气道内超声特征在纵隔淋巴结结核与结节病鉴别诊断中的作用  

Endobronchial ultrasound in differential diagnosis of mediastinal tubercular lymphadenopathy and sarcoidosis

作　　者：王昌国[1] 曾大雄[1] 蒋军红[1] 黄建安[1] Chang-guo Wang;Da-xiong Zeng;Jun-hong Jiang;Jian-an Huang(Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China)

机构地区：[1]苏州大学附属第一医院呼吸与危重症医学科,江苏苏州215006

出　　处：《中国内镜杂志》2017年第8期1-6,共6页China Journal of Endoscopy

基　　金：国家临床重点专科建设项目(No:2012);江苏省社会发展-临床前沿技术(No:BE2016672)

摘　　要：目的探讨纵隔淋巴结结核与结节病的气道内超声特征,为纵隔淋巴结结核与结节病的鉴别诊断探索新的途径。方法回顾性分析16例纵隔淋巴结结核和30例结节病患者共计74枚淋巴结的气道内超声影像,比较两者在淋巴结大小、边界、融合和回声特点方面的差异。结果纵隔淋巴结结核长径和短径均小于结节病[(15.77±4.10)vs(19.76±5.83),t=3.28,P=0.021;(12.67±4.09)vs(16.81±5.54),t=3.56,P=0.001];纵隔淋巴结结核在边界不清、融合、存在局部高回声区及存在局部低/无回声区的发生率上均明显高于结节病[50.0%(11/22)vs 17.3%(9/52),χ~2=8.38,P=0.004;18.2%(4/22)vs 0.0%(0/52),P=0.008;50.0%(11/22)vs 0.0%(0/52),P=0.000;63.6%(14/22)vs 0.0%(0/52),P=0.000];而在淋巴门结构发生率上淋巴结结核和结节病无明显差异[9.1%(2/22)vs 19.2%(10/52),P=0.491]。结论纵隔淋巴结的大小、边界、融合、淋巴结内存在局部高回声区及低/无回声区等气道内超声特征有助于淋巴结结核与结节病的鉴别。Objective Study the endobronchial ultrasound features of mediastinal tubercular lymphadenopathyand sarcoidosis to probe a new method for the differential diagnosis.Methods The endobronchial ultrasoundfeatures of74lymph nodes in16mediastinal tubercular lymphadenopathy and30sarcoidosis patients diagnosed inour department were studied retrospectively,and the sizes,borders,fusion and echo features of mediastinal tubercularlymphadenopathy were compared to sarcoidosis.Results Both of the long size and the short size of mediastinaltubercular lymphadenopathy were smaller than sarcoidosis[(15.77±4.10)vs(19.76±5.83),t=3.28,P=0.021;(12.67±4.09)vs(16.81±5.54),t=3.56,P=0.001].And the following features were statistically significant oftubercular lymphadenopathy as compared to sarcodosis:indistinct borders,fusion of lymph nodes,hyperechoicechotexture and patchy anechoic/hypoechoic areas[50.0%(11/22)vs17.3%(9/52),χ2=8.38,P=0.004;18.2%(4/22)vs0.0%(0/52),P=0.008;50.0%(11/22)vs0.0%(0/52),P=0.000;63.6%(14/22)vs0.0%(0/52),P=0.000,respectively).However,there was no significant difference in the existence of central hilar structure[9.1%(2/22)vs19.2%(10/52),P=0.491]between mediastinal tubercular lymphadenopathy and sarcoidosis.Conclusions The endobronchial ultrasound features of mediastinal lymph nodes,including sizes,borders,fusion,hyperechoicechotexture and patchy anechoic/hypoechoic areas are helpful in the differential diagnosis of mediastinal tubercularlymphadenopathy and sarcoidosis.

关 键 词：气道内超声 结节病 淋巴结结核 

分 类 号：R445.1[医药卫生—影像医学与核医学]