【摘要】 目的 分析探讨颈部淋巴结核(CTL)的诊断方法。方法回顾性分析青岛市胸科医院2012年4月至2013年12月收治的128例颈部肿块患者(其中96例确诊为颈部淋巴结核,作为观察组;32例为非颈部淋巴结核患者,作为对照组)的诊断过程,比较128例患者PPD试验、结核抗体检测、标本浓缩集菌抗酸杆菌检测、颈部CT增强扫描检查、结核感染T淋巴细胞斑点试验(T-SPOT.TB)(其中观察组60例进行了检测)、结核分枝杆菌-DNAPCR共6种方法的诊断阳性率。采用SPSS 13.0统计软件进行处理,对组间和观察组样本率采用x~2检验进行比较,P<0.05为差异有统计学意义。结果对照组与观察组结核抗体检查阳性率分别为46.88%(15/32)、56.25%(54/96),两组比较差异无统计学意义(x~2=0.849,P=0.357)。对照组PPD试验、浓缩集菌抗酸杆菌检测、CT增强扫描、T-SPOT.TB、结核分枝杆菌-DNA PCR检查阳性率分别为25.00%(8/32)、0%(0/32)、15.63%(5/32)、9.38%(3/32)、0%(0/32),观察组各阳性率分别为84.38%(81/96)、13.54%(13/96)、92.71%(89/96)、98.33%(59/60)、97.92%(94/96),5项组间比较差异均有统计学意义(分别为x~2=39.938,P<0.01;x~2=4.823,P=0.028;x~2=73.105,P<0.01;x~2=75.154,P<0.01;x~2=117.961,P<0.01)。结论CT增强扫描、血清T-SPOT.TB和结核分枝杆菌-DNA-PCR在临床上对于颈部淋巴结核的检查阳性率较高;结合多种检查方法有助于辅助诊断颈部淋巴结核,同时有助于颈部肿块的鉴别诊断。更多还原

【Abstract】 Objective To evaluate diagnostic methods of cervical tuberculous lymphadenitis(CTL).Methods The clinical data of 128 patients with neck masses from April 2012 to December 2013 were summarized,in which 96 cases with CTL and 32 cases with cervical non-tuberculous lymphadenitis(non-CTL) has been confirmed.The positive rates of purified protein derivative(PPD) skin test,anti-tuberculosis antibody(TB-Ab),concentrated acid fast bacilli examination,the neck CT enhancement scan,T-SPOT.TB assay,Mtb-DNA-PCR were compared in the diagnosis of CTL.Statistical analysis was done by SPSS 13.0,comparisons between observation group and control group were performed using Chi-squared test.P<0.05 was considered statistically significant.Results The positive rates of TB-Ab in control group and observation group was respectively 46.88%(15/32) and56.25%(54/96),the difference was not statistically significant(X~2=0.849,P=0.357).The positive rates of PPD test,concentrated acid fast bacilli examination,CT enhanced scan,T-SPOT.TB assay,Mtb-DNA-PCR in the control group were respectively 25.00%(8/32),0%(0/32),15.63%(5/32),9.38%(3/32) and 0%(0/32);while those in the observation group were 84.38%(81/96),13.54%(13/96),92.71%(89/96),98.33%(59/60)and97.92%(94/96),the differences had statistical significance(X~2 =39.938,P<0.01;X~2=4.823,P= 0.028;x~2=73.105,P<0.01;X~2 =75.154,P<0.01;X~2 = 117.961,P<0.01).Conclusion The positive rates of CT enhancement scan,T-SPOT.TB assay and Mtb-DNA-PCR are higher than other methods in the diagnosis of CTL.Combination of a variety of inspection methods may help to diagnosis of CTL and differential diagnosis of neck mass.更多还原