诊断性抗结核治疗在鉴别肠道克罗恩病与肠结核中的意义

Values of Short-term Anti-tuberculosis Treatment in Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis

目的评价诊断性抗结核治疗在鉴别肠道克罗恩病（CD）与肠结核（ITB）中的作用。方法回顾性分析本院近4年来（2009年1月至2013年10月）因肠道病变诊断不明,接受2~3个月诊断性抗结核治疗,最后确诊为CD或ITB患者的临床及内镜检查资料;以最终的综合诊断为标准,对诊断性抗结核治疗在鉴别CD和ITB中的准确性、敏感性和特异性进行评估。结果研究共纳入64例患者,其中肠结核33例,克罗恩病31例。在最终确诊为肠结核的患者中,31例患者经诊断性抗结核治疗后,其临床及内镜表现明显改善,红细胞沉降率（ESR）和C反应蛋白（CRP）明显下降（P〈0.05）,血红蛋白（HGB）明显上升（P〈0.05）。相反,在最终确诊为克罗恩病的患者中,只有3例患者临床症状及内镜表现有一定改善。克罗恩病患者的克罗恩病疾病活动指数（CDAI）评分在诊断性抗结核治疗的前后差异并无统计学意义。诊断性抗结核治疗在鉴别CD和ITB中的准确性、敏感性和特异性分别为92.19%、93.94%、90.32%。结论诊断性抗结核治疗有助于CD和ITB的鉴别诊断,在临床上具有一定的可行性。

Objective To determine the values of short-term anti-tuberculosis treatment in the differential diagnosis of Crohn＇s disease（CD）and intestinal tuberculosis（ITB）.Methods A review of cases（from January2009 to October 2013）with a 2-3 month therapeutic trial of anti-tuberculosis was performed.The clinical manifestation and endoscopic findings of the patients,and the accuracy,sensitivity and specificity of the short term anti-tuberculosis trial for differential diagnosis of ITB and CD were analysed.Results Sixty-four cases entered into study,with 33 diagnosed with ITB and 31 with CD.In the ITB patients,31 had significant improvement in their clinical and endoscopic manifestations,with decreased erythrocyte sedimentation rate（ESR）and C-reactive portein（CRP）（P〈0.05）and increased hemoglobin（HGB）（P〈0.05）.On the contrary,only three CD patients showed improvement in their disease activity（CDAI）.The accuracy of short-term anti-tuberculosis treatment in the differential diagnosis was 92.19%,with a sensitivity and specificity of 93.94% and 90.32%,respectively.There was no significant difference in CDAI scores in the CD patients prior to and after 2-3months trial of anti-tuberculosis treatment.Conclusion Short term trial of anti-tuberculosis treatment is valuable and feasible in the differential diagnosis of ITB and CD.