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| 淋巴结结核脓液病原学诊断特点 |
| Etiological diagnosis features of lymph node pus from tubercular lymphadenitis |
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| DOI：10.3969/j.issn.1007-8134.2021.04.009 |
| 中文关键词: 淋巴结结核 结核分枝杆菌 核酸检测 诊断 |
| 英文关键词: tubercular lymphadenitis Mycobacterium tuberculosis nucleic acid detection diagnosis |
| 基金项目:传染病防治科技重大专项“结核病新疫苗的临床试验和关键技术研究”（2018ZX10731301）；国家自然科学基金（81701974） |
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| 中文摘要: |
| 目的 分析首次诊断为淋巴结结核病例的脓液病原学诊断特点，为临床医生提供选择诊断方法的理论依据。方法 收集我中心结核临床实验室2016年1月—2017年12月所有淋巴结结核脓液标本的病例资料，从中选出首诊时在超声引导下或无超声引导下用注射器穿刺抽脓的初诊淋巴结结核病例51例。分析病例的相关临床资料，包括性别、年龄、病原学检验结果、病理学结果、影像学结果等。结果 51例病例中，女性31例；年龄18～78岁，平均为（33.0±13.7）岁，20～30岁者占54.8%；肺部CT无异常表现的有32例；15例病例行细针穿刺病理学检查，呈典型干酪样坏死改变3例。将同时行脓液结核分枝杆菌核酸检测（nucleic acid amplification tests, NAAT）和抗酸染色涂片的标本检测结果进行比较，NAAT阳性率为88.2%，抗酸染色涂片阳性率为19.6%，2者比较差异有统计学意义（P＜0.05）；将同时行结核分枝杆菌NAAT和分枝杆菌快速培养的标本检测结果进行比较，NAAT阳性率为91.3%，分枝杆菌快速培养阳性率为30.4%，2者比较差异有统计学意义（P＜0.05）。结论 对于淋巴结结核的诊断，将抽吸的脓液行NAAT可以作为首选诊断方法。 |
| 英文摘要: |
| Objective To analyze the etiological diagnosis features of lymph node pus from tubercular lymphadenitis patients upon the first diagnosis, and provide theoretical evidence for clinicians to choose the diagnosis methods. Methods The case data of all lymph node pus specimens were collected from tuberculosis clinical laboratory in our center from January 2016 to December 2017. Fifty-one cases diagnosed with tubercular lymphadenitis by pus aspiration using syringe with or without ultrasound guidance upon the first diagnosis were selected. The clinical data of patients were analyzed, including gender, age, etiological test results, pathological results and imaging results. Results Among 51 patients, 31 cases were female. The patients aged 18-78 years old with an average age of (33.0±13.7) years old, and 54.8% of patients were 20-30 years old. Thirty-two cases had no abnormal lung CT images. Fine needle puncture biopsy was performed in 15 patients. Typical pathological features with caseous necrosis were found in 3 cases. Specimens tested simultaneously by nucleic acid amplification test (NAAT) and acid fast staining smear were compared. The positive rate of NAAT was 88.2% and the positive rate of acid fast staining smear was 19.6%, with statistical difference (P＜0.05). Specimens tested simultaneously by NAAT and Mycobacterium rapid culture were compared. The positive rate of NAAT was 91.3% and the positive rate of Mycobacterium rapid culture was 30.4%, with statistical difference (P＜0.05). Conclusions For the diagnosis of tubercular lymphadenitis, NAAT of aspirated pus can be the preferred choice for diagnosis. |
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