计算机断层扫描小肠造影在鉴别克罗恩病与肠结核方面比结肠镜检查更具价值：一种潜在的诊断算法。

Computed tomographic enterography adds value to colonoscopy in differentiating Crohn's disease from intestinal tuberculosis: a potential diagnostic algorithm.

作者信息

Mao Ren, Liao Wang-di, He Yao, Ouyang Chun-hui, Zhu Zhen-hua, Yu Chen, Long Shun-hua, Chen Yu-jun, Li Zi-ping, Wu Xiao-ping, Lv Nong-hua, Hu Pinjin, Chen Minhu

机构信息

Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

出版信息

Endoscopy. 2015 Apr;47(4):322-9. doi: 10.1055/s-0034-1391230. Epub 2015 Feb 12.

DOI:10.1055/s-0034-1391230

PMID:25675175

Abstract

BACKGROUND

Crohn's disease and intestinal tuberculosis (ITB) are chronic granulomatous disorders that are difficult to distinguish. Computed tomographic enterography (CTE) yields striking ﬁndings for Crohn's disease in the small bowel but its role in differentiating Crohn's from ITB is undefined. This prospective study aimed to investigate the value of CTE for differential diagnosis between Crohn's disease and ITB.

PATIENTS AND METHODS

105 consecutive patients (67 Crohn's, 38 ITB) who underwent CTE and colonoscopy were enrolled. CTE findings and colonoscopic parameters were compared between Crohn's disease and ITB by blinded reviewers. Based on univariate and multiple logistic regression analyses, a diagnostic algorithm combining colonoscopy and CTE was formulated. and its performance validated on 60 new patients (40 Crohn's, 20 ITB).

RESULTS

On univariate analysis of CTE findings, proximal small-bowel involvement, asymmetrical mural thickening, segmental small-bowel lesions, mural stratification, the comb sign, and mesentery fibrofatty proliferation were significantly more common in Crohn's disease, whereas mesenteric lymph node change (calcification or central necrosis) and focal ileocecal lesions were more common in ITB. On multivariate analysis, segmental small-bowel involvement (odds ratio [OR] 0.104, 95 % confidence interval [95 %CI] 0.022 - 0.50), and comb sign (OR 0.02, 95 %CI 0.003 - 0.26) were independent predictors of Crohn's. Combining CTE and colonoscopic findings increased the accuracy of diagnosing either Crohn's disease or ITB from 66.7 % (70/105) to 95.2 % (100/105) in the development set (P < 0.001). Sensitivity, speciﬁcity, and area under the curve for receiver-operating characteristic (ROC) in the validation dataset were 92.5 %, 80 %, and 0.862 (95 %CI 0.75 - 0.98), respectively.

CONCLUSIONS

CTE adds unique information to colonoscopy in differential diagnosis between Crohn's disease and ITB, allowing correct diagnosis in most patients.

摘要

背景

克罗恩病和肠结核（ITB）是难以鉴别的慢性肉芽肿性疾病。计算机断层扫描小肠造影（CTE）对小肠克罗恩病有显著的影像学表现，但其在鉴别克罗恩病与肠结核中的作用尚不明确。本前瞻性研究旨在探讨CTE在克罗恩病与肠结核鉴别诊断中的价值。

患者与方法

纳入105例连续接受CTE和结肠镜检查的患者（67例克罗恩病患者，38例肠结核患者）。由不知情的评估者比较克罗恩病和肠结核患者的CTE表现及结肠镜检查参数。基于单因素和多因素逻辑回归分析，制定了一种结合结肠镜检查和CTE的诊断算法，并在60例新患者（40例克罗恩病患者，20例肠结核患者）中验证其性能。

结果

对CTE表现进行单因素分析时，近端小肠受累、不对称肠壁增厚、节段性小肠病变、肠壁分层、梳征及肠系膜纤维脂肪增生在克罗恩病中显著更常见，而肠系膜淋巴结改变（钙化或中央坏死）及局灶性回盲部病变在肠结核中更常见。多因素分析显示，节段性小肠受累（比值比[OR]0.104，95%置信区间[95%CI]0.022 - 0.50）及梳征（OR 0.02，95%CI 0.003 - 0.26）是克罗恩病的独立预测因素。在训练集中，结合CTE和结肠镜检查结果可将克罗恩病或肠结核的诊断准确率从66.7%（70/105）提高至95.2%（100/105）（P<0.001）。验证数据集中，受试者工作特征曲线（ROC）的灵敏度、特异度及曲线下面积分别为92.5%、80%和0.862（95%CI 0.75 - 0.98）。