【摘要】：背景與目的：腸結(jié)核(intestinal tuberculosis, ITB)與克羅恩病(Crohn's disease, CD)的鑒別診斷困難,傳統(tǒng)方法與目前的一些新指標(biāo)新方法均存在靈敏度或特異度低的缺陷,納入多方面指標(biāo)的臨床診斷評(píng)分系統(tǒng)可更好地結(jié)合臨床、實(shí)驗(yàn)室、影像學(xué)、內(nèi)鏡及組織病理學(xué)表現(xiàn),理論上對(duì)鑒別診斷更有意義。目前存在著兩套評(píng)分系統(tǒng)：韓國(guó)的Lee評(píng)分系統(tǒng)及目前的國(guó)內(nèi)評(píng)分系統(tǒng)。本研究的目的在于探討臨床診斷評(píng)分系統(tǒng)在臨床實(shí)踐中的應(yīng)用價(jià)值,以期指導(dǎo)下一步大樣本前瞻性研究更好地完善評(píng)分系統(tǒng),為臨床鑒別診斷腸結(jié)核和克羅恩病提供依據(jù)。 方法：回顧性分析2003年至2012年在我院住院確診的68例ITB與56例CD患者的臨床資料,分別用Lee評(píng)分系統(tǒng)及國(guó)內(nèi)評(píng)分系統(tǒng)進(jìn)行評(píng)分并對(duì)比兩套評(píng)分系統(tǒng)對(duì)ITB和CD診斷的靈敏度及特異度,評(píng)估其臨床應(yīng)用價(jià)值。本研究同時(shí)對(duì)兩組確診患者的臨床、實(shí)驗(yàn)室、影像學(xué)、內(nèi)鏡及組織病理學(xué)表現(xiàn)進(jìn)行對(duì)比分析,納入具有統(tǒng)計(jì)學(xué)差異的特征性病變制定以目前的國(guó)內(nèi)評(píng)分系統(tǒng)為基礎(chǔ)的本研究評(píng)分系統(tǒng),并評(píng)估其應(yīng)用價(jià)值。 結(jié)果：1.支持ITB診斷的靈敏度、特異度：Lee評(píng)分系統(tǒng)為79.4%、80.4%,目前的國(guó)內(nèi)評(píng)分系統(tǒng)為51.5%、98.2%,本研究評(píng)分系統(tǒng)為86.8%、92.9%；支持CD診斷的靈敏度、特異度：Lee評(píng)分系統(tǒng)為48.2%、97.1%,目前的國(guó)內(nèi)評(píng)分系統(tǒng)為58.9%、97.1%,本研究評(píng)分系統(tǒng)為82.1%、94.1%;2.比較Lee評(píng)分系統(tǒng)、目前的國(guó)內(nèi)評(píng)分系統(tǒng)與本研究評(píng)分系統(tǒng)靈敏度、特異度的差異,在支持ITB診斷上：Lee評(píng)分系統(tǒng)的靈敏度高于目前的國(guó)內(nèi)評(píng)分系統(tǒng),特異度低于目前的國(guó)內(nèi)評(píng)分系統(tǒng),兩者比較均P0.05,差異有統(tǒng)計(jì)學(xué)意義；本研究評(píng)分系統(tǒng)的靈敏度高于目前的國(guó)內(nèi)評(píng)分系統(tǒng),P0.017,差異有統(tǒng)計(jì)學(xué)意義,兩者的特異度無(wú)統(tǒng)計(jì)學(xué)差異；本研究評(píng)分系統(tǒng)與Lee評(píng)分系統(tǒng)之間的靈敏度及特異度均無(wú)統(tǒng)計(jì)學(xué)差異。3.比較Lee評(píng)分系統(tǒng)、目前的國(guó)內(nèi)評(píng)分系統(tǒng)與本研究評(píng)分系統(tǒng)靈敏度、特異度的差異,在支持CD診斷上：Lee評(píng)分系統(tǒng)與目前的國(guó)內(nèi)評(píng)分系統(tǒng)之間的靈敏度及特異度均無(wú)統(tǒng)計(jì)學(xué)差異；本研究評(píng)分系統(tǒng)的靈敏度高于Lee評(píng)分系統(tǒng)及目前的國(guó)內(nèi)評(píng)分系統(tǒng),P0.017,差異有統(tǒng)計(jì)學(xué)意義,三套評(píng)分系統(tǒng)的特異度無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論Lee評(píng)分系統(tǒng)和目前的國(guó)內(nèi)評(píng)分系統(tǒng)在ITB和CD的鑒別診斷上無(wú)明顯優(yōu)劣性；以目前的國(guó)內(nèi)評(píng)分系統(tǒng)為基礎(chǔ)的本研究評(píng)分系統(tǒng)在ITB和CD診斷靈敏度上優(yōu)于目前的國(guó)內(nèi)評(píng)分系統(tǒng),亦優(yōu)于Lee評(píng)分系統(tǒng)；特異度上無(wú)統(tǒng)計(jì)學(xué)差異。可指導(dǎo)下一步進(jìn)行前瞻性大樣本多中心的研究制定更加完善合理的評(píng)分系統(tǒng),為臨床鑒別診斷腸結(jié)核和克羅恩病提供依據(jù)。
[Abstract]:Background & objective: it is difficult to differentiate (intestinal tuberculosis, ITB) from Crohn's disease (Crohn's disease, CD) in intestinal tuberculosis. The traditional methods and some new methods have the defect of low sensitivity or specificity. The clinical diagnostic scoring system incorporating multiple indicators can better integrate clinical, laboratory, imaging, endoscopic and histopathological findings, which is more useful for differential diagnosis in theory. At present, there are two sets of scoring systems: Korea's Lee scoring system and the current domestic scoring system. The purpose of this study is to explore the application value of clinical diagnostic scoring system in clinical practice in order to guide the next large sample prospective research to improve the scoring system and provide the basis for clinical differential diagnosis of intestinal tuberculosis and Crohn's disease. Methods: the clinical data of 68 cases of ITB and 56 cases of CD diagnosed in our hospital from 2003 to 2012 were analyzed retrospectively. Lee scoring system and domestic scoring system were used to evaluate the sensitivity and specificity of the two scoring systems in the diagnosis of ITB and CD. The clinical, laboratory, imaging, endoscopic and histopathological findings of the two groups were compared and analyzed. To include statistical differences in the development of characteristic lesions based on the current domestic scoring system, and evaluate its application value. Results: 1. The sensitivity and specificity of supporting ITB diagnosis: the Lee scoring system was 79.4 and 80.4, the current domestic scoring system was 51.5 and 98.2, and the score system in this study was 86.8 percent and 92.9percent. The sensitivity and specificity of supporting CD diagnosis: the Lee scoring system was 48.2 and 97.1, the current domestic scoring system was 58.9 and 97.1.The score system in this study was 82.1 and 94.1. Comparing the Lee scoring system, the difference of sensitivity and specificity between the present domestic scoring system and this research scoring system, in supporting the diagnosis of ITB: the sensitivity of the Lee scoring system is higher than that of the current domestic scoring system. The specificity was lower than that of the current domestic scoring system, both of which were compared with each other (P0.05), and the difference was statistically significant. The sensitivity of this system is higher than that of the domestic scoring system, P0.017, the difference is statistically significant, the specificity of the two has no statistical difference; There was no significant difference in sensitivity and specificity between this system and Lee scoring system. Compared with the Lee scoring system, the difference of sensitivity and specificity between the present domestic scoring system and this research system, in supporting the diagnosis of CD: there was no statistical difference in sensitivity and specificity between the Lee scoring system and the current domestic scoring system; The sensitivity of this scoring system is higher than that of Lee scoring system and the current domestic scoring system (P0.017), the difference is statistically significant, and the specificity of the three sets of scoring systems has no statistical difference. Conclusion the Lee scoring system and the current domestic scoring system have no obvious advantages and disadvantages in the differential diagnosis of ITB and CD. Based on the present domestic scoring system, the diagnostic sensitivity of ITB and CD is superior to that of Lee and the specificity of the system is not statistically different. It can guide the prospective multi-center study and establish a more perfect and reasonable scoring system for clinical differential diagnosis of intestinal tuberculosis and Crohn's disease.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R524;R574

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