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*

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），χ2=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。
Abstract: Objective Study the endobronchial ultrasound features of mediastinal tubercular lymphadenopathy and sarcoidosis to probe a new method for the differential diagnosis. Methods The endobronchial ultrasound features of 74 lymph nodes in 16 mediastinal tubercular lymphadenopathy and 30 sarcoidosis patients diagnosed in our department were studied retrospectively, and the sizes, borders, fusion and echo features of mediastinal tubercular lymphadenopathy were compared to sarcoidosis. Results Both of the long size and the short size of mediastinal tubercular 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 of tubercular lymphadenopathy as compared to sarcodosis: indistinct borders, fusion of lymph nodes, hyperechoic echotexture and patchy anechoic/hypoechoic areas [50.0% (11/22) vs 17.3% (9/52), χ2 = 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, respectively). However, there was no significant difference in the existence of central hilar structure [9.1% (2/22) vs 19.2% (10/52), P = 0.491] between mediastinal tubercular lymphadenopathy and sarcoidosis. Conclusions The endobronchial ultrasound features of mediastinal lymph nodes, including sizes, borders, fusion, hyperechoic echotexture and patchy anechoic/hypoechoic areas are helpful in the differential diagnosis of mediastinal tubercular lymphadenopathy and sarcoidosis.