克罗恩病与肠结核鉴别诊断的临床研究
发布时间:2018-01-10 13:23
本文关键词:克罗恩病与肠结核鉴别诊断的临床研究 出处:《浙江大学》2017年硕士论文 论文类型:学位论文
【摘要】:目的验证国内外用于克罗恩病(Crohn's Disease,CD)与肠结核(Intestinal Tuberculosis,ITB)鉴别诊断的数学模型的诊断价值,进一步探究临床特征上的鉴别要点。方法收集2007年3月至2016年11月在浙江大学医学院附属邵逸夫医院门诊或者住院期间确诊为CD或ITB的患者72例,根据临床资料分别验证国内的何瑶等和韩国的Jung等创立的鉴别模型,并回顾性地对72例患者的临床表现、血清学、影像学、内镜学及病理学资料进行分析比较,选取其中有统计学差异的指标用二项Logistic回归分析,进一步明确鉴别要点。结果国内何瑶的临床和内镜鉴别模型具有很高的特异性(91.2%),韩国Jung的七项因素模型具有较高的敏感度(97.4%)和符合率(84.7%),两模型受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC 曲线)下面积相同,且一致性较高。进一步的临床资料分析,倾向于CD的临床特征包括年龄小、病程长、肛周疾病、回肠末段以上小肠受累、纵形溃疡和鹅卵石样外观,既往或活动性肺结核、结核菌素试验(Purified Protein Derivative,PPD)阳性、T细胞斑点试验(T cells spottest,T-SPOT.TB)阳性、隐窝脓肿、融合性肉芽肿、肉芽肿数目多、肉芽肿大则倾向ITB诊断,对临床症状、影像学及内镜特征进行二项Logistic回归分析后未出现统计学差异。结论CD与ITB的鉴别诊断应综合临床、血清学、影像学、内镜及病理特点,应用国内外的鉴别诊断模型有助于确诊,加入包括更具体的病理特征在内的鉴别要点可能会提高鉴别效能。
[Abstract]:Objective to verify the application of Crohnen disease (Crohnella diseaseus) and intestinal tuberculosis (Tuberculosis) at home and abroad. ITB) the diagnostic value of mathematical model for differential diagnosis. Methods from March 2007 to November 2016 patients with CD or ITB were diagnosed as CD or ITB at the run run run Shaw Hospital affiliated to Zhejiang University School of Medicine from March 2007 to November 2016. There were 72 cases. According to the clinical data, we verified the differential models of Ho Yao et al. And Jung et al., and reviewed the clinical manifestations, serological and imaging findings of 72 patients. Endoscopy and pathological data were analyzed and compared. The indexes with statistical difference were analyzed by binomial Logistic regression analysis. Results the clinical and endoscopic differential models of Ho Yao had high specificity (91.2%). The seven factor models of Jung in Korea have high sensitivity (97.4) and coincidence rate (84.7). The area under the receiver Operating Characteristic curve was the same. Further analysis of clinical data showed that the clinical features of CD included age, long course of disease, perianal disease, small intestine involvement above the end of ileum, longitudinal ulcer and cobblestone appearance. In previous or active pulmonary tuberculosis, the tuberculin test was positive for purified Protein Derivatives. T cell spot test showed T cells spottest T-SPOT.TB positive, crypt abscess, fused granuloma, granulomatous number and granuloma were more likely to be diagnosed by ITB. There was no statistical difference in clinical symptoms, imaging and endoscopic features after Logistic regression analysis. Conclusion the differential diagnosis of CD and ITB should be integrated with clinical, serological, imaging. Endoscopic and pathological features, the application of the domestic and foreign differential diagnosis model is helpful to the diagnosis, including more specific pathological features of the differential points may improve the effectiveness of differential diagnosis.
【学位授予单位】:浙江大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R574.62;R524
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