頸部分枝桿菌淋巴腺炎

目的：頸部分枝桿菌感染是臨床上常見的問題，其臨床表現多樣，且診斷相對困難，因此本研究主要探討，頸部分枝桿菌淋巴腺炎之各項臨床症狀與特性及相關檢驗結果之分析。方法：以回溯病歷方式，收集2004年8月至2014年7月，於國立成功大學醫學院附設醫院，接受頸部腫塊切除手術且病理診斷為頸部發炎性肉芽腫淋巴腺炎併中心乾酪性壞死之病患，記錄病患之性別、年紀、頸部淋巴腺炎發生區域、相關臨床症狀及血液學檢查、有無結核菌或非結核分枝桿菌感染病史及其他共病史以及頸部腫塊病理組織及痰液之抗酸性染色、結核菌聚合酶連鎖反應(polymerase chain reaction, PCR)(TB PCR)檢驗及分枝桿菌培養之結果，最後追蹤病患接受相關治療之情形。結果：共有110名病患納入本研究，男性有51例(46%)，女性有59例(54%)，病患平均年紀為45 ±22歲。頸部腫塊的大小平均約為1.8 × 2.2 cm。頸部腫塊好發於單側，且常見於頸部第Ⅱ區或第Ⅲ區，發燒、咳嗽、體重減輕等臨床症狀表現都不明顯，有62例(56.4%)的病例於診斷前並沒有共病症及結核菌或非結核分枝桿菌感染史。頸部腫塊抗酸性染色、TB PCR檢驗及分枝桿菌培養的陽性率各為65.1%、22.5%及13.4%，陽性培養中結核菌及非結核分枝桿菌的比率為4：3，但這三種檢驗有一種呈現陰性時，並不代表其餘二種檢驗也會以陰性來表現。結論：本研究顯示，頸部分枝桿菌淋巴腺炎，好發於單側頸部，臨床症狀表現不明顯，且分枝桿菌培養陽性率偏低，頸部腫塊病理切片檢查合併頸部腫塊抗酸性染色、TB PCR檢驗及分枝桿菌培養是診斷頸部分枝桿菌淋巴腺炎的主要工具，但頸部分枝桿菌淋巴腺炎之臨床表現及相關檢驗結果，需要更進一步的研究來證實。

關鍵字

結核病；分枝桿菌；頸部淋巴腺炎

並列摘要

BACKGROUND: This study aimed to investigate the clinical features, symptoms and related laboratory results of patients with cervical mycobacterial lymphadenitis. METHODS: The medical records of 110 patients who had been treated with neck mass excision and were diagnosed as infectious granulomatous cervical lymphadenitis with central caseous necrosis between August, 2004 and July, 2014 were evaluated retrospectively. Clinical and laboratory data including age, sex, the site of lymphadenitis, clinical symptoms, comorbidity, hematologic findings, acid fast stain, tuberculosis polymerase chain reaction (TB PCR), and mycobacterial culture were recorded for analysis. RESULTS: Among the 110 patients, 51(46%) were male and 59(54%) were female. The average age was 45 ± 22 years old. The average neck mass size was 1.8 × 2.2 cm. The cervical lymphadenitis was frequently located at unilateral site and in the neck level of II or III. Over half (56.4%) of the patients had no previous history of mycobacterial infection and any comorbidity. The positive rates of infectious granulomatous cervical lymphadenitis with central caseous necrosis for acid fast stain, TB PCR and mycobacterial culture were 65.1%, 22.5% and 13.4%, respectively. The culture ratio of tuberculosis and nontuberculosis was 4 : 3. No significant correlation was noted between the comorbidity and the results of acid fast stain, TB PCR and mycobacterial culture. CONCLUSIONS: According to our retrospective analysis, cervical mycobacterial lymphadenitis occurs more frequently at unilateral neck. The main tool of diagnosis is based on pathology finding combined with acid fast stain, TB PCR and mycobacterial culture. However, these examinations have limitations for the accurate diagnosis of cervical mycobacterial lymphadenitis. Further studies are needed to confirm the diagnosis of cervical mycobacterial lymphadenitis and the findings of the related laboratory results.

並列關鍵字

tuberculosis ； mycobacteria ； neck lymphadenitis

國際替代計量

頸部分枝桿菌淋巴腺炎

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