临床诊断评分系统在肠结核与克罗恩病鉴别诊断中的应用价值

发布时间：2019-02-23 16:29

【摘要】：背景与目的：肠结核(intestinal tuberculosis, ITB)与克罗恩病(Crohn's disease, CD)的鉴别诊断困难,传统方法与目前的一些新指标新方法均存在灵敏度或特异度低的缺陷,纳入多方面指标的临床诊断评分系统可更好地结合临床、实验室、影像学、内镜及组织病理学表现,理论上对鉴别诊断更有意义。目前存在着两套评分系统：韩国的Lee评分系统及目前的国内评分系统。本研究的目的在于探讨临床诊断评分系统在临床实践中的应用价值,以期指导下一步大样本前瞻性研究更好地完善评分系统,为临床鉴别诊断肠结核和克罗恩病提供依据。方法：回顾性分析2003年至2012年在我院住院确诊的68例ITB与56例CD患者的临床资料,分别用Lee评分系统及国内评分系统进行评分并对比两套评分系统对ITB和CD诊断的灵敏度及特异度,评估其临床应用价值。本研究同时对两组确诊患者的临床、实验室、影像学、内镜及组织病理学表现进行对比分析,纳入具有统计学差异的特征性病变制定以目前的国内评分系统为基础的本研究评分系统,并评估其应用价值。结果：1.支持ITB诊断的灵敏度、特异度：Lee评分系统为79.4%、80.4%,目前的国内评分系统为51.5%、98.2%,本研究评分系统为86.8%、92.9%；支持CD诊断的灵敏度、特异度：Lee评分系统为48.2%、97.1%,目前的国内评分系统为58.9%、97.1%,本研究评分系统为82.1%、94.1%;2.比较Lee评分系统、目前的国内评分系统与本研究评分系统灵敏度、特异度的差异,在支持ITB诊断上：Lee评分系统的灵敏度高于目前的国内评分系统,特异度低于目前的国内评分系统,两者比较均P0.05,差异有统计学意义；本研究评分系统的灵敏度高于目前的国内评分系统,P0.017,差异有统计学意义,两者的特异度无统计学差异；本研究评分系统与Lee评分系统之间的灵敏度及特异度均无统计学差异。3.比较Lee评分系统、目前的国内评分系统与本研究评分系统灵敏度、特异度的差异,在支持CD诊断上：Lee评分系统与目前的国内评分系统之间的灵敏度及特异度均无统计学差异；本研究评分系统的灵敏度高于Lee评分系统及目前的国内评分系统,P0.017,差异有统计学意义,三套评分系统的特异度无统计学差异。结论Lee评分系统和目前的国内评分系统在ITB和CD的鉴别诊断上无明显优劣性；以目前的国内评分系统为基础的本研究评分系统在ITB和CD诊断灵敏度上优于目前的国内评分系统,亦优于Lee评分系统；特异度上无统计学差异。可指导下一步进行前瞻性大样本多中心的研究制定更加完善合理的评分系统,为临床鉴别诊断肠结核和克罗恩病提供依据。
[Abstract]:Background & objective: it is difficult to differentiate (intestinal tuberculosis, ITB) from Crohn's disease (Crohn's disease, CD) in intestinal tuberculosis. The traditional methods and some new methods have the defect of low sensitivity or specificity. The clinical diagnostic scoring system incorporating multiple indicators can better integrate clinical, laboratory, imaging, endoscopic and histopathological findings, which is more useful for differential diagnosis in theory. At present, there are two sets of scoring systems: Korea's Lee scoring system and the current domestic scoring system. The purpose of this study is to explore the application value of clinical diagnostic scoring system in clinical practice in order to guide the next large sample prospective research to improve the scoring system and provide the basis for clinical differential diagnosis of intestinal tuberculosis and Crohn's disease. Methods: the clinical data of 68 cases of ITB and 56 cases of CD diagnosed in our hospital from 2003 to 2012 were analyzed retrospectively. Lee scoring system and domestic scoring system were used to evaluate the sensitivity and specificity of the two scoring systems in the diagnosis of ITB and CD. The clinical, laboratory, imaging, endoscopic and histopathological findings of the two groups were compared and analyzed. To include statistical differences in the development of characteristic lesions based on the current domestic scoring system, and evaluate its application value. Results: 1. The sensitivity and specificity of supporting ITB diagnosis: the Lee scoring system was 79.4 and 80.4, the current domestic scoring system was 51.5 and 98.2, and the score system in this study was 86.8 percent and 92.9percent. The sensitivity and specificity of supporting CD diagnosis: the Lee scoring system was 48.2 and 97.1, the current domestic scoring system was 58.9 and 97.1.The score system in this study was 82.1 and 94.1. Comparing the Lee scoring system, the difference of sensitivity and specificity between the present domestic scoring system and this research scoring system, in supporting the diagnosis of ITB: the sensitivity of the Lee scoring system is higher than that of the current domestic scoring system. The specificity was lower than that of the current domestic scoring system, both of which were compared with each other (P0.05), and the difference was statistically significant. The sensitivity of this system is higher than that of the domestic scoring system, P0.017, the difference is statistically significant, the specificity of the two has no statistical difference; There was no significant difference in sensitivity and specificity between this system and Lee scoring system. Compared with the Lee scoring system, the difference of sensitivity and specificity between the present domestic scoring system and this research system, in supporting the diagnosis of CD: there was no statistical difference in sensitivity and specificity between the Lee scoring system and the current domestic scoring system; The sensitivity of this scoring system is higher than that of Lee scoring system and the current domestic scoring system (P0.017), the difference is statistically significant, and the specificity of the three sets of scoring systems has no statistical difference. Conclusion the Lee scoring system and the current domestic scoring system have no obvious advantages and disadvantages in the differential diagnosis of ITB and CD. Based on the present domestic scoring system, the diagnostic sensitivity of ITB and CD is superior to that of Lee and the specificity of the system is not statistically different. It can guide the prospective multi-center study and establish a more perfect and reasonable scoring system for clinical differential diagnosis of intestinal tuberculosis and Crohn's disease.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R524;R574

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