Jung Yunho, Hwangbo Young, Yoon Soon Man, Koo Hoon Sup, Shin Hyun Deok, Shin Jeong Eun, Moon Hee Seok, Kang Sang Bum, Lee Jeong Rok, Huh Kyu Chan
Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan-si, Chungcheongnam-do, South Korea.
Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan-si, Chungcheongnam-do, South Korea.
Am J Gastroenterol. 2016 Aug;111(8):1156-64. doi: 10.1038/ajg.2016.212. Epub 2016 Jun 14.
A differential diagnosis between intestinal tuberculosis (ITB) and Crohn's disease (CD) is challenging. The aim of this study was to investigate the clinical, endoscopic, and histological features and to create a predictive score model for differentiating CD and ITB.
In total, 261 patients, 99 with ITB and 162 with CD, were recruited from seven tertiary centers from 2005 to 2013 and reviewed retrospectively. For the creation of a validated model, parameters were selected by univariate logistic regression and receiver operating characteristic curve analyses. Then, the prediction model was established on the basis of β-coefficients of the multivariate logistic regression. For the validation of the model, the same regression equation was tested on the other group.
Age, diarrhea, ring-shaped ulcer, longitudinal ulcer, sigmoid involvement, suspicious radiological pulmonary tuberculosis, and gender were selected as the factors for a seven-marker model. In the seven-marker model of the validation data set, the sensitivity, specificity, positive predictive value, and negative predictive value with a cutoff level of 0.35 were 98.0, 92.4, 88.9, and 98.6, respectively.
The seven-marker model seems to be highly reliable for differentiating between ITB and CD and could be conveniently used by clinicians to obtain results.
鉴别肠结核（ITB）和克罗恩病（CD）具有挑战性。本研究旨在调查其临床、内镜及组织学特征，并创建一个用于区分CD和ITB的预测评分模型。
2005年至2013年期间，从7个三级中心招募了261例患者，其中99例为ITB患者，162例为CD患者，并进行回顾性分析。为创建一个经过验证的模型，通过单因素逻辑回归和受试者工作特征曲线分析来选择参数。然后，基于多因素逻辑回归的β系数建立预测模型。为验证该模型，在另一组患者中测试相同的回归方程。
年龄、腹泻、环形溃疡、纵行溃疡、乙状结肠受累、可疑的放射性肺结核及性别被选为七指标模型的因素。在验证数据集的七指标模型中，截断值为0.35时，灵敏度、特异度、阳性预测值和阴性预测值分别为98.0、92.4、88.9和98.6。
七指标模型在区分ITB和CD方面似乎高度可靠，临床医生可方便地使用该模型得出结果。
