Zhao Ningjun, Zhang Yi, Li Keyong
Department of Otorhinolaryngology, Head and Neck Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China.
Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China.
Exp Ther Med. 2017 Nov;14(5):5093-5096. doi: 10.3892/etm.2017.5167. Epub 2017 Sep 21.
The present study investigated the clinical characteristics and diagnosis of modern laryngeal tuberculosis (TB). A total of 61 patients that were pathologically diagnosed with laryngeal TB between 1998 and 2012 were retrospectively analyzed using laryngoscopy methods. The primary symptoms of laryngeal TB observed in the present study include hoarseness and sore throat, and in the majority of cases, laryngeal TB was not associated with pulmonary TB (ratio 41/61, 67.2%). Systemic symptoms included low-grade fever and night sweats, which were rarely observed (20/61, 32.8%). Laryngoscopy results were summarized into 3 types: Edema type (24 cases), proliferation type (34 cases) and ulcer exudation type (3 cases). The positive rate of purified protein derivative (PPD) examination was 86.9%, which was 63.9% for sputum bacterium analysis. Pathological analysis indicated that there were a large number of phagocytes and giant cell reactions, stroma hyperplasia of epithelioid cells, and the Langhans cells constituted of granuloma and necrotic tissue, with caseous necrosis as a typical manifestation. Modern laryngeal TB is characterized by severe local symptoms like hoarseness and sore throat and mild systemic symptoms like fever and night sweat, and the diagnosis is based on patient history, laryngoscopy analysis, and PPD and sputum bacteria examinations used in combination. However, pathological biopsies and acid-fast bacilli examinations are required for the final diagnosis.
本研究调查了现代喉结核(TB)的临床特征及诊断方法。对1998年至2012年间经病理诊断为喉结核的61例患者,采用喉镜检查方法进行回顾性分析。本研究中观察到的喉结核主要症状包括声音嘶哑和咽痛,大多数情况下,喉结核与肺结核无关(比例为41/61,67.2%)。全身症状包括低热和盗汗,较少见(20/61,32.8%)。喉镜检查结果归纳为3种类型:水肿型(24例)、增生型(34例)和溃疡渗出型(3例)。结核菌素纯蛋白衍生物(PPD)检查阳性率为86.9%,痰菌分析阳性率为63.9%。病理分析表明,有大量吞噬细胞及巨细胞反应,上皮样细胞间质增生,由肉芽肿和坏死组织构成朗汉斯细胞,典型表现为干酪样坏死。现代喉结核的特征为声音嘶哑和咽痛等严重局部症状以及发热和盗汗等轻微全身症状,诊断基于患者病史、喉镜检查分析以及联合使用PPD和痰菌检查。然而,最终诊断需要病理活检和抗酸杆菌检查。