T细胞斑点试验在肠结核及克罗恩病鉴别诊断中的临床价值

发布时间：2018-06-12 19:39

本文选题：结核杆菌T细胞斑点试验 + 肠结核　；参考：《第三军医大学学报》2015年20期

【摘要】：目的探讨结核杆菌T细胞斑点试验(T-SPOT.TB)在肠结核(intestinal tuberculosis,ITB)和克罗恩(Crohn’s disease,CD)病鉴别诊断中的价值。方法回顾性分析2012年3月至2014年12月贵州省人民医院消化内科就诊并确诊的64例肠结核和克罗恩病住院患者。35例ITB患者中19例男性,16例女性,年龄14~77(37.3±16.5)岁。29例CD患者中13例男性,16例女性,年龄15~74(35.2±18.9)岁。比较2组患者在临床表现、实验室检查结果、内镜及病理学检查结果上的差异,统计分析T-SPOT.TB在ITB和CD中的阳性率及诊断ITB的灵敏度、特异度、阳性预测值和阴性预测值,评价T-SPOT.TB鉴别诊断CD和ITB的临床价值。结果 ITB患者腹泻(31.4%vs 65.5%,χ2=7.41,P0.01)、便血(8.6%vs 41.3%,χ2=9.51,P0.01)、肠梗阻(11.4%vs 34.5%,χ2=3.799,P0.05)和肠穿孔(0%vs 10.3%,χ2=3.799,P0.05)的发生率显著低于CD患者。T-SPOT.TB试验在ITB中的阳性率显著高于CD患者(91.4%vs 6.9%,χ2=45.508,P0.01),其敏感性和阳性预测值(PPV)分别为91.4%和94.1%,特异性和阴性预测值(NPV)分别为93.1%和90.0%。环行溃疡(20.0%vs 3.4%,χ2=3.972,P0.05)和回盲瓣受累(77.1%vs 51.7%,χ2=4.542,P0.05)在ITB中多见,而纵行溃疡(2.9%vs 20.6%,χ2=5.177,P0.05)、卵石征(0%vs 27.6%,χ2=11.034,P0.01)和肠腔狭窄(14.3%vs 37.9%,χ2=4.729,P0.05)在CD多见。淋巴细胞聚集在ITB中的发生率显著低于CD(31.4%vs 86.2%,χ2=19.338,P0.01),干酪样肉芽肿在ITB中的发生率显著高于CD(42.8%vs 0%,χ2=16.233,P0.01)。结论 T-SPOT.TB对ITB的诊断具有较高的灵敏度及特异度,有助于鉴别CD和ITB。
[Abstract]:Objective to investigate the value of T-SPOT.TB in the differential diagnosis of intestinal tuberculosis (ITB) and Crohns disease (CDD). Methods from March 2012 to December 2014, a total of 64 hospitalized patients with enteric tuberculosis and Crohn's disease, including 19 males and 16 females, were retrospectively analyzed in the Department of Digestive Medicine, Guizhou Provincial people's Hospital. Of the 29 CD patients, 13 were male and 16 were female, aged 1574 卤18.9 years. The clinical manifestations, laboratory findings, endoscopic and pathological findings were compared between the two groups. The positive rate of T-SPOT.TB in ITB and CD and the sensitivity, specificity, positive predictive value and negative predictive value of T-SPOT.TB in ITB and CD were analyzed. To evaluate the clinical value of T-SPOT.TB in differential diagnosis of CD and ITB. Results the incidence of diarrhea 31.4 vs 65.5in ITB patients was significantly lower than that in patients with CD. The positive rate of T-SPOT.TB test in ITB was significantly higher than that in CD patients. The positive rate of T-SPOT.TB test in ITB was significantly higher than that in CD patients (91.4 vs 6.93, 蠂 ~ 25.508p 0.01, 蠂 ~ 45.508p 0.01, 蠂 ~ 25.508p 0.01, P 0.05) and intestinal perforation (P _ 0.05 vs 10.3, 蠂 ~ 23.799P 0.05). The positive rate of T-SPOT.TB test in ITB was significantly higher than that in CD patients (91.4 vs 6.931, 蠂 ~ (45.508) P _ (0.01) P _ (0.01). The positive rate of T-SPOT.TB test was 91.4% higher than that of CD patients. The specific and negative predictive values of NPV were 93.1% and 90.0%, respectively. Circular ulcer 20.0 vs 3.4, 蠂 2 + 3.972P 0.05) and ileocecal valve involvement 77.1 vs 51.7, 蠂 24.542 P 0.05) were found in ITB, while longitudinal ulcers were 2.9vs 20.6, 蠂 25.177P 0.05, pebble sign 0 vs 27.6T, 蠂 2 / 11.034P 0.01) and lumen stenosis 14.3vs 37.9p 0.05). The incidence of lymphocyte aggregation in ITB was significantly lower than that in CD31. 4 vs 86. 2. The incidence of caseous granuloma in ITB was significantly higher than that in CDT 42. 8 vs 0. 01. Conclusion T-SPOT.TB has high sensitivity and specificity in the diagnosis of ITB, which is helpful to distinguish CD from ITB.
【作者单位】：贵州省人民医院消化内科;
【分类号】：R524;R574.62

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