摘要
目的分析总结淋巴结结核的临床特点，提高淋巴结结核的诊断水平。方法对2012年1月至2016年12月南方医科大学附属南方医院首次诊断的129例淋巴结结核患者的临床资料进行回顾性分析。计数资料采用卡方检验，非正态分布的计量资料采用秩和检验。结果129例患者，就诊病程长短不一，以1～3个月多见（45.7%），83例（73.6%）以淋巴结肿大为主诉就诊，主要累及颈部（56.6%），以单个淋巴结多见（61.2%），少数伴有发热症状（34.1%）。病理检查阳性率94.3%，结核感染T淋巴细胞斑点试验（T cell spot test of tuberculosis infection, T-SPOT.TB）阳性率93.3%，结核菌素试验（purified protein derivative，PPD）阳性率69.6%。病理学诊断100例（77.5%），诊断性治疗诊断27例（20.9%），培养诊断2例（1.6%），总平均诊断时间（10.4±6.5） d。发热组中位年龄50.5岁，中位病程2.5个月，非发热组发病中位年龄35（24，49）岁，中位病程1.2（0.5，6.0）个月，两组比较差异均有统计学意义（Z值分别为－3.118和－2.982，均P〈0.05）。发热组的深部淋巴结比例（54.5%比11.8%），白细胞计数升高比例（34.1% 比7.1%）、中性粒细胞百分比升高比例（31.8% 比1.8%）、红细胞沉降率升高比例（97.1% 比56.1%）、C反应蛋白升高比例（95.0%比40.0%），以及通过诊断性治疗诊断比例（47.7%比7.1%）均高于非发热组，两组比较差异均有统计学意义（χ2值分别为27.337、15.545、13.567、19.347、25.410、28.974，均P〈0.05）。结论淋巴结结核症状不典型，早期易误诊、漏诊，需重视T-SPOT.TB、病理学检查，诊断以病理学为主；无结核中毒症状患者多见于青年人，以病理学诊断为主；伴有结核中毒症状患者多见于中年人，病程较长，以深部淋巴结结核为主，病情较严重，近一半以诊断性治疗诊断。
ObjectiveTo analyze and summarize the clinical characteristics of tubercular lymphadenitis, and to improve the ability of diagnosis. MethodsClinical records of 129 patients first confirmed with tubercular lymphadenitis were collected retrospectively from Nanfang Hospital of Southern Medical University between January 2012 and December 2016. The categorical variables were described with the percentage （%） and compared with the chi-squaue test. Non-normal distribution data were described with M（P25, P75） and compared with rank sum test.ResultsThe disease courses were different in all cases, mostly of 1-3 months （45.7%）. Among the cases, 83 cases （73.6%） complained of lymph node enlargement. The predominant involved lymph node site was cervical （56.6%） with main presentation of single lymph node （61.2%）. Only a few cases presented with fever （34.1%）. The positive rate of histological examinations was 94.3%, while the positive rate of T cell spot test of tuberculosis infection （T-SPOT.TB） test was 93.3% and purified protein derivative （PPD） test was 69.6%. In the diagnosis of tubercular lymphadenitis, 100 cases （77.5%） were confirmed by histological examinations, 27 cases （20.9%） were given diagnostic treatment, and only 2 case （1.6%） was confirmed by culture. The average period of diagnosis was （10.4±6.5） days. The median age of patients with fever was 50.5 years old with a median disease course of 2.5 months, while the median age of patients fever was 35（24, 49） years old with a median disease course of 1.2（0.5, 6.0） months. The differences between two groups were statistically significant （Z=-3.118 and -2.982, respectively, both P〈0.05）. Patients with fever had higher proportion of swollen deep lymph nodes （54.5% vs 11.8%）, elevated white blood cell counts （34.1% vs 7.1%） and neutrophils （31.8% vs 1.8%）, elevated erythrocyte sedimentation rate （97.1% vs 56.1%）, elevated C-reactive protein （95.0% vs 40.0%） and received diagnostic
作者
李文飞
陈鸿杰
吴帅
廖桂婵
彭劼
Li Wen f ei , Chert Hongjie , Wu Shuai , Liao Guichan , Peng Jie(Department of Infectious Diseases, Nan fang Hospital of Southern Medical University, Guangzhou 510515, Chin)
出处
《中华传染病杂志》
CAS
CSCD
2018年第4期213-217,共5页
Chinese Journal of Infectious Diseases
