肠结核21例临床诊断及预后分析
摘要
目的：探讨肠结核的临床特点,了解如何提高肠结核的正确诊断率及肠结核的预后。
方法：回顾性分析我院2005.12-2010.1收治的21例肠结核患者的临床资料并结合文献分析探讨。
结果：21例患者中男性7例,女性14例；年龄在19-88岁之间,平均年龄47.8岁。文化程度以初中及以下(85.7%)的农民为主(42.8%)。常见症状为腹痛(66.7%),但疼痛位置不定,多以下腹痛为主；其次是消瘦(47.6%),表现为腹胀和腹泻的亦较多,但以肠外病变为首要表现的不多。体征以腹部压痛为主(66.7),也常触及浅表淋巴结肿大(28.6%)。实验室检查中多数患者血沉升高(80.9%),另外贫血(61.9%)、PPD实验阳性(57.0%)、CRP增高(57.0%)以及低蛋白血症和血CA125升高(各占47.6%)也有较高的提示意义。影像学上,胸片(64.7%)可用于筛查结核,CT扫描便于发现病变位置(86.7%),但是诊断特异性不高,多数提示病变肠段增厚(73.4%)或占位可能(13.3%)。大肠镜或胶囊内镜检查多提示病变肠段溃疡(73.3%),且病变多位于右半结肠或回肠。病理组织学检查见肉芽肿性炎(52.6%)或抗酸染色找到抗酸杆菌(36.8%)。治疗过程中1例患者因抗结核药物无法耐受而自行停药,其余病人中：治疗后57.1%的患者腹痛完全缓解,66.7%体重增加,85.7%腹胀消失,71.4%腹泻消失,能耐受治疗的所有患者体温均恢复正常。
结论：肠结核是临床上较常见的疾病,但是诊断和鉴别诊断较困难,与克罗恩病鉴别尤其困难。诊断时要综合既往结核病史或结核病接触史、临床症状、体征、实验室检查以及肠镜或手术病理、影像学检查等资料,确诊主要依靠肠镜或手术病理。胸部正位片可用于筛查结核,腹部CT便于发现病变位置,但诊断特异性不强。除非有严重并发症,肠结核患者的预后一般均较好。
Objective:To investigate the clinical features and prognosis of intestinal tuberculosis and learn how to improve the rate of correct diagnosis.
Methods:The clinical data of 21 patients with intestinal tuberculosis were analyzed retrospectively and related literatures were discussed.
Results:There were 7 cases of male,14 cases of female in total 21 cases; aged between 19 and 88 years old with an average age 47.8 years old. Most of the patients graduated from or under from Middle School (85.7%), and they are mainly farmers (42.8%). Common symptoms included abdominal pain (66.7%), weight loss (47.6%), abdominal distention, and diarrhea, little manifested as extra-intestinal lesions. The location of pain was uncertainty and most lies in inferior belly. The physical examination of intestinal tuberculosis was non-specific, most Signs in abdominal tenderness (66.7), and were often touched on superficial lymph nodes (28.6%). Most laboratory tests in such patients were abnormal, such as erythrocyte sedimentation rate elevated (80.9%), anemia (61.9%), PPD test positive(57.0%), CRP increased (57.0%) and hypoproteinemia(47.6%) and serum CA125 (47.6%) also elevated, which can tip intestinal tuberculosis. The chest X-ray (64.7%) can be used for screening of tuberculosis, CT scans easy to find location of lesions (86.7%), but its specificity is not high, most indicated thickened bowel wall (73.4%) or a lump (13.3%). Colonoscopy or capsule endoscopy indicated signify ulcer (73.3%), and the lesions were located at right colon or ileum. Granulomatous inflammation (52.6%) can be found in Histopathological or acid-fast bacilli were found (36.8%). After treatment,1 patient was removed because she could not tolerate the anti-TB drugs, in the other patients:57.1% of abdominal pain was complete remission,66.7%weight increase,85.7%of abdominal distension disappeared,71.4%of the diarrhea disappeared, the body temperature of all patients tolerated the treatment returned to normal in all patients.
Conclusion:Intestinal TB is a common disease, but its diagnosis and differential diagnosis was rather difficult, and the identification between the two diseases is particularly difficult. When diagnosed of tuberculosis, we should make up of a comprehensive decision including the history of TB or TB exposure, clinical history, signs, and colonoscopy or surgical pathology, chest X-ray, CT scans etc., but when making a diagnosis, we mainly rely on colonoscopy or surgery pathology. So we can use chest X-ray for screening for tuberculosis; use abdominal CT for finding the location of lesion. Unless there are serious complications, the prognosis of patients with intestinal tuberculosis is generally good.
方法：回顾性分析我院2005.12-2010.1收治的21例肠结核患者的临床资料并结合文献分析探讨。
结果：21例患者中男性7例,女性14例；年龄在19-88岁之间,平均年龄47.8岁。文化程度以初中及以下(85.7%)的农民为主(42.8%)。常见症状为腹痛(66.7%),但疼痛位置不定,多以下腹痛为主；其次是消瘦(47.6%),表现为腹胀和腹泻的亦较多,但以肠外病变为首要表现的不多。体征以腹部压痛为主(66.7),也常触及浅表淋巴结肿大(28.6%)。实验室检查中多数患者血沉升高(80.9%),另外贫血(61.9%)、PPD实验阳性(57.0%)、CRP增高(57.0%)以及低蛋白血症和血CA125升高(各占47.6%)也有较高的提示意义。影像学上,胸片(64.7%)可用于筛查结核,CT扫描便于发现病变位置(86.7%),但是诊断特异性不高,多数提示病变肠段增厚(73.4%)或占位可能(13.3%)。大肠镜或胶囊内镜检查多提示病变肠段溃疡(73.3%),且病变多位于右半结肠或回肠。病理组织学检查见肉芽肿性炎(52.6%)或抗酸染色找到抗酸杆菌(36.8%)。治疗过程中1例患者因抗结核药物无法耐受而自行停药,其余病人中：治疗后57.1%的患者腹痛完全缓解,66.7%体重增加,85.7%腹胀消失,71.4%腹泻消失,能耐受治疗的所有患者体温均恢复正常。
结论：肠结核是临床上较常见的疾病,但是诊断和鉴别诊断较困难,与克罗恩病鉴别尤其困难。诊断时要综合既往结核病史或结核病接触史、临床症状、体征、实验室检查以及肠镜或手术病理、影像学检查等资料,确诊主要依靠肠镜或手术病理。胸部正位片可用于筛查结核,腹部CT便于发现病变位置,但诊断特异性不强。除非有严重并发症,肠结核患者的预后一般均较好。
Objective:To investigate the clinical features and prognosis of intestinal tuberculosis and learn how to improve the rate of correct diagnosis.
Methods:The clinical data of 21 patients with intestinal tuberculosis were analyzed retrospectively and related literatures were discussed.
Results:There were 7 cases of male,14 cases of female in total 21 cases; aged between 19 and 88 years old with an average age 47.8 years old. Most of the patients graduated from or under from Middle School (85.7%), and they are mainly farmers (42.8%). Common symptoms included abdominal pain (66.7%), weight loss (47.6%), abdominal distention, and diarrhea, little manifested as extra-intestinal lesions. The location of pain was uncertainty and most lies in inferior belly. The physical examination of intestinal tuberculosis was non-specific, most Signs in abdominal tenderness (66.7), and were often touched on superficial lymph nodes (28.6%). Most laboratory tests in such patients were abnormal, such as erythrocyte sedimentation rate elevated (80.9%), anemia (61.9%), PPD test positive(57.0%), CRP increased (57.0%) and hypoproteinemia(47.6%) and serum CA125 (47.6%) also elevated, which can tip intestinal tuberculosis. The chest X-ray (64.7%) can be used for screening of tuberculosis, CT scans easy to find location of lesions (86.7%), but its specificity is not high, most indicated thickened bowel wall (73.4%) or a lump (13.3%). Colonoscopy or capsule endoscopy indicated signify ulcer (73.3%), and the lesions were located at right colon or ileum. Granulomatous inflammation (52.6%) can be found in Histopathological or acid-fast bacilli were found (36.8%). After treatment,1 patient was removed because she could not tolerate the anti-TB drugs, in the other patients:57.1% of abdominal pain was complete remission,66.7%weight increase,85.7%of abdominal distension disappeared,71.4%of the diarrhea disappeared, the body temperature of all patients tolerated the treatment returned to normal in all patients.
Conclusion:Intestinal TB is a common disease, but its diagnosis and differential diagnosis was rather difficult, and the identification between the two diseases is particularly difficult. When diagnosed of tuberculosis, we should make up of a comprehensive decision including the history of TB or TB exposure, clinical history, signs, and colonoscopy or surgical pathology, chest X-ray, CT scans etc., but when making a diagnosis, we mainly rely on colonoscopy or surgery pathology. So we can use chest X-ray for screening for tuberculosis; use abdominal CT for finding the location of lesion. Unless there are serious complications, the prognosis of patients with intestinal tuberculosis is generally good.
引文
参考文献
[1]. World Heath Organization. Tuberculosis facts,2008. Http://www.who.int/tb.
[2]. World Heath Organization. Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendation for HIV prevalent and resource constrained settings (WHO/HTM/TB/2007,379);2007.Http://whqlibdoc.who.int/hq/2007/WHO-HTM-TB-2007-379-eng.pdf.
[3]. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol,1993; 88:989-999.
[4]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F.Intestinal tuberculosis mimicking Crohn's disease:lessons relearned in a new era.Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[5]. Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis.2009; 22(5):490-496.
[6]. Park SH, Yang SK, Yang DH, Kim KJ, Yoon SM, Choe JW, Ye BD, Byeon JS, Myung SJ, Kim JH. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother.2009; 53(10): 4167-4171.
[7]. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol.2002; 97(6):1446-1451.
[8]. Stop TB Partnership and WHO. The Global Plan to Stop TB 2006-2015. WHO, Geneva,Switzerland (2006).
[9]. Raviglione MC, Uplekar MW. WHO's new stop TB strategy. Lancet.2006; 367(9514):952-955.
[10]. Gilinsky NH, Voigt MD, Bass DH, Marks IN. Tuberculosis perforation of the bowel. A report of 8 cases. S Afr Med J.1986; 70(1):44-46.
[11]. Kakar A, Aranya RC, Nair SK. Acute perforation of small intestine due to tuberculosis. Aust N Z J Surg.1983; 53(4):381-383.
[12]. Chan HW, Cheung CY, Chan YH, Chu YY, Lee KC, Chau KF, Li CS. Intestinal tuberculosis as a cause of gastrointestinal bleeding in a renal transplant recipient. Transpl Int.2010 Jan 12.
[13]. Brohee G. Crohn's disease and intestinal tuberculosis. Acta Gastroenterol Belg. 1950; 13; 1091-1105.
[14]. Sandborn WJ, Hanauer SB. Infliximab in the treatment of Crohn's disease:a use's guide for clinicians. Am J Gastroenterol 2002; 97:2962-2972.
[15]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn's disease:lessons relearnd in a new era. Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[16]. Marshall JB. Tuberculosis of the gastrointestinal tract and peri-toneum. Am J Gastroenterol,1993; 88:989-999.
[17]. Bernhard JS, Bhatia G, Knauer CM. Gastrointestinal tuberculosis. J Clin Gastroenterol,2000; 30:397-402.
[18]. Ha HK, Ko GY, Yu ES, Yoon K, Hong WS, Kim HR, Jung HY, Yang SK, Jee KN, Min YI, Auh YH. Intestinal tuberculosis with abdominal complications:radiologic and pathologic features. Abdom Imaging.1999; 24(1):32-38.
[19]. Wang JY, Lee LN, Chou CS, Huang CY, Wang SK, Lai HC, Hsueh PR, Luh KT. Performance assessment of a nested-PCR assay and the BD probe Tec ET system for detection of Mycobacterium tuberculosis in clinical speciments. J Clin Microbiol,2004; 42:4599-4603.
[20]. Pettengell KE, Larsen C, Garb M, Mayet FG, Simjee AE, Pirie D. Gastrointestinal tuberculosis in patients with pulmonary tuberculosis. Q J Med, 1990; 74:303-308.
[21]. Wilson D, Nachega J, Morroni C, Chaisson R, Maartens G. Diagnosing smear negative tuberculosis using case definitions and treatment response in HIV-infected adults. Int J Tuberc Lung Dis.2006; 10(1):31-38.
[22]. Epstein D, Watermeyer G, Kirsch R. The diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007; 25(12):1373-1388.
[23]. Bhansali SK. Abdominal tuberculosis:experience with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[24]. Novis BH, Bank S, Marks IN. Gastrointestinal and peritoneal tuberculosis:a study of cases at Groote Schuur Hospital 1962-1977. S Afr Med J,1973; 47:365-372.
[25]. Harada N. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku.2006; 81(11):681-686.
[26]. Davies PD, Pai M. The diagnosis and misdiagnosis of tuberculosis. Int J Tuberc Lung Dis.2008; 12:1226-1234.
[27]. Girardi E, Angeletti C, Puro V, Sorrentino R, Magnavita N, Vincenti D, Carrara S, Butera O, Ciufoli AM, Squarcione S, Ippolito G, Goletti D. Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers. Euro Surveill.2009; 14(43). pii:19373.
[28]. Chawla K, Gupta S, Mukhopadhyay C, Rao PS, Bhat SS. PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries.2009; 3(2):83-87.
[29]. Bhansali SK. Abdominal tuberculosis:experiences with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[30].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008：16(1)：57-58。
[32]. Koh DM, Burn PR, Mathews G, Nelson M, Healy JC. Abdominal computed tomographic findings of Mycobacterium tuberculosis and Mycobacterium avium intracellulare infection in HIV seropositive patients. Can Assoc Radiol J.2003; 54(1):45-50.
[31]. Hamiton SR, Morson BC. Pathology of Crohn's disease. In:Haubrich WAS, Schaffner F, Berk JE, eds. Bockus gastroenterology. Philadelphia:WB Saunders, 1995; 1398-1409.
[33]. Schulze K, Warner HA, Murray D. Intestinal tuberculosis:experience at a Canadian teaching institution. Am J Med.1977; 63(5):735-745.
[34]. Chen WS, Leu SY, Hsu H, Lin JK, Lin TC. Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis. Dis Colon Rectum.1992; 35(2):189-192.
[35]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-651.
[36]. Toth A, Fackelmann J, Pigott W, Tolomeo O. Tuberculosis prevention and treatment. Can Nurse.2004; 100(9):27-30.
[37]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[38]. Chung KM, Kim HS, Park SY, Lim SR, Ryang DY, Jeong HK, Lee WS, Park CH, Lee JH, Choi SK, Rew JS. The changes in incidence of Crohn's disease and intestinal tuberculosis in Korea. Korean J Gastroenterol.2008; 52(6):351-358.
[39]. Kim JH, Jeon YC, Kim TY Eun CS, Sohn JH, Han DS, Jang JJ, Park YW. A case of synchronous intestinal tuberculosis involving the stomach and colon. Korean J Gastroenterol.2008; 52(5):320-324.
[40]. Barreiros AP, Braden B, Schieferstein-Knauer C, Ignee A, Dietrich CF. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol.2008; 43(10):1224-1231.
[41]. Chong VH. Diagnosing lower gastrointestinal tuberculosis:colonoscopy is essential. Int J Colorectal Dis.2009 Dec 11. [Epub ahead of print].
[42]. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of whole blood IFNgamma test using PPD and recombinant antigen challenge for diagnosis of pulmonary and extra-pulmonary tuberculosis. Indian J Exp Biol.2009; 47(6):463-468.
[43]. Scott GM, Murphy PG, Gemidjioglu ME. Predicting deterioration of treated tuberculosis by corticosteroid reserve and C-reactive protein. J Infect.1990; 21(1):61-69.
[44]. Bajaj G, Rattan A, Ahmad P. Prognostic value of'C reactive protein in tuberculosis. Indian Pediatr.1989; 26(10):1010-1013.
[45]. Lawn SD, Wiktor S, Coulibaly D, Ackah AN, Lal RB. Serum C-reactive protein and detection of tuberculosis in persons co-infected with the human immuno-deficiency virus. Trans R Soc Trop Med Hyg.2001; 95(1):41-42.
[46]. Beers MH, ed. Merck manual of diagnosis and therapy,18th ed. Whitehouse Station, NJ; Merck Research Laboratories,2006; 1508-1515.
[47]. Gerberding JK. Statement by Julie. Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services TB:CDC'S public health response. June 6,2007. www.hhs.gov/asl/testify/2007/ 06/t20070606a.html. Accessed January 18,2008.
[48]. Toman K. Tuberculosis case-finding and chemotherapy, Questions and Answers. First Edition WHO 1979:28-38 and 44-50 and Second Edition WHO 2004; 51-65.
[49]. WHO:Framework for effective tuberculosis control. WHO/TB/94.179, Geneva, WHO; 1994.
[50]. van Cleeff MR, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR. The role and performance of chest X-ray for the diagnosis of tuberculosis:a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis.2005; 5:111.
[51]. Makanjuola D. CT and barium features of gastrointestinal and peritoneal tuberculosis. Saudi J Gastroenterol.1997; 3(3):133-139.
[52]. Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol.2004; 10(24):3647-3649.
[53]. Muneef MA, Memish Z, Mahmoud SA, Sadoon SA, Bannatyne R, Khan Y. Tuberculosis in the belly:a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol.2001; 36(5):528-532.
[54]. Tarcoveanu E, Filip V, Moldovanu R, Dimofte G, Lupascu C, Vlad N, Vasilescu A, Epure O. Abdominal tuberculosis-a surgical reality. Chirurgia (Bucur).2007; 102(3):303-308.
[55]. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma:abdominal tuberculosis. World J Gastroenterol.2003; 9(5):1098-1101.
[56]. Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients:an ongoing challenge for physicians. World J Gastroenterol.2006; 12(39):6371-6375.
[57]. Sinkala E, Gray S, Zulu I, Mudenda V, Zimba L, Vermund SH, Drobniewski F, Kelly P. Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia. BMC Infect Dis.2009; 9:44.
[58]. Pulimood AB, Ramakrishna BS, Kurian G, Peter S, Patra S, Mathan VI, Mathan MM. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut.1999; 45(4):537-541.
[1]. World Heath Organization. Tuberculosis facts,2008. Http://www.who.int/tb.
[2]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F.Intestinal tuberculosis mimicking Crohn's disease:lessons relearned in a new era.Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[3]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-651.
[4]. Chung KM, Kim HS, Park SY, Lim SR, Ryang DY, Jeong HK, Lee WS, Park CH, Lee JH, Choi SK, Rew JS. The changes in incidence of Crohn's disease and intestinal tuberculosis in Korea. Korean J Gastroenterol.2008; 52(6):351-358.
[5]. Al-Ghamdi AS, Al-Mofleh IA, Al-Rashed RS, Al-Amri SM, Aljebreen AM, Isnani AC, El-Badawi R. Epidemiology and outcome of Crohn's disease in a teaching hospital in Riyadh. World J Gastroenterol.2004; 10(9):1341-1344.
[6]. Lee YM, Fock K, See SJ, Ng TM, Khor C, Teo EK. Racial differences in the prevalence of ulcerative colitis and Crohn's disease in Singapore. J Gastroenterol Hepatol.2000; 15(6):622-625.
[7]. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis.2004; 10(5):646-651.
[8]. Sood A, Midha V, Sood N, Bhatia AS, Avasthi G Incidence and prevalence of ulcerative colitis in Punjab. Gut.2003; 52(11):1587-1590.
[9]. Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America:a systematic review. Aliment Pharmacol Ther. 2002; 16(1):51-60.
[10]. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:incidence, prevalence, and environmental influences. Gastroenterology.2004; 126(6):1504- 1517.
[11]. Ouyang Q, Tandon R, Goh KL, Pan GZ, Fock KM, Fiocchi C, Lam SK, Xiao SD. Management consensus of inflammatory bowel disease for the Asia-Pacific region. J Gastroenterol Hepatol.2006; 21(12):1772-1782.
[12]. Park SH, Yang SK, Yang DH, Kim KJ, Yoon SM, Choe JW, Ye BD, Byeon JS, Myung SJ, Kim JH. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother.2009; 53(10):4167-4171.
[13].欧阳钦；Rakesh Tandon; KL Goh;潘国宗；KM Fock; Claudio Fiocchi; SK Lam;萧树东；张虎(翻译)；梁红亮(翻译)；王芳芳(翻译)；欧阳钦(审校)。亚太地区炎症性肠病处理共识意见(一)。胃肠病学。2006；11(4)：233-238。
[14].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008：16(1)：57-58。
[15]. Sonnenberg A. Demographic characteristics of hospitalized IBD patients. Dig Dis Sci.2009; 54(11):2449-2455.
[16]. Sonnenberg A. Inflammatory bowel disease. In:Johanson JF, ed. Digestive disease; risk factors and prevention. Philadelphia:Lippincott-Raven Publishers; 1997.
[17]. Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees. Gut.1990; 31(9):1037-1040.
[18]. Johnston RD, Logan RF. What is the peak age for onset of IBD? Inflamm Bowel Dis.2008;14(Suppl 2):S4-S5.
[19]. Blanchard JF, Bernstein CN, Wajda A, Rawsthorne P. Small-area variations and sociodemographic correlates for the incidence of Crohn's disease and ulcerative colitis. Am J Epidemiol.2001; 154(4):328-335.
[20]. Reddy SI, Burakoff R. Inflammatory bowel disease in African Americans. Inflamm Bowel Dis.2003; 9(6):380-385.
[21]. Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis.2009; 22(5):490-496.
[22]. Toth A, Fackelmann J, Pigott W, Tolomeo O. Tuberculosis prevention and treatment. Can Nurse.2004; 100(9):27-30.
[23]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-6651.
[24]. Kim JH, Jeon YC, Kim TY, Eun CS, Sohn JH, Han DS, Jang JJ, Park YW. A case of synchronous intestinal tuberculosis involving the stomach and colon. Korean J Gastroenterol.2008; 52(5):320-324.
[25]. Bhansali SK. Abdominal tuberculosis:experience with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[26]. Novis BH, Bank S, Marks IN. Gastrointestinal and peritoneal tuberculosis:a study of cases at Groote Schuur Hospital 1962-1977. S Afr Med J,1973; 47:365-372.
[27]. Epstein D, Watermeyer G, Kirsch R. The diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007; 25(12):1373-1388.
[28]. Gilinsky NH, Voigt MD, Bass DH, Marks IN. Tuberculosis perforation of the bowel. A report of 8 cases. S Afr Med J.1986; 70(1):44-46.
[29]. Kakar A, Aranya RC, Nair SK. Acute perforation of small intestine due to tuberculosis. Aust N Z J Surg.1983; 53(4):381-383.
[30]. Wilson D, Nachega J, Morroni C, Chaisson R, Maartens G. Diagnosing smear negative tuberculosis using case definitions and treatment response in HIV-infected adults. Int J Tuberc Lung Dis.2006; 10(1):31-38.
[31]. Vind I, Riis L, Jess T, Knudsen E, Pedersen N, Elkjaer M, Bak Andersen I, Wewer V, N(?)rregaard P, Moesgaard F, Bendtsen F, Munkholm P; DCCD study group. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County,2003-2005; a population-based study from the Danish Crohn colitis database. Am J Gastroenterol.2006; 101 (6):1274-1282.
[32]. Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, Ha HK. Crohn disease of the small bowel:comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology.2009; 251(3): 751-761.
[33]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic
characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[34]. Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, Johnson CD, Bruining DH, Loftus EV Jr, Sandborn WJ, Pardi DS, Mandrekar JN. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol.2009; 193(1):113-121.
[35]. Pulimood AB, Ramakrishna BS, Kurian G, Peter S, Patra S, Mathan VI, Mathan MM. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut.1999; 45(4):537-541.
[36]. Howell JS, Knapton PJ. Ileo-caecal tuberculosis. Gut.1964; 5:517-523.
[37]. Shepherd NA. Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol.1991;44(9):726-733.
[38]. Makanjuola D. Is it Crohn's disease or intestinal tuberculosis? CT analysis. Eur J Radiol.1998;28(1):55-61.
[39]. Koh DM, Burn PR, Mathews G, Nelson M, Healy JC. Abdominal computed tomographic findings of Mycobacterium tuberculosis and Mycobacterium avium intracellulare infection in HIV seropositive patients. Can Assoc Radiol J.2003; 54(1):45-50.
[40]. WHO:Framework for effective tuberculosis control. WHO/TB/94.179, Geneva, WHO; 1994.
[41]. Toman K. Tuberculosis case-finding and chemotherapy, Questions and Answers. First Edition WHO 1979:28-38 and 44-50 and Second Edition WHO 2004:51-65.
[42]. van Cleeff MR, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR. The role and performance of chest X-ray for the diagnosis of tuberculosis:a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis.2005; 5:111.
[43].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008；16(1)：57-58。
[44]. Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between TB and CD. Endoscopy,2006,38(6):592-597.
[45]. Lewis BS. Ileoscopy should be part of standard colonoscopy. A comparison of radiographic and endoscopic evaluation of the ileum. J Clin Gastroenterol.2000; 31(2)：103-104.
[46].中华医学会消化病学分会炎症性肠病协作组。中国炎症性肠病诊断治疗规范的共识意见。中华内科杂志。2008；(1)：73-79。
[47]. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol.2002; 97(6):1446-1451.
[48]. Aberra FN, Stettler N, Brensinger C, Lichtenstein GR. Lewis JD. Risk for active tuberculosis in inflammatory bowel disease patients. Clin Gastroenterol Hepatol. 2007; 5(9):1070-1075.
[49]. Netherland NA, Peter S. Gastrointestinal:positron emission tomography (PET) in intestinal tuberculosis:masquerading hot spots. J Gastroenterol Hepatol.2009; 24(11):1798-1799.
[50]. Cirillo LC, Camera L, Della Noce M, Castiglione F, Mazzacca G, Salvatore M. Accuracy of enteroclysis in Crohn's disease of the small bowel:retrospective study. Eur Radiol.2000; 10(12):1894-1898.
[51]. Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in Crohn's disease patients suspected of small bowel activity:findings and clinical impact. J Gastroenterol.2009; 44(4):271-276.
[52]. Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol.2010; 105(2):289-297.
[53]. Rubio CA, Kapraali M, Befrits R. Further studies on the frequency of colorectal cancer in Crohn's colitis:an 11-year survey in the Northwest Stockholm County. Anticancer Res.2009; 29(10):4291-4295.
[54]. Kumarasinghe MP, Quek TP, Chau CY, Mustapha NR, Luman W, Ooi CJ. Endoscopic biopsy features and diagnostic challenges of adult Crohn's disease at initial presentation. Pathology.2010; 42(2):131-137.
[55]. Harada N. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku.2006; 81(11):681-686.
[56]. Girardi E, Angeletti C, Puro V, Sorrentino R, Magnavita N, Vincenti D, Carrara S, Butera O, Ciufoli AM, Squarcione S, Ippolito G, Goletti D. Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers. Euro Surveill.2009; 14(43). pⅱ:19373.
[57]. Chawla K, Gupta S, Mukhopadhyay C, Rao PS, Bhat SS. PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries.2009; 3(2):83-87.
[58]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[59]. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of whole blood IFNgamma test using PPD and recombinant antigen challenge for diagnosis of pulmonary and extra-pulmonary tuberculosis. Indian J Exp Biol.2009; 47(6):463-468.
[60]. Scott GM, Murphy PG, Gemidjioglu ME. Predicting deterioration of treated tuberculosis by corticosteroid reserve and C-reactive protein. J Infect.1990; 21(1):61-69.
[61]. Bajaj G, Rattan A, Ahmad P. Prognostic value of'C reactive protein in tuberculosis. Indian Pediatr.1989; 26(10):1010-1013.
[62]. Lawn SD, Wiktor S, Coulibaly D, Ackah AN, Lal.RB. Serum C-reactive protein and detection of tuberculosis in persons co-infected with the human immunodeficiency virus. Trans R Soc Trop Med Hyg.2001; 95(1):41-42.
[1]. Taketa K.α-Fetoprotein:Reevaluation in hepatology. Hepatology,1990; 12: 1420-1432.
[2]. Sedek J, Ganss B, MeKee MD. Ostcopontin. Crit TEV Oral Biol Med,2000; 11(3):279-303.
[3]. Zhang J, Takahashi K, Takahashi F, et al. Differential osteopontin Expression in lung cancer. Cancer Lett.2001,171(2):215-222.
[4]. Wai P Y, Kuo P C. The role of osteopentin in tumor metastasis. J Surg Res,2004; 121(2):228-241.
[5]. Simon T. Barry,Steven B. Ludbrook,Elaine Murrison et al. A regulated interaction between a5β1 integrin and osteopontin. Biochem Biophys Res Commun.2000; 267(3):764-769.
[6]. Mari L. Shinohara, Hye-Jung Kim, June-Ho Kim et al. Alternative tran-slation of osteopontin generates intracellular and secreted isoforms that mediate distinct biological activities in dendritic cells. Proc Natl Acad Sci U S A.2008; 105(20): 7235-7239.
[7]. Yukihiro Iso,Tokihiko Sawada, Toshie Okada. Loss of E-cadherin mRNA and gain of osteopontin mRNA are useful markers for detecting early recurrence of HCV-related hepatocellular carcinoma. Journal of Surgical Oncology.2005; 92(4): 304-311.
[8]. Gotoh M, Sakamoto M, Kanetaka K,et al. Overexpression of osteopontin in hepatocellular carcinoma. Pathology International.2002; 52(1):19-24.
[9]. Pavel V. Korita MDa, Toshifumi Wakai. et al. Overexpression of osteopontin independently correlates with vascular invasion and poor prognosis in patients with hepatocellular carcinoma. Human Pathology.2008; 39(12):1777-1783.
[10]. Hung-Wei Pan, Yueh-Hsing Ou, Shian-Yang Peng, et al. Overexpression of osteopontin is associated with intrahepatic metastasis, early recurrence, and poorer prognosis of surgically resected hepatocellular carcinoma. Caner.2003; 98(1):119-127.
[11].姜伟栋,印芳颖,韩喜春等。骨桥蛋白在原发性肝癌中的表达及其与预后的关系。中国实验诊断学。2007；11(3)：307-308。
[12]. Jin Kim, Seung S. Ki, Sang D, et al. Elevated plasma osteopontin levels in patients with hepatocellular carcinoma. American Journal of Gastroenterology.2006; 101(9):2051-2059.
[13]. Qing-Hai Ye, Lun-Xiu Qin, Marshonna Forgues, et al.Predicting heaptitis B virus-positive metastatic hepatocellular carcinomas using gene expression profiling and supervised machine learning. Nature Medicine,2003; 9(4):416-423.
[14]. Gao C, Guo H, Downey L, et al. Osteopontin-dependent CD44v6 expression and cell adhesion in HepG2 cells. Carcinogenesis.2003; 24(12):1871-1878.
[15]. S. Beckebaum, X. Chen, G.C. Sotiropoulos,et al. Role of osteopontin and CD44s expression for patients with hepatocellular carcinoma undergoing liver transplantation or resection. Transplantation Proceedings.2008; 40(9):3182-3184.
[16]. Guo-Xin Zhang, Zhi-Quan Zhao, Hong-Di Wang, et al. Enhancement of osteopontin expression in HepG2 cells by epidermal growth factor via phosphatidy-linositol 3-kinase signaling pathway. World J Gastroenterol.2004; 10(2):205-208.
[17].雷海鸣,卞建民,詹志林。肝癌细胞中P13K信号通路对骨桥蛋白表达的影响。山东医药。2007；47(27)：20-21。
[18]. Sirisha Emani, Jinping Zhang, Lucie Guo, et al. RNA Stability regulates differential expression of the metastasis protein, osteopontin, in hepatocellular cancer. Surgery.2008; 143(6):803-812.
[19]. Zhang J, Guo H, Mi Z,et al. EF1A1-actin interactions alter mRNA stability to determine differential osteopontin expression in HepG2 and Hep3B cells. Experimental Cell Research.2009; 315(2):304-312.
[20]. Zhao J,Dong L,Lu B,et al.Down-regulation of osteopontin suppresses growth and metastasis of hepatocellular carcinoma via induction of apoptosis. Gastroentero -logy.2008; 135(3):956-968.
[21]. Hongtao Guo,Carlos E, Marroquin,et al. Nitric oxide-dependent osteopontin expression induces metastatic behavior in HepG2 cells. Digestive Diseases and Sciences.2005; 50(7):1288-1298.
[22].温敏杰,朱光辉,蔡文松等。靶向骨桥蛋白基因的RNA干扰对裸鼠肝癌影响的实验研究。临床和实验医学杂志。2008；7(2)：1-2。
[1]. World Heath Organization. Tuberculosis facts,2008. Http://www.who.int/tb.
[2]. World Heath Organization. Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendation for HIV prevalent and resource constrained settings (WHO/HTM/TB/2007,379);2007.Http://whqlibdoc.who.int/hq/2007/WHO-HTM-TB-2007-379-eng.pdf.
[3]. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol,1993; 88:989-999.
[4]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F.Intestinal tuberculosis mimicking Crohn's disease:lessons relearned in a new era.Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[5]. Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis.2009; 22(5):490-496.
[6]. Park SH, Yang SK, Yang DH, Kim KJ, Yoon SM, Choe JW, Ye BD, Byeon JS, Myung SJ, Kim JH. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother.2009; 53(10): 4167-4171.
[7]. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol.2002; 97(6):1446-1451.
[8]. Stop TB Partnership and WHO. The Global Plan to Stop TB 2006-2015. WHO, Geneva,Switzerland (2006).
[9]. Raviglione MC, Uplekar MW. WHO's new stop TB strategy. Lancet.2006; 367(9514):952-955.
[10]. Gilinsky NH, Voigt MD, Bass DH, Marks IN. Tuberculosis perforation of the bowel. A report of 8 cases. S Afr Med J.1986; 70(1):44-46.
[11]. Kakar A, Aranya RC, Nair SK. Acute perforation of small intestine due to tuberculosis. Aust N Z J Surg.1983; 53(4):381-383.
[12]. Chan HW, Cheung CY, Chan YH, Chu YY, Lee KC, Chau KF, Li CS. Intestinal tuberculosis as a cause of gastrointestinal bleeding in a renal transplant recipient. Transpl Int.2010 Jan 12.
[13]. Brohee G. Crohn's disease and intestinal tuberculosis. Acta Gastroenterol Belg. 1950; 13; 1091-1105.
[14]. Sandborn WJ, Hanauer SB. Infliximab in the treatment of Crohn's disease:a use's guide for clinicians. Am J Gastroenterol 2002; 97:2962-2972.
[15]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn's disease:lessons relearnd in a new era. Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[16]. Marshall JB. Tuberculosis of the gastrointestinal tract and peri-toneum. Am J Gastroenterol,1993; 88:989-999.
[17]. Bernhard JS, Bhatia G, Knauer CM. Gastrointestinal tuberculosis. J Clin Gastroenterol,2000; 30:397-402.
[18]. Ha HK, Ko GY, Yu ES, Yoon K, Hong WS, Kim HR, Jung HY, Yang SK, Jee KN, Min YI, Auh YH. Intestinal tuberculosis with abdominal complications:radiologic and pathologic features. Abdom Imaging.1999; 24(1):32-38.
[19]. Wang JY, Lee LN, Chou CS, Huang CY, Wang SK, Lai HC, Hsueh PR, Luh KT. Performance assessment of a nested-PCR assay and the BD probe Tec ET system for detection of Mycobacterium tuberculosis in clinical speciments. J Clin Microbiol,2004; 42:4599-4603.
[20]. Pettengell KE, Larsen C, Garb M, Mayet FG, Simjee AE, Pirie D. Gastrointestinal tuberculosis in patients with pulmonary tuberculosis. Q J Med, 1990; 74:303-308.
[21]. Wilson D, Nachega J, Morroni C, Chaisson R, Maartens G. Diagnosing smear negative tuberculosis using case definitions and treatment response in HIV-infected adults. Int J Tuberc Lung Dis.2006; 10(1):31-38.
[22]. Epstein D, Watermeyer G, Kirsch R. The diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007; 25(12):1373-1388.
[23]. Bhansali SK. Abdominal tuberculosis:experience with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[24]. Novis BH, Bank S, Marks IN. Gastrointestinal and peritoneal tuberculosis:a study of cases at Groote Schuur Hospital 1962-1977. S Afr Med J,1973; 47:365-372.
[25]. Harada N. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku.2006; 81(11):681-686.
[26]. Davies PD, Pai M. The diagnosis and misdiagnosis of tuberculosis. Int J Tuberc Lung Dis.2008; 12:1226-1234.
[27]. Girardi E, Angeletti C, Puro V, Sorrentino R, Magnavita N, Vincenti D, Carrara S, Butera O, Ciufoli AM, Squarcione S, Ippolito G, Goletti D. Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers. Euro Surveill.2009; 14(43). pii:19373.
[28]. Chawla K, Gupta S, Mukhopadhyay C, Rao PS, Bhat SS. PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries.2009; 3(2):83-87.
[29]. Bhansali SK. Abdominal tuberculosis:experiences with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[30].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008：16(1)：57-58。
[32]. Koh DM, Burn PR, Mathews G, Nelson M, Healy JC. Abdominal computed tomographic findings of Mycobacterium tuberculosis and Mycobacterium avium intracellulare infection in HIV seropositive patients. Can Assoc Radiol J.2003; 54(1):45-50.
[31]. Hamiton SR, Morson BC. Pathology of Crohn's disease. In:Haubrich WAS, Schaffner F, Berk JE, eds. Bockus gastroenterology. Philadelphia:WB Saunders, 1995; 1398-1409.
[33]. Schulze K, Warner HA, Murray D. Intestinal tuberculosis:experience at a Canadian teaching institution. Am J Med.1977; 63(5):735-745.
[34]. Chen WS, Leu SY, Hsu H, Lin JK, Lin TC. Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis. Dis Colon Rectum.1992; 35(2):189-192.
[35]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-651.
[36]. Toth A, Fackelmann J, Pigott W, Tolomeo O. Tuberculosis prevention and treatment. Can Nurse.2004; 100(9):27-30.
[37]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[38]. Chung KM, Kim HS, Park SY, Lim SR, Ryang DY, Jeong HK, Lee WS, Park CH, Lee JH, Choi SK, Rew JS. The changes in incidence of Crohn's disease and intestinal tuberculosis in Korea. Korean J Gastroenterol.2008; 52(6):351-358.
[39]. Kim JH, Jeon YC, Kim TY Eun CS, Sohn JH, Han DS, Jang JJ, Park YW. A case of synchronous intestinal tuberculosis involving the stomach and colon. Korean J Gastroenterol.2008; 52(5):320-324.
[40]. Barreiros AP, Braden B, Schieferstein-Knauer C, Ignee A, Dietrich CF. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol.2008; 43(10):1224-1231.
[41]. Chong VH. Diagnosing lower gastrointestinal tuberculosis:colonoscopy is essential. Int J Colorectal Dis.2009 Dec 11. [Epub ahead of print].
[42]. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of whole blood IFNgamma test using PPD and recombinant antigen challenge for diagnosis of pulmonary and extra-pulmonary tuberculosis. Indian J Exp Biol.2009; 47(6):463-468.
[43]. Scott GM, Murphy PG, Gemidjioglu ME. Predicting deterioration of treated tuberculosis by corticosteroid reserve and C-reactive protein. J Infect.1990; 21(1):61-69.
[44]. Bajaj G, Rattan A, Ahmad P. Prognostic value of'C reactive protein in tuberculosis. Indian Pediatr.1989; 26(10):1010-1013.
[45]. Lawn SD, Wiktor S, Coulibaly D, Ackah AN, Lal RB. Serum C-reactive protein and detection of tuberculosis in persons co-infected with the human immuno-deficiency virus. Trans R Soc Trop Med Hyg.2001; 95(1):41-42.
[46]. Beers MH, ed. Merck manual of diagnosis and therapy,18th ed. Whitehouse Station, NJ; Merck Research Laboratories,2006; 1508-1515.
[47]. Gerberding JK. Statement by Julie. Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services TB:CDC'S public health response. June 6,2007. www.hhs.gov/asl/testify/2007/ 06/t20070606a.html. Accessed January 18,2008.
[48]. Toman K. Tuberculosis case-finding and chemotherapy, Questions and Answers. First Edition WHO 1979:28-38 and 44-50 and Second Edition WHO 2004; 51-65.
[49]. WHO:Framework for effective tuberculosis control. WHO/TB/94.179, Geneva, WHO; 1994.
[50]. van Cleeff MR, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR. The role and performance of chest X-ray for the diagnosis of tuberculosis:a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis.2005; 5:111.
[51]. Makanjuola D. CT and barium features of gastrointestinal and peritoneal tuberculosis. Saudi J Gastroenterol.1997; 3(3):133-139.
[52]. Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol.2004; 10(24):3647-3649.
[53]. Muneef MA, Memish Z, Mahmoud SA, Sadoon SA, Bannatyne R, Khan Y. Tuberculosis in the belly:a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol.2001; 36(5):528-532.
[54]. Tarcoveanu E, Filip V, Moldovanu R, Dimofte G, Lupascu C, Vlad N, Vasilescu A, Epure O. Abdominal tuberculosis-a surgical reality. Chirurgia (Bucur).2007; 102(3):303-308.
[55]. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma:abdominal tuberculosis. World J Gastroenterol.2003; 9(5):1098-1101.
[56]. Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients:an ongoing challenge for physicians. World J Gastroenterol.2006; 12(39):6371-6375.
[57]. Sinkala E, Gray S, Zulu I, Mudenda V, Zimba L, Vermund SH, Drobniewski F, Kelly P. Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia. BMC Infect Dis.2009; 9:44.
[58]. Pulimood AB, Ramakrishna BS, Kurian G, Peter S, Patra S, Mathan VI, Mathan MM. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut.1999; 45(4):537-541.
[1]. World Heath Organization. Tuberculosis facts,2008. Http://www.who.int/tb.
[2]. Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F.Intestinal tuberculosis mimicking Crohn's disease:lessons relearned in a new era.Eur J Gastroenterol Hepatol.2007; 19(4):347-349.
[3]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-651.
[4]. Chung KM, Kim HS, Park SY, Lim SR, Ryang DY, Jeong HK, Lee WS, Park CH, Lee JH, Choi SK, Rew JS. The changes in incidence of Crohn's disease and intestinal tuberculosis in Korea. Korean J Gastroenterol.2008; 52(6):351-358.
[5]. Al-Ghamdi AS, Al-Mofleh IA, Al-Rashed RS, Al-Amri SM, Aljebreen AM, Isnani AC, El-Badawi R. Epidemiology and outcome of Crohn's disease in a teaching hospital in Riyadh. World J Gastroenterol.2004; 10(9):1341-1344.
[6]. Lee YM, Fock K, See SJ, Ng TM, Khor C, Teo EK. Racial differences in the prevalence of ulcerative colitis and Crohn's disease in Singapore. J Gastroenterol Hepatol.2000; 15(6):622-625.
[7]. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis.2004; 10(5):646-651.
[8]. Sood A, Midha V, Sood N, Bhatia AS, Avasthi G Incidence and prevalence of ulcerative colitis in Punjab. Gut.2003; 52(11):1587-1590.
[9]. Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America:a systematic review. Aliment Pharmacol Ther. 2002; 16(1):51-60.
[10]. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease:incidence, prevalence, and environmental influences. Gastroenterology.2004; 126(6):1504- 1517.
[11]. Ouyang Q, Tandon R, Goh KL, Pan GZ, Fock KM, Fiocchi C, Lam SK, Xiao SD. Management consensus of inflammatory bowel disease for the Asia-Pacific region. J Gastroenterol Hepatol.2006; 21(12):1772-1782.
[12]. Park SH, Yang SK, Yang DH, Kim KJ, Yoon SM, Choe JW, Ye BD, Byeon JS, Myung SJ, Kim JH. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother.2009; 53(10):4167-4171.
[13].欧阳钦；Rakesh Tandon; KL Goh;潘国宗；KM Fock; Claudio Fiocchi; SK Lam;萧树东；张虎(翻译)；梁红亮(翻译)；王芳芳(翻译)；欧阳钦(审校)。亚太地区炎症性肠病处理共识意见(一)。胃肠病学。2006；11(4)：233-238。
[14].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008：16(1)：57-58。
[15]. Sonnenberg A. Demographic characteristics of hospitalized IBD patients. Dig Dis Sci.2009; 54(11):2449-2455.
[16]. Sonnenberg A. Inflammatory bowel disease. In:Johanson JF, ed. Digestive disease; risk factors and prevention. Philadelphia:Lippincott-Raven Publishers; 1997.
[17]. Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees. Gut.1990; 31(9):1037-1040.
[18]. Johnston RD, Logan RF. What is the peak age for onset of IBD? Inflamm Bowel Dis.2008;14(Suppl 2):S4-S5.
[19]. Blanchard JF, Bernstein CN, Wajda A, Rawsthorne P. Small-area variations and sociodemographic correlates for the incidence of Crohn's disease and ulcerative colitis. Am J Epidemiol.2001; 154(4):328-335.
[20]. Reddy SI, Burakoff R. Inflammatory bowel disease in African Americans. Inflamm Bowel Dis.2003; 9(6):380-385.
[21]. Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis.2009; 22(5):490-496.
[22]. Toth A, Fackelmann J, Pigott W, Tolomeo O. Tuberculosis prevention and treatment. Can Nurse.2004; 100(9):27-30.
[23]. Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, Deo V, Aggarwal A, Tiwari RP, Sreenivas V, Gupta SD. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol.2010; 105(3):642-6651.
[24]. Kim JH, Jeon YC, Kim TY, Eun CS, Sohn JH, Han DS, Jang JJ, Park YW. A case of synchronous intestinal tuberculosis involving the stomach and colon. Korean J Gastroenterol.2008; 52(5):320-324.
[25]. Bhansali SK. Abdominal tuberculosis:experience with 300 cases. Am J Gastroenterol,1977; 67:324-337.
[26]. Novis BH, Bank S, Marks IN. Gastrointestinal and peritoneal tuberculosis:a study of cases at Groote Schuur Hospital 1962-1977. S Afr Med J,1973; 47:365-372.
[27]. Epstein D, Watermeyer G, Kirsch R. The diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther.2007; 25(12):1373-1388.
[28]. Gilinsky NH, Voigt MD, Bass DH, Marks IN. Tuberculosis perforation of the bowel. A report of 8 cases. S Afr Med J.1986; 70(1):44-46.
[29]. Kakar A, Aranya RC, Nair SK. Acute perforation of small intestine due to tuberculosis. Aust N Z J Surg.1983; 53(4):381-383.
[30]. Wilson D, Nachega J, Morroni C, Chaisson R, Maartens G. Diagnosing smear negative tuberculosis using case definitions and treatment response in HIV-infected adults. Int J Tuberc Lung Dis.2006; 10(1):31-38.
[31]. Vind I, Riis L, Jess T, Knudsen E, Pedersen N, Elkjaer M, Bak Andersen I, Wewer V, N(?)rregaard P, Moesgaard F, Bendtsen F, Munkholm P; DCCD study group. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County,2003-2005; a population-based study from the Danish Crohn colitis database. Am J Gastroenterol.2006; 101 (6):1274-1282.
[32]. Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, Ha HK. Crohn disease of the small bowel:comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology.2009; 251(3): 751-761.
[33]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic
characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[34]. Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, Johnson CD, Bruining DH, Loftus EV Jr, Sandborn WJ, Pardi DS, Mandrekar JN. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol.2009; 193(1):113-121.
[35]. Pulimood AB, Ramakrishna BS, Kurian G, Peter S, Patra S, Mathan VI, Mathan MM. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut.1999; 45(4):537-541.
[36]. Howell JS, Knapton PJ. Ileo-caecal tuberculosis. Gut.1964; 5:517-523.
[37]. Shepherd NA. Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol.1991;44(9):726-733.
[38]. Makanjuola D. Is it Crohn's disease or intestinal tuberculosis? CT analysis. Eur J Radiol.1998;28(1):55-61.
[39]. Koh DM, Burn PR, Mathews G, Nelson M, Healy JC. Abdominal computed tomographic findings of Mycobacterium tuberculosis and Mycobacterium avium intracellulare infection in HIV seropositive patients. Can Assoc Radiol J.2003; 54(1):45-50.
[40]. WHO:Framework for effective tuberculosis control. WHO/TB/94.179, Geneva, WHO; 1994.
[41]. Toman K. Tuberculosis case-finding and chemotherapy, Questions and Answers. First Edition WHO 1979:28-38 and 44-50 and Second Edition WHO 2004:51-65.
[42]. van Cleeff MR, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR. The role and performance of chest X-ray for the diagnosis of tuberculosis:a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis.2005; 5:111.
[43].杨维良,张好刚。论肠结核的诊治现状。临床外科杂志。2008；16(1)：57-58。
[44]. Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between TB and CD. Endoscopy,2006,38(6):592-597.
[45]. Lewis BS. Ileoscopy should be part of standard colonoscopy. A comparison of radiographic and endoscopic evaluation of the ileum. J Clin Gastroenterol.2000; 31(2)：103-104.
[46].中华医学会消化病学分会炎症性肠病协作组。中国炎症性肠病诊断治疗规范的共识意见。中华内科杂志。2008；(1)：73-79。
[47]. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol.2002; 97(6):1446-1451.
[48]. Aberra FN, Stettler N, Brensinger C, Lichtenstein GR. Lewis JD. Risk for active tuberculosis in inflammatory bowel disease patients. Clin Gastroenterol Hepatol. 2007; 5(9):1070-1075.
[49]. Netherland NA, Peter S. Gastrointestinal:positron emission tomography (PET) in intestinal tuberculosis:masquerading hot spots. J Gastroenterol Hepatol.2009; 24(11):1798-1799.
[50]. Cirillo LC, Camera L, Della Noce M, Castiglione F, Mazzacca G, Salvatore M. Accuracy of enteroclysis in Crohn's disease of the small bowel:retrospective study. Eur Radiol.2000; 10(12):1894-1898.
[51]. Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in Crohn's disease patients suspected of small bowel activity:findings and clinical impact. J Gastroenterol.2009; 44(4):271-276.
[52]. Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol.2010; 105(2):289-297.
[53]. Rubio CA, Kapraali M, Befrits R. Further studies on the frequency of colorectal cancer in Crohn's colitis:an 11-year survey in the Northwest Stockholm County. Anticancer Res.2009; 29(10):4291-4295.
[54]. Kumarasinghe MP, Quek TP, Chau CY, Mustapha NR, Luman W, Ooi CJ. Endoscopic biopsy features and diagnostic challenges of adult Crohn's disease at initial presentation. Pathology.2010; 42(2):131-137.
[55]. Harada N. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku.2006; 81(11):681-686.
[56]. Girardi E, Angeletti C, Puro V, Sorrentino R, Magnavita N, Vincenti D, Carrara S, Butera O, Ciufoli AM, Squarcione S, Ippolito G, Goletti D. Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers. Euro Surveill.2009; 14(43). pⅱ:19373.
[57]. Chawla K, Gupta S, Mukhopadhyay C, Rao PS, Bhat SS. PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries.2009; 3(2):83-87.
[58]. Gu Q, Ouyang Q, Zhang WY, Li GD. A comparison of clinical and pathologic characteristics between Crohn's disease and intestinal tuberculosis. Zhonghua Nei Ke Za Zhi.2009; 48(4):291-294.
[59]. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of whole blood IFNgamma test using PPD and recombinant antigen challenge for diagnosis of pulmonary and extra-pulmonary tuberculosis. Indian J Exp Biol.2009; 47(6):463-468.
[60]. Scott GM, Murphy PG, Gemidjioglu ME. Predicting deterioration of treated tuberculosis by corticosteroid reserve and C-reactive protein. J Infect.1990; 21(1):61-69.
[61]. Bajaj G, Rattan A, Ahmad P. Prognostic value of'C reactive protein in tuberculosis. Indian Pediatr.1989; 26(10):1010-1013.
[62]. Lawn SD, Wiktor S, Coulibaly D, Ackah AN, Lal.RB. Serum C-reactive protein and detection of tuberculosis in persons co-infected with the human immunodeficiency virus. Trans R Soc Trop Med Hyg.2001; 95(1):41-42.
[1]. Taketa K.α-Fetoprotein:Reevaluation in hepatology. Hepatology,1990; 12: 1420-1432.
[2]. Sedek J, Ganss B, MeKee MD. Ostcopontin. Crit TEV Oral Biol Med,2000; 11(3):279-303.
[3]. Zhang J, Takahashi K, Takahashi F, et al. Differential osteopontin Expression in lung cancer. Cancer Lett.2001,171(2):215-222.
[4]. Wai P Y, Kuo P C. The role of osteopentin in tumor metastasis. J Surg Res,2004; 121(2):228-241.
[5]. Simon T. Barry,Steven B. Ludbrook,Elaine Murrison et al. A regulated interaction between a5β1 integrin and osteopontin. Biochem Biophys Res Commun.2000; 267(3):764-769.
[6]. Mari L. Shinohara, Hye-Jung Kim, June-Ho Kim et al. Alternative tran-slation of osteopontin generates intracellular and secreted isoforms that mediate distinct biological activities in dendritic cells. Proc Natl Acad Sci U S A.2008; 105(20): 7235-7239.
[7]. Yukihiro Iso,Tokihiko Sawada, Toshie Okada. Loss of E-cadherin mRNA and gain of osteopontin mRNA are useful markers for detecting early recurrence of HCV-related hepatocellular carcinoma. Journal of Surgical Oncology.2005; 92(4): 304-311.
[8]. Gotoh M, Sakamoto M, Kanetaka K,et al. Overexpression of osteopontin in hepatocellular carcinoma. Pathology International.2002; 52(1):19-24.
[9]. Pavel V. Korita MDa, Toshifumi Wakai. et al. Overexpression of osteopontin independently correlates with vascular invasion and poor prognosis in patients with hepatocellular carcinoma. Human Pathology.2008; 39(12):1777-1783.
[10]. Hung-Wei Pan, Yueh-Hsing Ou, Shian-Yang Peng, et al. Overexpression of osteopontin is associated with intrahepatic metastasis, early recurrence, and poorer prognosis of surgically resected hepatocellular carcinoma. Caner.2003; 98(1):119-127.
[11].姜伟栋,印芳颖,韩喜春等。骨桥蛋白在原发性肝癌中的表达及其与预后的关系。中国实验诊断学。2007；11(3)：307-308。
[12]. Jin Kim, Seung S. Ki, Sang D, et al. Elevated plasma osteopontin levels in patients with hepatocellular carcinoma. American Journal of Gastroenterology.2006; 101(9):2051-2059.
[13]. Qing-Hai Ye, Lun-Xiu Qin, Marshonna Forgues, et al.Predicting heaptitis B virus-positive metastatic hepatocellular carcinomas using gene expression profiling and supervised machine learning. Nature Medicine,2003; 9(4):416-423.
[14]. Gao C, Guo H, Downey L, et al. Osteopontin-dependent CD44v6 expression and cell adhesion in HepG2 cells. Carcinogenesis.2003; 24(12):1871-1878.
[15]. S. Beckebaum, X. Chen, G.C. Sotiropoulos,et al. Role of osteopontin and CD44s expression for patients with hepatocellular carcinoma undergoing liver transplantation or resection. Transplantation Proceedings.2008; 40(9):3182-3184.
[16]. Guo-Xin Zhang, Zhi-Quan Zhao, Hong-Di Wang, et al. Enhancement of osteopontin expression in HepG2 cells by epidermal growth factor via phosphatidy-linositol 3-kinase signaling pathway. World J Gastroenterol.2004; 10(2):205-208.
[17].雷海鸣,卞建民,詹志林。肝癌细胞中P13K信号通路对骨桥蛋白表达的影响。山东医药。2007；47(27)：20-21。
[18]. Sirisha Emani, Jinping Zhang, Lucie Guo, et al. RNA Stability regulates differential expression of the metastasis protein, osteopontin, in hepatocellular cancer. Surgery.2008; 143(6):803-812.
[19]. Zhang J, Guo H, Mi Z,et al. EF1A1-actin interactions alter mRNA stability to determine differential osteopontin expression in HepG2 and Hep3B cells. Experimental Cell Research.2009; 315(2):304-312.
[20]. Zhao J,Dong L,Lu B,et al.Down-regulation of osteopontin suppresses growth and metastasis of hepatocellular carcinoma via induction of apoptosis. Gastroentero -logy.2008; 135(3):956-968.
[21]. Hongtao Guo,Carlos E, Marroquin,et al. Nitric oxide-dependent osteopontin expression induces metastatic behavior in HepG2 cells. Digestive Diseases and Sciences.2005; 50(7):1288-1298.
[22].温敏杰,朱光辉,蔡文松等。靶向骨桥蛋白基因的RNA干扰对裸鼠肝癌影响的实验研究。临床和实验医学杂志。2008；7(2)：1-2。