リンパ節結核23症例の臨床的検討 TUBERCULOUS LYMPHADENITIS : A CLINICAL STUDY OF 23 CASES

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抄録

[目的・方法] 結核専門病床を有しない当院呼吸器内科において5年間に経験したリンパ節結核につき, retrospectiveに臨床的検討を行った。 [結果] 結核症207例中リンパ節結核は23例で, 男性7例, 女性16例と女性に多く, 年齢は18-99歳, 平均45.7歳であった。主訴は頸部腫瘤と発熱が多く, ツベルクリン反応は2例を除き中等度-強陽性であった。リンパ節腫脹部位は, 頸部16例, 腋窩3例, 縦隔7例, 肺門3例, 腹部3例, 鼠径1例であった。肺門・縦隔のリンパ節腫脹を伴わないものが15例あった。11例はリンパ節以外に明らかな結核病巣を認めなかった。リンパ節生検を施行した7例中4例で抗酸菌を検出し, 他の3例も病理所見より診断できた。リンパ節針吸引を施行した5例中2例で抗酸菌を検出した。5例は組織学的・細菌学的な診断が得られず, 画像や治療経過などから臨床的に診断した。リンパ節の造影CTでは, 11例中7例で中心部の低濃度領域と辺縁部の強調所見を認めた。6-30カ月 (平均14.5カ月) の化学療法を行い, 全例軽快したが1例はのちに再発した。 [結論] 本症では, 各種検体の細菌学的検査やリンパ節の病理組織診断に加えて画像所見やツベルクリン反応が診断の参考になり, 総合的に診断していくことが重要と考えられた。

[Introduction] Tuberculous lymphadenitis is a relatively rare disease in adults. In the absence of pulmonary tuberculosis, tuberculous lymphadenitis is very difficult to differentiate from other diseases. We described our experiences of patients with tuberculous lymphadenitis.<BR>[Results] We diagnosed 23 patients with tuberculous lymphadenitis out of 207 patients with tuberculosis. Their ages ranged from 18 to 99 years (mean, 45.7 years), and the maleto-female ratio was 7: 16. The most common complaints were cervical mass and fever. With the exception of two patients, all diagnosed patients had a strong positive skin test to tuberculin. Observing the site of affected lymph nodes, 16 patients had cervical node involvement, 3 patients had axillary node involvement, 7 patients had mediastinal node involvement, 3 patients had hilar node involvement, 3 patients had abdominal node involvement, and 1 patient had inguinal node involvement. Fifteen patients had neither hilar nor mediastinal node involvement. Eleven patients had no tuberculous lesions other than lymphadenitis. Seven patients underwent biopsy of the lymph nodes. Four of these patients had the evidence of acidfast bacilli. The remaining three patients were also diagnosed histologically. Five patients underwent fine needle aspiration. Two of them had the evidence of acid-fast bacilli. Acid-fast bacilli were detected in 10 out of 16 sputum samples and in 1 out of 2 pleural effusion samples. Five patients were diagnosed clinically by image (Computed tomography etc.) and by therapeutic effect. Eleven cases underwent contrast-enhanced computed tomography (CT) of the lymph nodes. Seven cases showed central low attenuation with peripheral rim enhancement, whereas the other four cases showed homogeneous attenuation. All patients received chemotherapy for a mean duration of 14.5 months (range, 6-30 years) with apparent improvement, but 1 patient relapsed.<BR>[Conclusion] Tuberculous lymphadenitis remains one of important targets for the differential diagnosis of lymphadenopathy. It is essential that a peripheral lymph node biopsy be performed and examined either histologically and/or microbiologically. A tuberculin skin test and contrast-enhanced CT imaging should also be performed.

収録刊行物

  • 結核

    結核 79(5), 349-354, 2004-05-15

    一般社団法人 日本結核病学会

参考文献:  14件中 1-14件 を表示

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    10013132965
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00229776
  • NDL 記事登録ID
    026779550
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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