CAJ | 학술논문

目的：通过分析儿童淋巴结结核患者的淋巴穿刺液中分枝杆菌检测结果特点，以提高其阳性检出率。方法对269例临床诊断为结核性淋巴结结核的儿童，采用细针穿刺，对所获病理组织消化、离心沉淀后，分别进行涂片抗酸染色镜检、分枝杆菌培养及对硝基苯甲酸生长试验（简称PNB法）进行菌型鉴定检查，统计分析培养、涂片镜检结果及菌型分布特点，采用χ2检验比较抗酸染色与分枝杆菌培养阳性率差异，以及BACTEC MGIT 960分枝杆菌分析系统与罗氏培养法阳性率差异。结果269例患儿中，108例（40．15％）患者分枝杆菌培养阳性，其中BACTEC MGIT 960系统与罗氏培养法的阳性率分别为38．66％（104／269）、28．99％（78／269），涂片阳性者170例，阳性率为63．19％（170／269）；两者结合可明确诊断70．63％（190／269）儿童淋巴结结核患者。涂片镜检法与分枝杆菌培养法的阳性率差异有统计学意义（P＜0．01），BACTEC MGIT 960系统与罗氏培养法的阳性率差异显著（P＜0．05）。108株临床分离株中，结核杆菌复合群105株（97．2％），非结核分枝杆菌3株（2．8％）。结论对儿童淋巴结结核患者细针穿刺标本，采取先消化、再离心沉淀浓缩集菌，会极大提高抗酸杆菌涂片阳性率，但同时会降低培养的阳性率；相比罗氏固体培养，BACTEC MGIT 960系统能显著提高分枝杆菌培养的阳性率。结核分枝杆菌复合群是造成儿童淋巴结结核患者感染的主要病原菌。
목적：통과분석인동림파결결핵환자적림파천자액중분지간균검측결과특점，이제고기양성검출솔。방법대269례림상진단위결핵성림파결결핵적인동，채용세침천자，대소획병리조직소화、리심침정후，분별진행도편항산염색경검、분지간균배양급대초기분갑산생장시험（간칭PNB법）진행균형감정검사，통계분석배양、도편경검결과급균형분포특점，채용χ2검험비교항산염색여분지간균배양양성솔차이，이급BACTEC MGIT 960분지간균분석계통여라씨배양법양성솔차이。결과269례환인중，108례（40．15％）환자분지간균배양양성，기중BACTEC MGIT 960계통여라씨배양법적양성솔분별위38．66％（104／269）、28．99％（78／269），도편양성자170례，양성솔위63．19％（170／269）；량자결합가명학진단70．63％（190／269）인동림파결결핵환자。도편경검법여분지간균배양법적양성솔차이유통계학의의（P＜0．01），BACTEC MGIT 960계통여라씨배양법적양성솔차이현저（P＜0．05）。108주림상분리주중，결핵간균복합군105주（97．2％），비결핵분지간균3주（2．8％）。결론대인동림파결결핵환자세침천자표본，채취선소화、재리심침정농축집균，회겁대제고항산간균도편양성솔，단동시회강저배양적양성솔；상비라씨고체배양，BACTEC MGIT 960계통능현저제고분지간균배양적양성솔。결핵분지간균복합군시조성인동림파결결핵환자감염적주요병원균。
Objective To improve the diagnosis of tuberculosis ( TB) by analyzing Mycobacterium infection in fine-needle aspiration biopsy specimens from children with tuberculous lymphadenitis .Methods Fine-needle aspiration biopsy was performed on 269 children with tuberculous lymphadenitis diagnosed by Shanghai Public Health Clinical Center from January 2011 to September 2013 .The needle aspiration biopsy specimens were processed for acid-fast bacillus (AFB) smear test, mycobacterial culture and Mycobacterium identification ( p-nitrobenzoic acid inhibition test ) .Results Cytological diagnosis of tuberculous lymphade-nitis was made for 269 patients.The positive results by AFB smear test were detected in 63.19% of 269 specimens (n=170) and 40.15%(n=108) specimens were positive in mycobacterial culture .The differ-ence between the two tests were significant (P<0.01).The positive rate of Mycobacterium detected by using BACTEC MGIT 960 automated system and L?wenstein-Jensen culture method were 38 .66% ( n=104 ) and 28.99%(n=78), respectively, showing the significant difference between two tests (P<0.05).AFB smear test in combination with mycobacterial culture could precisely diagnose 70.63% of tuberculous lym-phadenitis in children.Of the 108 clinical isolates, 105 strains (97.2%) were Mycobacterium tuberculosis complex and the rest were non-tuberculous Mycobacterium strains (2.8%).Conclusion The positive rate by AFB smear test was significantly increased in fine needle aspiration biopsy specimens after a series of treatments including sample digestion , centrifugation and precipitation , but the positive rate of mycobacterial culture was reduced .Diagnostic accuracy could be significantly improved by using BACTEC MGIT 960 sys-tem.Mycobacterium tuberculosis complex was the predominant pathogenic bacterium in children with tubercu-lous lymphadenitis .