Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Inflamm Bowel Dis. 2011 Jun;17(6):1308-13. doi: 10.1002/ibd.21490. Epub 2010 Nov 4.
Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST).
Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered.
In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (≥10 mm) in patients with ITB was significantly higher than patients with CD (67% versus 9% and 69% versus 16%, respectively; P < 0.001). The QFT and TST had good agreement (κ = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67% sensitivity, 90% specificity, 87% positive predictive value, and 73% negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively).
The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.
鉴别肠结核（ITB）和克罗恩病（CD）具有挑战性。本研究前瞻性评估了 QuantiFERON-TB gold 试验（QFT）在 ITB 和 CD 鉴别诊断中的临床效用，并将其与结核菌素皮肤试验（TST）的临床效用进行了比较。
2007 年 6 月至 2008 年 11 月，从韩国的 13 家医院招募了疑似内镜检查发现 ITB 或 CD 的患者。进行 QFT 和 TST 检测。如果初始诊断未得到确认，则给予 2-3 个月的经验性抗结核治疗。
共分析了 128 例患者，其中 64 例为 ITB，64 例为 CD。ITB 患者的中位年龄大于 CD 患者（47 岁比 31 岁，P < 0.001）。ITB 患者的 QFT 和 TST（≥10mm）阳性率显著高于 CD 患者（67%比 9%和 69%比 16%，均 P < 0.001）。QFT 和 TST 具有良好的一致性（κ=0.724，P < 0.001）。QFT 在 ITB 中的诊断有效性为 67%的敏感性、90%的特异性、87%的阳性预测值和 73%的阴性预测值。QFT 和 TST 之间这些参数没有差异。QFT 阳性的似然比高于 TST 阳性的似然比（分别为 7.1 和 4.4）。
QFT 是 ITB 诊断中结合 TST 的一种有限但有用的诊断辅助手段。
