细针吸取细胞学结合PCR法在淋巴结结核诊断中的应用及其与传统微生物检测方法的比较

Comparative evaluation of the diagnostic method in 162 cases of tuberculous lymphadenitis

目的研究对比162例淋巴结结核的诊断方法。方法选取浙江省金华市中心医院于2008年1月～2010年6月经细针穿刺细胞学诊断淋巴结结核或可疑结核的病例，穿刺组织同时进行抗酸染色、细菌培养及PCR扩增检测结核分枝杆菌DNA（TB—DNA）。结果TB—DNA阳性117例，阳性率为72．2％；抗酸染色阳性71例，阳性率为43．8％；细菌培养阳性99例，阳性率为61．1％；在61例FNAC直接诊断结核的病例，PCR及细菌培养阳性率明显高于抗酸染色（χ2值均为13．739，P〈0．01），在101例FNAC诊断为可疑结核或不排除结核的病例，PCR阳性率高于细菌培养及抗酸染色（χ2值分别为6．706、13．612，P均〈0．01）；抗酸染色及细菌培养阳性的病例TB—DNA均阳性；FNAC结合PCR结果可明确诊断80．9％结核。结论FNAC是诊断淋巴结结核简便有效的方法，PCR扩增高效、快速、敏感、特异，可作为FNAC诊断结核很好的补充，FNAC结合PCR技术是较好的淋巴结结核的诊断方法。

Objective To evaluate the diagnostic method in 162 cases of tuberculous lymphadenitis. Methods A-total of 162 cases of tuberculous lymphadenitis were performed by fine needle aspiration cytology（FNAC）,as well as acid-fast bacil- lus stain（AFB）, culture and PCR; Results Among the 162 cases, 117 cases were TB-DNA positive（117/162,72.2%）, while the positivity of AFB was 43.8% （71/162）,and culture was 61.1%（99/162）; In 61 definitely diagnosed tuberculous lymphadeni tis by FNAC cases, the positive rate of PCR and of culture were significantly higher than which of AFB （P 〈 0.01）, and in 101 cases which diagnosed suspiciously, the positive rate of PCR was higher than which of AFB and culture （P〈 0.01）.The positive cases of AFB and culture were all TB-DNA positive; FNAC combined with PCR can diagnose 80.9% tuberculous lym- phadenitis clearly. Conclusion FNAC combined with PCR to test TB-DNA is the most simple and effective diagnostic method of tuberculous lymphadenitis.