克罗恩病与肠结核的临床分析与比较  

The clinical analysis of Crohn's disease and intestinal tuberculosis

作　　者：邹宁[1] 刘晓红[1] 周旭东[2] 

机构地区：[1]中国医学科学院北京协和医院消化科,北京100730 [2]中国医学科学院北京协和医院病理科,北京100730

出　　处：《临床内科杂志》2005年第12期827-830,共4页Journal of Clinical Internal Medicine

摘　　要：目的对克罗恩病(CD)与肠结核(IT)进行临床分析和比较,找出对鉴别诊断有帮助的要点.方法回顾性分析我院1983年～2004年间住院的62例CD患者和21例IT患者的临床资料.结果CD男性多见.临床表现、各种并发症的出现、实验室检查、腹部B超/CT以及消化道造影均对鉴别诊断帮助不大,CD的肠黏膜活检诊断率低.CD与IT的常见部位都是回肠及回盲部,但CD可累及直肠,吻合口病变为77.4%.CD纵行溃疡仅占13.6%,而环形溃疡却占26.7%,回盲瓣受累22.2%,IT瘘管形成并不罕见(14.3%).CD肠系膜淋巴结最大直径为(10±3)mm,均无上皮样肉芽肿,而IT肠系膜淋巴结最大直径为(18±5)mm,P＜0.01,均有上皮样肉芽肿,41.2%有干酪样坏死.CD裂隙溃疡多于IT(P＜0.01).CD中全层炎、淋巴组织增生、黏膜下层水肿均比IT多(P＜0.05).结论CD与IT的鉴别需要多方面综合判断,手术标本的病理对鉴别有重要意义.Objective To find out the main points which are beneficial for differential diagnosing Crohn＇ s disease （CD） and intestinal tuberculosis （IT） by clinical analysis. Methods 62 cases of CD and 21 cases of TB confirmed postoperatively were investigated retrospectively during 1983 （2004 in PUMC hospital. Results Male dominated in CD （41/62）. There were little valuable for differential diagnosis in clinical presentations, the occurrence of complications,laboratory examination, abdominal ultrasonography/ computerized tomography and gastrointestinal radiography. The positive ratio of colon endoscopy biopsy was low. The ileum and ileocecum were involved in both CD and IT,but the rectum only involved in CD. The lesions of stoma were 77.4%. The longitudinal ulcers were not so often found （ 13.6% ） than the circular ulcer （26.7%） in CD. The damage of the ileocecal valve was seen in 22.2% of CD. Fistula formation was not rare in IT （ 14.3% ）. The maximum diameter of the mesenteric lymph nodes was （ 10 ± 3 ）mm and no epithelioid granuloma found in CD cases ,but （18 ± 5 ） mm in IT （P 〈 0.01 ） and epithelioid granuloma was found in all IT cases. 41.2% of IT had caseous necrosis. Fissure ulcers in CD are more common than that in IT （P 〈 0.01 ）. Transmural inflammations, proliferation of lymph tissues and edema of submucosa in CD were more common than those in IT（ P 〈 0.05 ）. Conclusions It is essential to take an overall consideration in differential diagnosis between CD and IT. The careful examination on operational specimen is very important.

关 键 词：克罗恩病 肠结核 肠系膜淋巴结 上皮样肉芽肿 干酪样坏死 裂隙溃疡 全层炎 

分 类 号：R574.62[医药卫生—消化系统] R524[医药卫生—内科学]