| BackgroundCrohn’s disease(CD), also known as regional enteritis or segmental enteritis, was collectively referred to as inflammatory bowel disease(IBD) with ulcerative colitis,which was named after Corhn for that he was the first one who reported the disease in 1932[1]. It was reported that the incidence of IBD has increased by nearly 4 times since 1990 in China, but the pathogenesis of CD has not yet entirely clear, and it lacks of soecific clinical manifestations. At the same time, there was no golden standard in the diagnosis of CD, which made it has a high misdiagnosis rate and was easily confused with intestinal tuberculosis(ITB), primary intestinal lymphoma(PIL) and other disease.As a result, it was delayed in diagnosis and treatment. The differential diagnosis has always a problem for clinicians. China was a major country of tuberculosis, but the clinical manifestation of tuberculosis was not often typical and drug-resistant tuberculosis was becoming more and more serious, which made it difficult to diagnosis and treatment. ITB was the most common extra-pulmonary tuberculosis and it was similar with CD in clinical manifestation, auxiliary examination, imaging studies, endoscopic examination and pathological diagnosis. If ITB misdiagnosis for CD, the application of corticosteroid therapy made it easily dissemination of tuberculosis, and if CD misdiagnosis for ITB, it will lead to inappropriate anti-tuberculosis therapy and delay off the illness. PIL was the most common extranodal lymphoma, mainly damage the digestive tract. Although the incidence rate of PIL was low, but its condition was more serious, and the misdiagnosis will lead to delay of treatment. In this paper, the clinical data of CD, ITB and CD, PIL were compared and analyzed with hope to provide useful antidiastole approaches for clinical diagnosis.ObjectiveTo explore the significance of antidiastole indicators and establish a clinically available differential diagnosis approaches through the analysis of clinical manifestations, laboratory examinations, imaging findings, endoscopic examination and pathological features of CD, ITB and PIL. MethodsCollected the hospital diagnosis of CD, ITB and PIL cases in Fujian Provincial Hospital during January 2004 to December 2014, reviewed the results of patient’s general information, clinical manifestations, laboratory examination, imaging, colonoscopy and pathological features and analysis the relevant indicators with statistical significance for antidiastole. ResultsCompared with the ITB group, the CD group has no difference in gender and age(P>0.05) and has a longer course of disease(P=0.005). The clinical indicators(abdominal pain, diarrhea, hematochezia, fever, anemia, weight loss, low protein, intestinal obstruction and ascites) between two groups have no difference(P>0.05). The incidence of extra intestinal lesions in CD group was higher than ITB group, and the incidence of pulmonary tuberculosis in ITB group was higher than CD group(P<0.001). The specificity and positive predictive values of extra intestinal lesions in CD group were 100.0%, and the specificity, positive predictive values and negative predictive values of pulmonary tuberculosis in ITB group were higher(100.0%, 100.0%, 81.1%). 5 cases in ITB group who tested by TSpot.TB were all positive, versus 15 cases in CD group who tested by TSpot.TB was only 1 case with weakly positive. And the rest of the indicators, such as increased leukocyte, anemia, increased globulin, increased erythrocyte sedimentation rate(ESR) and increased C-reactive protein(CRP), have no significant difference in both groups(P>0.05). The CD group and ITB group were all mainly with multiple irregular ulcers, which were all mainly occurred in ileocecus and colon. The specificity and positive predictive value of segmental distribution of ulcer in CD group was higher(86.7%, 86.7%), and typical longitudinal ulcer, fissured ulcers, crazy-paving sign were not common seen in CD group. None of the cases occurred in small intestine in ITB group. There was no difference of deformation and stricture in ileocecal valve between two groups(P>0.05). Both of groups shown the imaging change of bowel wall thickening, luminal stenosis and lymphadenovarix, and the typical image findings in CD, such as mucosal stratification(1 case), target sign(none) or comb sign(4 cases), were not common seen. The caseation in ITB group were higher than that of CD group(P<0.05), and the specificity and positive predictive value were all 100.0%, but the sensitivity was not high(22.2%), only 4 from 18 cases were detected.Compared with the PIL group, the CD group has no difference in gender(P>0.05) and has a younger age of onset and longer course of disease(P<0.05). Both of the groups have shown abdominal pain, diarrhea and hematochezia as the mainly clinical manifestations, and except for extra intestinal lesions, there were no statistically significant difference in all of other clinical manifestations. There were no statistically significant differences of the laboratory examination(increased leukocyte, anemia, increased globulin, increased ESR and increased CRP) between both groups. The CD group was mainly with multiple irregular ulcers, which can affect the whole colon, and the incidence of lesion occurred in terminal ileum/ileocecus and coexist in ileocolon were higher than PIL group(P<0.05), which were mainly shown as a single protrude lesion. There was no significant difference between two groups in image changes. In CD group, the incidence of inflammatory granuloma, acute and chronic inflammatory cell aggregation were significantly higher than that of PIL group(P<0.05), but both of the changes were nonspecific, and pathological immunohistochemistry were necessary to diagnose in most of the PIL confirmed cases. Conclusions1. In the differential diagnosis of CD and ITB, the extra intestinal lesions and segmental distribution of ulcer shown a high degree of specificity.2. In the positive correlation index of diagnosis of ITB, TSpot.TB and pulmonary tuberculosis shown a high degree of sensitivity and specificity.3. The CD group has a younger age of onset and longer of course of disease than PIL group. In endoscopic, it was mainly shown as multiple irregular ulcers, which was common occurred in the terminal ileum/ileocecus. Extra intestinal lesion has shown a high degree of specificity.4. PIL was mainly shown as a single lesion, protrude type. Pathological immunohistochemistry were necessary to diagnose in PIL confirmed cases, which was appeared as ulcerative lesion in endoscope. |
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