内镜活检对肠结核的诊断价值

Diagnosis of intestinal tuberculosis by endoscopic mucosal biopsies

目的探讨结肠镜检查及其活检标本对肠结核的诊断价值。方法对高度怀疑肠结核的患者24例进行结肠镜、胸腹部X线、病理组织学和结核菌PCR试验检查,并比较其阳性率。结果34例患者最终确诊为肠结核的有23例、克罗恩病3例、结肠癌3例,其他疾病5例。在各疾病中的阳性率均无明显差异。腹部X线阳性率47.8%,假阳性27.3%;内镜诊断阳性率为52.2%,假阳性27.3%:活检组织病理学阳性率82.6%,假阳性9.1%;PCR阳性率73.9%,假阳性18.2%;PPD 阳性率52.2%,假阳性9.1%。结论结肠镜检查诊断肠结构的阳性率不同,结肠镜活检标本进行组织学和结核菌PCR检测可显著提高肠结核的诊断率。

Objectives To investigate the diagnostic value of mucosal biopsy specimens obtained at colonoscopy to intestinal tuberculosis. Methods A total of 34 endoscopic biopsy specimens from patients with a high index of suspicion of intestinal tuberculosis were subjected to abdominal X-rays, colonoscopy, pathological analysis, and PCR assay. Results Twenty-three patients were diagnosed as intestinal tuberculosis. The positive rate of intestinal tuberculosis by abdominal X-rays, colonoscopy, pathological analysis, PCR assay and PPD test was 47.8%, 52.2%, 82.6%, 73.9% and 52.2%, respectively. The false positive rate of intestinal tuberculosis by abdominal X-rays, colonoscopy, pathological analysis, PCR assay and PPD test was 27.3%, 27.3%, 9.1%, 18.2% and 9.1%, respectively. Conclusions Endoscopic biopsy has a diagnostic value in the intestinal tuberculosis, but false positive results are still a challenge.