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胡佳, 张鑫, 张燕.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.四川大学学报(医学版),2015,46(2):331-335
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
  
中文关键词:  诊断性抗结核治疗克罗恩病肠结核
英文关键词:Short-term anti-tuberculosis treatmentCrohn’s diseaseIntestinal tuberculosis
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中文摘要:
      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。
英文摘要:
      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 January 2009 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 2-3 months 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.
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