电视纵隔镜联合CD4/CD8对纵隔结核和结节病的诊断价值

目的探讨电视纵隔镜联合检测CD4／CD8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CD4／CD8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CD4为（65±13）％,CD8为（9．4±2．6）％,CD4／CD8为7．3±1．8;结核病病灶中CD4为（41±11）％,CD8为（11．8±3．4）％,CD4／CD8为3．6±1．1,结节病病灶中的CD4／CD8明显高于结核病病灶。如果将CD4／CD8〉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CD4／CD8比值对诊断结核病和结节病有一定价值。

The clinical application of videomediastinoscopy combined with the examination of CD4/CD8 in the diagnosis of mediastinal tuberculosis and sarcoidosis

OBJECTIVE: To evaluate the role of videomediastinoscopy combined with the examination of CD(4)/CD(8) in the diagnosis of tuberculosis and sarcoidosis of the mediastinum. METHODS: The clinical records of 90 patients who underwent videomediastinoscopy from February 2003 to September 2005 were retrospectively reviewed. The expression of CD(4)/CD(8) was studied using immunohistochemical method in the tissues from 57 cases with a diagnosis of tuberculosis or sarcoidosis and noncaseating granuloma without classical "sarcoid" pathology obtained by videomediastinoscopy. RESULTS: Sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granuloma without classical "sarcoid" in 6 patients. The diagnostic accuracy was 93.3% (84/90). The expression of CD(4) and CD(8) in sarcoidosis was (65 +/- 13)% and (9.4 +/- 2.6)%, respectively. While the expression of CD(4) and CD(8) in tuberculosis was (41 +/- 11)% and (11.8 +/- 3.4)%, respectively. The rate of CD(4)/CD(8) in sarcoidosis was higher than that in tuberculosis (7.3 +/- 1.8 and 3.6 +/- 1.1, respectively, t = 1.883, P = 0.000). The accuracy, specificity and sensitivity for diagnosis of sarcoidosis was 90.2%, 85.7% and 91.9%, respectively, if the cutoff value of CD(4)/CD(8) was 5. No complication or mortality was reported. CONCLUSION: Videomediastinoscopy is an effective procedure for the diagnosis of mediastinal diseases. The examination of CD(4)/CD(8) adds more information to the differentiation of tuberculosis from sarcoidosis.