中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2012年
6期
325-328
,共4页
何瑶%陈瑜君%杨红%胡仁伟%欧阳春辉%黄梅芳%廖旺娣%钱家鸣%欧阳钦%吴小平%夏冰%吕农华%胡品津
何瑤%陳瑜君%楊紅%鬍仁偉%歐暘春輝%黃梅芳%廖旺娣%錢傢鳴%歐暘欽%吳小平%夏冰%呂農華%鬍品津
하요%진유군%양홍%호인위%구양춘휘%황매방%료왕제%전가명%구양흠%오소평%하빙%려농화%호품진
Crohn病%肠结核%内镜下特征%临床特征
Crohn病%腸結覈%內鏡下特徵%臨床特徵
Crohn병%장결핵%내경하특정%림상특정
Crohn disease%Intestinal tuberculosis%Endoscopic characteristics%Clinical features
目的 统一克罗恩病(CD)与肠结核(ITB)内镜下病变特征的中文命名,分析二者的临床、内镜鉴别要点.方法 由协作组5家医院10名专家分析讨论136例CD及ITB的临床及内镜特征,得出肯定的内镜下病变特征.对有统计学差异的特征根据诊断特异度进行评分,以ROC曲线求出两病肯定诊断的分界值.结果 以统一文字描述CD、ITB的内镜标准图像,二者的内镜特征鉴别点:病变≥4个肠段、累及直肠、纵行溃疡、鹅卵石外观以及环形溃疡.临床特征鉴别点:活动性肺结核、PPD皮试强阳性、肛瘘或肛周脓肿以及CD肠外表现.136例中病理确诊(干酪样坏死)4.4％(6/136),采用本研究评分系统对无病理证据病例评分,肯定诊断39.7％ (54/136),可疑诊断18.4％(25/136).结论 提高对内镜病变特征的识别和统一判别标准有助于CD和ITB的鉴别诊断.采用临床内镜评分可提高CD与ITB鉴别诊断率.半数患者不能依靠活检病理和临床内镜评分获得比较可靠的诊断,需进一步研究更完善的评分体系.
目的 統一剋囉恩病(CD)與腸結覈(ITB)內鏡下病變特徵的中文命名,分析二者的臨床、內鏡鑒彆要點.方法 由協作組5傢醫院10名專傢分析討論136例CD及ITB的臨床及內鏡特徵,得齣肯定的內鏡下病變特徵.對有統計學差異的特徵根據診斷特異度進行評分,以ROC麯線求齣兩病肯定診斷的分界值.結果 以統一文字描述CD、ITB的內鏡標準圖像,二者的內鏡特徵鑒彆點:病變≥4箇腸段、纍及直腸、縱行潰瘍、鵝卵石外觀以及環形潰瘍.臨床特徵鑒彆點:活動性肺結覈、PPD皮試彊暘性、肛瘺或肛週膿腫以及CD腸外錶現.136例中病理確診(榦酪樣壞死)4.4％(6/136),採用本研究評分繫統對無病理證據病例評分,肯定診斷39.7％ (54/136),可疑診斷18.4％(25/136).結論 提高對內鏡病變特徵的識彆和統一判彆標準有助于CD和ITB的鑒彆診斷.採用臨床內鏡評分可提高CD與ITB鑒彆診斷率.半數患者不能依靠活檢病理和臨床內鏡評分穫得比較可靠的診斷,需進一步研究更完善的評分體繫.
목적 통일극라은병(CD)여장결핵(ITB)내경하병변특정적중문명명,분석이자적림상、내경감별요점.방법 유협작조5가의원10명전가분석토론136례CD급ITB적림상급내경특정,득출긍정적내경하병변특정.대유통계학차이적특정근거진단특이도진행평분,이ROC곡선구출량병긍정진단적분계치.결과 이통일문자묘술CD、ITB적내경표준도상,이자적내경특정감별점:병변≥4개장단、루급직장、종행궤양、아란석외관이급배형궤양.림상특정감별점:활동성폐결핵、PPD피시강양성、항루혹항주농종이급CD장외표현.136례중병리학진(간락양배사)4.4％(6/136),채용본연구평분계통대무병리증거병례평분,긍정진단39.7％ (54/136),가의진단18.4％(25/136).결론 제고대내경병변특정적식별화통일판별표준유조우CD화ITB적감별진단.채용림상내경평분가제고CD여ITB감별진단솔.반수환자불능의고활검병리화림상내경평분획득비교가고적진단,수진일보연구경완선적평분체계.
Objective To unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.Methods A collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.Results Firstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.Conclusion Identification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.
