Zhang Tianyu, Fan Rong, Wang Zhengting, Hu Shurong, Zhang Maochen, Lin Yun, Tang Yonghua, Zhong Jie
Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China.
Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China.
Int J Clin Exp Med. 2015 Oct 15;8(10):17578-89. eCollection 2015.
The aim of the study was to evaluate clinical manifestations, T-SPOT, endoscopy and CT enterography to differentiate Crohn's disease (CD) from intestinal tuberculosis (ITB).
128 in patients with suspected CD and ITB were prospectively enrolled in the study. Demographic, clinical, laboratory, endoscopic and CT enterographic data were collected. After treatment for 6 months, when a definite diagnosis was reached, the differential diagnostic value of each parameter was analyzed. Multivariable logistic regression was used to analyze further, parameters of statistical significance to establish a mathematical regression equation. Receiver operating characteristic curves were plotted.
Clinical parameters helpful in differentiating CD from ITB included diarrhea, night sweat and perianal disease. Endoscopic parameters were useful in differentiating CD from ITB including transverse ulcers, longitudinal ulcers, rodent-like ulcers and patulous ileocecal valve. CT enterographic parameters aided the identification of the two conditions. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of a mathematical regression model established for 6 parameters of clinical endoscopy and CT enterography were 97.8%, 96.8%, 97.6%, 98.9% and 93.7% respectively, whereas those for T-SPOT were 96.8%, 91.3%, 92.7%, 78.9% and 98.8% respectively.
T-SPOT is useful to exclude a diagnosis of ITB. Differentiating CD from ITB is a difficult clinical problem that requires a consideration of clinical, T-SPOT, endoscopic and CT enterographic parameters for accurate diagnosis.
本研究旨在评估临床表现、T-SPOT、内镜检查及CT小肠造影在鉴别克罗恩病（CD）与肠结核（ITB）方面的作用。
前瞻性纳入128例疑似CD和ITB的患者。收集人口统计学、临床、实验室、内镜及CT小肠造影数据。治疗6个月后，当确诊时，分析各参数的鉴别诊断价值。采用多变量逻辑回归进一步分析具有统计学意义的参数，以建立数学回归方程。绘制受试者工作特征曲线。
有助于鉴别CD与ITB的临床参数包括腹泻、盗汗及肛周病变。内镜参数对鉴别CD与ITB有用，包括横行溃疡、纵行溃疡、鼠咬状溃疡及回盲瓣开放。CT小肠造影参数有助于鉴别这两种疾病。为临床内镜及CT小肠造影的6项参数建立的数学回归模型的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为97.8%、96.8%、97.6%、98.9%及93.7%，而T-SPOT的相应值分别为96.8%、91.3%、92.7%、78.9%及98.8%。
T-SPOT有助于排除ITB诊断。鉴别CD与ITB是一个临床难题，需要综合考虑临床、T-SPOT、内镜及CT小肠造影参数以准确诊断。
