肠结核和克罗恩病外周血淋巴细胞凋亡：对诊断鉴别的意义

Apoptosis in peripheral blood lymphocytes in intestinal tuberculosis and Crohn's disease: Implications to diagnostic differentiation.

作者信息

Nayak Suprabha Suresh, Shetty Mamatha Vishwanatha, Pai Cannanore Ganesh, Guruprasad Kanive Parashiva, Satyamoorthy Kapaettu

机构信息

Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576 104, India.

School of Life Sciences, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576 104, India.

出版信息

Indian J Gastroenterol. 2020 Aug;39(4):338-345. doi: 10.1007/s12664-019-01011-z. Epub 2020 Aug 17.

DOI:10.1007/s12664-019-01011-z

PMID:32803718

Abstract

AIM

Intestinal tuberculosis (ITb) and Crohn's disease (CD) mimic each other often leading to misdiagnosis. We evaluated the difference between ITb and CD using the extent of apoptosis in peripheral blood lymphocytes.

METHODS

CD4 cells as a percentage of the lymphocytes and viable, dead, total apoptotic, early apoptotic, and late apoptotic CD4 cells were assessed in the peripheral blood by flow cytometry in healthy controls and patients with confirmed active ITb and CD prior to initiating therapy. Early apoptotic and total apoptotic cells were further expressed as a proportion of the percentage of CD4 cells.

RESULTS

The percentages of CD4 cells (6.5 [3.0, 8.7] vs. 13.40 [10.15, 13.40]; p < 0.001), total apoptotic cells (0.13 [0.0, 0.22] vs. 0.08 [0.0, 0.21]; p = 0.045), early apoptotic (1.24 [0.55, 2.54] vs. 0.71 [0.40, 1.30]; p = 0.037), and the proportion of the latter two parameters (17.18 [5.61, 57.33] vs. 4.84 [2.71, 9.83]; p-value 0.039) and (17.18 [7.4, 67.50] vs. 5.51 [3.10, 11.03]; p-value 0.036) were significantly different between patients with ITb and CD. The best sensitivity, specificity, and positive and negative predictive values for the diagnosis of ITb were seen with the CD4 cell percentage (82.6%, 82.4%, 86.4%, 77.8%, respectively) and the proportion of early apoptotic cells (73.9%, 70.6%, 77.3%, 66.7%, respectively).

CONCLUSION

CD4 cells as a percentage of peripheral blood lymphocytes and the proportion of early apoptotic CD4 cells show promise to diagnostic differentiation between ITb and CD.

摘要

目的

肠结核（ITb）和克罗恩病（CD）症状相似，常导致误诊。我们通过评估外周血淋巴细胞凋亡程度来研究ITb与CD之间的差异。

方法

采用流式细胞术检测健康对照者以及确诊为活动性ITb和CD且尚未开始治疗的患者外周血中CD4细胞占淋巴细胞的百分比以及存活、死亡、总凋亡、早期凋亡和晚期凋亡的CD4细胞数量。早期凋亡细胞和总凋亡细胞进一步表示为CD4细胞百分比的比例。

结果

ITb患者和CD患者的CD4细胞百分比（6.5 [3.0, 8.7] 对13.40 [10.15, 13.40]；p < 0.001）、总凋亡细胞（0.13 [0.0, 0.22] 对0.08 [0.0, 0.21]；p = 0.045）、早期凋亡细胞（1.24 [0.55, 2.54] 对0.71 [0.40, 1.30]；p = 0.037）以及后两个参数的比例（17.18 [5.61, 57.33] 对4.84 [2.71, 9.83]；p值0.039）和（17.18 [7.4, 67.50] 对5.51 [3.10, 11.03]；p值0.036）存在显著差异。诊断ITb的最佳敏感性、特异性、阳性预测值和阴性预测值分别见于CD4细胞百分比（分别为82.6%、82.4%、86.4%、77.8%）和早期凋亡细胞比例（分别为73.9%、70.6%、77.3%、66.7%）。