摘要
目的:探讨对鉴别诊断克罗恩病(Crohn's disease,CD)和肠结核(intestinal tuberculosis,ITB)有价值的临床及内镜指标和方法.方法:回顾性分析2003-06/2009-02住院的CD患者130例、ITB患者122例的临床及内镜资料;采用Logistic回归分析的方法筛选鉴别CD和ITB的相关指标,并应用回归方程(数学模型)的方法和ROC曲线分析其诊断效能.结果:对CD和ITB鉴别有价值的临床指标分别是:血便、肠道手术史、肛周疾病、肺结核、腹水、PPD阳性;有意义的临床指标的回归数学模型对CD和ITB鉴别诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为90.3%、76.8%、83.8%、80.7%、88.0%.对CD和ITB鉴别有价值的内镜指标是:直肠受累、纵行溃疡、鹅卵石征、受累回盲瓣固定开口、环形溃疡、鼠咬状溃疡;有意义的内镜指标的回归数学模型对CD和ITB鉴别诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为82.9%、82.0%、82.5%、82.9%、82.0%.结论:筛选出的临床和内镜指标可能对CD和ITB的鉴别有用,应用临床指标、内镜指标回归数学模型的方法可提高诊断的敏感性和准确性.
AIM： To evaluate the value of clinical and endoscopic parameters for differential diagnosis of Crohn’s disease （CD） from intestinal tuberculosis （ITB）. METHODS： The clinical and colonoscopic data from 130 CD patients and 122 ITB patients, who were treated from June 2003 to February 2009, were analyzed retrospectively. The parameters for differentiating CD from ITB were screenedby logistic regression analysis. The diagnostic efficacy of the screened parameters was analyzed using the regression equation and receiver operating characteristic （ROC） curve. RESULTS： The clinical parameters helpful in differentiating CD from ITB include bloody stools, history ofintestinal surgery, perianal diseases, history of pulmonary tuberculosis, ascites and positive PPD skin test. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression math-ematical model established using these clinical parameters are 90.3%, 76.8%, 83.8%, 80.7% and 88.0%, respectively. The endoscopic parameters helpful in differentiating CD from ITB include retcum involvement, longitudinal ulcer, cobblestoning, stuck open ileocecal valve, ring ulcer and rodent ulcer. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of regression mathematical model established using these endoscopic parameters are 82.9%, 82.0%, 82.5%, 82.9% and 82.0%, respectively. CONCLUSION： The parameters screened may aid in distinguishing CD from ITB. The regression mathematical model established using clinical and endoscopic parameters can help improve the sensitivity and accuracy of differential diagnosis between CD and ITB.
出处
《世界华人消化杂志》
CAS
北大核心
2010年第6期621-627,共7页
World Chinese Journal of Digestology
关键词
克罗恩病
肠结核
鉴别诊断
临床特征
内镜表现
回归方程
Crohn’s disease
Intestinal tuberculosis
Differential diagnosis
Clinical feature
Endoscopic feature
Regression equation
