超声引导下多模联合检查在淋巴结分枝杆菌感染诊断中的应用

Application value of ultrasound-guided multimodal examinations in the diagnosis of lymph node mycobacterial infection

目的探讨超声引导下多模联合检查在淋巴结分枝杆菌感染诊断中的应用价值。方法回顾性分析2019年1月至2020年12月绍兴文理学院附属医院初诊疑似淋巴结分枝杆菌感染患者42例的临床资料,均在超声引导下行淋巴结负压穿刺术,观察涂片抗酸染色、细菌培养、病理诊断及三种检查联合诊断,并与痰液和肺泡灌洗液涂片抗酸染色及细菌培养结果比较。结果穿刺液涂片抗酸染色、细菌培养、病理联合诊断的阳性率为71.4%(30/12),显著高于穿刺液涂片抗酸染色阳性率[26.2%(11/42)]、细菌培养阳性率[42.9%(18/42)]、病理阳性率50.0%[(21/42)],差异均有统计学意义(χ^(2)=17.20、7.00、4.04,P<0.001、P<0.01、P=0.040)。痰液涂片和培养阳性率为21.4%(9/33),肺泡灌洗液涂片抗酸染色和培养阳性率为28.6%(12/30),差异有统计学意义(χ^(2)=21.11、15.43,均P<0.001)。结论超声引导下对疑似分枝杆菌感染病变淋巴结进行负压抽吸、穿刺活检,采用抗酸染色、细菌培养、病理检查等多模式诊断相结合,可提高分枝杆菌的检出率和诊断率。

Objective To investigate the application value of ultrasound-guided multimodal examinations in the diagnosis of lymph node mycobacterial infection.Methods The clinical data of 42 patients with suspected lymph node mycobacterial infection who were initially diagnosed at the Affiliated Hospital of Shaoxing University from January 2019 to December 2020 were retrospectively analyzed.All patients underwent an ultrasound-guided lymph node-negative pressure puncture.Acid-fast staining,bacterial culture,pathological examination or their combination were used to screen lymph nodes for mycobacterial infection.The results were compared with those of acid-fast staining and bacterial culture of sputum and bronchoalveolar lavage fluid smears.Results The combined application of acid fast staining,bacterial culture,and pathological examination for the puncture fluid smear showed a positive rate of 71.4%(30/42),which was significantly higher than the positive rate[26.2%(11/42)]for acid fast staining of the puncture fluid smear,the positive rate[42.9%(18/42)]for bacterial culture of the puncture fluid,and the positive rate[50.0%(21/42)]of pathological examination(χ^(2)=17.20,7.00,4.04,P<0.001,P<0.01,P=0.040).The positive rate for sputum smear and bacterial culture was 21.4%(9/33).The positive rate for acid fast staining and bacterial culture of the bronchoalveolar lavage fluid was 28.6%(12/30).The differences were statistically significant(χ^(2)=21.11,15.43,both P<0.001).Conclusion Ultrasound-guided negative pressure aspiration and puncture biopsy of lymph nodes combined with acid fast staining,bacterial culture,and pathological examinations can markedly increase the detection rate and diagnostic rate of mycobacterial infection.