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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

, PP. 2091-2095

Keywords: 结核杆菌T细胞斑点试验,肠结核,克罗恩病,鉴别诊断

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Abstract:

目的探讨结核杆菌T细胞斑点试验(T-SPOT.TB)在肠结核(intestinaltuberculosis,ITB)和克罗恩(Crohn’sdisease,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%vs65.5%,χ2=7.41,P<0.01)、便血(8.6%vs41.3%,χ2=9.51,P<0.01)、肠梗阻(11.4%vs34.5%,χ2=3.799,P<0.05)和肠穿孔(0%vs10.3%,χ2=3.799,P<0.05)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%vs6.9%,χ2=45.508,P<0.01),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%vs3.4%,χ2=3.972,P<0.05)和回盲瓣受累(77.1%vs51.7%,χ2=4.542,P<0.05)在ITB中多见,而纵行溃疡(2.9%vs20.6%,χ2=5.177,P<0.05)、卵石征(0%vs27.6%,χ2=11.034,P<0.01)和肠腔狭窄(14.3%vs37.9%,χ2=4.729,P<0.05)在CD多见。淋巴细胞聚集在ITB中的发生率显著低于CD(31.4%vs86.2%,χ2=19.338,P<0.01),干酪样肉芽肿在ITB中的发生率显著高于CD(42.8%vs0%,χ2=16.233,P<0.01)。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。

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