基于组织学定性和定量分析的克罗恩病与肠结核鉴别诊断评分系统的建立  

Establishment of scoring system in differential diagnosis of Crohn's disease and intestinal tuberculosis based on quantltative and quatltative analysis of histological evaluation

作　　者：胡宝英[1] 袁帅[1] 周海华[1] 

机构地区：[1]南方医科大学附属小榄医院消化科,广东中山528415

出　　处：《中国医药导报》2017年第23期118-121,共4页China Medical Herald

摘　　要：目的建立一个有效的基于组织学定性和定量分析的克罗恩病(CD)与肠结核(ITB)鉴别诊断评分系统。方法参照CD与ITB诊断标准,确诊CD 35例,ITB 31例。采集两组患者的定性(裂隙状溃疡、隐窝脓肿、黏膜下层增宽、非干酪性肉芽肿、干酪性肉芽肿)与定量(每张切片肉芽肿数量、每10个高倍镜视野淋巴细胞聚集数)组织病理学资料,对以上数据先进行单因素分析,再行多因素Logistic回归分析,根据回归模型中的β值建立鉴别诊断评分系统。用受试者工作特性(ROC)曲线下面积检验评分系统的鉴别诊断效能。结果非干酪性肉芽肿、每张切片肉芽肿数量和每10个高倍镜视野淋巴细胞聚集数被纳入多因素Logistic回归模型,根据模型中各变量的β值赋予分值并建立评分系统。该评分系统ROC曲线下面积为0.762(95%CI 0.630~0.895)。结论基于组织学定性和定量分析所建立的CD与ITB鉴别诊断评分系统为两者的鉴别诊断提供了一种有效的新方法。Objective To establish an effective differential diagnostic model of Crohn＇s disease （CD） and intestinal tu- berculosis （ITB） based on quanthative and quatltative analysis of histological evaluation. Methods 66 patients （35 cases of CD, 31 cases of ITB） were precisely diagnosed according to the current criteria. Quantitative （fissuring ulcers, crypt abscess, thickened submucosa, non-caseating granulomas, caseating granuloma） and quathative （the number of granuloma in each section, the number of lymphoid aggregation in 10 high power field） histological evaluation of the two groups were col- lected. Variables were analyzed by univariate analysis first, then by multivariae Logistic regression analysis. A differen- tial diagnosis model was developed based on the Logistic regression model and the scoring system was established in accordance with assigning of the value of each variable/3 in the model. Application efficiency of the diagnostic scoring system was tested by calculating area under the receiver operating characteristic （ROC） curve. Results The non-caseat- ing granulomas, the number of granuloma in each section, and the number of lymphoid aggregation in 10 high power field were included in the multivariate Logistic regression model. Area under the ROC curve of the diagnostic score scheme was 0.762 （95%CI 0.630-0.895）. Conclusion The differential scoring system based on quanthative and quatltative analysis of histological evaluation provides a new and effective method for differential diagnosis between CD and ITB.

关 键 词：克罗恩病 肠结核 鉴别诊断 评分系统 

分 类 号：R524[医药卫生—内科学]