肠结核与克罗恩病的临床鉴别及粪便菌群分析在鉴别诊断中的意义(1)

http://www.100md.com 2011年6月1日 熊震 张力文

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     【摘要】目的：总结肠结核与克罗恩病在临床症状，内镜表现以及粪便菌群分析结果对两者鉴别诊断的意义。方法：回顾性分析我院2005年1月-2011年12月于我院确诊的21例肠结核和30例克罗恩病病例，同时选择10例健康患者作对照,记录患者的临床症状、内镜表现特点及粪便菌群分析结果。结果：克罗恩病患者临床表现为消化道出血者占53.4%(16/30),较肠结核(14.4%, 3/21)多见(P<0.001) ; 30.0%(9/30)克罗恩病患者有肠外表现(口腔溃疡、皮疹、关节痛、肛周病变) ,而肠结核患者未见; 内镜下克罗恩病表现为纵行/裂隙样溃疡(43.3% , 13/30) 、卵石征(26.7% , 8/30) 、节段性病变(53.3 % , 16/30) 多于肠结核(6.8 %、4.2%、0),(P值分别为0.001、0.016、0.000) ; 克罗恩病组乳酸杆菌、双岐杆菌与正常组比较明显减少(P<0.01)，拟杆菌较正常组明显增多 (P<0.01);肠结核组乳酸杆菌、双岐杆菌、大肠杆菌与正常组比较明显减少 (P<0.01或 P<0.05)，拟杆菌较正常组明显增多(P<0.01);肠结核组拟杆菌较克罗恩病组增多明显，相比具有统计学差异 (P<0.05)，克罗恩病组大肠杆菌较肠结核组增多明显，相比具有统计学差异(P<0.05);肠球菌、金葡菌和酵母菌数量在各组间无明显差别。结论：肠结核与克罗恩病的鉴别诊断需结合临床特征和内镜检查，粪便菌群分析有助于对肠结核和克罗恩病的鉴别诊断。

    【关键词】肠结核;克罗恩病;粪便菌群分析;鉴别诊断

    【中图分类号】R574.6 【文献标识码】A 【文章编号】1008-6455(2011)12-0007-02

    Functional efficacy of clinical feature and intestinal flora in the differential diagnosis of intestinal tuberculosis and Crohn disease

    Xiong Zhen Zhang Liwen 【Abstract】Objective: to summarize the Functional efficacy of clinical feature, endoscopic feature and intestinal flora in the differential diagnosis of intestinal tuberculosis and Crohn disease. Methods: 21 cases diagnosed as intestinal tuberculosis and 30 Crohn disease from Jan. 2005 to Dec. 2010 were reviewed. The clinical manifestation, endoscopic findings, and the result of intestinal flora were analyzed. Results: Hematochezia was more frequently seen in CD patients (53.4%, 16/30) than that in ITB (14.4%, 3/21, P<0.001). Extraintestinal manifestations such as oral ulcer, skin rash, arthralgia and perianal diseases, were seen in 29. 3% CD patients compared with none in ITB. Under the endoscope, CD appeared as longitudinal/ fissure like ulcers for 43.3% (13/30) , cobblestone mucosa 26.7% ( 8/30 ) , and segmental lesion 53.3% (16/30) , significantly higher than those in ITB . Lactobacillus and bifidobacteria decreased obviously but bacteroid increased in Crohn disease compared with normal control group. Lactobacillus，bifidobacteria and Escherichia coli decreased obviously but bacteroid increased in iniestinal tuberculosis compared with normal control group ......

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