原发性颈淋巴结结核的治疗体会及Elispot技术的诊断价值  

Treatment experience of primary cervical lymph node tuberculosis and diagnostic value of Elispot technology

作　　者：黄华[1] 乐晓华[1] 陈心春[1] 李红春[1] 

机构地区：[1]深圳市第三人民医院普外科,518020

出　　处：《国际呼吸杂志》2009年第8期463-466,共4页International Journal of Respiration

基　　金：广东省自然科学基金项目（7008514）,深圳市科技局重点项目（200701008）

摘　　要：目的 探讨原发性颈淋巴结结核的各种治疗方法的优缺点及评价酶联免疫斑点（Elispot）检测外周血中结核分枝杆菌性抗原特异性γ干扰素水平在颈淋巴结结核中的诊断价值。方法 回顾分析89例原发性颈淋巴结结核患者的临床资料，30例（A组）采用内科治疗（化疗1～1．5年），28例（B组）行肿块全部切除加区域性颈淋巴结清扫术，16例（C组）行淋巴结结核病灶切除术，15例（D组）行病灶切开刮除、开放引流术，所有手术患者术后均化疗1年。用Elispot技术对患者外周血中产生结核菌抗原特异性γ干扰素的水平进行定量检测，同时检测患者的结核抗体。结果 A组中22例肿块继续增大并增多（73．3％），其中9例形成脓肿破溃；B组无一例复发；C组5例复发（31．3％）；D组3例形成结核性窦道，4例再发淋巴结肿块（46．7％）；保守治疗和手术治疗复发率比较有明显统计学差异（χ^2=9．69，P〈0．01），保守治疗复发率明显升高；三种手术方式复发率比较也有明显统计学差异（χ^2=14．47，P〈0．01），此4组患者手术愈合时间有统计学差异（F=104．44，P〈0．01），B组患者手术愈合时间最短，复发率最低；Elispot、结核抗体检测患者的阳性率分别是87．6％、62．9％（χ^2=14．61，P〈0．01）。结论 原发性颈淋巴结结核的治疗应以手术为主，手术治疗能缩短治疗时间，减少药物用量及不良反应，能明显提高治愈率，降低复发率，而手术方式首选肿块全部切除加区域性颈淋巴结清扫术；Elispot技术优于结核抗体，可用于颈淋巴结结核的辅助诊断。Objective To discuss advantage and disadvantage of primary cervical lymph node tuberculosis treatment and evaluate the diagnostic value of enzyme-linked immune spot（Elispot） in peripheral blood of Mycohacterium tuberculosis antigen-specific interferon-γ in the level of cervical lymph node tuberculosis. Methods Clinical data of 89 cases of primary cervical lymph node tuberculosis were retrospectively analyzed. Thirty cases （group A） adopted medical treatment （chemotherapy 1 to 1.5 years）. Twenty-eight cases （group B） adopted all the mass excision regional neck dissection. Sixteen cases （group C） adopted lymph node tuberculosis lesions resection. Fifteen cases （group D） adopted curettage cut line focus and open drainage. The chemotherapy of all the patients after surgery was one year. Elispot technology was used to detect.the level of antigen-specific interferon-γ in peripheral blood of patients with tuberculosis and tuberculosis antibody of patients. Results Mass of 22 cases in group A continued to increase （73.3 %）, in which nine cases formed abscess. There was no recurrence in group B. Five cases had recurrence in group C （31.3 %）. In group D, three cases formed tuberculous sinus, four patients had lymph node tumor recurrence （46.7%）. Recurrence rate had significant difference between conservative treatment and surgical treatment （χ^2=9.69, P 〈0.01）. Relapse rate of conservative treatment significantly increased. The relapse rate of three surgical methods had significant difference （χ^2=14.47, P 〈0.01）. The healing time in four groups had significant difference （ F =104.44, P 〈0.01）. Healing time was the shortest and relapse rate was the lowest in group B. The positive rates of patients detected by Elispot, tuberculosis antibody were 87.6%, 62.9% （χ^2=14.61, P 〈0.01）. Conclusions Primary cervical lymph node tuberculosis treatment should be based on surgery. Surgery can shorten the treatment period,reduce the amount of drugs and side effects. All th

关 键 词：结核 淋巴结 颈部 外科手术 酶联免疫斑点 结核抗体 

分 类 号：R5[医药卫生—内科学]