Huang Xin, Liao Wang-Di, Yu Chen, Tu Yi, Pan Xiao-Lin, Chen You-Xiang, Lv Nong-Hua, Zhu Xuan
Xin Huang, Wang-Di Liao, Xiao-Lin Pan, You-Xiang Chen, Nong-Hua Lv, Xuan Zhu, Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Gastroenterol. 2015 Mar 28;21(12):3650-6. doi: 10.3748/wjg.v21.i12.3650.
To investigate the clinical features of Crohn's disease (CD) and intestinal tuberculosis (ITB) with a scoring system that we have developed.
A total of 25 CD and 40 ITB patients were prospectively enrolled from August 2011 to July 2012. Their characteristics and clinical features were recorded. Laboratory, endoscopic, histologic and radiographic features were determined. The features with a high specificity were selected to establish a scoring system. The features supporting CD scored +1, and those supporting ITB scored -1; each patient received a final total score. A receiver operating characteristic (ROC) curve was used to determine the best cut-off value for distinguishing CD from ITB.
Based on a high specificity of differentiating between CD and ITB, 12 features, including longitudinal ulcers, nodular hyperplasia, cobblestone-like mucosa, intestinal diseases, intestinal fistula, the target sign, the comb sign, night sweats, the purified protein derivative test, the interferon-γ release assay (T-SPOT.TB), ring ulcers and ulcer scars, were selected for the scoring system. The results showed that the average total score of the CD group was 3.12 ± 1.740, the average total score of the ITB group was -2.58 ± 0.984, the best cutoff value for the ROC curve was -0.5, and the diagnostic area under the curve was 0.997, which was statistically significant (P < 0.001). The patients whose total scores were higher than -0.5 were diagnosed with CD; otherwise, patients were diagnosed with ITB. Overall, the diagnostic accuracy rate and misdiagnosis rate of this scoring system were 97% and 3%, respectively.
Some clinical features are valuable for CD and ITB diagnosis. The described scoring system is key to differentiating between CD and ITB.
运用我们开发的评分系统研究克罗恩病（CD）和肠结核（ITB）的临床特征。
2011年8月至2012年7月前瞻性纳入25例CD患者和40例ITB患者。记录其特征和临床特点。确定实验室、内镜、组织学和影像学特征。选择具有高特异性的特征建立评分系统。支持CD的特征得+1分，支持ITB的特征得-1分；每位患者获得最终总分。采用受试者工作特征（ROC）曲线确定区分CD与ITB的最佳临界值。
基于CD与ITB鉴别的高特异性，选择纵行溃疡、结节状增生、鹅卵石样黏膜、肠道病变、肠瘘、靶征、梳征、盗汗、结核菌素纯蛋白衍生物试验、干扰素-γ释放试验（T-SPOT.TB）、环形溃疡和溃疡瘢痕这12项特征用于评分系统。结果显示，CD组平均总分3.12±1.740，ITB组平均总分-2.58±0.984，ROC曲线的最佳临界值为-0.5，曲线下诊断面积为0.997，差异有统计学意义（P<0.001）。总分高于-0.5的患者诊断为CD；否则，患者诊断为ITB。总体而言，该评分系统的诊断准确率和误诊率分别为97%和3%。
一些临床特征对CD和ITB的诊断有价值。所描述的评分系统是区分CD和ITB的关键。
