Chen Y M, Lee P Y, Su W J, Perng R P
Chest Department, Veterans General Hospital-Taipei, Taiwan, ROC.
Tuber Lung Dis. 1992 Dec;73(6):368-71. doi: 10.1016/0962-8479(92)90042-I.
We retrospectively studied 71 cases of lymph node tuberculosis confirmed by culture or pathology from 1983 to 1989. Young adults were most frequently involved and the female to male ratio was 3:2. of 71 patients, three-quarters presented with palpable masses and two-thirds were asymptomatic. The cervical nodes were most frequently involved. Roentgenographic evidence of pulmonary tuberculosis was detected in 42% of patients and sputum culture-positive tuberculosis occurred in 7%. Tuberculin skin testing is less useful in our country due to routine BCG vaccination during infancy and early childhood. Selective excisional biopsy in addition to clinical information was necessary for differential diagnosis. 48 patients received regular treatment and were followed up for at least 1 year. Fresh nodes or enlargement of existing nodes developed in 10% of patients during treatment. Residual nodes were present in 10% of patients at the end of 9-month treatment with rifampicin, isoniazid and ethambutol, including prolonged or modified regimens in some individuals. In conclusion, in areas with a high frequency of tuberculous strains presenting a primary resistance to isoniazid, a 9-month regimen of rifampicin, isoniazid and ethambutol is recommended for lymph node tuberculosis.
我们回顾性研究了1983年至1989年间经培养或病理确诊的71例淋巴结结核病例。青壮年最常受累，男女比例为3:2。71例患者中，四分之三有可触及的肿块，三分之二无症状。颈部淋巴结最常受累。42%的患者有肺结核的影像学证据，7%的患者痰培养为阳性结核。由于我国在婴幼儿期常规接种卡介苗，结核菌素皮肤试验在我国用处较小。除临床信息外，选择性切除活检对鉴别诊断很有必要。48例患者接受了正规治疗并随访至少1年。10%的患者在治疗期间出现新的淋巴结或现有淋巴结肿大。在使用利福平、异烟肼和乙胺丁醇进行9个月治疗结束时，包括一些患者采用延长或调整方案，10%的患者仍有残留淋巴结。总之，在结核菌株对异烟肼呈现原发性耐药的高发地区，推荐使用利福平、异烟肼和乙胺丁醇的9个月方案治疗淋巴结结核。
