The Application Value Of T-cell Spot Of Tuberculosis Test And HLA-G Detection In Differential Diagnosis Of Ileocecal Ulcer

Objective:To investigate the expression and differential diagnostic value of T-SPOT.TB and HLA-G in patients with inflammatory bowel disease(IBD)and intestinal tuberculosis(ITB).Methods:From August 2013 to May 2019,in First hospital of shanxi medical university,21patients with intestinal tuberculosis(ITB),26 patients with Crohn’s disease(CD),28patients with ulcerative colitis(UC)were selected as the observation group,and 33nonspecific ulcer patients were treated as control group.The clinical data,T-SPOT.TB and colonoscopy results of all patients were collected,and the sensitivity and specificity of T-SPOT.TB in ITB,UC and CD patients were analyzed,the expression of HLA-G in intestinal mucosa biopsies was detected by immunohistochemistry,analysis of the value of differential diagnosis in patients with ITB,UC,CD and nonspecific ileocecal ulcer.Results:1.There was no significant difference in clinical manifestations of abdominal pain,diarrhea,intestinal obstruction and intestinal perforation among the groups;Fever was more likely to be diagnosed by ITB,which was significantly different from that in each group(χ~2=14.997,P=0.002).Abdominal mass are more common in ITB and CD,which was different from that in each group(χ~2=13.954,P=0.003).2.The positive rate of ASCA in CD group was higher than that in other groups(χ~2=15.973,P=0.001),The sensitivity and specificity of ASCA in the diagnosis of CD were 50.00%and 86.59%,respectively;The positive rate of p-ANCA in the UC group was significantly higher than that of the other groups(χ~2=21.100,P=0.000),The sensitivity and specificity of p-ANCA in the diagnosis of UC were 57.14%and 86.25%,respectively.3.The positive rate of T-SPOT.TB in ITB group(90.5%)was significantly higher than that in CD(7.7%),UC(7.1%)and ileocecal nonspecific ulcer group(3.0%),The difference was statistically significant(χ~2=70.494,P=0.000).The sensitivity,specificity,positive predictive value and negative predictive value of T-SPOT.TB in the diagnosis of ITB were 90.48%(19/21),94.25%(82/87),79.17%(19/24),97.62%(82/84),respectively.4.Caseous necrotizing granuloma was found only in 2 ITB patients;In CD,neutrophils,eosinophils and lymphocytes infiltrated the mucosal myometrium in 24patients,three cases of aphthous ulcers,two cases of fissuring ulcer,no crypt abscess;Among 28 UC patients,27 cases inflammatory lesions with lymphocytic and plasma cell infiltration,8 cases had crypt abscess;All 33 non-specific ulcers were diffuse non-specific inflammatory lesions with neutrophils and inflammatory cells.5.The positive rates of HLA-G in CD,UC were 65.38%(17/26)and 67.86%(19/28),respectively.There was no significant difference between the two groups(χ~2=0.037,P=0.847).There was no HLA-G expression in the ITB group and the nonspecific ileocecal ulcer.Conclusion:1.T-SPOT.TB is helpful to the diagnosis of ITB and has important clinical value in the differential diagnosis of IBD and ITB.2.HLA-G is helpful to exclude ITB and nonspecific ileocecal ulcer,and has potential application value in the diagnosis of IBD.