克罗恩病与肠结核的临床、内镜及组织学鉴别。

Clinical, endoscopic and histological differentiations between Crohn's disease and intestinal tuberculosis.

机构信息

Department of Gastroenterology, Nanfang Hospital, Guangzhou, China.

出版信息

Digestion. 2012;85(3):202-9. doi: 10.1159/000335431. Epub 2012 Feb 17.

DOI:10.1159/000335431

PMID:22354097

Abstract

BACKGROUND AND AIM

Differentiating Crohn's disease from intestinal tuberculosis often challenges clinicians in countries where tuberculosis and Crohn's disease coexist. The aim of this study was to screen out clinical, endoscopic and histological features which may be helpful in distinguishing Crohn's disease from intestinal tuberculosis.

METHODS

43 patients with a confirmed diagnosis of intestinal tuberculosis and 53 patients with Crohn's disease were recruited for this study. Their clinical, endoscopic and histological features were subjected to univariate and multivariate analyses.

RESULTS

On univariate analysis, the features of hematochezia, intestinal obstruction, fistula, oral ulcers, longitudinal ulcers, cobblestone appearance and pseudopolyps were more common in Crohn's disease than in intestinal tuberculosis (p < 0.05). The features of night sweats, concomitant pulmonary tuberculosis, positive tuberculin skin test, positive antibody to tuberculosis, abdominal lymphadenopathy, ascites, transverse ulcers, patulous ileocecal valve, and granulomas were more common in intestinal tuberculosis than in Crohn's disease (p < 0.05). Granulomas exceeding 300 μm in maximal diameter, more than five granulomas per section, and confluent granulomas were more frequently identified in intestinal tuberculosis than in Crohn's disease (p < 0.05). On further multivariable logistic regression analysis, night sweats (OR 0.1, CI 0.02-0.1), longitudinal ulcers (OR 35.5, CI 1.8-683.2), and granulomas (OR 0.02, CI 0.002-0.2) were found to be significant predictors in differentiating Crohn's disease from intestinal tuberculosis. Receiver-operating characteristic (ROC) analysis was performed on the scores of patients from the final multivariate logistic model, and the area under the ROC curve was 0.8642 (95% CI 0.79-0.94).

CONCLUSIONS

Night sweats, longitudinal ulcers and granulomas were the most important features to differentiate Crohn's disease from intestinal tuberculosis.

摘要

背景与目的

在结核病和克罗恩病共存的国家，鉴别克罗恩病和肠结核常常给临床医生带来挑战。本研究旨在筛选有助于鉴别克罗恩病和肠结核的临床、内镜和组织学特征。

方法

本研究纳入了 43 例确诊为肠结核和 53 例克罗恩病患者。对他们的临床、内镜和组织学特征进行单因素和多因素分析。

结果

单因素分析显示，便血、肠梗阻、瘘管、口腔溃疡、纵行溃疡、鹅卵石样外观和假息肉在克罗恩病中更为常见，而盗汗、合并肺结核、结核菌素皮肤试验阳性、抗结核抗体阳性、腹腔淋巴结肿大、腹水、横行溃疡、回盲瓣扩张和肉芽肿在肠结核中更为常见（均 P<0.05）。最大直径超过 300μm 的肉芽肿、每个切片超过 5 个肉芽肿和融合性肉芽肿在肠结核中更为常见，而在克罗恩病中则较少见（均 P<0.05）。进一步多变量逻辑回归分析显示，盗汗（OR 0.1，95%CI 0.02-0.1）、纵行溃疡（OR 35.5，95%CI 1.8-683.2）和肉芽肿（OR 0.02，95%CI 0.002-0.2）是鉴别克罗恩病和肠结核的显著预测因子。对最终多变量逻辑回归模型中患者的得分进行了受试者工作特征（ROC）分析，ROC 曲线下面积为 0.8642（95%CI 0.79-0.94）。