克罗恩病与溃疡性结肠炎、肠结核的临床鉴别诊断研究
|
摘要
目的：
在临床实践中,溃疡性结肠炎(UC)和克罗恩病(CD)的鉴别十分重要,然而常常由于临床表现不典型、模棱两可的内镜检查结果和影像表现以及肠镜下活检的深度不够,使得鉴别UC和CD成为一个难题。IBD的诊断指标包括一些生物学标记,本研究将相互独立的血清标记物作为参数进行整合,通过统计学工具和方法构建了一个用于鉴别仅结肠损伤的UC和CD的诊断模型,并进一步检验该诊断模型的效能。
并通过meta分析探讨克罗恩病(CD)与肠结核(ITB)内镜表现和组织病理学特征,为两者的鉴别诊断提供依据。
研究对象及方法：
2006年2月至2011年2月,采用回顾性分析的方法,收集了来自浙江大学医学院附属第一医院的140名UC住院患者和174名CD住院患者的资料。首次住院治疗的这段时间收集周围静脉血液样本,根据所测的血清标记物的结果,我们构建了两个逻辑回归模型。为了评估最终拟合模型的有效性,我们还用了受试者工作特征(ROC)来评估该诊断模型的预测效果,ROC曲线下面积(AUC)用来评估其准确度。
检索Pubmed、EBSCO、Web of science、中国生物医学文献数据库(the Cochrane Library and Chinese Biomedicine Database)、维普、万方数据库等数据库,时间1995年1月到2013年6月发表的关于克罗恩病和肠结核内镜表现和组织病理学特征的文献,由2名评价员独立采用QUADAS(Quality Assessment of Diagnostic AccuracyStudies)工具进行质量评价,应用Meta-disc1.4和stata12.0做异质性检验,根据异质性检验结果选择相应的效应模型合并,评价其敏感性、特异性、似然比和诊断比值比,描绘SROC曲线并计算曲线下面积,对于研究间存在较高异质性,用Meta回归分析找异质性来源,并做敏感性分析。
结果：
我们利用BIC来挑选出与疾病状态相关的预测变量。在无效模型中,利用BIC选出了预测变量Alb,TC,Plt以及Alb:Plt.在备择模型中,同样的方法选出了新的预测变量GPDA以及另加的传统预测变量TCa,两两相互作用项Alb:Plt,Alb:GPDA, TCa:TC和Plt:GPDA.CD/UC指数(CUI)结果为CUl=1.901+0.425Alb-3.324TC一7.444TCa+0.018Plt+0.087GPDA-0.0007Alb:Plt-0.004Alb:GPDA+1.839TC:TCa+0.003Plt:GPDA。UC患者的CUI大于CD患者的,CUI>0则递增性倾向于UC的诊断,而CUI<0则对应CD诊断的可能性更高。无效模型和备择模型的AUCs的平均值分别为0.66(95%置信区间：0.59-0.72)和0.73(95%置信区间：0.67-0.80)。截断点对应的灵敏度和特异度,备择模型中分别为0.55和0.80,而无效模型中分别为0.46和0.79。
meta分析共纳入15篇文献,包括1271个研究对象,其中克罗恩病671个,肠结核600个。统计结果显示：以克罗恩病为阳性对照,其敏感性、特异性、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为：阿弗他溃疡0.39,0.80,2.20,0.75,3.34,0.7252；肠腔狭窄0.35,0.72,1.37,0.89,1.54,0.4626；鹅卵石征0.28,0.96,5.25,0.79,7.05,0.6212；跳跃征0.61,0.57,1.52,0.71,2.52,为0.6420；纵形溃疡0.42,0.94,6.18,0.65,11.02,0.7898；微肉芽肿0.42,0.69,1.42,0.82,2.08,0.5768。而以肠结核为阳性对照,环形溃疡0.43,0.88,3.66,0.64,7.07,0.7515；回盲部扩张0.38,0.91,3.98,0.74,5.98,0.8404；干酪样坏死0.42,1.00,17.10,0.69,38.25,0.9976；肉芽肿0.73,0.63,1.78,0.50,4.83,0.7268；融合肉芽肿0.41,0.99,17.74,0.60,29.86,0.9705；每个切片肉芽肿大于5个0.26,0.94,4.45,0.80,5.52,0.5702；粘膜下肉芽肿0.30,0.90,2.92,0.76,4.00,0.6559；不成比例的粘膜下炎症0.52,0.75,2.84,0.59,4.52,0.6679；肉芽组织0.31,0.92,3.68,0.72,5.23,0.8723；ulcers lined by histiocyte0.42,0.95,6.33,0.55,12.52,0.9248。
结论：
根据血清标记物的检测结果构建的CUI可成为克罗恩病和溃疡性结肠炎的鉴别诊断的辅助工具,特别是在临床病史不明,内镜和影像学特征异常,活组织检查模棱两可的情况下。
诊断性meta分析结果提示阿弗他溃疡、肠腔狭窄、鹅卵石征、跳跃征、纵形溃疡、微肉芽肿有助于诊断克罗恩病,而同时环形溃疡、回盲部扩张、干酪样坏死、肉芽肿、融合肉芽肿、每个切片肉芽肿大于5个、粘膜下肉芽肿、不成比例的粘膜下炎症和肉芽组织有助于诊断肠结核。因此,内镜结合病例组织活检的特异性表现对于鉴别克罗恩病和肠结核意义重大。
Aim:
To derive a model capable of distinguishing UC from CD, based on the measurement of independent serum markers.
To find out endoscopic and histological features for differentiation between Crohn' disease(CD) and intestinal tuberculosis(ITB) by meta-analysis.
Methods:
140UC and174CD hospitalized patients whose lesions were only in the colon at The First Affiliated Hospital, College of Medicine, Zhejiang University were recuited into this study. A panel of serum markers was measured for each patient. Then, a discrimination model using the Bayesian information criterion (BIC) was developed. The receiver operating characteristic (ROC) is used to evaluate the performance of the model, and the area under the ROC curve (AUC) is used as a measure of evaluating the accuracy of the model.
A search of Pubmed, web of science, EBSCO, the Chinese Biomedicine Database, Weipu and Wanfang database was undertaken from1995January to2013June. All the English and Chinese literatures for differential diagnosis of CD and ITB by endoscopy and histological features were collected. Study quality was assessed and data extraction were performed. The software of Meta-disc1.4and Stata12.0were used for calculated the sensitivity, specificity, likelihood ratio, diagnostic odds ratio, summary receiver operating characteristic curve and area under the curve(AUC) to evaluate the differentiation value of CD and ITB. Meta-regression and sensitive analyses were used when there was heterogeneity.
Results:
Serum albumin (Alb), total cholesterol (TC), total calcium (TCa), platelet (Plt), glycyl proline dipeptidyl aminopeptidase (GPDA) and the product terms Alb:Plt, Alb:GPDA, TCa:TC, and Plt:GPDA were selected into the diagnosis model using BIC. The resulting CD/UC Index (CUI) is CUI=1.901+0.425Alb-3.324TC-7.444TCa+0.018Pit+0.087GPDA-0.0007Alb:Plt-0.004Alb:GPDA+1.839TC:TCa+0.003Plt:GPDA, with CUI>0incrementally favored a diagnosis of UC, while CUI<0corresponded to a higher likelihood of a diagnosis of CD. An average value of the AUC for the CUI model is0.73(95%confidence interval:0.67-0.80).
Fifteen studies were included in the meta-analysis,with a total of1271cases with CD671cases and ITB600cases.The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC are: CD as positive controll, Aphthous ulcers0.39,0.80,2.20,0.75,3.34,0.7252; Stricture0.35,0.72,1.37,0.89,1.54,0.4626; Cobblestone appearance0.28,0.96,5.25,0.79,7.05,0.6212; Skip lesions0.61,0.57,1.52,0.71,2.52,0.6420; Longitudinal ulcers0.42,0.94,6.18,0.65,11.02,0.7898; Microgranulomas0.42,0.69,1.42,0.82,2.08,0.5768. ITB as positive control, Transverse ulcers0.43,0.88,3.66,0.64,7.07,0.7515; Patulous ileocecal valve0.38,0.91,3.98,0.74,5.98,0.8404; Caseous necrosis0.42,1.00,17.10,0.69,38.25,0.9976; Granuloma0.73,0.63,1.78,0.50,4.83,0.7268; Confluent granulomas0.41,0.99,17.74,0.60,29.86,0.9705; Granulomas>5per section0.26,0.94,4.45,0.80,5.52,0.5702; Granuloma in submucosa0.30,0.90,2.92,0.76,4.00,0.6559; Disproportionate submucosal inflammation0.52,0.75,2.84,0.59,4.52,0.6679; Granulation tissue0.31,0.92,3.68,0.72,5.23,0.8723; ulcers lined by histiocyte0.42,0.95,6.33,0.55,12.52,0.9248.
Conclusions:
The CUI, derived from commonly available serum biomarkers, could try to differentiate ulcerative colitis from Crohn's disease in patients with lesions only in the colon and unclear clinical features as a new menthod.
Meta-analysis shows that aphthous ulcers, stricture, cobblestone appearance, skip lesions, longitudinal ulcers and microgranulomas are helpful to diagnosis of CD, while transverse ulcers, patulous ileocecal valve, caseous necrosis, granuloma, confluent granulomas, granulomas>5per section, granuloma in submucosa, disproportionate submucosal inflammation, granulation tissue and ulcers lined by histiocyte can help to diagnosis of ITB. So the endoscopy and histological features is contribute to differential diagnosis of CD and ITB.
在临床实践中,溃疡性结肠炎(UC)和克罗恩病(CD)的鉴别十分重要,然而常常由于临床表现不典型、模棱两可的内镜检查结果和影像表现以及肠镜下活检的深度不够,使得鉴别UC和CD成为一个难题。IBD的诊断指标包括一些生物学标记,本研究将相互独立的血清标记物作为参数进行整合,通过统计学工具和方法构建了一个用于鉴别仅结肠损伤的UC和CD的诊断模型,并进一步检验该诊断模型的效能。
并通过meta分析探讨克罗恩病(CD)与肠结核(ITB)内镜表现和组织病理学特征,为两者的鉴别诊断提供依据。
研究对象及方法：
2006年2月至2011年2月,采用回顾性分析的方法,收集了来自浙江大学医学院附属第一医院的140名UC住院患者和174名CD住院患者的资料。首次住院治疗的这段时间收集周围静脉血液样本,根据所测的血清标记物的结果,我们构建了两个逻辑回归模型。为了评估最终拟合模型的有效性,我们还用了受试者工作特征(ROC)来评估该诊断模型的预测效果,ROC曲线下面积(AUC)用来评估其准确度。
检索Pubmed、EBSCO、Web of science、中国生物医学文献数据库(the Cochrane Library and Chinese Biomedicine Database)、维普、万方数据库等数据库,时间1995年1月到2013年6月发表的关于克罗恩病和肠结核内镜表现和组织病理学特征的文献,由2名评价员独立采用QUADAS(Quality Assessment of Diagnostic AccuracyStudies)工具进行质量评价,应用Meta-disc1.4和stata12.0做异质性检验,根据异质性检验结果选择相应的效应模型合并,评价其敏感性、特异性、似然比和诊断比值比,描绘SROC曲线并计算曲线下面积,对于研究间存在较高异质性,用Meta回归分析找异质性来源,并做敏感性分析。
结果：
我们利用BIC来挑选出与疾病状态相关的预测变量。在无效模型中,利用BIC选出了预测变量Alb,TC,Plt以及Alb:Plt.在备择模型中,同样的方法选出了新的预测变量GPDA以及另加的传统预测变量TCa,两两相互作用项Alb:Plt,Alb:GPDA, TCa:TC和Plt:GPDA.CD/UC指数(CUI)结果为CUl=1.901+0.425Alb-3.324TC一7.444TCa+0.018Plt+0.087GPDA-0.0007Alb:Plt-0.004Alb:GPDA+1.839TC:TCa+0.003Plt:GPDA。UC患者的CUI大于CD患者的,CUI>0则递增性倾向于UC的诊断,而CUI<0则对应CD诊断的可能性更高。无效模型和备择模型的AUCs的平均值分别为0.66(95%置信区间：0.59-0.72)和0.73(95%置信区间：0.67-0.80)。截断点对应的灵敏度和特异度,备择模型中分别为0.55和0.80,而无效模型中分别为0.46和0.79。
meta分析共纳入15篇文献,包括1271个研究对象,其中克罗恩病671个,肠结核600个。统计结果显示：以克罗恩病为阳性对照,其敏感性、特异性、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为：阿弗他溃疡0.39,0.80,2.20,0.75,3.34,0.7252；肠腔狭窄0.35,0.72,1.37,0.89,1.54,0.4626；鹅卵石征0.28,0.96,5.25,0.79,7.05,0.6212；跳跃征0.61,0.57,1.52,0.71,2.52,为0.6420；纵形溃疡0.42,0.94,6.18,0.65,11.02,0.7898；微肉芽肿0.42,0.69,1.42,0.82,2.08,0.5768。而以肠结核为阳性对照,环形溃疡0.43,0.88,3.66,0.64,7.07,0.7515；回盲部扩张0.38,0.91,3.98,0.74,5.98,0.8404；干酪样坏死0.42,1.00,17.10,0.69,38.25,0.9976；肉芽肿0.73,0.63,1.78,0.50,4.83,0.7268；融合肉芽肿0.41,0.99,17.74,0.60,29.86,0.9705；每个切片肉芽肿大于5个0.26,0.94,4.45,0.80,5.52,0.5702；粘膜下肉芽肿0.30,0.90,2.92,0.76,4.00,0.6559；不成比例的粘膜下炎症0.52,0.75,2.84,0.59,4.52,0.6679；肉芽组织0.31,0.92,3.68,0.72,5.23,0.8723；ulcers lined by histiocyte0.42,0.95,6.33,0.55,12.52,0.9248。
结论：
根据血清标记物的检测结果构建的CUI可成为克罗恩病和溃疡性结肠炎的鉴别诊断的辅助工具,特别是在临床病史不明,内镜和影像学特征异常,活组织检查模棱两可的情况下。
诊断性meta分析结果提示阿弗他溃疡、肠腔狭窄、鹅卵石征、跳跃征、纵形溃疡、微肉芽肿有助于诊断克罗恩病,而同时环形溃疡、回盲部扩张、干酪样坏死、肉芽肿、融合肉芽肿、每个切片肉芽肿大于5个、粘膜下肉芽肿、不成比例的粘膜下炎症和肉芽组织有助于诊断肠结核。因此,内镜结合病例组织活检的特异性表现对于鉴别克罗恩病和肠结核意义重大。
Aim:
To derive a model capable of distinguishing UC from CD, based on the measurement of independent serum markers.
To find out endoscopic and histological features for differentiation between Crohn' disease(CD) and intestinal tuberculosis(ITB) by meta-analysis.
Methods:
140UC and174CD hospitalized patients whose lesions were only in the colon at The First Affiliated Hospital, College of Medicine, Zhejiang University were recuited into this study. A panel of serum markers was measured for each patient. Then, a discrimination model using the Bayesian information criterion (BIC) was developed. The receiver operating characteristic (ROC) is used to evaluate the performance of the model, and the area under the ROC curve (AUC) is used as a measure of evaluating the accuracy of the model.
A search of Pubmed, web of science, EBSCO, the Chinese Biomedicine Database, Weipu and Wanfang database was undertaken from1995January to2013June. All the English and Chinese literatures for differential diagnosis of CD and ITB by endoscopy and histological features were collected. Study quality was assessed and data extraction were performed. The software of Meta-disc1.4and Stata12.0were used for calculated the sensitivity, specificity, likelihood ratio, diagnostic odds ratio, summary receiver operating characteristic curve and area under the curve(AUC) to evaluate the differentiation value of CD and ITB. Meta-regression and sensitive analyses were used when there was heterogeneity.
Results:
Serum albumin (Alb), total cholesterol (TC), total calcium (TCa), platelet (Plt), glycyl proline dipeptidyl aminopeptidase (GPDA) and the product terms Alb:Plt, Alb:GPDA, TCa:TC, and Plt:GPDA were selected into the diagnosis model using BIC. The resulting CD/UC Index (CUI) is CUI=1.901+0.425Alb-3.324TC-7.444TCa+0.018Pit+0.087GPDA-0.0007Alb:Plt-0.004Alb:GPDA+1.839TC:TCa+0.003Plt:GPDA, with CUI>0incrementally favored a diagnosis of UC, while CUI<0corresponded to a higher likelihood of a diagnosis of CD. An average value of the AUC for the CUI model is0.73(95%confidence interval:0.67-0.80).
Fifteen studies were included in the meta-analysis,with a total of1271cases with CD671cases and ITB600cases.The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC are: CD as positive controll, Aphthous ulcers0.39,0.80,2.20,0.75,3.34,0.7252; Stricture0.35,0.72,1.37,0.89,1.54,0.4626; Cobblestone appearance0.28,0.96,5.25,0.79,7.05,0.6212; Skip lesions0.61,0.57,1.52,0.71,2.52,0.6420; Longitudinal ulcers0.42,0.94,6.18,0.65,11.02,0.7898; Microgranulomas0.42,0.69,1.42,0.82,2.08,0.5768. ITB as positive control, Transverse ulcers0.43,0.88,3.66,0.64,7.07,0.7515; Patulous ileocecal valve0.38,0.91,3.98,0.74,5.98,0.8404; Caseous necrosis0.42,1.00,17.10,0.69,38.25,0.9976; Granuloma0.73,0.63,1.78,0.50,4.83,0.7268; Confluent granulomas0.41,0.99,17.74,0.60,29.86,0.9705; Granulomas>5per section0.26,0.94,4.45,0.80,5.52,0.5702; Granuloma in submucosa0.30,0.90,2.92,0.76,4.00,0.6559; Disproportionate submucosal inflammation0.52,0.75,2.84,0.59,4.52,0.6679; Granulation tissue0.31,0.92,3.68,0.72,5.23,0.8723; ulcers lined by histiocyte0.42,0.95,6.33,0.55,12.52,0.9248.
Conclusions:
The CUI, derived from commonly available serum biomarkers, could try to differentiate ulcerative colitis from Crohn's disease in patients with lesions only in the colon and unclear clinical features as a new menthod.
Meta-analysis shows that aphthous ulcers, stricture, cobblestone appearance, skip lesions, longitudinal ulcers and microgranulomas are helpful to diagnosis of CD, while transverse ulcers, patulous ileocecal valve, caseous necrosis, granuloma, confluent granulomas, granulomas>5per section, granuloma in submucosa, disproportionate submucosal inflammation, granulation tissue and ulcers lined by histiocyte can help to diagnosis of ITB. So the endoscopy and histological features is contribute to differential diagnosis of CD and ITB.
引文
[1]Vermeire S, Van Assche G, Rutgeerts P. C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis 2004;10:661-665.
[2]Palmon R, Brown SJ, Abreu MT. What is the role and significance of serum and stool biomarkers in the diagnosis of EBD? Inflamm Bowel Dis 2008; 14 Suppl 2:S187-S189.
[3]Mendoza JL, Abreu MT. Biological markers in inflammatory bowel disease: Practical consideration for clinicians. Gastroenterol Clin Biol 2009;33 Suppl 3:S158-S173.
[4]Sappati Biyyani RS, Putka BS, Mullen KD. Dyslipidemia and lipoprotein profiles in patients with inflammatory bowel disease. J Clin Lipidol 2010;4:478-482.
[5]Etzel JP, Larson MF, Anawalt BD, Collins J, Dominitz JA. Assessment and management of low bone density in inflammatory bowel disease and performance of professional society guidelines. Inflamm Bowel Dis 2011;17:2122-2129.
[6]Shen J, Ran ZH, Zhang Y, Cai Q, Yin HM, Zhou XT, Xiao SD.. Biomarkers of altered coagulation and fibrinolysis as measures of disease activity in active inflammatory bowel disease:a gender-stratified, cohort analysis. Thromb Res 2009;123:604-611.
[7]Poullis AP, Zar S, Sundaram KK, Moodie SJ, Risley P, Theodossi A, Mendall MA. A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation-and diarrhoea-predominant functional bowel disorders. Eur J Gastroenterol Hepatol 2002; 14:409-412.
[8]Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, Ransil B, Wild G, Cohen A, Edwardes MD, Stevens AC. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001;120:13-20.
[9]Danese S, Motte Cd Cde L, Fiocchi C. Platelets in infl ammatory bowel disease: clinical, pathogenic, and therapeutic implications. Am J Gastroenterol 2004;99:938-945.
[10]Klinger MH. Platelets and inflammation. Anat Embryol (Berl) 1997;196:1-11.
[11]Schwarz G. Estimating the dimension of a model. Ann Statist 1978;6:461-464.
[12]Fox J. Applied regression analysis and generalized linear models, second edition. Thousand Oaks, CA:Sage,2008.
[13]Zhou X, Obuchowski NA, McClish DK. Statistical methods in diagnostic medicine, John Wiley & Sons, Inc., New York,2002.
[14]Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60:571-607.
[15]Dubinsky MC, Ofman JJ, Urman M, Targan SR, Seidman EG. Clinical utility of serodiagnostic testing in suspected pediatric inflammatory bowel disease. Am J Gastroenterol 2001;96:758-765.
[16]Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011;140:1817-1826.e2.
[17]Conrad K, Schmechta H, Klafki A, Lobeck G, Uhlig HH, Gerdi S, Henker J. Serological differentiation of inflammatory bowel diseases. Eur J Gastroenterol Hepatol 2002;14:129-135.
[18]Konrad A, Lehrke M, Schachinger V, Seibold F, Stark R, Ochsenkuhn T, Parhofer KG, Goke B, Broedl UC. Resistin is an inflammatory marker of inflammatory bowel disease in humans. Eur J Gastroenterol Hepatol 2007; 19:1070-1074.
[19]Iskandar HN, Ciorba MA. Biomarkers in inflammatory bowel disease:current practices and recent advances. Transl Res 2012;159:313-325.
[20]Hopsu-Havu VK, Glenner GG. A new dipeptide naphthylamidase hydrolyzing glycyl-prolyl-beta-naphthlamide. Histochemie 1966;7:197-201.
[21]Hutchinson DR, Halliwell RP, Lockhart JD, Parke DV. Glycylprolyl-p-nitroanilidase in hepatobiliary disease. Clin Chim Acta 1981;109:83-89.
[22]Kojima J, Kanatani M, Nakamura N, Kashiwagi T, Tohjoh F, Akiyama M. Serumand liver glycylproline dipeptidyl aminopeptidase activity in ratswith experimental hepatic cancer. Clin Chim Acta 1980;107:105-110.
[23]Yoshii Y, Kasugai T, Kato T, Nagatsu T, Sakakibara S. Changes in serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase) activity of patients with gastric carcinoma after surgical excision and the enzyme activity in the carcinoma tissue. Biochem Med 1981;25:276-282.
[24]Fagan EA, Dyck RF, Maton PN, Hodgson HJ, Chadwick VS, Petrie A, Pepys MB. Serum levels of C-reactive protein in Crohn's disease and ulcerative colitis. Eur J Clin Invest 1982;12:351-359.
[25]Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD:useful, magic, or unnecessary toys? Gut 2006;55:426-431.
[26]Vagianos K, Bector S, McConnell J, Bernstein CN. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007;31:311-319.
[27]Alkim H, Ayaz S, Alkim C, Ulker A, Sahin B. Continuous active state of coagulation system in patients with nonthrombotic inflammatory bowel disease. Clin Appl Thromb Hemost 2011;17:600-604.
[28]Sawada K, Takahashi R, Saniabadi AR, Ohdo M, Shimoyama T. Elevated plasma cryofibrinogen in patients with active inflammatory bowel disease is morbigenous. World J Gastroenterol 2006;12:1621-1625.
[1]Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J. Gastroenterol.12(38),6102-6108(2006).
[2]Molodecky NA, Soon IS, Rabi DM et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology142(1),46-54.e42; quiz e30(2012).
[3]Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: 1504-1517.
[4]Makharia GK. Rising incidence and prevalence of Crohn's disease in Asia:is it apparent or real? J Gastroenterol Hepatol 2006; 21:929-31.
[5]Sood A, Midha V. Epidemiology of infl ammatory bowel disease in Asia. Indian J Gastroenterol 2007;26:285-9.
[6]Benchimol El, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease:a systematic review of international trends. Inflamm. Bowel Dis.l7(1),423-439(2011)
[7]Abramson O, Durant M, Mow W et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in northern California,1996 to 2006. J. Pediatr.157(2),233-239.e 1 (2010)
[8]Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347:417-29.
[9]Thwaites GE, Nquyen DB, Nquyen HD,et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351: 1741-51.
[10]American Gastroenterological Association Institute. Technical review on corticosteroids, immunomodulators and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130:940-87.
[11]Lee YJ, Yang SK, Myung SJ et al. The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis. Korean J Gastroenterol 2004; 44:153-159.
[12]Gilinsky NH, Marks IN, Kottler RE, et al. Abdominal tuberculosis. A 10-year review. S Afr Med J 1983;64:849-57.
[13]Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tuberculosis mimicking Crohn's disease:case report. BMC Gastroenterol 2002;2:10.
[14]Petroianni A, Mugnaini L, Laurendi G, et al. Abdominal tuberculosis mimicking Crohn's disease:a difficult diagnosis. Report of a case. Panminerva Med 2002;44:155-8.
[15]Sinhasan SP, Puranik RB, Kulkarni MH. Abdominal tuberculosis may masquerade many diseases. Saudi J Gastroenterol.2011 Mar-Apr; 17(2):110-3.
[16]Yang SK. Current status and clinical characteristics of inflammatory bowel disease in Korea. Korean J Gastroenterol 2002; 40:1-14.
[17]Tonghua L, Guozong P, Minzhang C. Crohn's disease:clinicopathologic manifestations and differential diagnosis from enterocolonic tuberculosis. Chinese Med J 1981; 94:431-440.
[18]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007 Jun 15; 25(12):1373-88.
[19]王吉耀,主编.循证医学与临床实践[M].北京：科学出版社,2002：86.
[20]Travis SPL, Stange EF, Le'mann M et al. European evidence based consensus on the diagnosis and management of Crohn's disease:current management. Gut 2006; 55:16-35.
[21]中华医学会消化病学分会.对炎症性肠病诊断治疗规范的建议.中华内科杂志,2001,40：138-141
[22]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见.中华消化杂志,2007,27：545-550.
[23]Xuefeng Li,Xiaowei Liu,Yiyou Zou, et al. Predictors of Clinical and Endoscopic Findings in Differentiating Crohn's Disease from Intestinal Tuberculosis. Dig Dis Sci (2011) 56:188-196.
[24]Haisheng Yu, Ying Liu, Yadong Wang, et al. Clinical, Endoscopic and Histological Differentiations between Crohn's Disease and Intestinal Tuberculosis. Digestion 2012;85:202-209.
[25]AK Dutta, MK Sahu, SK Gangadharan, A Chacko. Distinguishing Crohn's disease from intestinal tuberculosis-a prospective study. Tropical Gastroenterology 2011;32(3):204-209.
[26]顾清,欧阳钦,张文燕,李甘地.克罗恩病与肠结核临床及病理特征的对比研究.中华内科杂志,2009,48(4)：291-294.
[27]Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006;38:592-7.
[28]GK Makharia, S Srivastava, P Das, et al. Clinical, Endoscopic, and Histological Differentiations Between Crohn's Disease and Intestinal Tuberculosis. Am J Gastroenterol 2010; 105:642-651.
[29]Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008; 14:741-6.
[30]何瑶,陈瑜君,杨红等.回结肠克罗恩病与肠结核临床及内镜特征比较.中华消化内镜杂志,2012,9(6),325-328
[31]Zhou ZY, Luo HS. Diff erential diagnosis between Crohn's disease and intestinal tuberculosis in China, Int J Clin Pract 2006; 60:212-4.
[32]Yue Li, Li-fan Zhang, Xiao-qing Liu. The role of in vitro interferon γ-release assay in differentiating intestinal tuberculosis from Crohn's disease in China. Journal of Crohn's and Colitis (2012) 6,317-323.
[33]朱庆强,吴晶涛,陈文新等.克罗恩病与肠结核的临床表现和内镜及CT特征分析.中华全科医师杂志,2012,11(10)：765-769.
[34]缪应雷欧阳钦陈岱云普苹.内镜及病理学检查在克罗恩病和肠结核鉴别诊断中的价值.中华消化内镜杂志,2002,19(1)：9-12.
[35]Patel N, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, Gupte P: Gastrointestinal luminal tuberculosis:establishing the diagnosis. J Gastroenterol Hepatol 2004;19:1240-1246.
[36]Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004; 10:646-651.
[37]Yang SK, Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease in Asia. Inflamm Bowel Dis 2001; 7:260-270.
[38]Bourreille A, Ignjatovic A, Aabakken L, et al, Review Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease:an international OMED-ECCO consensus. World Organisation of Digestive Endoscopy (OMED) and the European Crohn's and Colitis Organisation (ECCO). Endoscopy.2009 Jul; 41(7):618-37.
[39]Misra SP, Misra V, Dwivedi M. Ileoscopy in patients with ileocolonic tuberculosis. World J Gastroenterol.2007 Mar 21; 13(11):1723-7.
[40]Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon:histological patterns with clinical implications. Am J Gastroenterol,2000,95:878-896.
[41]Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 Updated September 2006. The Cochrane Collaboration,2006,136.
[42]Houwelinegen HC, Arends L, Stijnen T. Advanced method in meta-analysis: multivariate approach and meta regression. Stat Med,2002,21:589-624.
[43]Higgins Julia PT, Thompson SG, Deek JJ, at al. Measuring inconsistency in meta-analyses. BMJ,2003,557-560.
[44]Pulimood AB, Ramakrishna BS, Kurian G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut 1999;45:537-541.
[45]Pulimood AB, Peter S, Ramakrishna B et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. J Gastroenterol Hepatol.2005; 20:688-696.
[46]Kirsch R, Pentecost M, Hall Pde M et al. Role of colonoscopic biopsy in distinguishing between Crohn's disease and intestinal tuberculosis. J Clin Pathol,2006; 59:840-844.
[47]Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn's disease. Gut.1972 Apr; 13(4):260-9.
[48]Amarapurkar DN, Patel ND, Amarapurkar AD, et al. Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India 2004; 52:863-867.
[49]Gan HT, Chen YQ, Ouyang Q, et al. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97:1446-1451.
[50]Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005 Apr; 37(4):351-6.
[51]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25:1373-1388.
[52]Patel N, Amarapurkar D, Agal S,et al. Gastrointestinal luminal tuberculosis:establishing a diagnosis. J Gastroenterol Hepatol 2004; 19: 1240-1246.
[1]Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J. Gastroenterol.12(38),6102-6108(2006).
[2]Molodecky NA, Soon IS, Rabi DM et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology142(1),46-54.e42; quiz e30(2012).
[3]Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: 1504-1517.
[4]Makharia GK. Rising incidence and prevalence of Crohn's disease in Asia:is it apparent or real? J Gastroenterol Hepatol 2006; 21:929-31.
[5]Sood A, Midha V. Epidemiology of infl ammatory bowel disease in Asia. Indian J Gastroenterol 2007;26:285-9.
[6]Benchimol El, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease:a systematic review of international trends. Inflamm. Bowel Dis.17(1),423-439(2011)
[7]Abramson O, Durant M, Mow W et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in northern California,1996 to 2006. J. Pediatr.157(2),233-239.el (2010)
[8]Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347:417-29.
[9]Thwaites GE, Nquyen DB, Nquyen HD,et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351: 1741-51.
[10]American Gastroenterological Association Institute. Technical review on corticosteroids, immunomodulators and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130:940-87.
[11]Lee YJ, Yang SK, Myung SJ et al. The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis. Korean J Gastroenterol 2004; 44:153-159.
[12]Gilinsky NH, Marks IN, Kottler RE, et al. Abdominal tuberculosis. A 10-year review. S Afr Med J 1983;64:849-57.
[13]Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tuberculosis mimicking Crohn's disease:case report. BMC Gastroenterol 2002;2:10.
[14]Petroianni A, Mugnaini L, Laurendi G, et al. Abdominal tuberculosis mimicking Crohn's disease:a difficult diagnosis. Report of a case. Panminerva Med 2002;44:155-158.
[15]Sinhasan SP, Puranik RB, Kulkarni MH. Abdominal tuberculosis may masquerade many diseases. Saudi J Gastroenterol.2011 Mar-Apr; 17(2):110-3.
[16]Yang SK. Current status and clinical characteristics of inflammatory bowel disease in Korea. Korean J Gastroenterol 2002; 40:1-14.
[17]Tonghua L, Guozong P, Minzhang C. Crohn's disease:clinicopathologic manifestations and differential diagnosis from enterocolonic tuberculosis. Chinese Med J 1981; 94:431-440.
[18]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007 Jun 15; 25(12):1373-88.
[19]Patel N, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, Gupte P: Gastrointestinal luminal tuberculosis:establishing the diagnosis. J Gastroenterol Hepatol 2004;19:1240-1246.
[20]Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004; 10:646-651.
[21]Yang SK, Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease in Asia. Inflamm Bowel Dis 2001; 7:260-270.
[22]韩麦,吕愈敏,裴斐,杨雪松.肠结核与克罗恩病的临床鉴别及肠黏膜结核分枝杆菌聚合酶链反应检测的意义.胃肠病学和肝病学杂志,2009,18(9)：820-823.
[23]刘小伟,李学锋,邹益友,等.Logistic回归分析对克罗恩病和肠结核鉴别指标的筛选.世界华人消化杂志2010；18(6)：621-627.
[24]Lee YJ, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS, Kim KJ, Lee GH, Jung HY, Hong WS, Kim JH, Min YI, Chang SJ, Yu CS. Analysis of colonoscopic fi ndings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006; 38:592-597.
[25]Kirsch R, Pentecost M, Hall Pde M, Epstein DP, Watermeyer G, Friederich PW. Role of colonoscopic biopsy in distinguishing between Crohn's disease and intestinal tuberculosis. J Clin Pathol 2006; 59:840-844.
[26]Shyn PB, Mortele KJ, Britz-Cunningham SH, et al. Low-dose 18F-FDG PET/CT enterography:improving on CT enterography assessment of patients with Crohn disease. JNucl Med,2010,51:1841-1848.
[27]Gan HT, Chen YQ, Ouyang Q. Differentiation between Intestinal Tuberculosis and Crohn's Disease in Endoscopic Biopsy Specimens by Polymerase Chain Reaction. Am J Gastroenterol,2002,97:1446-1451.], [Brodie D, Lederer DJ, Gallardo JS, et al. Use of an interferongamma release assay to diagnose latent tuberculosis infection in the foreign-born. Chest,2008,133:869-874.
[28]Piersimoni C, Scarparo C. Relevance of commercial amplification methods for direct detection of Mycobacterium tuberculosis complex inclinical samples. J Clin Microbiol,2003,41(12):5355-5365.
[29]甘华田,欧阳钦,步宏,等.聚合酶链反应对肠结核和克隆病的诊断价值.中华内科杂志,1995,34(1)：30-33.
[30]Amarapurkar DN, PatelND, Amarapurkar AD, et al. Tissue polymerase chain reaction indiagnosis of intestinal tuberculosis and Crohn's disease [J]. J Assoc Physicians India,2004,52:863-867.
[31]Misra SP, Misra V, Dwivedi M. Ileoscopy in patients with ileocolonic tuberculosis. World J Gastroenterol.2007 Mar 21; 13(11):1723-7.
[32]Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon:histological patterns with clinical implications. Am J Gastroenterol,2000,95:878-896.
[33]Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn's disease. Gut.1972 Apr; 13(4):260-9.
[34]Amarapurkar DN, Patel ND, Amarapurkar AD, et al. Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India 2004; 52:863-867.
[35]Gan HT, Chen YQ, Ouyang Q, et al. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97:1446-1451.
[36]Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005 Apr; 37(4):351-6.
[37]Xuefeng Li,Xiaowei Liu,Yiyou Zou, et al. Predictors of Clinical and Endoscopic Findings in Differentiating Crohn's Disease from Intestinal Tuberculosis. Dig Dis Sci (2011) 56:188-196.
[38]Haisheng Yu, Ying Liu, Yadong Wang, et al. Clinical, Endoscopic and Histological Differentiations between Crohn's Disease and Intestinal Tuberculosis. Digestion 2012;85:202-209.
[39]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25:1373-1388.
[40]Patel N, Amarapurkar D, Agal S,et al. Gastrointestinal luminal tuberculosis:establishing a diagnosis. J Gastroenterol Hepatol 2004; 19: 1240-1246.
[41]Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 Updated September 2006. The Cochrane Collaboration,2006,136.
[42]Houwelinegen HC, Arends L, Stijnen T. Advanced method in meta-analysis: multivariate approach and meta regression. Stat Med,2002,21:589-624.
[43]Higgins Julia PT, Thompson SG, Deek JJ, at al. Measuring inconsistency in meta-analyses. BMJ,2003,557-560.
[44]王吉耀,主编.循证医学与临床实践[M].北京：科学出版社,2002：86.
[2]Palmon R, Brown SJ, Abreu MT. What is the role and significance of serum and stool biomarkers in the diagnosis of EBD? Inflamm Bowel Dis 2008; 14 Suppl 2:S187-S189.
[3]Mendoza JL, Abreu MT. Biological markers in inflammatory bowel disease: Practical consideration for clinicians. Gastroenterol Clin Biol 2009;33 Suppl 3:S158-S173.
[4]Sappati Biyyani RS, Putka BS, Mullen KD. Dyslipidemia and lipoprotein profiles in patients with inflammatory bowel disease. J Clin Lipidol 2010;4:478-482.
[5]Etzel JP, Larson MF, Anawalt BD, Collins J, Dominitz JA. Assessment and management of low bone density in inflammatory bowel disease and performance of professional society guidelines. Inflamm Bowel Dis 2011;17:2122-2129.
[6]Shen J, Ran ZH, Zhang Y, Cai Q, Yin HM, Zhou XT, Xiao SD.. Biomarkers of altered coagulation and fibrinolysis as measures of disease activity in active inflammatory bowel disease:a gender-stratified, cohort analysis. Thromb Res 2009;123:604-611.
[7]Poullis AP, Zar S, Sundaram KK, Moodie SJ, Risley P, Theodossi A, Mendall MA. A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation-and diarrhoea-predominant functional bowel disorders. Eur J Gastroenterol Hepatol 2002; 14:409-412.
[8]Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, Ransil B, Wild G, Cohen A, Edwardes MD, Stevens AC. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001;120:13-20.
[9]Danese S, Motte Cd Cde L, Fiocchi C. Platelets in infl ammatory bowel disease: clinical, pathogenic, and therapeutic implications. Am J Gastroenterol 2004;99:938-945.
[10]Klinger MH. Platelets and inflammation. Anat Embryol (Berl) 1997;196:1-11.
[11]Schwarz G. Estimating the dimension of a model. Ann Statist 1978;6:461-464.
[12]Fox J. Applied regression analysis and generalized linear models, second edition. Thousand Oaks, CA:Sage,2008.
[13]Zhou X, Obuchowski NA, McClish DK. Statistical methods in diagnostic medicine, John Wiley & Sons, Inc., New York,2002.
[14]Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60:571-607.
[15]Dubinsky MC, Ofman JJ, Urman M, Targan SR, Seidman EG. Clinical utility of serodiagnostic testing in suspected pediatric inflammatory bowel disease. Am J Gastroenterol 2001;96:758-765.
[16]Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011;140:1817-1826.e2.
[17]Conrad K, Schmechta H, Klafki A, Lobeck G, Uhlig HH, Gerdi S, Henker J. Serological differentiation of inflammatory bowel diseases. Eur J Gastroenterol Hepatol 2002;14:129-135.
[18]Konrad A, Lehrke M, Schachinger V, Seibold F, Stark R, Ochsenkuhn T, Parhofer KG, Goke B, Broedl UC. Resistin is an inflammatory marker of inflammatory bowel disease in humans. Eur J Gastroenterol Hepatol 2007; 19:1070-1074.
[19]Iskandar HN, Ciorba MA. Biomarkers in inflammatory bowel disease:current practices and recent advances. Transl Res 2012;159:313-325.
[20]Hopsu-Havu VK, Glenner GG. A new dipeptide naphthylamidase hydrolyzing glycyl-prolyl-beta-naphthlamide. Histochemie 1966;7:197-201.
[21]Hutchinson DR, Halliwell RP, Lockhart JD, Parke DV. Glycylprolyl-p-nitroanilidase in hepatobiliary disease. Clin Chim Acta 1981;109:83-89.
[22]Kojima J, Kanatani M, Nakamura N, Kashiwagi T, Tohjoh F, Akiyama M. Serumand liver glycylproline dipeptidyl aminopeptidase activity in ratswith experimental hepatic cancer. Clin Chim Acta 1980;107:105-110.
[23]Yoshii Y, Kasugai T, Kato T, Nagatsu T, Sakakibara S. Changes in serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase) activity of patients with gastric carcinoma after surgical excision and the enzyme activity in the carcinoma tissue. Biochem Med 1981;25:276-282.
[24]Fagan EA, Dyck RF, Maton PN, Hodgson HJ, Chadwick VS, Petrie A, Pepys MB. Serum levels of C-reactive protein in Crohn's disease and ulcerative colitis. Eur J Clin Invest 1982;12:351-359.
[25]Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD:useful, magic, or unnecessary toys? Gut 2006;55:426-431.
[26]Vagianos K, Bector S, McConnell J, Bernstein CN. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007;31:311-319.
[27]Alkim H, Ayaz S, Alkim C, Ulker A, Sahin B. Continuous active state of coagulation system in patients with nonthrombotic inflammatory bowel disease. Clin Appl Thromb Hemost 2011;17:600-604.
[28]Sawada K, Takahashi R, Saniabadi AR, Ohdo M, Shimoyama T. Elevated plasma cryofibrinogen in patients with active inflammatory bowel disease is morbigenous. World J Gastroenterol 2006;12:1621-1625.
[1]Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J. Gastroenterol.12(38),6102-6108(2006).
[2]Molodecky NA, Soon IS, Rabi DM et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology142(1),46-54.e42; quiz e30(2012).
[3]Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: 1504-1517.
[4]Makharia GK. Rising incidence and prevalence of Crohn's disease in Asia:is it apparent or real? J Gastroenterol Hepatol 2006; 21:929-31.
[5]Sood A, Midha V. Epidemiology of infl ammatory bowel disease in Asia. Indian J Gastroenterol 2007;26:285-9.
[6]Benchimol El, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease:a systematic review of international trends. Inflamm. Bowel Dis.l7(1),423-439(2011)
[7]Abramson O, Durant M, Mow W et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in northern California,1996 to 2006. J. Pediatr.157(2),233-239.e 1 (2010)
[8]Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347:417-29.
[9]Thwaites GE, Nquyen DB, Nquyen HD,et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351: 1741-51.
[10]American Gastroenterological Association Institute. Technical review on corticosteroids, immunomodulators and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130:940-87.
[11]Lee YJ, Yang SK, Myung SJ et al. The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis. Korean J Gastroenterol 2004; 44:153-159.
[12]Gilinsky NH, Marks IN, Kottler RE, et al. Abdominal tuberculosis. A 10-year review. S Afr Med J 1983;64:849-57.
[13]Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tuberculosis mimicking Crohn's disease:case report. BMC Gastroenterol 2002;2:10.
[14]Petroianni A, Mugnaini L, Laurendi G, et al. Abdominal tuberculosis mimicking Crohn's disease:a difficult diagnosis. Report of a case. Panminerva Med 2002;44:155-8.
[15]Sinhasan SP, Puranik RB, Kulkarni MH. Abdominal tuberculosis may masquerade many diseases. Saudi J Gastroenterol.2011 Mar-Apr; 17(2):110-3.
[16]Yang SK. Current status and clinical characteristics of inflammatory bowel disease in Korea. Korean J Gastroenterol 2002; 40:1-14.
[17]Tonghua L, Guozong P, Minzhang C. Crohn's disease:clinicopathologic manifestations and differential diagnosis from enterocolonic tuberculosis. Chinese Med J 1981; 94:431-440.
[18]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007 Jun 15; 25(12):1373-88.
[19]王吉耀,主编.循证医学与临床实践[M].北京：科学出版社,2002：86.
[20]Travis SPL, Stange EF, Le'mann M et al. European evidence based consensus on the diagnosis and management of Crohn's disease:current management. Gut 2006; 55:16-35.
[21]中华医学会消化病学分会.对炎症性肠病诊断治疗规范的建议.中华内科杂志,2001,40：138-141
[22]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见.中华消化杂志,2007,27：545-550.
[23]Xuefeng Li,Xiaowei Liu,Yiyou Zou, et al. Predictors of Clinical and Endoscopic Findings in Differentiating Crohn's Disease from Intestinal Tuberculosis. Dig Dis Sci (2011) 56:188-196.
[24]Haisheng Yu, Ying Liu, Yadong Wang, et al. Clinical, Endoscopic and Histological Differentiations between Crohn's Disease and Intestinal Tuberculosis. Digestion 2012;85:202-209.
[25]AK Dutta, MK Sahu, SK Gangadharan, A Chacko. Distinguishing Crohn's disease from intestinal tuberculosis-a prospective study. Tropical Gastroenterology 2011;32(3):204-209.
[26]顾清,欧阳钦,张文燕,李甘地.克罗恩病与肠结核临床及病理特征的对比研究.中华内科杂志,2009,48(4)：291-294.
[27]Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006;38:592-7.
[28]GK Makharia, S Srivastava, P Das, et al. Clinical, Endoscopic, and Histological Differentiations Between Crohn's Disease and Intestinal Tuberculosis. Am J Gastroenterol 2010; 105:642-651.
[29]Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008; 14:741-6.
[30]何瑶,陈瑜君,杨红等.回结肠克罗恩病与肠结核临床及内镜特征比较.中华消化内镜杂志,2012,9(6),325-328
[31]Zhou ZY, Luo HS. Diff erential diagnosis between Crohn's disease and intestinal tuberculosis in China, Int J Clin Pract 2006; 60:212-4.
[32]Yue Li, Li-fan Zhang, Xiao-qing Liu. The role of in vitro interferon γ-release assay in differentiating intestinal tuberculosis from Crohn's disease in China. Journal of Crohn's and Colitis (2012) 6,317-323.
[33]朱庆强,吴晶涛,陈文新等.克罗恩病与肠结核的临床表现和内镜及CT特征分析.中华全科医师杂志,2012,11(10)：765-769.
[34]缪应雷欧阳钦陈岱云普苹.内镜及病理学检查在克罗恩病和肠结核鉴别诊断中的价值.中华消化内镜杂志,2002,19(1)：9-12.
[35]Patel N, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, Gupte P: Gastrointestinal luminal tuberculosis:establishing the diagnosis. J Gastroenterol Hepatol 2004;19:1240-1246.
[36]Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004; 10:646-651.
[37]Yang SK, Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease in Asia. Inflamm Bowel Dis 2001; 7:260-270.
[38]Bourreille A, Ignjatovic A, Aabakken L, et al, Review Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease:an international OMED-ECCO consensus. World Organisation of Digestive Endoscopy (OMED) and the European Crohn's and Colitis Organisation (ECCO). Endoscopy.2009 Jul; 41(7):618-37.
[39]Misra SP, Misra V, Dwivedi M. Ileoscopy in patients with ileocolonic tuberculosis. World J Gastroenterol.2007 Mar 21; 13(11):1723-7.
[40]Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon:histological patterns with clinical implications. Am J Gastroenterol,2000,95:878-896.
[41]Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 Updated September 2006. The Cochrane Collaboration,2006,136.
[42]Houwelinegen HC, Arends L, Stijnen T. Advanced method in meta-analysis: multivariate approach and meta regression. Stat Med,2002,21:589-624.
[43]Higgins Julia PT, Thompson SG, Deek JJ, at al. Measuring inconsistency in meta-analyses. BMJ,2003,557-560.
[44]Pulimood AB, Ramakrishna BS, Kurian G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut 1999;45:537-541.
[45]Pulimood AB, Peter S, Ramakrishna B et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. J Gastroenterol Hepatol.2005; 20:688-696.
[46]Kirsch R, Pentecost M, Hall Pde M et al. Role of colonoscopic biopsy in distinguishing between Crohn's disease and intestinal tuberculosis. J Clin Pathol,2006; 59:840-844.
[47]Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn's disease. Gut.1972 Apr; 13(4):260-9.
[48]Amarapurkar DN, Patel ND, Amarapurkar AD, et al. Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India 2004; 52:863-867.
[49]Gan HT, Chen YQ, Ouyang Q, et al. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97:1446-1451.
[50]Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005 Apr; 37(4):351-6.
[51]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25:1373-1388.
[52]Patel N, Amarapurkar D, Agal S,et al. Gastrointestinal luminal tuberculosis:establishing a diagnosis. J Gastroenterol Hepatol 2004; 19: 1240-1246.
[1]Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J. Gastroenterol.12(38),6102-6108(2006).
[2]Molodecky NA, Soon IS, Rabi DM et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology142(1),46-54.e42; quiz e30(2012).
[3]Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: 1504-1517.
[4]Makharia GK. Rising incidence and prevalence of Crohn's disease in Asia:is it apparent or real? J Gastroenterol Hepatol 2006; 21:929-31.
[5]Sood A, Midha V. Epidemiology of infl ammatory bowel disease in Asia. Indian J Gastroenterol 2007;26:285-9.
[6]Benchimol El, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease:a systematic review of international trends. Inflamm. Bowel Dis.17(1),423-439(2011)
[7]Abramson O, Durant M, Mow W et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in northern California,1996 to 2006. J. Pediatr.157(2),233-239.el (2010)
[8]Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347:417-29.
[9]Thwaites GE, Nquyen DB, Nquyen HD,et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351: 1741-51.
[10]American Gastroenterological Association Institute. Technical review on corticosteroids, immunomodulators and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130:940-87.
[11]Lee YJ, Yang SK, Myung SJ et al. The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis. Korean J Gastroenterol 2004; 44:153-159.
[12]Gilinsky NH, Marks IN, Kottler RE, et al. Abdominal tuberculosis. A 10-year review. S Afr Med J 1983;64:849-57.
[13]Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tuberculosis mimicking Crohn's disease:case report. BMC Gastroenterol 2002;2:10.
[14]Petroianni A, Mugnaini L, Laurendi G, et al. Abdominal tuberculosis mimicking Crohn's disease:a difficult diagnosis. Report of a case. Panminerva Med 2002;44:155-158.
[15]Sinhasan SP, Puranik RB, Kulkarni MH. Abdominal tuberculosis may masquerade many diseases. Saudi J Gastroenterol.2011 Mar-Apr; 17(2):110-3.
[16]Yang SK. Current status and clinical characteristics of inflammatory bowel disease in Korea. Korean J Gastroenterol 2002; 40:1-14.
[17]Tonghua L, Guozong P, Minzhang C. Crohn's disease:clinicopathologic manifestations and differential diagnosis from enterocolonic tuberculosis. Chinese Med J 1981; 94:431-440.
[18]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007 Jun 15; 25(12):1373-88.
[19]Patel N, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, Gupte P: Gastrointestinal luminal tuberculosis:establishing the diagnosis. J Gastroenterol Hepatol 2004;19:1240-1246.
[20]Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004; 10:646-651.
[21]Yang SK, Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease in Asia. Inflamm Bowel Dis 2001; 7:260-270.
[22]韩麦,吕愈敏,裴斐,杨雪松.肠结核与克罗恩病的临床鉴别及肠黏膜结核分枝杆菌聚合酶链反应检测的意义.胃肠病学和肝病学杂志,2009,18(9)：820-823.
[23]刘小伟,李学锋,邹益友,等.Logistic回归分析对克罗恩病和肠结核鉴别指标的筛选.世界华人消化杂志2010；18(6)：621-627.
[24]Lee YJ, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS, Kim KJ, Lee GH, Jung HY, Hong WS, Kim JH, Min YI, Chang SJ, Yu CS. Analysis of colonoscopic fi ndings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006; 38:592-597.
[25]Kirsch R, Pentecost M, Hall Pde M, Epstein DP, Watermeyer G, Friederich PW. Role of colonoscopic biopsy in distinguishing between Crohn's disease and intestinal tuberculosis. J Clin Pathol 2006; 59:840-844.
[26]Shyn PB, Mortele KJ, Britz-Cunningham SH, et al. Low-dose 18F-FDG PET/CT enterography:improving on CT enterography assessment of patients with Crohn disease. JNucl Med,2010,51:1841-1848.
[27]Gan HT, Chen YQ, Ouyang Q. Differentiation between Intestinal Tuberculosis and Crohn's Disease in Endoscopic Biopsy Specimens by Polymerase Chain Reaction. Am J Gastroenterol,2002,97:1446-1451.], [Brodie D, Lederer DJ, Gallardo JS, et al. Use of an interferongamma release assay to diagnose latent tuberculosis infection in the foreign-born. Chest,2008,133:869-874.
[28]Piersimoni C, Scarparo C. Relevance of commercial amplification methods for direct detection of Mycobacterium tuberculosis complex inclinical samples. J Clin Microbiol,2003,41(12):5355-5365.
[29]甘华田,欧阳钦,步宏,等.聚合酶链反应对肠结核和克隆病的诊断价值.中华内科杂志,1995,34(1)：30-33.
[30]Amarapurkar DN, PatelND, Amarapurkar AD, et al. Tissue polymerase chain reaction indiagnosis of intestinal tuberculosis and Crohn's disease [J]. J Assoc Physicians India,2004,52:863-867.
[31]Misra SP, Misra V, Dwivedi M. Ileoscopy in patients with ileocolonic tuberculosis. World J Gastroenterol.2007 Mar 21; 13(11):1723-7.
[32]Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon:histological patterns with clinical implications. Am J Gastroenterol,2000,95:878-896.
[33]Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn's disease. Gut.1972 Apr; 13(4):260-9.
[34]Amarapurkar DN, Patel ND, Amarapurkar AD, et al. Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India 2004; 52:863-867.
[35]Gan HT, Chen YQ, Ouyang Q, et al. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97:1446-1451.
[36]Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005 Apr; 37(4):351-6.
[37]Xuefeng Li,Xiaowei Liu,Yiyou Zou, et al. Predictors of Clinical and Endoscopic Findings in Differentiating Crohn's Disease from Intestinal Tuberculosis. Dig Dis Sci (2011) 56:188-196.
[38]Haisheng Yu, Ying Liu, Yadong Wang, et al. Clinical, Endoscopic and Histological Differentiations between Crohn's Disease and Intestinal Tuberculosis. Digestion 2012;85:202-209.
[39]Epstein D, Watermeyer G, Kirsch R. Review article:the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25:1373-1388.
[40]Patel N, Amarapurkar D, Agal S,et al. Gastrointestinal luminal tuberculosis:establishing a diagnosis. J Gastroenterol Hepatol 2004; 19: 1240-1246.
[41]Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 Updated September 2006. The Cochrane Collaboration,2006,136.
[42]Houwelinegen HC, Arends L, Stijnen T. Advanced method in meta-analysis: multivariate approach and meta regression. Stat Med,2002,21:589-624.
[43]Higgins Julia PT, Thompson SG, Deek JJ, at al. Measuring inconsistency in meta-analyses. BMJ,2003,557-560.
[44]王吉耀,主编.循证医学与临床实践[M].北京：科学出版社,2002：86.