克罗恩病与肠结核的MSCT表现及其临床改变对比分析  

Clinical and MSCT Features of Crohn Disease and Intestinal Tuberculosis

作　　者：曾涵江[1] 张笑[2] 徐忠孜[1] 黄子星[1] 张丽芝[1] 陈冬冬[1] 罗艺[1] 李学明[1] 余建群[1] 

机构地区：[1]四川大学华西医院放射科,四川成都610041 [2]四川省乐山市人民医院CT/MRI室,四川乐山614000

出　　处：《中国普外基础与临床杂志》2014年第7期900-904,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的对比分析克罗恩病(Crohn disease,CD)及肠结核(intestinal tuberculosis,ITB)的多层螺旋CT(MSCT)表现特点,以提高对两者的鉴别诊断水平。方法回顾性分析经手术及病理学检查证实的38例CD及13例ITB患者的临床表现、体征、实验室检查及MSCT表现特点,比较两者的异同点。结果 MSCT征象对比结果显示:①CD以肠管均匀增厚为主;ITB以不均匀增厚为主(Ρ<0.05)。②CD以肠腔不规则狭窄为主;ITB以肠腔同轴狭窄为主(Ρ<0.05)。③ITB较CD更易出现肠周淋巴结增大和强化,系膜血管增多、迂曲(Ρ<0.05)。CD与ITB均可表现出腹痛、腹泻、发热、贫血、便血、消瘦;实验室检查中血沉升高、C-反应蛋白阳性、白蛋白降低以及肠道并发症;其中CD便血更多见,肠结核更常合并肺结核(Ρ<0.05)。结论 CD和肠结核具有相似的临床表现和实验室检查结果;MSCT表现二者各有一定特点,综合分析对两者的诊断及鉴别诊断有一定意义。Objective To compare Crohn disease （CD） with intestinal tuberculosis （ITB） in clinical and multislice CT （MSCT） features that may be helpful for the differential diagnosis. Methods Thirty-eight patients with CD and 13 with ITB proved surgically and pathologically were recruited for this study. The clinical symptoms， laboratory， and MSCT findings in these patients were retrospectively analyzed. Results The MSCT changes helpful in distinguishing CD from ITB included：①CD presented symmetrical intestinal wall thickening in most cases， while ITB were asymmetric（Ρ＜0.05）. ②The irregular stricture was more common usually shown in CD groups， while coaxial in ITB （Ρ＜0.05）. ③The lymphadenopathy with obvious enhancement and tortuously mesenteric vessels were frequently found in ITB group（Ρ＜0.05）. The clinical features of CD including abdominal pain， diarrhea， fever， anemia， hematochezia， weight loss，and intestinal complications were similar with ITB， and similar results were detected in the laboratory examination including the acceleration of erythrocyte sedimentation rate， postive C-reactive protein， and the reduction of albumin. The feature of hematochezia was more common in CD than in ITB， while concomitant pulmonary tuberculosis was more revealed in ITB （Ρ＜0.05）. Conclusions The MSCT findings of CD and ITB are characteristic. Combined with the similar clinical and laboratory features， the features of MSCT maybe helpful for definitive diagnosis.

关 键 词：克罗恩病 肠结核 多层螺旋CT 临床特征 

分 类 号：R574.62[医药卫生—消化系统] R524[医药卫生—内科学] R816.5[医药卫生—临床医学]