The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
권호 표지

The Usefulness of Colonoscopic Biopsy in the Diagnosis of Intestinal Tuberculosis and Pattern of Concomitant Extra-intestinal Tuberculosis

장결핵의 진단을 위한 대장내시경 생검과 장외결핵의 유용성

Lee, Yun-Jung;Yang, Suk-Kyun;Myung, Seung-Jae;Byeon, Jeong-Sik;Park, Il-Gwon;Kim, Jung-Sun;Lee, Gin-Hyug;Jung,, Hwoon-Yong;Hong, Weon-Seon;Kim, Jin-Ho;Min, Young-Il
이윤정;양석균;명승재;변정식;박일권;김정선;이진혁;정훈용;홍원선;김진호;민영일

  • Published : 20040900
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Abstract

Background/Aims: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. Methods: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. Results: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. Conclusions: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.

목적: 장결핵은 우리나라에서 감소 추세에 있을 것으로 추정되지만 크론병의 증가로 인해 크론병과의 감별진단이 새로운 문제로 대두되었다. 본 연구는 장결핵의 진단에 있어 대장내시경 생검 조직을 이용한 검사의 유용성 및 장외 결핵의 빈도를 구하고자 시행되었다. 대상 및 방법: 1995년 11월부터 2003년 12월까지 서울아산병원에서 장결핵으로 진단받은 225명의 환자들을 대상으로 의무기록을 통하여 후향적으로 조사하였다. 결과: 대상 환자의 평균 연령은 40.6세(14-81세)였고 남녀 비는 1:1.8이었다. 생검 조직의 병리학적 검사 결과 육아종은 163명(72.4%), 건락성 괴사는 25명(11.1%). 항산균은 39명(17.3%)에서 발견되었다. 생검 조직의 결핵균배양검사를 시행한 177명 중 52명(29.3%)에서 결핵균이 배양되었다. 장외결핵이 동반된 경우는 총 84명(37.3%)이었고 이 중 활동성 폐결핵이 동반된 경우가 67명(29.8%)이었다. 생검 조직의 병리 검사 결과 건락성 육아종 또는 항산균이 발견되어 장결핵으로 확진된 경우는 52명(23.1%)이었다. 생검 조직의 병리 소견 또는 장외결핵의 동반에 의해 대장내시경검사 직후 장결핵으로 진단된 경우는 107명(47.6%)이었다. 생검 조직을 활용한 검사(병리 소견 또는 결핵균 배양)에 의해 장결핵으로 확진된 경우는 87명(38.7%)이었다. 생검 조직의 병리 소견, 장외결핵의 동반 또는 추가적인 결핵균 배양검사에 의해 장결핵으로 확진된 경우는 126명(56.0%)이었다. 결론: 대장내시경검사에 의해 장결핵이 의심되는 경우 진단율을 호전시키기 위해 생검 조직의 일반적인 병리 검사 외에도 항산균 염색 및 결핵균 배양이 동시에 시행되어야 할 것으로 생각된다.

Keywords

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