Sekine Katsunori, Nagata Naoyoshi, Shindo Takuma, Morino Eriko, Shimbo Takuro, Akiyama Junichi, Mizokami Masashi, Uemura Naomi
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Int J Colorectal Dis. 2015 Jul;30(7):939-45. doi: 10.1007/s00384-015-2208-8. Epub 2015 Apr 14.
Differential diagnosis of intestinal tuberculosis (ITB) and inflammatory bowel disease (IBD) can be difficult, but many gastroenterologists may only perform biopsy for pathology and their own experience. This study aimed to identify optimal sample collection and pathogen detection methods for diagnosing ITB.
A cohort of 182 patients (50 had ITB and 132 had IBD or other colonic diseases) who underwent colonoscopy was analyzed. Sensitivity of acid-fast bacilli (AFB), culture, polymerase chain reaction (PCR), and granuloma pathology on hematoxylin and eosin stain for diagnosing ITB were compared in relation to biopsy, endoscopic aspirated intestinal fluid, or standard stool evaluations. We also evaluated which combination offered the highest yield to diagnose intestinal tuberculosis in addition to granuloma pathology.
Between ITB and non-ITB, no significant differences were observed in age, sex, and nationality. In biopsy analysis, sensitivity was as follows: culture (50%), AFB (38%), PCR (25%), granuloma pathology (51%), and caseous granuloma (8.2%), while specificity of granuloma pathology was low (80%), compared to other tests. In intestinal fluid analysis, sensitivity was as follows: culture (46%), AFB (42%), and PCR (35%). In standard stool analysis, sensitivity was as follows: culture (47%), AFB (37%), and PCR (23%). Granuloma pathology plus biopsy culture offered the highest combination sensitivity (77 %), significantly (P < 0.01) higher than that for granuloma pathology alone (51%).
When encountering suspected intestinal tuberculosis or IBD on colonoscopy, biopsy culture is recommended in addition to pathological assessment of granuloma. This diagnostic strategy will lead to accurate differential diagnosis of colonic disease, facilitating appropriate treatment.
肠结核（ITB）与炎症性肠病（IBD）的鉴别诊断可能存在困难，但许多胃肠病学家可能仅依靠病理活检及自身经验来进行诊断。本研究旨在确定诊断ITB的最佳样本采集和病原体检测方法。
对182例接受结肠镜检查的患者（50例患有ITB，132例患有IBD或其他结肠疾病）进行队列分析。比较了抗酸杆菌（AFB）、培养、聚合酶链反应（PCR）以及苏木精-伊红染色下肉芽肿病理检查对ITB诊断的敏感性，这些检测分别针对活检组织、内镜吸取的肠液或标准粪便样本。我们还评估了除肉芽肿病理检查外，哪种组合在诊断肠结核方面的阳性率最高。
ITB组与非ITB组在年龄、性别和国籍方面未观察到显著差异。在活检分析中，敏感性如下：培养（50%）、AFB（38%）、PCR（25%）、肉芽肿病理检查（51%）以及干酪样肉芽肿（8.2%），而与其他检测相比，肉芽肿病理检查的特异性较低（80%）。在肠液分析中，敏感性如下：培养（46%）、AFB（42%）和PCR（35%）。在标准粪便分析中，敏感性如下：培养（47%）、AFB（37%）和PCR（23%）。肉芽肿病理检查加活检培养的组合敏感性最高（77%），显著高于单独进行肉芽肿病理检查的敏感性（51%）（P<0.01）。
在结肠镜检查中遇到疑似肠结核或IBD时，除了对肉芽肿进行病理评估外，建议进行活检培养。这种诊断策略将有助于准确鉴别结肠疾病，促进合理治疗。
