장결핵 및 결핵성복막염 : 최근 5년간(1989년∼1994년)의 임상분석

유선경,김진천,김해련,김우성,김석구 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.4

장결핵과 크론병의 감별 진단에 있어서 체외 Interferon-γ 검사의 유용성

송근암,김일두 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24

배경/목적: 복부 증상과 회맹부 궤양을 나타내는 환자에서 장결핵과 크론병의 감별 진단은 임상적으로 매우 중요하나 증상과 내시경적 소견 및 조직 검사만으로 감별하는 것은 매우 어렵다. 이러한 환자에서 체외 interferon-γ (INF-γ) 검사의 장결핵의 진단에 있어서의 유용성을 알아보고자 하였다. 대상 및 방법: 2008년 1월 부터 2008년 8월까지 부산대학교병원에 복부 증상으로 내원하여 대장내시경을 시행한 만 18세 이상의 환자들 중 내시경 소견이 장결핵과 크론병에 모두 해당할 수 있다고 판단되어 내시경만으로 감별진단이 불가능한 환자 23명을 대상으로 체외 INF-γ 검사를 위해 T SPOT-TB 검사를 시행하였다. 최종 진단은 대장내시경의 육안적 소견, 조직학적 소견, 약물 치료에 대한 반응 및 2개월 이상의 추적 검사로 내려졌다. 결과: 체외 INF-γ 검사는 양성이 13명, 음성이 10명으로 측정되었다. 최종 진단은 양성인 13명 중 장결핵 7명, 크론병 3명, 비특이적인 장염 2명, 베쳇병 1명이었고 음성인 10명 중 장결핵은 없었고 크론병 7명, 비특이적인 장염 2명, 궤양성대장염 1명이었다. 검사의 장결핵에 대한 민감도는 100%, 특이도는 62.5%, 양성 에측치는 53.8%, 음성 예측치는 100% 였다. 결론: 임상적으로 장결핵과 크론병의 감별진단이 어려운 경우에 장결핵의 배제에 있어서 체외 INF-γ 검사가 유용한 검사로 생각된다. 장결핵의 진단을 위한 체외 INF-γ 검사의 유용성에 대해서는 좀 더 대규모 연구가 필요하다. Purpose: It is difficult to differentiate intestinal tuberculosis from Crohn's disease clinically and endoscopically. The aim of this study was to evaluate the effectiveness of in vitro interferon-γ (INF-γ) assay for differential diagnosis between intestinal tuberculosis and Crohn's disease. Methods: 23 patients with common symptoms and colonoscopic findings of intestinal tuberculosis and Crohn's disease were enrolled in this study. T SPOT-TB blood test was performed for in vitro INF-γ assay in all patients. Abdominal computed tomography, chest X-ray, and reviewing past history of tuberculosis were performed in all patients. AFB stain and culture and PCR of mycobacterium tuberculosis in colonoscopic biopsy specimen were also performed in all patients. All patients were diagnosed as intestinal tuberculosis, Crohn's disease or other disease after evaluation and follow up for two month. Results: 13 patients were tested as positive in INF-γ assay and 10 were as negative. Among the positive patients, 7 were intestinal tuberculosis, 3 were Crohn's disease, 2 were nonspecific colitis and 1 was Behcet's disease. Among the negative patients, 7 were Crahn's disease, 2 were nonspecific colitis, 1 was ulcerative colitis and none was intestinal tuberculosis. The sensitivity of T SPOT-TB blood test for intestinal tuberculosis was 100%, specificity was 62.5%, positive predictive value was 53.8% and negative predictive value was 100%. Conclusions: In vitro INF-γ assay was an effective diagnostic method to rule out intestinal tuberculosis when the assay result was negative and the differential diagnosis of intestinal tuberculosis and Crohn's disease was difficult. Prospective large scale studies are required for futher evaluation of the effectiveness of in vitro INF-γ assay for diagnosis of intestinal tuberculosis.

장결핵의 조기 진단을 위한 대장 내시경적 검사의 유용성

황기은,장남수,박창영,임시영,김병익,전우규,정을순,이상종 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.4

장결핵의 임상상 : 합병증 발생의 위험인자를 중심으로

최승목,양석균,정훈용,하현권,유창식,김진천,김해경,원선영,정성애 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.4

장결핵에 동반된 대장암 1예

차재명,이정일,최재원,주광로,정성원,신현필,허우영,이석환 대한소화기내시경학회 2008 Clinical Endoscopy Vol.37 No.5

만성 염증성 장질환은 대장암을 유발할 수 있는 전암성 병변으로 잘 알려져 있다. 하지만, 장결핵은 대장암과 동반된 일부 증례들이 보고되었음에도 불구하고 그 인과관계가 뚜렷하지 않다. 장결핵과 대장암이 동시에 발생한 경우 병리조직학적으로 오진을 할 수 있고, 영상의학적으로 장결핵에 의한 림프절 종대를 대장암의 림프절 전이로 오인할 수 있기 때문에 수술 전 정확한 병기 판정이 어려울 수 있어서 주의가 요구된다. 저자들은 복통으로 내원한 43세 여자의 상행결장에 대장암과 장결핵이 중복된 1예를 경험하여 이를 보고하며, 문헌 고찰을 통하여 국내외에서 보고된 유사한 증례들의 임상적인 특징에 대해 분석하였다.

포스터 전시 : 위장관 ; 경도자 색전술로 치료한 공장 결핵에 의한 대량 출혈 1예

양문희 ( M. H. Yang ),김범수 ( B. S. Kim ),정석 ( S. Jeong ),박상우 ( S. W. Park ),김훈수 ( H. S. Kim ),박우상 ( W. S. Park ),김인한 ( I. H. Kim ),이진우 ( J. W. Lee ),이돈행 ( D. H. Lee ),김형길 ( H. G. Kim ),김영수 ( Y. S. Kim ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

장결핵의 흔한 합병증은 천공, 폐색, 누공, 영양결핍 등이 있으며 대량의 위장관 출혈이 합병되는 경우는 매우 드물다. 또한 장결핵에 의한 다량 출혈이 있는 경우에 수술적인 치료를 하게 되며 경도자 동맥색전술로 치료한 경우는 세계적으로 아직 보고된 바가 없다. 연자 등은 공장 결핵에 의해 활력징후가 불안정할 정도의 대량 출혈이 있었던 환자에서 응급으로 상부장간막동맥 혈관조영술을 시행하여 공장동맥의 분지에서 출혈이 있음을 확인하고 경도자 동맥색전술로 치료한

장천공을 유발한 대장결핵이 동반된 대장암 1예

김치훈,한혜승,김정환,김병국,장성환 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.5

Tuberculosis can involve any part of the body and there are case reports of tuberculosis coexisting with malignancy in most body organs. However, cases of intestinal tuberculosis associated with colon cancer have rarely reported. Inflammatory bowel diseases can progress to malignant diseases due to mucosal dysplastic change. Similarly, intestinal tuberculosis can cause chronic inflammation, but the exact relationship between intestinal tuberculosis and colon cancer is currently obscure. A 71-year-old woman visited our hospital because of abrupt right lower abdominal pain that progressed to rebound tenderness and abdominal rigidity. Abdominal computed tomography showed a polypoid mass in the cecum and a distended terminal ileum. Right hemicolectomy was performed and the surgical specimen revealed extremely well differentiated adenocarcinoma combined with intestinal tuberculosis and bowel perforation in the cecum. We report here on a rare case of colon cancer coexisting with colonic tuberculosis and this presented as bowel perforation. We also include a review of the relevant literature. 결핵은 인체의 어느 부위에서나 감염을 일으킬 수 있으며 대부분의 장기에서 악성종양과 합병되는 경우가 보고되지만 대장에서 두 질환이 합병되는 경우는 드물며, 더욱이 장천공이 동반되고 병리 소견에서 최대 고분화 선암을 보인 경우는 보고된 바 없다. 염증성 장질환은 만성 염증을 일으켜서 점막의 이형성 변화를 일으킬 수 있는 전암성 병변이지만 이와 비슷한 양상으로 만성 염증을 일으킬 수 있는 장결핵의 경우에는 아직 대장암과의 인과관계에 대한 기전이 확립되어 있지 않다. 최대 고분화 선암은 정상적인 선과 흡사한 형태를 지닌 분화가 좋은 선암으로 세포들은 풍부한 세포질과 일정한 핵을 지닌다. 저자들은 우하복부 통증을 주소로 내원하여 시행한 복부 컴퓨터단층촬영에서 맹장 부위에 대장암이 의심되고 장천공을 시사하는 임상 소견이 있어서 우반 결장절제술을 시행 받은 환자에서 병변에 장천공이 관찰되고 조직검사에서 장결핵과 최대 고분화 선암이 동반된 1예를 경험하여 문헌고찰과 함께 보고한다.

최근 10년간 장결핵의 임상양상(2001-2010)

조주연 ( Joo Yeon Cho ),김유선 ( You Sun Kim ),박원우 ( Won Wo Park ),총배천 ( Tsung Pei Chuan ),김현태 ( Hyun Tae Kim ),이상렬 ( Sang Ryul Lee ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeoung Soep Moon ) 대한장연구학회 2011 Intestinal Research Vol.9 No.1

Background/Aims: Intestinal tuberculosis (ITB) evades early diagnosis due to non-specific clinical manifestations and difficulties in confirming the disease process. In the current study, we determined the diagnostic appearance and clinical manifestations of ITB in recent 10 years according to diagnostic guidelines, as proposed by the IBD Study Group of Korean Association for the Study of the Intestinal Diseases (KASID). Methods: Fifty-six patients with ITB who were diagnosed at Seoul Paik Hospital between January 2001 and August 2010 were retrospectively reviewed. The diagnosis of ITB was defined as definite or probable in accordance with the diagnostic guidelines and the clinical features were analyzed in comparison with previous studies involving ITB in Korea. Results: The mean age at the time of diagnosis was 45±15 years (range, 17-71 years). Definite and probable diagnoses were obtained in 29% and 71% of the patients, respectively. Twenty-three percent of the patients had synchronous active pulmonary TB and 14% of the patients had other forms of abdominal TB, such as TB mesenteric lymphadenitis or peritonitis. The most common symptoms were abdominal pain (43%), followed by diarrhea (30%), weight loss (14%). Twenty-seven percent of the patients (15 cases) were asymptomatic and diagnosed on comprehensive health care or post-operative surveillance. Only 2 patients (3.6%) underwent surgery for complications, such as intestinal obstruction and perforation. Conclusions: ITB is still prevalent in Korea; however, in the recent 10 years the symptoms of ITB have been milder than previously reported. In addition, the complication rates of ITB were remarkably decreased, suggesting that early diagnosis of ITB was increased. (Intest Res 2011;9:0-18)

장결핵 환자에서 감염후 과민성 장증후군의 발생빈도와 임상양상

이종수 ( Jong Soo Lee ),정성애 ( Sung Ae Jung ),염혜정 ( Hye Jung Yeom ),조유경 ( Yoo Kyung Cho ),김성은 ( Seong Eun Kim ),이시내 ( Si Nae Lee ),문일환 ( Il Hwan Moon ) 대한장연구학회 2005 Intestinal Research Vol.3 No.1

Background/Aims: The purpose of this study is to investigate the prevalence of PI-IBS after intestinal tuberculosis and the correlation of serotonin-containing EC cell and PI-IBS after intestinal tuberculosis. Methods: We reviewed the medical records of 14 patients with intestinal tuberculosis between January, 2001 and September, 2002. The diagnosis of PI-IBS was based on Rome II criteria. We performed immunohistochemical stain of serotonin antibody on colonoscopic biopsy specimens from 14 patients with tuberculosis and 11 asymptomatic controls. Results: Eight (58%) of 14 intestinal tuberculosis patients had no symptom and 3 patients (21%) had persistent IBS by Rome II criteria. Three patients with PI-IBS were all male. The severity of lesion by colonoscopy was severe in patients with PI-IBS (p<0.05). Serotonin-containing EC cell counts were higher in 14 patients with intestinal tuberculosis compared with 11 patients of normal controls (8.4/HPF vs. 0.2/HPF, p<0.05) and increased EC cells persisted after treatment of tuberculosis. Conclusions: PI-IBS was increased in patients with severe intestinal tuberculosis by colonoscopy. Serotonin-containing EC cells were increased in patients with intestinal tuberculosis. (Intest Res 2005;3:55-60)

장결핵과 크론병의 감별 진단에 있어서 체외 Interferon-γ 검사의 유용성

이정남 ( Jung Nam Lee ),류동엽 ( Dong Yup Ryu ),박성한 ( Sung Han Park ),유현석 ( Hyun Seok You ),이봉은 ( Bong Eun Lee ),김동욱 ( Dong Uk Kim ),김태오 ( Tae Oh Kim ),허정 ( Jeong Heo ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am So 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6

Background/Aims: It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohn`s disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-γ) assay for differential diagnosis between ITB and CD. Methods: Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-γ-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis. Results: Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcet`s enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcet`s enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively. Conclusions: When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD. (Korean J Gastroenterol 2010;55:376- 383)