| 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. |
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