摘要
目的:评价病变淋巴结病理组织的抗酸染色镜检(简称“抗酸染色”)、常规病理学镜检(简称“病理镜检”)和TB-DNA检查在浅表淋巴结结核中的诊断价值,旨在寻求最佳的浅表淋巴结结核诊断方法。方法:采用回顾性研究方法,参照入组标准收集2022年1—9月重庆市公共卫生医疗救治中心因浅表淋巴结肿大而接受淋巴结活检且均在门诊随访3个月以上的114例患者基本信息、活检方式,以及每例患者取1枚淋巴结活检病理组织的抗酸染色、病理镜检、TB-DNA等资料。以最终临床诊断为参照标准,比较不同方法的检测效能。结果:114例淋巴结肿大患者中,病理组织TB-DNA检查阳性率[80.7%(92/114)]明显高于抗酸染色[2.6%(3/114)],差异有统计学意义(χ^(2)=142.935,P=0.000),低于病理镜检阳性率[91.2%(104/114)],差异有统计学意义(χ^(2)=5.235,P=0.022);联合病理镜检的阳性率[98.2%(112/114)]明显高于TB-DNA和病理镜检,差异均有统计学意义(χ^(2)=18.627,P=0.000;χ^(2)=5.630,P=0.018),最终104例患者诊断为淋巴结结核,10例诊断为非结核病变。104例淋巴结结核患者中,36例(34.6%)入院前未接受过抗结核治疗的患者和68例(65.4%)院外接受过抗结核治疗患者的病理镜检阳性率分别为88.9%(32/36)和95.6%(65/68),TB-DNA阳性率分别为80.6%(29/36)和91.2%(62/68),差异均无统计学意义(χ^(2)=0.785,P=0.376;χ^(2)=1.554,P=0.213);79例(76.0%)行超声引导下穿刺活检的患者和25例(24.0%)行手术切除病灶活检患者的病理镜检阳性率分别为96.2%(76/79)和84.0%(21/25),TB-DNA阳性率分别为89.9%(71/79)和80.0%(20/25),差异均无统计学意义(χ^(2)=2.770,P=0.096;χ^(2)=0.910,P=0.340)。114例患者以最终临床诊断为参照标准,抗酸染色、病理镜检和TB-DNA的敏感度分别为2.9%(3/104)、93.3%(97/104)和87.5%(91/104),特异度分别为100.0%(10/10)、30.0%(3/10)和90.0%(9/10),一致率分别为11.4%(13/114)、87.7%(100/114)和80.7%(92/114),Kappa值分别为0.005、0.233和0.502。结论:浅表淋巴结结核以颈部淋巴结结核为主,好发于中青年,抗酸染色的阳性率极低,病理镜检与TB-DNA检测有较高的诊断效能,两者联合检测可提高检测阳性率。对于一般性的浅表淋巴结,淋巴结穿刺活检与手术切除病灶活检诊断效能相当,考虑到费用、创伤等因素,淋巴结穿刺活检可作为首选。
Objective:To evaluate the value of acid-fast staining,routine pathology microscopy(short“pathology microscopy”),and TB-DNA in diagnosis of superficial lymph node tuberculosis,to seek the optimal diagnostic method of superficial lymph node tuberculosis.Methods:A retrospective study was conducted.Following the inclusion criteria,we collected basic information,biopsy methods,and acid-fast staining,pathology microscopy,TB-DNA of pathological tissues,and other data from 114 patients who underwent lymph node biopsy due to superficial lymph node enlargement at Chongqing Public Health Medical Center from January to September 2022,and were followed up in the outpatient department for more than 3 months(1 lymph node biopsy was taken from each patient).The diagnostic efficiency of different methods was compared based on the final clinical diagnosis as a reference standard.Results:Among 114 patients with lymphadenopathy,the positive rate of TB-DNA examination in pathological tissue(80.7%(92/114))was higher than that of acid-fast staining(2.6%(3/114))with significant difference(χ^(2)=142.935,P=0.000),lower than that of pathology microscopy(91.2%(104/114))with significant difference(χ^(2)=5.235,P=0.022).The positive rate of combined pathology microscopy(98.2%(112/114))was significantly higher than that of TB-DNA and pathology microscopy,and the difference was statistically significant(χ^(2)=18.627,P=0.000;χ^(2)=5.630,P=0.018).Finally,104 patients were finally diagnosed as lymph node tuberculosis,and 10 patients were diagnosed as non tuberculous lesions.Among 104 patients with lymph node tuberculosis,36(34.6%)patients did not receive anti-tuberculosis treatment before admission,and 68(65.4%)patients received anti-tuberculosis treatment outside the hospital,the positive rates of pathology microscopy were 88.9%(32/36)and 95.6%(65/68)with no significant difference(χ^(2)=0.785,P=0.376),and the positive rates of TB-DNA were 80.6%(29/36)and 91.2%(62/68)(χ^(2)=1.554,P=0.213).The positive rates of pathology microscopy in 79(76.0%)patients who underwent ultrasound-guided biopsy and 25(24.0%)patients who underwent surgical resection of the rates of lesion biopsy were 96.2%(76/79)and 84.0%(21/25)(χ^(2)=2.770,P=0.096),of TB-DNA were 89.9%(71/79)and 80.0%(20/25),respectively,with no statistically significant differences(χ^(2)=0.910,P=0.340).Using the final clinical diagnosis as the reference standard,the sensitivity of acid-fast staining,pathology microscopy,and TB-DNA were 2.9%(3/104),93.3%(97/104),and 87.5%(91/104),the specificity were 100.0%(10/10),30.0%(3/10),and 90.0%(9/10),the accuracy were 11.4%(13/114),87.7%(100/114),and 80.7%(92/114),and the Kappa values were 0.005,0.233,and 0.502.Conclusion:Superficial lymph node tuberculosis is mainly cervical lymph node tuberculosis,and is more common in middle-aged and young people.The positive rate of acid-fast staining is extremely low,and pathology microscopy and TB-DNA have higher diagnostic efficacy.Combining two examination methods can improve diagnostic performance.Although lymph node biopsy is equally effective in diagnosing general superficial lymph nodes as surgical lesion biopsy,considering factors such as cost and trauma,lymph node biopsy can be the first choice.
作者
曾琴
曾凡清
何坤
杨红红
刘敏
Zeng Qin;Zeng Fanqing;He Kun;Yang Honghong;Liu Min(Department of Infectious Diseases,Chongqing Public Health Medical Center,Chongqing 400036,China;Department of Pathology,Chongqing Public Health Medical Center,Chongqing 400036,China)
出处
《结核与肺部疾病杂志》
2024年第5期461-467,共7页
Journal of Tuberculosis and Lung Disease
基金
重庆市科卫联合医学科研项目(2024MSXM088)。
关键词
结核
淋巴结
临床实验室技术
诊断
评价研究
Tuberculosis
lymph node
Clinical laboratory techniques
Diagnosis
Evaluation studies
