克罗恩病与肠结核的临床、结肠镜特征分析

Analysis of Clinical and Endoscopic Characteristics for Crohn's Dsease and Intestinal Tuberculosis

目的:探讨克罗恩病与肠结核的临床及结肠镜特点,寻找更好的鉴别诊断策略。方法:对住院的27例克罗恩病与24例肠结核病例资料进行分析,分析其临床表现、内镜、组织病理学特征的异同之处。结果:克罗恩病并发肠梗阻、肠外表现(肛瘘、虹膜炎等)的几率明显高于肠结核(P<0.05),而肠结核合并肺结核的几率高于克罗恩病(P<0.05)。克罗恩病的内镜表现以纵形溃疡、铺路石样改变、管腔狭窄为主,病变主要在回肠末端。而肠结核的内镜表现以环形溃疡、鼠咬症为主要特征,多回盲瓣受累。克罗恩病的病理表现主要是裂隙样溃疡、非干酪样肉芽肿、淋巴细胞聚集,而肠结核病理表现主要是肠壁和淋巴结的干酪样坏死。结论:克罗恩病与肠结核的临床表现、内镜及病理学特征有相似之处,但是又各有特点,临床医生需综合判断减少对两者的误诊。

Objective： To make an comparative analysis of the clinical and endoscopic characteristics between cruhn＇s disease and intestinal tuberculosis for seeking better differential diagnosis strategy. Method： The clinical and endoscopic data from 27 cases with Crohn＇s disease and 24 cases with intestinal tuberculosis were restrospectively analyzed. Results： The patients with Crohn＇s disease complicated hy intestinal obstruction, anal fistula and iritis was significantly higher than the risk of intestinal tuberculosis （P〈0.05）, while the patients with intestinal tuberculosis suffering from tuberculosis was significantly higher than the risk of Crohn＇s disease （P〈0.05） . The endoscopic features of Crohn＇s disease were fissure-shape uleer, cobblestone sign, intestinal stenosis. The annular ulcer, rat bite-shape were common in intestinal tuberculosis. The histological changes in Crohn＇s disease were mainly fissure-shape ulcer, non-caseating granuloma, lymphocytic aggregation, while the histological changes in intestinal tubereulosis were caseous necrosis of intestinal wall or lymph nodes. Conclusion： There are some different characteristics in the clinical and endoscopic manifestations between Cruhn＇s disease and intestinal tuberculosis, so clinical doctors should have the comprehensive judgment to reduce the misdiagnosis.