克罗恩病与肠结核临床及内镜特征的鉴别分析

目的 探讨克罗恩病(CD)与肠结核(ITB)的临床及内镜特点,为两者的临别诊断提供依据.方法 回顾性分析2003年6月-2009年2月168例CD患者和156例ITB患者的临床及内镜资料.结果 CD以男性为主(男;女为108:60),肠道手术率较ITB高[(33.3%比10.9%,P<0.01)];CD的腹泻、便血、肛周疾病、肠梗阻的发生率分别为66.1%、32.1%、16.1%和28.0%.明显高于ITB组(分别为47.0%、7.7%、3.4%和9.4%,P值<0.05或<0.01);而ITB的发热、盗汗多于CD组(P值均<0.05),且伴肺结核、腹水发生率明显高于CD组(P值均<0.01);ITB的球蛋白升高、红细胞沉降率增快、结核菌素纯蛋白衍化物试验阳性率、结核抗体阳性率均高于CD组;CD患者内镜下纵行溃疡、网格状溃疡、卵石征、肠腔狭窄均多于ITB组(P值<0.01或<0.05),而ITB的环行溃疡、同盲瓣受累多见(P值<0.01或<0.05),且受累的回盲瓣常变形和开口固定.结论 CD与ITB各有其临床特点,临床特点结合内镜下卵石征、纵行溃疡、网格状溃疡、环行溃疡出现的概率、回盲瓣受累情况及形态变化是鉴别两者的重要特征.     

克罗恩病与肠结核临床、内镜及病理特征对比分析

目的对比分析克罗恩病与肠结核的临床、内镜及病理特征。方法选取南方医科大学珠江医院2006年3月-2012年3月住院并确诊为克罗恩病、肠结核的患者资料,进行回顾性分析,其中克罗恩病组(CD组)39例,肠结核组(ITB组)34例。结果 CD组血便多于ITB组,而ITB组盗汗、腹水多于CD组(P均0.05);CD组合并瘘管形成较多,ITB组则多合并肠外结核,两组比较差异有统计学意义(P均0.05);ITB组PPD试验阳性率明显高于CD组(P0.05);CD组纵形溃疡、鹅卵石征、节段性改变、假性息肉、黏膜桥多见,而ITB组环形溃疡、回盲瓣受累明显(P均0.05);裂隙状溃疡仅见于CD,干酪样肉芽肿仅见于ITB。结论临床上应综合分析二者的临床特征,结合内镜及病理对其鉴别诊断进行综合分析,才能进一步提高诊断的准确率。     

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.     

克罗恩病与肠结核临床及内镜表现的比较

目的通过对克罗恩病(CD)与肠结核(IT)的临床及内镜表现进行回顾性分析,找出对鉴别诊断有帮助的要点。方法对我院1981年12月至2005年12月收治的32例CD和12例IT住院患者的临床症状、并发症、内镜检查进行分析。结果CD患者平均年龄低于IT患者(P<0.05)。肠外结核IT常见(P<0.01)。CD结肠纵行溃疡及铺路石样改变明显高于IT患者(P<0.01),而IT以环形溃疡为主(P<0.05)。肠镜病理示CD有大量淋巴细胞聚集,IT可见干酪样肉芽肿及找到抗酸杆菌(P<0.01)。而临床症状、并发症CD与IT相似(P>0.05)。结论内镜及其病理检查对鉴别CD和IT起到重要作用。     

Logistic回归分析对克罗恩病和肠结核鉴别指标的筛选

目的:探讨对鉴别诊断克罗恩病(Crohn'sdisease,CD)和肠结核(intestinal tuberculosis,ITB)有价值的临床及内镜指标和方法.方法:回顾性分析2003-06/2009-02住院的CD患者130例、ITB患者122例的临床及内镜资料:采用Logistic回归分析的方法筛选鉴别CD和ITB的相关指标,并应用回归方程(数学模型)的方法和ROC曲线分析其诊断效能.结果:对CD和ITB鉴别有价值的临床指标分别是:血便、肠道手术史、肛周疾病、肺结核、腹水、PPD阳性;有意义的临床指标的回归数学模型对CD和ITB鉴别诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为90.3%、76.8%、83.8%、80.7%、88.0%.对CD和ITB鉴别有价值的内镜指标是:直肠受累、纵行溃疡、鹅卵石征、受累回盲瓣固定开口、环形溃疡、鼠咬状溃疡:有意义的内镜指标的回归数学模型对CD和ITB鉴别诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为82.9%、82.0%、82.5%、82.9%、82.0%.结论:筛选出的临床和内镜指标可能对CD和ITB的鉴别有用,应用临床指标、内镜指标回归数学模型的方法可提高诊断的敏感性和准确性.     

肠结核与克罗恩病的鉴别进展

肠结核(intestinal tuberculosis,ITB)与克罗恩病(Crohn’s disease,CD)有相似的临床及内镜表现,他们的鉴别诊断是具有挑战性的,到目前为止尚没有一项特异性的指标可以鉴别两者,近年在鉴别诊断方面有较大进展,故本文就ITB与CD的临床、病理、内镜表现作一综述。     

肠结核与克罗恩病的鉴别诊断分析

近年来肠结核（ITB）和克罗恩病（CD）的发病率呈逐年升高趋势,因两者的临床、内镜以及病理学检查结果均有很大的相似性,因此两者间的鉴别诊断一直是临床医师面临的难题。本研究采用回顾性分析方法,对本院最近6年来确诊的 ITB 患者和 CD 患者的资料进行分析,总结其临床、内镜、病理学特点及抗酸杆菌染色检查结果,为寻求更好的鉴别诊断方法提供参考。     

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.     

炎症性肠病诊断与治疗的共识意见(2012年·广州)病理诊断部分解读

炎症性肠病(IBD)是一组病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。UC在病理学上可表现为黏膜糜烂、浅溃疡、固有膜内重度弥漫性急性、慢性炎性细胞浸润、隐窝脓肿等,但缺乏特征性改变;CD可有透壁性炎症、裂隙状溃疡/阿弗他溃疡、非干酪样坏死性肉芽肿、神经节细胞增生等改变,但亦无诊断金标准。因此,UC和CD的确诊均不能单纯依靠病理检查,尤其是黏膜活检标本病理检查,而需结合临床、内镜、影像学和组织病理学表现进行综合分析并随访观察,在排除感染性和其他非感染性结肠炎的基础上作出诊断。     

克罗恩病与肠结核的临床分析与比较

目的对克罗恩病(CD)与肠结核(IT)进行临床分析和比较,找出对鉴别诊断有帮助的要点。方法回顾性分析我院1983年~2004年间住院的62例CD患者和21例IT患者的临床资料。结果CD男性多见。临床表现、各种并发症的出现、实验室检查、腹部B超/CT以及消化道造影均对鉴别诊断帮助不大,CD的肠黏膜活检诊断率低。CD与IT的常见部位都是回肠及回盲部,但CD可累及直肠,吻合口病变为77.4%。CD纵行溃疡仅占13.6%,而环形溃疡却占26.7%,回盲瓣受累22.2%,IT瘘管形成并不罕见(14.3%)。CD肠系膜淋巴结最大直径为(10±3)mm,均无上皮样肉芽肿,而IT肠系膜淋巴结最大直径为(18±5)mm,P<0.01,均有上皮样肉芽肿,41.2%有干酪样坏死。CD裂隙溃疡多于IT(P<0.01)。CD中全层炎、淋巴组织增生、黏膜下层水肿均比IT多(P<0.05)。结论CD与IT的鉴别需要多方面综合判断,手术标本的病理对鉴别有重要意义。     

结核杆菌T细胞斑点试验在克罗恩病与肠结核鉴别诊断中的应用价值

目的 评价结核杆菌T细胞斑点试验(T-spot.TB)在克罗恩病(CD)与肠结核鉴别诊断中的价值.方法 采集2010年5月至2010年10月第四军医大学西京医院126例患者的外周静脉血标本,密度梯度离心法分离外周血单个核细胞,根据试剂盒说明书操作步骤进行T-spot.TB.结合临床表现、影像学、内镜、病理检查、其他实验室检查及对经验性抗结核治疗的反应作出CD及肠结核的临床诊断.分析T-spot.TB诊断CD和肠结核的敏感度与特异度.结果 确诊CD患者15例[11.9％(15/126)],肠结核患者14例[11.1％(14/126)],肠外结核患者40例[31.7％(40/126)].CD、肠结核、肠外结核、其他疾病患者T-spot.TB阳性率分别为1/15、12/14、70％(28/40)、0％(0/57),各组间差异有统计学意义(P=0.00).CD与肠结核者的T-spot.TB阳性率间差异有统计学意义(x2=70.58,P=0.00).T-spot.TB检测CD的敏感度和特异度分别为93.3％(14/15)和87.5％(14/16),检测肠结核时则分别为85.7％(12/14)和93.3％(14/15),CD的阴性预测值[87.5％(14/16)]高于肠结核的阴性预测值[12.5％(2/16)].结论 T-spot.TB检测有助于鉴别诊断CD与肠结核.     

内镜及病理学检查在克罗恩病和肠结核鉴别诊断中的价值

目的 评价内镜及组织病理学检查在克罗恩病和肠结核的鉴别诊断中的价值。方法 回顾性复习经手术证实的克罗恩病和肠结核各30例资料，对其临床、内镜表现、手术记录等进行分析，并重新审读病理切片。结果 内镜诊断克罗恩病的灵敏度、特异度和准确性分别为80．0％、25．6％和49．3％，而在肠结核中的灵敏度、特异度和准确性分别为86．7％、46．2％和63．8％。克罗恩病的病理学特征有非干酪样肉芽肿、粘膜下层增宽、裂隙样溃疡和淋巴细胞聚集；肠结核的病理特征有肠壁或肠淋巴结干酪样坏死、粘膜下层变窄或闭缩。结论 尽管找到了克罗恩病和肠结核的临床、内镜和组织病理学特征，但手术标本的组织病理学在鉴别诊断中仍起决定作用。     

双气囊小肠镜鉴别诊断克罗恩病与小肠结核的价值

目的: 探讨双气囊小肠镜在克罗恩病与小肠结核鉴别诊断中的价值.方法:对38例临床怀疑小肠克罗恩病、小肠结核的患者进行小肠镜检查. 内镜诊断与病理和临床随访相结合, 评价双气囊小肠镜在两种疾病鉴别诊断中的应用价值.结果: 在38例患者中, 经病理和临床随访确诊克罗恩病18例, 小肠结核20例. 经双气囊小肠镜检查诊断为小肠克罗恩病14例, 检出率36.8%(14/38), 符合率77.8%(14/18);小肠结核为18例检出率47.4%(18/38), 符合率90.0%(18/20).结论:双气囊小肠镜是小肠克罗恩病与小肠结核鉴别诊断较为理想的方法, 并能对病变范围和严重程度作出正确的判断.     

Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction

OBJECTIVES: It is difficult to differentiate intestinal tuberculosis from Crohn's disease because of similar clinical, pathological, radiological, and endoscopic findings. The purpose of this study was to investigate the value of polymerase chain reaction (PCR) assay in the differentiation intestinal tuberculosis from Crohn's disease, and compare the histopathological features of endoscopic biopsy of the two disorders. METHODS: A total of 39 endoscopic biopsy specimens from patients with intestinal tuberculosis and 30 specimens from patients with Crohn's disease were subjected to pathological analysis retrospectively, Ziehl-Neelsen stain, and PCR assay. RESULTS: Except for granuloma with caseation and confluence, which was the characteristic of intestinal tuberculosis, other pathological features of intestinal tuberculosis and Crohn's disease were very similar or were difficult to find in endoscopic biopsy specimens. The positivity rate by PCR in 39 intestinal tuberculosis specimens was 64.1% (25/39), but was zero by PCR in 30 Crohn's disease specimens. Moreover, in the tissues of intestinal tuberculosis with granulomas similar to those of Crohn's disease, there were 71.4% (10/14) positive by PCR, and there were 61.1% (11/18) positive in intestinal tuberculosis tissues without granulomas. CONCLUSIONS: Biopsy is of limited diagnostic value in the differentiation intestinal tuberculosis from Crohn's disease, and PCR is valuable in the differentiation between intestinal tuberculosis and Crohn's disease.     

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。     

Clinicopathologic features of Crohn's disease with free intestinal perforation

BACKGROUND/AIMS: Free perforation is the most serious intestinal complication of Crohn's disease, and early diagnosis is an important determinant of survival. The aim of this study was to evaluate the clinical and histopathologic characteristics of free perforation associated with Crohn's disease. METHODOLOGY: Twelve free perforations in 10 patients with Crohn's disease were studied. We mainly examined the clinical characteristics, methods for definitive diagnosis and histopathologic features of free intestinal perforation with Crohn's disease. RESULTS: Nine patients had 1 perforation, and 1 had 3 perforations occurring within a short period. Computed tomography was significantly more sensitive than plain radiography for detecting free air in the abdomen at the time of perforation. Histopathologic examination showed that free perforation occurred most frequently in the ileum, on the side attached to the mesentery. Intestinal strictures and dilatations were presented distal to 10 perforations (83%). CONCLUSIONS: Our results suggest that computed tomography of the abdomen was useful for the definitive diagnosis of free intestinal perforation in Crohn's disease. Histopathologic findings indicated that increased intraluminal pressure due to stricture and local circulatory disturbance of the mucosa caused by intestinal dilatation were involved in the development of free perforation in patients with Crohn's disease.     

Differential Diagnosis of Intestinal Tuberculosis from Crohn's Disease and Primary Intestinal Lymphoma in China

Background/Aims:

There are many similarities and overlaps in clinical, radiological, endoscopic, and histological features among intestinal tuberculosis (ITB), Crohn''s disease (CD), and primary intestinal lymphoma (PIL), and the differential diagnosis of ITB can be very challenging for clinicians.

Patients and Methods:

The clinical, radiologic, endoscopic, and pathological data of 213 patients were analyzed retrospectively. According to the diagnostic criteria and exclusive criteria of ITB, CD, and PIL, 83 patients were recruited and divided into three groups, including 30 cases in the ITB group, 38 cases in the CD group, and 15 cases in the PIL group, and the medical data and statistical analysis were recorded.

Results:

Rural patients with abdominal pain as the first symptom and with transverse ulcer and caseating granulomas were more common in the ITB group than the CD group, whereas urban patients with stool change as the first symptom, moderate or severe anemia, thickening of intestinal wall, rectal involvement, skipping distribution, prominent lymphoid aggregates, and irregular glands were more common in CD group than ITB group (P < 0.05). Young patients (age < 30 years) with fever, weakness, fatigue, abdominal mass, intestinal perforation, and emergent operation were more common in ITB group than PIL group, whereas thickening of intestinal wall, malignant lymphocytes, limited distribution, and involvement of small intestine occurred more in PIL group than ITB group (P < 0.05).

Conclusion:

The differential diagnosis of ITB from CD and PIL can be made by a combination of clinical manifestation, endoscopy, and pathological examinations.