肠结核和克罗恩病临床病理改变的比较

THE COMPARISION OF THE CLINICAL HISTOLOGIC FEATURES OF CROHN'S DISEASE AND INTESTINAL TUBERCULOSIS

目的:探讨肠结核和克罗恩病(Crohn’s disease,CD)在临床、内镜、病理表现方面的差异及抗酸染色法对于肠结核和克罗恩病鉴别诊断的价值。方法:选取30例肠结核和25例克罗恩病,分别比较二者的临床表现及并发症、内镜下表现、病理表现,同时进行抗酸染色镜检。结果:①并发症:腹腔脓肿在CD更加常见(P<0.05)②内镜:肠腔狭窄、卵石征和节段性改变在CD更加常见(P<0.05);③病理:肉芽肿,尤其是干酪性肉芽肿和肉芽肿的融合在肠结核中更加多见(P<0.05);④抗酸染色镜检在肠结核的阳性率仅为20%,而在CD中无一例检出。结论:肠结核和克罗恩病两病在临床表现、内镜下表现及病理表现方面均存在很多相似性,二者的临床鉴别诊断存在着很大的困难,但综合各项指标并仔细加以鉴别,也可以将两者区分开来。

Objective： To diagnosis the Crohn＇ s disease （CD） and intestinal tuberculosis （TB） by the differences of clinical presentation, endoscopy features, histologic features and Add- fast bacillus test. Methods： 30 TB patients and 25 CD patients were taken into study. The clinical presentation, endoscopy feature, histologic features and Acid - fast bacillus appearance were compared. Results： （1）eomplieations： the abdominal abscess is more common in CD （P〈：0.05）. （2）endoscopy features： intestinal narrow, cobblestone appearance, segmental ehangs is more common in CD （P〈0.05）. （3）histologic features： granuloma, special ca.seating granuloma is more common in TB （P 〈 0.05）. （4）the positive rate of Acid- fast bacillus test is only 20 % in TB patients, but in CD patients, none was tested. Conclusion： CD and TB have many same appearences in clinical presentation, endoscopy features, histologie features, so the diagnosis and differential diagnosis is very difficult. If all facters were taken into consideration and distinguished carefully, it is possibible to diagnosis it correctly.