Department of Gastroenterology, Zhongnan Hospital, Wuhan University School of Medicine, Wuhan, Hubei Province, China.
J Dig Dis. 2013 Feb;14(2):68-75. doi: 10.1111/1751-2980.12017.
To evaluate the diagnostic utility of interferon-γ release assay (T-SPOT.TB) for the differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITB).
A total of 103 CD and 88 ITB patients, confirmed by histology and anti-tuberculosis treatment response from 2003 to 2011, were included. Their characteristics and clinical features were recorded. Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) of IS6110, in vitro T-SPOT.TB, tuberculin skin test (TST), immunoglobulin G (IgG) antibody to MTB (protein chip), serum anti-Saccharomyces cerevisiae antibodies (ASCA IgG, chronic inflammatory bowel disease profile) and acid-fast staining of biopsied colonic tissue specimens were performed. Statistical analysis was conducted to determine their concordance with the diagnosis and its sensitivity, specificity, positive (PPV) and negative predictive value (NPV).
Abnormal pulmonary X-ray, ascites and lesions of both cecum and ascending colon were more associated with ITB, while intestinal surgery and lesions of both ileum and adjacent colon were more commonly seen in CD. Significant diagnostic concordance was found using T-SPOT.TB (κ = 0.786) by consistency test. The sensitivity, specificity, PPV and NPV of T-SPOT.TB were 86%, 93%, 88% and 91%, respectively, and the sensitivity and NPV were significantly higher than other examinations (P < 0.05).
T-SPOT.TB is a valuable assay in differentiating ITB from CD, particularly in the diagnostic exclusion of ITB based on its high specificity and NPV.
评估干扰素-γ释放试验（T-SPOT.TB）在克罗恩病（CD）和肠结核（ITB）鉴别诊断中的诊断价值。
纳入 2003 年至 2011 年期间经组织学和抗结核治疗反应证实的 103 例 CD 和 88 例 ITB 患者，记录其特征和临床特征。进行结核分枝杆菌（MTB）IS6110 聚合酶链反应（PCR）、体外 T-SPOT.TB、结核菌素皮肤试验（TST）、MTB 免疫球蛋白 G（IgG）抗体（蛋白芯片）、血清抗酿酒酵母抗体（ASCA IgG、慢性炎症性肠病谱）和活检结肠组织标本抗酸染色。进行统计学分析以确定其与诊断的一致性及其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
异常肺部 X 线、腹水和盲肠及升结肠病变更与 ITB 相关，而肠手术和回肠及邻近结肠病变更常见于 CD。一致性检验显示 T-SPOT.TB 具有显著的诊断一致性（κ=0.786）。T-SPOT.TB 的敏感性、特异性、PPV 和 NPV 分别为 86%、93%、88%和 91%，敏感性和 NPV 显著高于其他检查（P<0.05）。
T-SPOT.TB 是鉴别 ITB 和 CD 的有价值的检测方法，尤其是基于其高特异性和 NPV 对 ITB 的诊断排除。
