Dutta Amit Kumar, Sahu Manoj Kumar, Gangadharan Sajith Kattiparambil, Chacko Ashok
Department of Gastrointestinal Sciences, Christian Medical College & Hospital, Vellore - 632004, Tamil Nadu, India.
Trop Gastroenterol. 2011 Jul-Sep;32(3):204-9.
Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) is clinically challenging but important for prognostication and patient management.
Patients with diagnosis of CD and ITB were prospectively enrolled in the study from January 2006 to October 2007. The patients were followed up for further 15 months to ascertain that the diagnosis had not changed. Clinical, laboratory, serological [IgG anti Saccharomyces cerevisiae antibody (ASCA)], endoscopic and histologic features were compared between the ITB and CD patients. The ASCA titers were estimated in 100 healthy controls. Patients were diagnosed as ASCA positive when their ASCA titers were three standard deviations above mean of controls.
Thirty patients with CD (age 33.9 + 15.2 years, 70% males) and thirty with ITB (age 35.1 + 12.2years, 53.3% males) were included in the study. Features commoner in CD were longer duration of symptoms (p < 0.001), blood mixed stool (p = 0.006), presence of longitudinal ulcers (p = 0.005) and skip lesions (p = 0.008) on colonoscopy and more number of colonic segments involved (p = 0.004). Anorexia was commoner in ITB patients (p = 0.008). Positive ASCA was commoner in CD (30%) than ITB (10%) but did not reach statistical significance (p = 0.1).
A combined evaluation of clinical features, endoscopy, histology and response to treatment is the key to differentiate between CD and ITB.
区分克罗恩病（CD）和肠结核（ITB）在临床上具有挑战性，但对于预后评估和患者管理至关重要。
2006年1月至2007年10月前瞻性纳入诊断为CD和ITB的患者。对患者进行为期15个月的随访，以确定诊断未发生变化。比较ITB患者和CD患者的临床、实验室、血清学[抗酿酒酵母抗体（ASCA）IgG]、内镜和组织学特征。测定100名健康对照者的ASCA滴度。当患者的ASCA滴度高于对照者平均值3个标准差时，诊断为ASCA阳性。
30例CD患者（年龄33.9±15.2岁，70%为男性）和30例ITB患者（年龄35.1±12.2岁，53.3%为男性）纳入研究。CD中更常见的特征包括症状持续时间更长（p<0.001）、便血（p=0.006）、结肠镜检查发现纵行溃疡（p=0.005）和跳跃性病变（p=0.008）以及累及的结肠段数更多（p=0.004）。厌食在ITB患者中更常见（p=0.008）。ASCA阳性在CD患者中（30%）比ITB患者中（10%）更常见，但未达到统计学意义（p=0.1）。
综合评估临床特征、内镜检查、组织学检查和对治疗的反应是区分CD和ITB的关键。
