克罗恩病和肠结核的临床内镜和病理特征分析

Analysis of Clinical, Endoscopic and Histological Features of Patients with Crohn′s Disease and Intestinal Tuberculosis

目的研究克罗恩病（Crohn′s disease，CD）和肠结核（intestinal tuberculosis，ITB）鉴别诊断特点。方法回顾性分析住院确诊的55例CD和35例ITB患者临床资料，应用Lee评分方法评估CD与ITB的诊断符合率。结果血便与肛周疾病在CD常见（P〈0．05），发热、盗汗、腹胀、合并肺结核、腹水、PPD皮试强阳性在ITB常见（P〈0．05）；CD内镜下见纵行溃疡、鹅卵石征、病灶常〉4节段者明显多于ITB（P〈0．05），而ITB内镜下更常见回盲瓣哆开、病灶常〈4节段（P〈0．05）。内镜活检标本对二者鉴别价值有限，手术标本透壁性全层炎、裂隙状溃疡、粘膜下层增宽在CD中更常见（P〈0．05），CD微肉芽肿检出率更高（P〈0．05），干酪样肉芽肿则只存在于ITB中（P〈0．05），肉芽肿位置于粘膜下层和浆膜层肉芽肿更常见于ITB（P〈0．05），肉芽肿数目ITB高于CD（P〈0．05）；应用Lee评分系统分别对CD组及ITB组进行评分，CD组〉0分者为42％，ITB组〈0分者为88％（P〈0．05）。结论CD与ITB的鉴别诊断需要综合临床、内镜、病理与Lee评分方法进行分析。

Objective To investigate the differential diagnosis of Crohn′s disease（CD） and intestinal tuberculos （ITB）. Methods 55 patients with CD and 35 patients with ITB Were rolled in the study, and their clinical data were analyzed retrospectively. The diagnostic accuracy rate of CD or ITB was used by Lee YJ score system. Results The common featrues of CD were bleeding stool and perianal pathological changes （ P 〈 0.05 ） , while of ITB were. fever, night sweats, abdominal distension, ascites and pulmonary tuberculosis （ P 〈 0.05 ）. Longitudinal ulcer, pebbles levy and more than four segmental focus in colonoscopy were more in CD than in ITB, and ileocecal valve duo open, less than four segmental focus in colonoscopy were more in ITB than in CD （P 〈 0.05）. The specimens of endoscopic biop-sy were lower value in differential diagnosis. The incidence rate of transmural inflammation of all layers ,fissure - liked ulcers, submucosal widened of surgical specimens in CD were higher than in ITB （ P 〈 0.05 ）. The detection rate of mi-crogranuloma in CD were higher than in ITB, but caseous granulomas was only in ITB, and granulomas located in the suubmucosa and serous layer in ITB were more common than in CD（ P 〈 0.05 ）. The number of granuloma in CD was lower than in ITB（P 〈 0.05 ）. The diagnosis rate of CD was 42% , and of ITB was 88% , which according to the Lee scoring system. Conclusion The differential diagnosis between CD and ITB should integrate analysis clinical, endo- scopic and pathological features and Lee YJ scoring system.