肠结核与克罗恩病的临床、内镜及病理的对比研究  

Comparative Analysis of Clinical,Endoscopic and Pathological Features of Intestinal Tuberculosis and Crohn's Disease

作　　者：潘霞[1,2] 张钢志[1,2] 

机构地区：[1]浙江大学医学院附属第二医院滨江院区 [2]杭州滨江医院消化内科,浙江杭州310009

出　　处：《中国现代医生》2011年第35期49-51,共3页China Modern Doctor

摘　　要：目的对比分析肠结核与克罗恩病的临床、内镜及病理特征。方法将我院2002年1月～2011年1月确诊的肠结核和克罗恩病患者作为入选对象,对其病例资料进行回顾性分析,其中肠结核23例,克罗恩病共116例,作为对比分析病例资料。结果肠结核组发生发热及血便的比率与克罗恩病组比较有统计学意义(P<0.05)。肠结核的血沉明显高于克罗恩病(P<0.05)。两组的Hb、ALB及ANCA、ASCA及PPD的实验室检查指标分别进行比较(P>0.05)。肠结核的内镜表现主要为充血水肿、糜烂、节段性改变及肠腔狭窄比较多见。克罗恩病内镜下表现主要为糜烂、充血水肿、节段性改变、裂隙状溃疡较多见。两组在充血水肿、糜烂、节段性改变、假性息肉方面比较,差异无统计学意义(P>0.05)。两组的炎症和肉芽肿形成无统计学差异,干酪性肉芽肿仅见于肠结核,裂隙样溃疡、淋巴结肿大聚集仅见于克罗恩病。肠结核并发肠腔狭窄并肠梗阻比率较高,而克罗恩病并发瘘管、上消化道出血较多(P<0.05)。结论肠结核与克罗恩病二者在诊断上常出现误诊,临床医生应综合分析二者的临床发病特征,结合内镜及病理对其鉴别诊断进行综合分析,才能进一步提高诊断的准确率。Objective To compare intestinal tuberculosis and Crohn＇s disease clinical, endoscopic and pathological features. Methods To seleeet intestinal tuberculosis and Crohn＇s disease as a selected object in our hospital from January 2002 to January 2011 diagnosis of,and to retrospective analyze the clinical data,including 23 cases of intestinal tuberculosis, 116 Crohn＇s disease cases in this study as a comparative analysis of clinical data. Results Intestinal tuberculosis group,fever and bloody stool were significantly differences compared with the rate of Crohn＇s disease group（P〈0.05）. ESR was lower inCrohn＇s disease group（P〈0.05）.Two groups of Hb, ALB,and ANCA,ASCA,and PPD＇s laboratory indexes were compared （P〉0.05）. Endoscopic findings of intestinal tuberculosis mainly congestion and edema,erosion,segmental changes,and lumen stenosis found more common. Crohn＇s disease endoscopic manifestations were erosion, edema,segmental changes,and fissure-like ulcers are more common. The two groups,erosion, edema, segmental changes,pseudo polyps in comparison（P^0.05）. Inflammation and granulomas in two groups had no differentiate（P〉0.05）. Caseous granuloma were only in ITB,Fissure-like ulcers,swollen lymph nodes were only in CD. Intestinal tuberculosis with higher rates of intestinal stenosis and obstruction,and Crohn＇s disease complicated by fistula,upper gastrointestinal bleeding more（P〈0.05）. Conclusion Intestinal tuberculosis and Crohn＇s disease often appear both in the diagnosis of misdiagnosis,the clinician should be a comprehensive analysis of the incidence of both clinical features,combined with the endoscopic and pathological differential diagnosis of its comprehensive analysis ,in order to further improve diagnostic accuracy.

关 键 词：肠结核 克罗恩病 临床表现 内镜 病理特征 

分 类 号：R524[医药卫生—内科学] R574[医药卫生—临床医学]