结核杆菌DNA检测在肠结核与克罗恩病鉴别诊断中的价值  

Polymerase chain reaction assay in differentiating intestinal tuberculosis from Crohn’s disease

作　　者：甘华田[1] 欧阳钦[1] 步宏[2] 杨秀英[2] 

机构地区：[1]华西医科大学第一医院消化内科,成都610041 [2]华西医科大学第一医院病理科,成都610041

出　　处：《中华消化杂志》2001年第4期215-218,共4页Chinese Journal of Digestion

摘　　要：目的　探讨聚合酶链反应 (PCR)技术对肠结核和克罗恩病 (Crohn’sdisease ,CD)的鉴别诊断价值 ,并对其内镜活检组织的病理改变进行比较。方法　对 38例肠结核和 30例CD活检组织进行病理分析、抗酸染色镜检和PCR技术检测结核杆菌DNA。结果　①淋巴细胞聚集在CD远较肠结核多见(P <0 .0 5 ) ;而肉芽肿 ,尤其是干酪样肉芽肿和肉芽肿的融合在肠结核却更多见 (P <0 .0 5 )。两者其他病理特点的差异在活检组织中不明显或难以发现 ;②PCR技术检测结核杆菌DNA总阳性率为 6 3.2 %(2 4/ 38例 ) ;在与CD肉芽肿形态相同的肠结核组中阳性率为 71.4% (10 / 14例 ) ;在无肉芽肿病变的肠结核组中阳性率为 6 4.7% (11/ 17例 )。而该技术在CD组无 1例阳性。抗酸染色镜检总阳性率为2 1.1% (8/ 38例 )。结论　内镜活检病理对肠结核与CD的鉴别诊断有一定局限。Objective To investigate the value of polymerase chain reaction(PCR) assay in differentiating intestinal tuberculosis(TB) from Crohn’s disease(CD), and compare the histopathological features of endoscopic biopsies of the two diseases. Methods 38 specimens of intestinal TB and 30 specimens of CD from endoscopic biopsies were subjected to pathological analysis, Ziehl Neelsen staining and PCR assay, retrospectively . Results ①The histological characteristics of intestinal TB were confluent granulomas often with caseating necrosis; and the characteristics of CD were lymphoid aggregation; other pathological features of the two diseases were no significant differences or difficult to find in biopsies.② The positivity rate with PCR in 38 intestinal TB specimens was 63.2%(24/38), but none in 30 CD specimens by PCR. Interestingly in the tissues of intestinal TB with similar granulomas as CD there were 71.4% (10/14) positive , and 64.7%(11/17) positive in the tissues of intestinal TB without granulomas. Conclusions Biopsy is of limited diagnostic value in the differentiation between intestinal TB and CD, and PCR is of help in the differentiation between them.

关 键 词：肠结核 克罗恩病 内镜活检 聚合酶链反应 DNA检测 结核杆菌 鉴别诊断 

分 类 号：R446.6[医药卫生—诊断学]