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目的探讨电视纵隔镜联合检测 CD_4/CD_8在纵隔结核病和结节病诊断中的应用价值。方法回顾性分析2003年2月至2005年9月我院单纯纵隔病灶诊断不明行电视纵隔镜检查患者90例,应用免疫组化法对病理证实为结节病、结核病或不典型肉芽肿的患者57例检测 CD_4/CD_8的表达情况。结果纵隔病灶活检确诊为结节病37例,结核病14例,淋巴瘤15例,原因不明的纵隔转移癌18例,无干酪性坏死又无典型结节细胞的肉芽肿6例,疾病确诊率为93.3%(84/90);结节病病灶中CD_4为(65±13)%,CD_8为(9.4±2.6)%,CD_4/CD_8为7.3±1.8;结核病病灶中 CD_4为(41±11)%,CD_8为(11.8±3.4)%,CD_4/CD_8为3.6±1.1,结节病病灶中的 CD_4/CD_8明显高于结核病病灶。如果将 CD_4/CD_8>5作为诊断结节病的标准,则诊断结节病的准确性、特异性和敏感性分别为90.2%、85.7%和91.9%。本组病例未发生手术并发症,无死亡病例。结论电视纵隔镜检查对诊断纵隔疑难病灶的准确率高,部分病例结合 CD_4/CD_8比值对诊断结核病和结节病有一定价值。
Objective To explore the value of using mediastinoscopy in the diagnosis of mediastinal tuberculosis and sarcoidosis in combination with CD_4 / CD_8. Methods A retrospective analysis of 90 patients with mediastinoscopy diagnosed in our hospital from February 2003 to September 2005 was performed without mediastinoscopy. The patients with pathologically confirmed sarcoidosis, tuberculosis or atypical granuloma were analyzed by immunohistochemistry 57 cases detected CD_4 / CD_8 expression. Results Thirty-seven cases of sarcoidosis were diagnosed by mediastinal biopsy, including 14 cases of tuberculosis, 15 cases of lymphoma, 18 cases of unexplained mediastinal metastasis, 6 cases of caseous necrosis and no typical nodular granuloma. The diagnosis rate was (9.4 ± 2.6)% for CD_8 and 7.3 ± 1.8 for CD_4 / CD_8; (41 ± 11)% for CD_4 in tuberculosis lesions (11.8 ± 3.4)% for CD_8, and 3.6 ± 1.1 for CD_4 / CD_8. CD_4 / CD_8 in sarcoidosis was significantly higher than that in tuberculosis. If CD_4 / CD_8> 5 was used as the standard for diagnosing sarcoidosis, the accuracy, specificity, and sensitivity of diagnosing sarcoidosis were 90.2%, 85.7%, and 91.9%, respectively. No complications occurred in this group of patients, no deaths. Conclusion Video-mediastinoscopy has high accuracy in diagnosing difficult lesions of mediastinum. In some cases, the combination of CD_4 / CD_8 ratio has certain value in diagnosing tuberculosis and sarcoidosis.