克罗恩病与肠结核患者的粪便菌群特征及其鉴别诊断价值

Characteristics and differential diagnosis of intestinal flora in Crohn’s disease and intestinal tuberculosis

目的:分析克罗恩病(Crohn's disease,CD)和肠结核(intestinal tuberculosis,ITb)患者肠道菌群的变化,探讨CD和ITb在肠道菌群方面的鉴别特征。方法:选取2007年6月至2009年11月CD患者15例、ITb患者23例,运用可培养细菌菌群分析的方法对每例患者住院后首次粪便进行分析,同期健康志愿者21人的粪便作对照。结果:CD和ITb患者肠道中均以双歧杆菌、拟杆菌、大肠杆菌和金黄色葡萄球菌为最多,CD组乳酸杆菌、双岐杆菌与正常组比较明显减少(P<0.01),拟杆菌较正常组明显增多(P<0.01);ITb组乳酸杆菌、双岐杆菌、大肠杆菌与正常组比较明显减少(P<0.01或P<0.05),拟杆菌较正常组明显增多(P<0.01);ITb组拟杆菌较CD组增多明显(P<0.05),CD组大肠杆菌较ITb组增多明显(P<0.05);各组肠球菌、金黄色葡萄球菌和酵母菌数量无明显差别(P>0.05)。结论:CD和ITb患者均存在肠道菌群紊乱,拟杆菌和大肠杆菌数量变化可能对二者具有鉴别诊断价值。

Objective To analyze the characteristics of intestinal flora in Crohn’s disease （ CD） and intestinal tuberculosis （ ITb） ,and to find potential identification features to differentiate these 2 diseases. Methods Fifteen CD patients,23 ITb patients,and 21 healthy volunteers （ controls） were enrolled from June 2007 to November 2009. Selective culturing was used for the enumeration of bacteria count. Results The intestinal flora was mainly composed of Bifidobacteria,Bacteroids,Escherichia coli and Staphylococcus aureus both in CD and ITb patients. Lactobacillus and Bifidobacteria decreased obviously but Bacteroid increased in CD patients compared with the control （ P 0. 01） . Lactobacillus,Bifidobacteria and Escherichia coli decreased obviously （ P 0. 05 ） , but Bacteroid increased in ITb patients compared with the control（ P 0. 01） . Bacteroid increased in ITb patients compared with CD patients（ P 0. 05 ） . No difference in Enterococcus,Staphylococcus aureus and Saccharomycete was found among the 3 groups（ P 0. 05 ） . Conclusion Intestinal flora disorder occurred in either CD or ITb patients. The alteration of Bacteroid and Escherichia coli can help differentiate the 2 diseases.