在结核病广泛流行的印度对克罗恩病进行诊断。
Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent.
作者信息
Amarapurkar Deepak N, Patel Nikhil D, Rane Priyamvada S
机构信息
Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai 400025, India.
出版信息
World J Gastroenterol. 2008 Feb 7;14(5):741-6. doi: 10.3748/wjg.14.741.
AIM
To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB).
METHODS
This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR).
RESULTS
The study is comprised of 26 patients with CD (age 36.6 +/- 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 +/- 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis: duration of symptoms (58.1 +/- 9.8 vs 7.2 +/- 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy; 75% when tuberculosis was reported in histology; 63.4% when granuloma was found in histology; 82.6% when TB PCR was positive; and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were: p-ANCA- 3.8% and 3.8%, c-ANCA- 3.8% and 0%, IgA ASCA- 38.4% and 23.1%, and IgG ASCA- 38.4% and 42.3%, respectively.
CONCLUSION
Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.
目的
确定能对克罗恩病（CD）诊断作出阳性预测并将其与胃肠道结核（GITB）相鉴别的参数。
方法
本前瞻性研究历时3年，纳入了连续的确诊为CD的印度患者以及数量相等的确诊为GITB的患者。记录了所有患者的人口统计学、临床、实验室、形态学和组织学特征。进行了诸如抗中性粒细胞胞浆抗体（p-ANCA）、抗中性粒细胞胞浆抗体（c-ANCA）、抗酿酒酵母抗体IgA（IgA ASCA）和抗酿酒酵母抗体IgG（IgG ASCA）等血清学检测。对内镜活检和/或手术组织标本进行抗酸杆菌涂片和培养以及结核组织聚合酶链反应（TB PCR）。CD和GITB的诊断基于标准标准。使用单因素卡方检验和多元逻辑回归（MLR）对数据进行分析。
结果
该研究包括26例CD患者（年龄36.6±8.6岁，男∶女 = 16∶10）和26例GITB患者（年龄37.2±9.6岁，男∶女 = 15∶11）。两组（CD与结核）之间的以下临床变量在单因素分析中具有显著性：症状持续时间（58.1±9.8个月 vs 7.2±3.4个月）、腹泻（69.2% vs 34.6%）、直肠出血（30.7% vs 3.8%）、发热（23.1% vs 69.2%）、腹水（7.7% vs 34.6%）以及炎症性肠病的肠外表现（61.5% vs 23.1%）。其中，除腹水和结肠外表现外，其余经MLR分析均具有统计学显著性。基于发热、直肠出血、腹泻和症状持续时间预测CD的准确率为84.62%，而当组织学报告为炎症性肠病时准确率为63.4%，手术后疾病复发时准确率为42.3%。当存在并存的肺部病变和/或腹部淋巴结病时预测GITB的准确率为73.1%；组织学报告为结核时准确率为75%；组织学发现肉芽肿时准确率为63.4%；TB PCR阳性时准确率为82.6%；抗酸杆菌涂片和/或培养阳性时准确率为61.5%。血清学检测对CD与GITB的鉴别无用。CD和GITB的阳性率分别为：p-ANCA - 3.8%和3.8%，c-ANCA - 3.8%和0%，IgA ASCA - 38.4%和23.1%，IgG ASCA - 38.4%和42.3%。
结论
诸如发热、直肠出血、腹泻和症状持续时间等简单临床参数在鉴别CD与GITB方面具有最高的准确率。
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