A 50-year-old man was referred to our hospital because of abnormal gastric endoscopic findings: hypertrophic folds with narrowing of the gastric lumen and multiple ulcers in the body. Gastric biopsy specimens showed non-specific inflammation. An open biopsy of the enlarged gastric regional lymph nodes was performed. The sections revealed effacement of the normal architecture and replacement by numerous epithelioid granulomas accompanied by Langhan's type giant cells with or without central caseous necrosis, strongly suggesting tuberculosis. However, mycobacteria and other causative organisms were not detected, and an anti-tuberculous regimen was ineffective. Repeat gastric biopsies were performed and, finally, atypical lymphocytes were observed infiltrating the mucosa. The patient was diagnosed with gastric T-cell lymphoma based on the results of immunohistochemical stainings. After chemotherapy, a total gastrectomy was performed. The diagnosis of gastric T-cell lymphoma with a sarcoid reaction was confirmed by histological findings of the sections. Namely, the gastric wall was replaced by atypical lymphocytes showing the phenotype of helper T cells, admixed with epithelioid granulomas with Langhan's type giant cells. Thus, this case suggests that regional lymph nodes in gastric lymphomas may be present as epithelioid granulomas with caseous necrosis, mimicking tuberculosis. Received: January 6, 2000 / Accepted: May 26, 2000     

克罗恩病和肠结核活检及手术标本的病理学特征分析148例

目的:探讨克罗恩病(Crohn's disease, CD)和肠结核(intestinal tuberculosis,ITB)活检及手术标本的病理学特征在二者鉴别诊断中的价值.方法:选取在湘雅二医院、湘雅医院、湘西自治州人民医院确诊的CD和ITB患者各55例,其中活检标本各55例;手术病理标本CD 29例,手术ITB 9例.统计每例标本的病理学特征并进行比较.结果:CD患者活检标本与ITB患者活检标本比较,黏膜下层增宽、裂隙状溃疡及肉芽肿差异均有统计学意义(37.5%vs14.0%,10.9%vs0%,10.9%vs43.6%,均P<0.05);手术标本比较,黏膜下层增宽、裂隙状溃疡、固有肌层增厚、鹅卵石征及肉芽肿差异均有统计学意义(51.7%vs11.1%,34.5%vs0%,62.1%vs11.1%,37.9%vs0%,20.7%vs77.8%,均P<0.05).结论:活检标本的病理学特征鉴别CD和ITB价值有限,手术标本病理学特征对他们有鉴别价值,但仍需结合临床、内镜及影像学检查综合诊断.     

干酪坏死性附睾结核声像特征及其临床与病理分析

目的分析干酪坏死性附睾结核高频彩色多普勒声像特征及其与临床、病理关系. 方法对资料齐全的12例经手术及病理证实的干酪坏死性附睾结核高频彩色多普勒检查结果及临床资料进行回顾性分析. 结果 (1)附睾结核症状隐匿,病程较长,平均年龄39.7岁,多数以单侧阴囊肿块就诊.本组资料结核菌素实验(PPD)阳性为67 %,患肺结核者为42 %.(2)附睾结核高频多普勒声像特征:附睾局部或全部肿大,外形失常,病变处呈不规则、不均质中等偏强或低回声,兼有局限性较小的不规则、均质低或无回声区,边界不清;高频彩色多普勒能量(CDPI):部分病灶见丰富或较丰富以动脉为主动、静脉血流信号.(3)继发改变:患侧睾丸肿大,内回声增强,患侧睾丸鞘膜积液. 结论干酪坏死性附睾结核高频彩色多普勒声像与其解剖、临床及病理密切相关,超声对其诊断及鉴别诊断具有重要临床意义.     

结肠镜结合病理检查对结直肠溃疡病因诊断的价值

结直肠溃疡可由多种疾病所致，目前结肠镜结合病理检查是诊断结直肠溃疡病因的主要手段。目的：探讨不同病因结直肠溃疡的特征和诊断方法，以期提高对相应疾病的认识。方法：回顾性分析四川大学华西医院93例结直肠溃疡患者的临床特点、结肠镜检查和活检病理资料。结果：结直肠溃疡的病因以溃疡性结肠炎（UC）、肠结核、缺血性结肠炎、结直肠孤立性溃疡、克罗恩病（CD）、感染性肠炎、内痔，息肉术后、恶性淋巴瘤等常见。临床诊断的敏感性为33．3％，病理诊断为46．2％，内镜诊断为61．3％，结肠镜检查结合病理诊断为73．1％。结肠镜下UC多为弥漫分布的不规则浅小溃疡；肠结核多为环形溃疡；CD多有铺路石样改变；缺血性结肠炎病变与正常肠段界限明显。多数UC患者可见隐窝脓肿；异型淋巴细胞见于恶性淋巴瘤，经免疫酶标检查可证实；干酪样肉芽肿和抗酸染色阳性对肠结核有确诊意义，肠结核和CD中均可见非干酪样肉芽肿。结论：结直肠溃疡病因复杂多样。结肠镜结合病理检查对结直肠溃疡的病因诊断具有重要价值。可显著提高其诊断敏感性。