Clinical value of T-cell spot test for tuberculosis in differentiating intestinal tuberculosis from Crohn’s disease

叶丽敏; 李岚; 白班俊

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Clinical value of T-cell spot test for tuberculosis in differentiating intestinal tuberculosis from Crohn’s disease

更新时间：2026-01-09

- Clinical value of T-cell spot test for tuberculosis in differentiating intestinal tuberculosis from Crohn’s disease
- Journal of Army Medical University Vol. 37, Issue 20, Pages: 2091-2095(2015)
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  CLC： R447;R524.04;R574.04
- Published：2015
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叶丽敏,李岚,白班俊.T细胞斑点试验在肠结核及克罗恩病鉴别诊断中的临床价值[J].陆军军医大学学报(原第三军医大学学报),2015,37(20):2091-2095.

　Ye Limin,Li Lan,Bai Banjun.Clinical value of T-cell spot test for tuberculosis in differentiating intestinal tuberculosis from Crohn’s disease[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(20):2091-2095.
叶丽敏,李岚,白班俊.T细胞斑点试验在肠结核及克罗恩病鉴别诊断中的临床价值[J].陆军军医大学学报(原第三军医大学学报),2015,37(20):2091-2095. DOI：

　Ye Limin,Li Lan,Bai Banjun.Clinical value of T-cell spot test for tuberculosis in differentiating intestinal tuberculosis from Crohn’s disease[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(20):2091-2095. DOI：

摘要

目的探讨结核杆菌T细胞斑点试验（T-SPOT.TB）在肠结核（intestinal tuberculosis，ITB）和克罗恩（Crohn’s disease，CD）病鉴别诊断中的价值。方法回顾性分析2012年3月至2014年12月贵州省人民医院消化内科就诊并确诊的64例肠结核和克罗恩病住院患者。35例ITB患者中19例男性，16例女性，年龄14～77（37.3±16.5）岁。29例CD患者中13例男性，16例女性，年龄15～74（35.2±18.9）岁。比较2组患者在临床表现、实验室检查结果、内镜及病理学检查结果上的差异，统计分析T-SPOT.TB在ITB和CD中的阳性率及诊断ITB的灵敏度、特异度、阳性预测值和阴性预测值，评价T-SPOT.TB鉴别诊断CD和ITB的临床价值。结果 ITB患者腹泻（31.4% vs 65.5%，χ

=7.41，P0.01）、便血（8.6% vs 41.3%，χ

=9.51，P0.01）、肠梗阻（11.4% vs 34.5%，χ

=3.799，P0.05）和肠穿孔（0% vs 10.3%，χ

=3.799，P0.05）的发生率显著低于CD患者。T-SPOT.TB试验在ITB中的阳性率显著高于CD患者（91.4% vs 6.9%，χ

=45.508，P0.01），其敏感性和阳性预测值（PPV）分别为91.4%和94.1%，特异性和阴性预测值（NPV）分别为93.1%和90.0%。环行溃疡（20.0% vs 3.4%，χ

=3.972，P0.05）和回盲瓣受累（77.1% vs 51.7%，χ

=4.542，P0.05）在ITB中多见，而纵行溃疡（2.9% vs 20.6%，χ

=5.177，P0.05）、卵石征（0% vs 27.6%，χ

=11.034，P0.01）和肠腔狭窄（14.3% vs 37.9%，χ

=4.729，P0.05）在CD多见。淋巴细胞聚集在ITB中的发生率显著低于CD（31.4% vs 86.2%，χ

=19.338，P0.01），干酪样肉芽肿在ITB中的发生率显著高于CD（42.8% vs 0%，χ

=16.233，P0.01）。结论 T-SPOT.TB对ITB的诊断具有较高的灵敏度及特异度，有助于鉴别CD和ITB。

Abstract

Objective To study the differential diagnosis value of T-cell spot test of tuberculosis (T-SPOT.TB) between intestinal tuberculosis and Crohn’s disease. Methods Sixty-four patients with intestinal tuberculosis (ITB) or Crohn’s disease (CD) in our department from Mar

2012 to Dec

2014 were retrospectively analyzed. The ITB patients were 37.3±16.5 years old (ranged from 14 to 77)

and 19 males and 16 females. The CD patients were 35.2±18.9 years old (ranged from 15 to 74)

were 13 males and 16 females. The sensitivity

specificity

positive predictive value

and negative predictive value of T-SPOT.TB in differential diagnosis between ITB and CD were evaluated by analyzing the clinical manifestations

laboratory examination results

endoscopic findings and pathological results. Results The incidences of diarrhea (31.4% vs 65.5%

Chi-square=7.41

P0.01)

hematochezia (8.6% vs 41.3%

Chi-square=9.51

P0.01)

obstruction (11.4% vs 34.5%

Chi-square=3.799

P0.05) and bowel perforation (0% vs 10.3%

Chi-square=3.799

P0.05) in the ITB patients were significantly lower than those in the CD patients. The positive rate of T-SPOT.TB test in the ITB patients was higher than that in the CD patients (91.4% vs 6.9%

Chi-square=45.508

P0.01)

with sensitivity and positive predictive value of 91.4% and 94.1%

respectively and specificity and negative predictive value of 93.1% and 90.0%

respectively. Circular ulcer (20.0% vs 3.4%

Chi-square=3.972

P0.05) and ileocecum involvement (77.1% vs 51.7%

Chi-square=4.542

P0.05) were significantly more common in the ITB patients

while higher incidences of longitudinal ulcer (2.9% vs 20.6%

Chi-square=5.177

P0.05)

pebble levy (0% vs 27.6%

Chi-square=11.034

P0.01) and luminal stenosis (14.3% vs 37.9%

Chi-square=4.729

P0.05) were found in the CD patients as compared with the ITB patients. Lymph cell aggregation incidence of ITB was significantly lower than that of CD (31.4% vs 86.2%

Chi-square=19.338

P0.01)

and granuloma formation was significantly more common in ITB as compared with CD (42.8% vs 0%

Chi-square=16.233

P0.01). Conclusion T-SPOT.TB blood test is useful for differential diagnosis between ITB and CD with high sensitivity and specificity.

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