克罗恩病与肠结核临床及内镜特征的鉴别分析

Clinical and endoscopic diagnosis in the differentiation of Crohn＇s disease from intestinal tuberculosis

目的探讨克罗恩病（cD）与肠结核（ITB）的临床及内镜特点，为两者的鉴别诊断提供依据。方法回顾性分析2003年6月-2009年2月168例CD患者和156例ITB患者的临床及内镜资料。结果CD以男性为主（男：女为108：60），肠道手术率较ITB高[（33．3％比10．9％，P〈0．01）]；CD的腹泻、便血、肛周疾病、肠梗阻的发生率分别为66．1％、32．1％、16．1％和28．0％，明显高于ITB组（分别为47．00o、7．7％、3．4％和9．4％，P值〈0．05或〈0．01）；而ITB的发热、盗汗多于CD组（P值均〈0．05），且伴肺结核、腹水发生率明显高于CD组（P值均〈0．01）；ITB的球蛋白升高、红细胞沉降率增快、结核菌素纯蛋白衍化物试验阳性率、结核抗体阳性率均高于CD组；CD患者内镜下纵行溃疡、网格状溃疡、卵石征、肠腔狭窄均多于ITB组（P值〈0．01或〈0．05），而ITB的环行溃疡、回盲瓣受累多见（P值〈0．01或〈0．05），且受累的回盲瓣常变形和开口固定。结论CD与ITB各有其临床特点，临床特点结合内镜下卵石征、纵行溃疡、网格状溃疡、环行溃疡出现的概率、回盲瓣受累情况及形态变化是鉴别两者的重要特征。

Objective To compare the clinical features and endoscopic findings of Crohn＇s disease（CD） and intestinal tuberculosis（ITB） in order to differentiate CD from ITB. Methods The clinical and endoscopic data from 168 patients with CD and 156 patients with ITB between June 2003 and February 2009 were retrospectively analyzed. Results The salient features of CD were male patients in predominance （male ： female was 108 ： 60） and high incidence of colectomy （CD 33.3 % vs ITB 10.9 %, P〈0. 01 ）. Diarrhea （66.1 % ）, hematochezia （32. 1 %）, perianal disease （16.1 %）, intestinal obstruction （28.0%） were more frequent in CD patients than in ITB patients （47.0%, 7.7%, 3.4%, 9.4% respectively, all P values〈0.05）. The salient features of ITB were night sweating, pulmonary tuberculosis, ascites, hyperglobulin, increased erythrocyte sedimentation rate and the positive serum antibody to mycobacterium. The endoscopic examination showed that the fissure-shape ulcer, gridshape ulcer, cobblestone sign and intestinal stricture were more frequent in CD patients than in ITB patients （all P values 〈0.05）. Whereas the circular ulcer and involved ileoeecal valve with fixed bouche shape were more common in ITB patients （P〈0.05）. Conclusions The clinical characteristics are different in CD and ITB patients. The endoscopic findings including fissure-shape ulcer, grid-shape ulcer, circular ulcer, cobblestone sign and the status of involved ileocecal valve are important in the differentiation of ITB from CD.