本文關(guān)鍵詞：克羅恩病與腸結(jié)核鑒別診斷的臨床研究　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的驗(yàn)證國(guó)內(nèi)外用于克羅恩病(Crohn's Disease,CD)與腸結(jié)核(Intestinal Tuberculosis,ITB)鑒別診斷的數(shù)學(xué)模型的診斷價(jià)值,進(jìn)一步探究臨床特征上的鑒別要點(diǎn)。方法收集2007年3月至2016年11月在浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院門診或者住院期間確診為CD或ITB的患者72例,根據(jù)臨床資料分別驗(yàn)證國(guó)內(nèi)的何瑤等和韓國(guó)的Jung等創(chuàng)立的鑒別模型,并回顧性地對(duì)72例患者的臨床表現(xiàn)、血清學(xué)、影像學(xué)、內(nèi)鏡學(xué)及病理學(xué)資料進(jìn)行分析比較,選取其中有統(tǒng)計(jì)學(xué)差異的指標(biāo)用二項(xiàng)Logistic回歸分析,進(jìn)一步明確鑒別要點(diǎn)。結(jié)果國(guó)內(nèi)何瑤的臨床和內(nèi)鏡鑒別模型具有很高的特異性(91.2%),韓國(guó)Jung的七項(xiàng)因素模型具有較高的敏感度(97.4%)和符合率(84.7%),兩模型受試者工作特征曲線(Receiver Operating Characteristic Curve,ROC 曲線)下面積相同,且一致性較高。進(jìn)一步的臨床資料分析,傾向于CD的臨床特征包括年齡小、病程長(zhǎng)、肛周疾病、回腸末段以上小腸受累、縱形潰瘍和鵝卵石樣外觀,既往或活動(dòng)性肺結(jié)核、結(jié)核菌素試驗(yàn)(Purified Protein Derivative,PPD)陽(yáng)性、T細(xì)胞斑點(diǎn)試驗(yàn)(T cells spottest,T-SPOT.TB)陽(yáng)性、隱窩膿腫、融合性肉芽腫、肉芽腫數(shù)目多、肉芽腫大則傾向ITB診斷,對(duì)臨床癥狀、影像學(xué)及內(nèi)鏡特征進(jìn)行二項(xiàng)Logistic回歸分析后未出現(xiàn)統(tǒng)計(jì)學(xué)差異。結(jié)論CD與ITB的鑒別診斷應(yīng)綜合臨床、血清學(xué)、影像學(xué)、內(nèi)鏡及病理特點(diǎn),應(yīng)用國(guó)內(nèi)外的鑒別診斷模型有助于確診,加入包括更具體的病理特征在內(nèi)的鑒別要點(diǎn)可能會(huì)提高鑒別效能。
[Abstract]:Objective to verify the application of Crohnen disease (Crohnella diseaseus) and intestinal tuberculosis (Tuberculosis) at home and abroad. ITB) the diagnostic value of mathematical model for differential diagnosis. Methods from March 2007 to November 2016 patients with CD or ITB were diagnosed as CD or ITB at the run run run Shaw Hospital affiliated to Zhejiang University School of Medicine from March 2007 to November 2016. There were 72 cases. According to the clinical data, we verified the differential models of Ho Yao et al. And Jung et al., and reviewed the clinical manifestations, serological and imaging findings of 72 patients. Endoscopy and pathological data were analyzed and compared. The indexes with statistical difference were analyzed by binomial Logistic regression analysis. Results the clinical and endoscopic differential models of Ho Yao had high specificity (91.2%). The seven factor models of Jung in Korea have high sensitivity (97.4) and coincidence rate (84.7). The area under the receiver Operating Characteristic curve was the same. Further analysis of clinical data showed that the clinical features of CD included age, long course of disease, perianal disease, small intestine involvement above the end of ileum, longitudinal ulcer and cobblestone appearance. In previous or active pulmonary tuberculosis, the tuberculin test was positive for purified Protein Derivatives. T cell spot test showed T cells spottest T-SPOT.TB positive, crypt abscess, fused granuloma, granulomatous number and granuloma were more likely to be diagnosed by ITB. There was no statistical difference in clinical symptoms, imaging and endoscopic features after Logistic regression analysis. Conclusion the differential diagnosis of CD and ITB should be integrated with clinical, serological, imaging. Endoscopic and pathological features, the application of the domestic and foreign differential diagnosis model is helpful to the diagnosis, including more specific pathological features of the differential points may improve the effectiveness of differential diagnosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R574.62;R524

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本文編號(hào)：1405430