电视纵隔镜联合CD_4/CD_8对纵隔结核和结节病的诊断价值  

The clinical application of videomediastinoscopy combined with the examination of CD_4/CD_8 in the diagnosis of mediastinal tuberculosis and sarcoidosis

作　　者：彭忠民[1] 刘奇[1] 王永康[2] 孟龙[1] 王磊[1] 陈景寒[1] 

机构地区：[1]山东省立医院胸外科,济南250021 [2]山东省立医院病理科,济南250021

出　　处：《中华结核和呼吸杂志》2007年第8期595-598,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：山东省优秀中青年科学家科研奖励基金(2004BS03018)

摘　　要：目的探讨电视纵隔镜联合检测 CD_4/CD_8在纵隔结核病和结节病诊断中的应用价值。方法回顾性分析2003年2月至2005年9月我院单纯纵隔病灶诊断不明行电视纵隔镜检查患者90例,应用免疫组化法对病理证实为结节病、结核病或不典型肉芽肿的患者57例检测 CD_4/CD_8的表达情况。结果纵隔病灶活检确诊为结节病37例,结核病14例,淋巴瘤15例,原因不明的纵隔转移癌18例,无干酪性坏死又无典型结节细胞的肉芽肿6例,疾病确诊率为93.3%(84/90);结节病病灶中CD_4为(65±13)%,CD_8为(9.4±2.6)%,CD_4/CD_8为7.3±1.8;结核病病灶中 CD_4为(41±11)%,CD_8为(11.8±3.4)%,CD_4/CD_8为3.6±1.1,结节病病灶中的 CD_4/CD_8明显高于结核病病灶。如果将 CD_4/CD_8>5作为诊断结节病的标准,则诊断结节病的准确性、特异性和敏感性分别为90.2%、85.7%和91.9%。本组病例未发生手术并发症,无死亡病例。结论电视纵隔镜检查对诊断纵隔疑难病灶的准确率高,部分病例结合 CD_4/CD_8比值对诊断结核病和结节病有一定价值。Objective To evaluate the role of videomediastinoscopy combined with the examination of CD4/CD8 in the diagnosis of tuberculosis and sarcoidosis of the mediastinum. Methods The clinical records of 90 patients who underwent videomediastinoscopy from February 2003 to September 2005 were retrospectively reviewed. The expression of CD4/CD8 was studied using immunohistochemical method in the tissues from 57 cases with a diagnosis of tuberculosis or sarcoidosis and noncaseating granuloma without classical ＂sarcoid＂ pathology obtained by videomediastinoscopy. Results Sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granuloma without classical ＂sarcoid＂ in 6 patients. The diagnostic accuracy was 93. 3% （ 84/90 ）. The expression of CD4 and CD8 in sarcoidosis was （ 65± 13 ） % and （ 9.4 ± 2.6 ） % , respectively. While the expression of CD4 and CD8 in tuberculsis was （41 ± 11 ）% and （11.8 ± 3.4 ）% , respectively. The rate of CD4/CD8 in sarcoidosis was higher than that in tuberculosis （7. 3 ± 1.8 and 3.6 ± 1.1, respectively, t = 1. 883, P = 0. 000 ）. The accuracy, specificity and sensitivity for diagnosis of sarcoidosis was 90. 2% , 85.7% and 91.9% , respectively, if the cutoff value of CD4/CD8 was 5. No complication or mortality was reported. Conclusion Videomediastinoscopy is an effective procedure for the diagnosis of mediastinal diseases. The examination of CD4/CD8 adds more information to the differentiation of tuberculosis from sarcoidosis.

关 键 词：纵隔镜检查 结核 结节病 

分 类 号：R529.0[医药卫生—内科学] R564[医药卫生—临床医学]