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目的 探讨颈部淋巴结结核(CTL)的临床诊治特点.方法 回顾性分析武汉市肺科医院2014年10月至2015年6月收治的210例CTL患者的临床资料,包括患者一般资料、淋巴结结核的部位、临床症状、病理资料、细菌学检查资料,以及治疗和转归情况等,归纳总结其临床诊治特点.结果 CTL以女性患者多见(73.33％,154/210);发病年龄以＜40岁的患者为主(65.71％,138/210),平均年龄(35.77±15.28)岁;初治患者占84.76％(178/210),好发于右侧颈部(65.24％,137/210).临床症状以发现颈部包块为主(91.43％,192/210),其他症状主要为发热(11.43％,24/210)、咳嗽(18.10％,38/210).210例患者均给予胸部X线或胸部CT检查,检查结果提示39.05％(82/210)的患者并发肺结核;耐多药CTL患者23例,占10.95％ (23/210).通过细针穿刺细胞学(FNAC)诊断CTL的确诊率为84.92％(152/179).在210例CTL患者中,结核菌素皮肤试验(PPD)和结核感染T细胞斑点试验(T-SPOT.TB)阳性率分别为74.72％(133/178)和86.27％(88/102).颈部淋巴结标本分别采用抗酸染色、结核分枝杆菌培养、Xpert MTB/RIF、聚合酶链反应检测结核分枝杆菌DNA(TB-DNA)、实时荧光恒温扩增检测结核分枝杆菌RNA (TB-RNA)5种不同方法检测,阳性率分别为9.04％(17/188)、27.66％(52/188)、74.38％(119/160)、67.25％(115/171)和0(0/25);Xpert MTB/RIF检测阳性率与抗酸染色比较,差异有统计学意义(x2=155.00,P＜0.01);与结核分枝杆菌培养阳性率比较,差异有统计学意义(x2=75.48,P＜0.01);与TB-DNA阳性率比较,差异无统计学意义(x2=2.02,P=0.155).210例患者明确诊断后均给予规范性抗结核药物治疗,其中148例患者给予手术治疗,手术治疗的患者中7例出现复发,给予二次手术;23例耐多药患者仍然处于治疗期间,其余187例患者均获得临床治愈.结论 CTL好发于年轻女性,Xpert MTB/RIF和TB-DNA检测对CTL有较高的诊断价值;正确的抗结核药物治疗及手术治疗是治愈CTL的重要手段.“,”Objective To investigate the clinical characteristics of cervical tuberculous lymphadenitis(CTL).Methods The following clinical information and data that collected from 210 cases with CTL,who admitted in Wuhan Pulmonary Hospital during October 2014 to June 2015,were analyzed retrospectively,including the general information of the patients,clinical symptoms,location of lymph node tuberculosis (TB),pathological and bacterio-logical examination results,and the information and data of diagnosis,treatment and treatment outcomes,etc.Results CTL was more common in female (73.33％,154/210);the proportion of the cases aged less than 40 years was 65.71％ (138/210),and the average age of the patients was (35.77±15.28);there were more new patients (84.76％,178/210) and the location of lymph node TB was mainly on the right side of the neck (65.24％,137/210).The main clinical signs and symptoms were neck mass (91.43％,192/210),fever (11.43％,24/210) and cough (18.10％,38/210).All patients received chest X-ray or CT scan and 39.05％ (82/210) of the patients were found to be complicated with pulmonary TB.Among 210 cases,23 cases were MDR-TB (10.95％,23/210).By using a diagnostic method which was called fine-needle aspiration cytology (FNAC),the diagnosis rate of CTL was 84.92％ (152/179).Among 210 patients with CTL,the positive rates of PPD and T-SPOT.TB were 74.72％ (133/178) and 86.27％ (88/102) respectively.The following 5 tests,including acid-fast staining,culture,Xpert MTB/RIF,TB-DNA and TB-RNA,were performed with the samples of the cervical lymph nodes obtained from 210 cases,and the positive rates were 9.04％ (17/188),27.66％ (52/188),74.38％ (119/160),67.25％ (115/171) and 0 (0/25) respectively.There were statistically significant differences between Xpert MTB/RIF and acid fast staining (x2 =155.00,P＜0.01);Xpert MTB/RIF and culture (x2 =75.48,P＜0.01);Xpert MTB/RIF and TB-DNA (x2=2.02,P=0.155).All patients were treated with reasonable anti-TB treatment regimens;148 cases received surgery and 7 cases were given secondary surgery due to relapse;187 patients were cured while the remaining 23 cases were still under treatment.Conclusion CTL usually occurred in young women.The value of Xpert MTB/RIF and TB-DNA tests for CTL diagnosis is high.The correct anti-TB chemotherapy and surgery are important measures for cure of CTL.