浅表淋巴结结核的诊断与治疗专家共识

doi:10.19982/j.issn.1000-6621.20230120

摘要/Abstract

摘要：

浅表淋巴结结核是最常见的肺外结核,因其临床症状缺乏特异性,与非结核性淋巴结炎、淋巴瘤、淋巴结转移癌等疾病鉴别困难。目前,浅表淋巴结结核治疗方式较多,主要包括全身化疗、局部治疗和中西医结合治疗等,而局部治疗又包括抗结核药物的局部注射,超声药物透入及病灶清除、切除等。因治疗方案各有优缺点,针对特定类型选用相应的治疗手段会取得更好的疗效。如何选取合理的治疗方案,我国尚缺乏相关指导性文件。为规范我国浅表淋巴结结核的诊断和治疗,提高临床医师对浅表淋巴结结核的诊治水平,使患者早日治愈,减少复发,中国人民解放军总医院第八医学中心、《中国防痨杂志》编辑委员会和中国医疗保健国际交流促进会结核病防治分会基础和临床学部联合组织专家,结合我国浅表淋巴结结核诊断及治疗的经验和方法,以及国外诊断和治疗相关研究成果,共同拟定《浅表淋巴结结核的诊断与治疗专家共识》。本共识概述了浅表淋巴结结核的流行病学特征、发病机制、病理生理特征和主要的临床表现,介绍了浅表淋巴结结核的常见检查方法,提出了诊断标准和需要鉴别诊断的疾病及预后,并根据疾病的不同临床分期及病理类型提出了治疗建议,以供临床医师对浅表淋巴结结核患者进行精准诊断、合理治疗。

关键词: 结核,淋巴结, 诊断,鉴别, 治疗应用, 总结性报告(主题)

Abstract:

Superficial lymph node tuberculosis is the most common extrapulmonary tuberculosis. Due to the lack of specificity in its clinical symptoms, it is hard to differentiate it from non-tuberculous lymphadenitis, lymphoma, lymph node metastatic cancer, and other diseases. At present, there are many treatment methods for superficial lymphoid tuberculosis, mainly including systemic chemotherapy, local treatment, and integrated treatment with traditional Chinese and western medicine, while local treatment includes local injection of anti-tuberculosis drugs, ultrasonic drug penetration, and focal clearance and resection. Due to the advantages and disadvantages of each treatment scheme, it is better to choose appropriate treatment methods for specific types. How to select a reasonable treatment plan still lacks relevant guidance documents. Therefore, to standardize the diagnosis and treatment of superficial lymph node tuberculosis, and improve the level of clinicians to enable the patients to recover early and reduce recurrence, the Eighth Medical Center of Chinese PLA General Hospital, the Editorial Board of the Chinese Journal of Antituberculosis, and the Basic and Clinical Speciality Committees of the Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care jointly organized experts to combine the experience and methods of diagnosis and treatment of superficial lymph node tuberculosis in China, as well as research results related to diagnosis and treatment abroad, to formulate Expert consensus on the diagnosis and treatment of superficial lymph node tuberculosis. This consensus outlines the epidemiology, pathogenesis, pathophysiological characteristics and main clinical manifestations of superficial lymph node tuberculosis. It also introduces common examination methods, puts forward the diagnostic criteria, differential diagnosis, and prognosis, and gives treatment suggestions according to different clinical stages and pathological types, so that the clinicians can accurately diagnose and reasonably treat the patients with superficial lymph node tuberculosis.

Key words: Tuberculosis, lymph node, Diagnosis, differential, Therapeutic uses, Consensus development conferences as topic

中图分类号:

R522
R81

中国人民解放军总医院第八医学中心结核病医学部, 《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会结核病防治分会. 浅表淋巴结结核的诊断与治疗专家共识[J]. 中国防痨杂志, 2023, 45(6): 531-542. doi: 10.19982/j.issn.1000-6621.20230120

Senior Department of Tuberculosis, the th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis, Tuberculosis Control Branch of China Intrnational Exchange and Promotive Association for Medical and Health Care. Expert consensus on the diagnosis and treatment of superficial lymph node tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(6): 531-542. doi: 10.19982/j.issn.1000-6621.20230120

图/表 2

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参考文献 116

[1]	曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统. 中国循证医学杂志, 2011, 11(9):985-990. doi:10.3969/j.issn.1672-2531.2011.09.002. doi: 10.3969/j.issn.1672-2531.2011.09.002
[2]	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2):127-133. doi:10.3969/j.issn.1672-2531.2008.02.012. doi: 10.3969/j.issn.1672-2531.2008.02.012
[3]	Yang D, Kong Y. The bacterial and host factors associated with extrapulmonary dissemination of Mycobacterium tuberculosis. Front Biol (Beijing), 2015, 10(3):252-261. doi:10.1007/s11515-015-1358-y. doi: 10.1007/s11515-015-1358-y
[4]	An H, Wang Z, Chen H, et al. Clinical efffcacy of short-course chemotherapy combined with topical injection therapy in treatment of superffcial lymph node tuberculosis. Oncotarget, 2017, 8(66):109889-109893. doi:10.18632/oncotarget.22492. doi: 10.18632/oncotarget.22492
[5]	Sarfaraz S, Iftikhar S, Salahuddin N. Frequency, clinical characteristics, risks, and outcomes of Paradoxical upgrading reactions during anti-tuberculosis treatment in tuberculous lymphadenitis. Pak J Med Sci, 2020, 36(1):S27-S32. doi:10.12669/pjms.36.ICON-Suppl.1711. doi: 10.12669/pjms.36.ICON-Suppl.1711
[6]	Rai DK, Kumar R, Ahmad S. Clinical characteristics and treatment outcome in Tubercular lymphadenitis patients-A prospective observational study. Indian J Tuberc, 2020, 67(4): 528-533. doi:10.1016/j.ijtb.2020.07.021. doi: 10.1016/j.ijtb.2020.07.021 URL
[7]	高璐珏, 黄子慧, 王新方, 等. 淋巴结结核1082例临床分析. 中国感染与化疗杂志, 2021, 21(5): 505-511. doi:10.16718/j.1009-7708.2021.05.001. doi: 10.16718/j.1009-7708.2021.05.001
[8]	Ganchua SKC, White AG, Klein EC, et al. Lymph nodes—The neglected battlefield in tuberculosis. PLoS Pathog, 2020, 16(8): e1008632. doi:10.1371/journal.ppat.1008632. doi: 10.1371/journal.ppat.1008632
[9]	Ashenafi S, Muvva JR, Mily A, et al. Immunosuppressive Features of the Microenvironment in Lymph Nodes Granulomas from Tuberculosis and HIV-Co-Infected Patients. Am J Pathol, 2022, 192(4): 653-670. doi:10.1016/j.ajpath.2021.12.013. doi: 10.1016/j.ajpath.2021.12.013 pmid: 35092727
[10]	Purohit MR, Mustafa T, Mørkve O, et al. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis, 2009, 13(5): 600-605. doi:10.1016/j.ijid.2008.06.046. doi: 10.1016/j.ijid.2008.06.046 pmid: 19111495
[11]	Neyro SE, Squassi IR, Medín M, et al. Peripheral tuberculous lymphadenitis in pediatrics: 16 years of experience in a tertiary care pediatric hospital of Buenos Aires, Argentina. Arch Argent Pediatr, 2018, 116(6): 430-436. doi:10.5546/aap.2018.eng.430. doi: 10.5546/aap.2018.eng.430 pmid: 30457726
[12]	Temple SE, Pham K, Glendenning P, et al. Endotoxin induced TNF and IL-10 mRNA production is higher in male than female donors: correlation with elevated expression of TLR4. Cell Immunol, 2008, 251(2): 69-71. doi:10.1016/j.cellimm.2008.04.013. doi: 10.1016/j.cellimm.2008.04.013 pmid: 18555210
[13]	Padberg I, Bätzing-Feigenbaum J, Sagebiel D. Association of extra-pulmonary tuberculosis with age, sex and season differs depending on the affected organ. Int J Tuberc Lung Dis, 2015, 19(6): 723-728. doi:10.5588/ijtld.14.0735. doi: 10.5588/ijtld.14.0735 pmid: 25946367
[14]	于佳佳, 李亮, 杜建, 等. 肺结核住院患者并发肺外结核状况及其与性别和年龄相关性的多中心研究. 中国防痨杂志, 2020, 42(6): 563-569. doi:10.3969/j.issn.1000-6621.2020.06.006. doi: 10.3969/j.issn.1000-6621.2020.06.006
[15]	任航空, 段李明, 黄大业, 等. 初治继发性肺结核患者治疗过程中并发颈部淋巴结结核的危险因素分析. 中国防痨杂志, 2020, 42(11): 1165-1170. doi:10.3969/j.issn.1000-6621.2020.11.005. doi: 10.3969/j.issn.1000-6621.2020.11.005
[16]	杨松, 王乐乐, 李同心, 等. 肺外结核流行病学研究进展. 中华流行病学杂志, 2021, 42(1): 171-176. doi:10.3760/cma.j.cn112338-20200814-01067. doi: 10.3760/cma.j.cn112338-20200814-01067
[17]	Pang P, Duan W, Liu S, et al. Clinical study of tuberculosis in the head and neck region-11 years’ experience and a review of the literature. Emerg Microbes Infect, 2018, 7(1): 4. doi:10.1038/s41426-017-0008-7. doi: 10.1038/s41426-017-0008-7
[18]	Liu Y, Chen J, Zhang C, et al. Ultrasound-Based Radiomics Can Classify the Etiology of Cervical Lymphadenopathy: A Multi-Center Retrospective Study. Front Oncol, 2022, 12: 856605. doi:10.3389/fonc.2022.856605. doi: 10.3389/fonc.2022.856605
[19]	高璐珏, 黄子慧, 高敏行, 等. 浅表淋巴结结核患者401例临床资料分析与治疗方法探析. 中华中医药杂志, 2020, 35(10): 5214-5219.
[20]	梁艳, 高清平. 210例浅表淋巴结肿大病因分析. 武汉大学学报(医学版), 2011, 32(1): 129-132. doi:10.14188/j.1671-8852.2011.01.005. doi: 10.14188/j.1671-8852.2011.01.005
[21]	赵有利, 金龙, 段亮. 淋巴结结核中西医诊治学. 上海: 上海科技出版社, 2018.
[22]	李文飞, 陈鸿杰, 吴帅, 等. 129例首次诊断淋巴结结核的回顾性分析. 中华传染病杂志, 2018, 36(4): 213-217. doi:10.3760/cma.j.issn.1000-6680.2018.04.004. doi: 10.3760/cma.j.issn.1000-6680.2018.04.004
[23]	刘万里, 钮晓红. 中西医结合外科腺体病学. 北京: 中国中医药出版社, 2021.
[24]	Sarfaraz S, Iftikhar S, Salahuddin N. Frequency, clinical chara-cteristics, risks, and outcomes of Paradoxical upgrading reactions during anti-tuberculosis treatment in tuberculous lymphadenitis. Pak J Med Sci, 2020, 36(1): S27-S32. doi:10.12669/pjms.36.ICON-Suppl.1711. doi: 10.12669/pjms.36.ICON-Suppl.1711
[25]	刘艳, 王仁权. 彩色多普勒超声检查在浅表淋巴结肿大诊断中的临床意义. 影像研究与医学应用, 2018, 2(16):241-243. doi:10.3969/j.issn.2096-3807.2018.16.165. doi: 10.3969/j.issn.2096-3807.2018.16.165
[26]	高侠. 彩色多普勒超声在浅表淋巴结结核的诊断中的应用价值研究. 中国医疗器械信息, 2016, 22(24): 119-120. doi:10.3969/j.issn.1006-6586.2016.24.058. doi: 10.3969/j.issn.1006-6586.2016.24.058
[27]	Chu J, Zhang Y, Zhang W, et al. The value of multimodal ultrasonography in differential diagnosis of tuberculous and non-tuberculous superficial lymphadenitis. BMC Surg, 2021, 21(1): 416. doi:10.1186/s12893-021-01418-6. doi: 10.1186/s12893-021-01418-6 pmid: 34906107
[28]	Cui QL, Yin SS, Fan ZH, et al. Diagnostic Value of Contrast-Enhanced Ultrasonography and Time-Intensity Curve in Differential Diagnosis of Cervical Metastatic and Tuberculous Lymph Nodes. J Ultrasound Med, 2018, 37(1): 83-92. doi:10.1002/jum.14311. doi: 10.1002/jum.14311 URL
[29]	杨高怡. 临床结核病超声诊断. 北京: 人民卫生出版社, 2016.
[30]	曹兵生, 张华, 梁建琴. 超声引导下穿刺活检对颈部淋巴结病变的诊断价值. 临床超声医学杂志, 2010, 12(4): 268-270. doi:10.3969/j.issn.1008-6978.2010.04.016. doi: 10.3969/j.issn.1008-6978.2010.04.016
[31]	张中良. 彩色多普勒超声在颈部淋巴结结核诊断中的价值. 中国医疗设备, 2018, 33(S2):47-48.
[32]	王慧. 135例颈部淋巴结结核的超声图像特征与病理学表现. 临床医药文献电子杂志, 2017, 4(50):9809-9810. doi:10.3877/j.issn.2095-8242.2017.50.078. doi: 10.3877/j.issn.2095-8242.2017.50.078
[33]	王秋萍, 哈晓吾, 郭佑民. 结核病影像诊断学教程. 西安: 西安交通大学出版社, 2018.
[34]	陈菲. 彩超与CT对浅表淋巴结结核诊断价值的对比研究. 中国超声医学杂志, 2020, 36(3): 283-285. doi:10.3969/j.issn.1002-0101.2020.03.031. doi: 10.3969/j.issn.1002-0101.2020.03.031
[35]	贾夏青, 高文霞, 武金龙, 等. CT和MRI在颈部淋巴结结核诊断中的应用价值分析. 影像研究与医学应用, 2019, 3(15): 138-139.
[36]	You SH, Kim B, Yang KS, et al. Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings. Eur Radiol, 2019, 29(10):5635-5645. doi:10.1007/s00330-019-06155-2. doi: 10.1007/s00330-019-06155-2
[37]	Baek HJ, Lee JH, Lim HK, et al. Diagnostic accuracy of the clinical and CT findings for differentiating Kikuchi’s disease and tuberculous lymphadenitis presenting with cervical lympha-denopathy. Jpn J Radiol, 2014, 32(11): 637-643. doi:10.1007/s11604-014-0357-2. doi: 10.1007/s11604-014-0357-2 pmid: 25230988
[38]	Lee S, Yoo JH, Lee SW. Kikuchi disease: differentiation from tuberculous lymphadenitis based on patterns of nodal necrosis on CT. AJNR Am J Neuroradiol, 2012, 33(1): 135-140. doi:10.3174/ajnr.A2724. doi: 10.3174/ajnr.A2724 URL
[39]	李香芬, 宋留存, 张楠, 等. 颈部结核性淋巴结肿大增强CT影像学表现及其病理分析. 实用医学影像杂志, 2021, 22(5):464-466. doi:10.16106/j.cnki.cn14-1281/r.2021.05.010. doi: 10.16106/j.cnki.cn14-1281/r.2021.05.010
[40]	Das P, Dixit R, Prakash A, et al. Diffusion-weighted magnetic resonance imaging of abdominal tuberculosis: a new take on an old disease. Abdom Radiol (NY), 2022, 47(10): 3446-3458. doi:10.1007/s00261-022-03607-0. doi: 10.1007/s00261-022-03607-0 pmid: 35864265
[41]	Vandecaveye V, De Keyzer F, Hermans R. Diffusion-weighted magnetic resonance imaging in neck lymph adenopathy. Cancer Imaging, 2008, 8(1): 173-180. doi:10.1102/1470-7330.2008.0025. doi: 10.1102/1470-7330.2008.0025 URL
[42]	Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol, 2009, 72(3): 381-387. doi:10.1016/j.ejrad.2008.09.034. doi: 10.1016/j.ejrad.2008.09.034 pmid: 18995981
[43]	Zhang Y, Chen J, Shen J, et al. Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy. Clin Radiol, 2013, 68(3): 224-231. doi:10.1016/j.crad.2011.04.002. doi: 10.1016/j.crad.2011.04.002 pmid: 22316593
[44]	King AD, Yeung DK, Ahuja AT, et al. Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5 T. Clin Radiol, 2005, 60(5): 592-598. doi:10.1016/j.crad.2004.11.012. doi: 10.1016/j.crad.2004.11.012 pmid: 15851048
[45]	蓝玉娟. CT和MRI在颈部淋巴结结核诊断中的应用. 医疗装备, 2017, 30(13): 21-22. doi:10.3969/j.issn.1002-2376.2017.13.014. doi: 10.3969/j.issn.1002-2376.2017.13.014
[46]	李宝学, 沙晋璐, 田葵, 等. MR扩散加权成像在颈部淋巴结结核诊断中的价值. 中国防痨杂志, 2020, 42(2): 154-158. doi:10.3969/j.issn.1000-6621.2020.02.013. doi: 10.3969/j.issn.1000-6621.2020.02.013
[47]	陈禄, 唐晨虎, 薛健, 等. MRI对颈部淋巴结结核诊断准确性及其影响因素分析. 医学临床研究, 2020, 37(6): 886-888. doi:10.3969/j.issn.1671-7171.2020.06.026. doi: 10.3969/j.issn.1671-7171.2020.06.026
[48]	倪明, 汪世存, 潘博, 等. ¹⁸F-FDG PET/CT显像在肺外结核诊断中的应用价值. 中国CT和MRI杂志, 2018, 16(9): 26-29.
[49]	柳伟坤, 李向东, 尹吉林, 等. 肺外结核¹⁸F-FDG PET/CT显像的诊断价值. 南方医科大学学报, 2013, 33(7): 1083-1086. doi:10.3969/j.issn.1673-4254.2013.07.31. doi: 10.3969/j.issn.1673-4254.2013.07.31
[50]	Mao XB, Li N, Huang ZS, et al. ¹⁸F-FDG PET-CT Diagnosis of Tuberculosis in Celiac Lymph Nodes. Int J Gen Med, 2020, 13: 1335-1339. doi:10.2147/IJGM.S287115. doi: 10.2147/IJGM.S287115 pmid: 33293851
[51]	王心静, 王涛, 何柯, 等. 淋巴结结核脓液病原学诊断特点. 传染病信息, 2021, 34(4):324-326. doi:10.3969/j.issn.1007-8134.2021.04.009. doi: 10.3969/j.issn.1007-8134.2021.04.009
[52]	Loizos A, Soteriades ES, Pieridou D, et al. Lymphadenitis by non-tuberculous mycobacteria in children. Pediatr Int, 2018, 60(12): 1062-1067. doi:10.1111/ped.13708. doi: 10.1111/ped.13708 pmid: 30290041
[53]	Fantahun M, Kebede A, Yenew B, et al. Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis. PLoS One, 2019, 4(9): e0222402. doi:10.1371/journal.pone.0222402. doi: 10.1371/journal.pone.0222402
[54]	Chen HK, Liu RS, Wang YX, et al. Xpert MTB/RIF Assay for the Diagnosis of Lymph Node Tuberculosis in Children: A Systematic Review and Meta-Analysis. J Clin Med, 2022, 11(15): 4616. doi:10.3390/jcm11154616. doi: 10.3390/jcm11154616 URL
[55]	Mohindra S, Nayak HK, Mohindra N, et al. Diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration of tubercular lymphadenitis using combination of cytology and Gene Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) genes. Indian J Gastroenterol, 2021, 40(6): 630-635. doi:10.1007/s12664-020-01136-6. doi: 10.1007/s12664-020-01136-6
[56]	Gouda K, Das U, Dhangadamajhi G. Utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of tuberculous lymphadenitis compared to GeneXpert in a tertiary health care center in Northern Odisha, India. Indian J Tuberc, 2021, 68(4): 437-444. doi:10.1016/j.ijtb.2021.01.005. doi: 10.1016/j.ijtb.2021.01.005 URL
[57]	Perdikogianni C, Galanakis E. Non-tuberculous mycobacterial cervical lymphadenitis in the immunocompetent child: diagnostic and treatment approach. Expert Rev Anti Infect Ther, 2014, 12(8): 959-965. doi:10.1586/14787210.2014.920691. doi: 10.1586/14787210.2014.920691 pmid: 24847775
[58]	Loizos A, Soteriades ES, Pieridou D, et al. Lymphadenitis by non-tuberculous mycobacteria in children. Pediatr Int, 2018, 60(12): 1062-1067. doi:10.1111/ped.13708. doi: 10.1111/ped.13708 pmid: 30290041
[59]	Biadglegne F, Tessema B, Sack U, et al. Drug resistance of Mycobacterium tuberculosis isolates from tuberculosis lymphadenitis patients in Ethiopia. Indian J Med Res, 2014, 140(1): 116-122. pmid: 25222786
[60]	Sharif N, Ahmed D, Mahmood RT, et al. Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients. Braz J Biol, 2021, 83: e244311.
[61]	Miranda RN, Khoury JD, Medeiros LJ. 淋巴结病理学图谱. 陈健, 董红岩, 译. 北京: 人民卫生出版社, 2018.
[62]	刘燕翔, 胥萍, 吴妹英, 等. 144例颈部肉芽肿性淋巴结炎患者病灶标本的病理与病原学分析. 结核病与肺部健康杂志, 2017, 6(1): 36-40. doi:10.3969/j.issn.2095-3755.2017.01.010. doi: 10.3969/j.issn.2095-3755.2017.01.010
[63]	汤鸿, 赵菲菲. 活检组织原位染色联合分子病理与人工智能技术提高结核分枝杆菌检测阳性率的价值分析. 诊断病理学杂志, 2021, 28(11): 972-976, 979. doi:10.3969/j.issn.1007-8096.2021.11.019. doi: 10.3969/j.issn.1007-8096.2021.11.019
[64]	穆晶, 刘子臣, 宋婧, 等. 分子病理学诊断颈部淋巴结结核及其耐药性的应用价值. 中国防痨杂志, 2018, 40(11):1170-1175. doi:10.3969/j.issn.1000-6621.2018.11.006. doi: 10.3969/j.issn.1000-6621.2018.11.006
[65]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 3: Diagnosis-Tests for tuberculosis infection. Geneva: World Health Organization, 2022.
[66]	余艳艳, 谭云洪, 朱权, 等. INF-γ和IL-2联合检测在结核病辅助诊断中的价值. 检验医学与临床, 2019, 16(11): 1477-1479, 1482.
[67]	杨倩婷, 邓国防, 尤信信, 等. IP-10在结核患者中的表达及在诊断中的应用. 新发传染病电子杂志, 2017, 2(4): 198-201. doi:10.3877/j.issn.2096-2738.2017.04.003. doi: 10.3877/j.issn.2096-2738.2017.04.003
[68]	丁小娟, 王丹, 张耀之, 等. 卡介菌纯蛋白衍生物和结核菌素纯蛋白衍生物在结核病筛查中差异对比的Meta分析. 中国防痨杂志, 2022, 44(10): 1096-1099. doi:10.19982/j.issn.1000-6621.20220156. doi: 10.19982/j.issn.1000-6621.20220156
[69]	夏厦, 张国英, 郭一迪, 等. γ-干扰素释放试验在淋巴结结核病中的诊断价值. 标记免疫分析与临床, 2019, 26(6):954-956,959. doi:10.11748/bjmy.issn.1006-1703.2019.06.013. doi: 10.11748/bjmy.issn.1006-1703.2019.06.013
[70]	中国防痨协会, 中国防痨协会学校与儿童结核病防治专业分会, 《中国防痨杂志》编辑委员会. 重组结核杆菌融合蛋白(EC)临床应用专家共识. 中国防痨杂志, 2020, 42(8):761-768. doi:10.3969/i.issn.1000-6621.2020.08.001. doi: 10.3969/i.issn.1000-6621.2020.08.001
[71]	中国防痨协会. 高危人群结核分枝杆菌潜伏感染检测及预防性治疗专家共识. 中国防痨杂志, 2021, 43(9):874-878. doi:10.3969/j.issn.1000-6621.2021.09.004. doi: 10.3969/j.issn.1000-6621.2021.09.004
[72]	《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会结核病防治分会基础学组和临床学组. 现阶段结核抗体检测在我国临床应用的专家共识. 中国防痨杂志, 2018, 40(1):9-13. doi:10.3969/j.issn.1000-6621.2018.01.004. doi: 10.3969/j.issn.1000-6621.2018.01.004
[73]	Beyene D, Lumc Franken K, Yamuah L, et al. Serodiagnosis of tuberculous lymphadenitis using a combination of antigens. J Infect Dev Ctries, 2010, 4(2):96-102. doi:10.3855/jidc.116. doi: 10.3855/jidc.116 URL
[74]	中国人民解放军总医院第八医学中心全军结核病研究所/全军结核病防治重点实验室/结核病诊疗新技术北京市重点实验室, 《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会结核病防治分会基础和临床学部. 活动性结核病患者免疫功能状态评估和免疫治疗专家共识(2021年版). 中国防痨杂志, 2022, 44(1):9-27. doi:10.19982/j.issn.1000-6621.20210680. doi: 10.19982/j.issn.1000-6621.20210680
[75]	何畏, 陈晴, 黄涛, 等. 肺结核及肺外结核患者外周血T淋巴细胞亚群的变化及其临床意义. 中国防痨杂志, 2019, 41(10): 1090-1095. doi:10.3969/j.issn.1000-6621.2019.10.005. doi: 10.3969/j.issn.1000-6621.2019.10.005
[76]	《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会结核病防治分会基础专业和临床专业学术部. 结核病患者外周血淋巴细胞亚群检测及临床应用专家共识. 中国防痨杂志, 2020, 42(10): 1009-1016. doi:10.3969/j.issn.1000-6621.2020.10.001. doi: 10.3969/j.issn.1000-6621.2020.10.001
[77]	Bennani K, Khattabi A, Akrim M, et al. Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study. JMIR Public Health Surveill, 2019, 5(4): e14252. doi:10.2196/14252. doi: 10.2196/14252
[78]	易著文, 刘利群. 浅表淋巴结结核的诊断与鉴别诊断. 中国实用儿科杂志, 2003, 18(7): 397-399. doi:10.3969/j.issn.1005-2224.2003.07.007. doi: 10.3969/j.issn.1005-2224.2003.07.007
[79]	丁荣梅, 蔡艳斌. 颈部淋巴结核误诊为颈淋巴结炎32例原因分析. 中国医学创新, 2009, 6(3):81. doi:10.3969/j.issn.1674-4985.2009.03.068. doi: 10.3969/j.issn.1674-4985.2009.03.068
[80]	丁雄, 唐新玉, 卢立标. 儿童浅表淋巴结肿大356例病因分析及诊断体会. 广西医学, 2011, 33(3): 326-328. doi:10.3969/j.issn.0253-4304.2011.03.028. doi: 10.3969/j.issn.0253-4304.2011.03.028
[81]	夏燕, 邢泽刚. 艾滋病合并浅表淋巴结肿大的超声表现及病因分析. 实用临床医学, 2018, 19(10): 70-72, 75. doi:10.13764/j.cnki.lcsy.2018.10.027. doi: 10.13764/j.cnki.lcsy.2018.10.027
[82]	杨俊超, 李丽, 李艳云. 浅表淋巴结肿大的病因诊断思维程序及处理. 中国全科医学, 2005, 8(4): 295-296, 306. doi:10.3969/j.issn.1007-9572.2005.04.018. doi: 10.3969/j.issn.1007-9572.2005.04.018
[83]	安苗, 杨林, 武柏林. 结缔组织病伴发淋巴结肿大的影像、病理特征及临床意义. 临床荟萃, 2018, 33(9): 817-821. doi:10.3969/j.issn.1004-583X.2018.09.018. doi: 10.3969/j.issn.1004-583X.2018.09.018
[84]	陈荣恒, 曾志超, 林中矫. 淋巴结反应性增生的临床诊断和病因研究. 实用预防医学, 2009, 16(1):187-188. doi:10.3969/j.issn.1006-3110.2009.01.081. doi: 10.3969/j.issn.1006-3110.2009.01.081
[85]	谷博, 程强, 全勇, 等. 猫抓病淋巴结炎的影像学表现及文献回顾. 中国临床医学影像杂志, 2020, 31(5):372-374. doi:10.12117/jccmi.2020.05.016. doi: 10.12117/jccmi.2020.05.016
[86]	陈玲娥. 高频超声诊断不同病因所致颈部浅表淋巴结肿大的临床探究. 影像研究与医学应用, 2018, 2(24):230-231. doi:10.3969/j.issn.2096-3807.2018.24.151. doi: 10.3969/j.issn.2096-3807.2018.24.151
[87]	黄秀玲, 董常峰. 超声新技术在颈部淋巴结结核中的应用价值. 新发传染病电子杂志, 2021, 6(3): 255-259. doi:10.19871/j.cnki.xfcrbzz.2021.02.020. doi: 10.19871/j.cnki.xfcrbzz.2021.02.020
[88]	唐神结, 高文. 临床结核病学. 2版. 北京: 人民卫生出版社, 2019.
[89]	刘江波, 范爱平, 戴勇群. 不同方法治疗颈部浅表淋巴结结核的临床研究. 现代诊断与治疗, 2013, 18: 4198-4199.
[90]	王仲元, 安慧茹, 陈红兵, 等. 短程化疗治疗浅表淋巴结结核的临床研究. 四川医学, 2010, 31(11): 1611-1613. doi:10.3969/j.issn.1004-0501.2010.11.015. doi: 10.3969/j.issn.1004-0501.2010.11.015
[91]	黄汉平, 张丽, 吴红兵, 等. 98例颈淋巴结结核疗效分析及治疗模式的探讨. 中国防痨杂志, 2000, 22(2): 93-94. doi:10.3969/j.issn.1000-6621.2000.02.015. doi: 10.3969/j.issn.1000-6621.2000.02.015
[92]	Wei YF, Liaw YS, Ku SC, et al. Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis. J Formos Med Assoc, 2008, 107(3): 225-231. doi:10.1016/S0929-6646(08)60140-0. doi: 10.1016/S0929-6646(08)60140-0 URL
[93]	王霄, 文强, 岳健博, 等. GeneXpert Mtb/RIF、抗酸染色及培养在浅表淋巴结结核诊断中的比较研究. 遵义医学院学报, 2016, 39(3):275-278.
[94]	李世立, 唐柳生, 陈敬捷. 艾滋病患者淋巴结结核分枝杆菌培养及耐药情况分析. 国际检验医学杂志, 2015, 36(2): 223-224. doi:10.3969/j.issn.1673-4130.2015.02.035. doi: 10.3969/j.issn.1673-4130.2015.02.035
[95]	潘丽萍, 张宗德. 耐药结核病诊治进展. 北京医学, 2021, 43(9): 844-846. doi:10.15932/j.0253-9713.2021.09.002. doi: 10.15932/j.0253-9713.2021.09.002
[96]	牛建明, 谭艳辉, 张丹, 等. 异烟肼、链霉素联合康复新治疗浅表淋巴结结核疗效观察. 现代中西医结合杂志, 2016, 25(36):4064-4066. doi:10.3969/j.issn.1008-8849.2016.36.026. doi: 10.3969/j.issn.1008-8849.2016.36.026
[97]	张旭, 唐薇, 李军, 等. 超声造影引导下局部药物注射治疗颈部淋巴结结核的应用价值. 中国乡村医药, 2021, 20(20): 22-23. doi:10.3969/j.issn.1006-5180.2021.20.014. doi: 10.3969/j.issn.1006-5180.2021.20.014
[98]	李清民. 利福平注射液治疗32例破溃的颈部浅表淋巴结结核观察. 临床肺科杂志, 2012, 17(6): 1135. doi:10.3969/j.issn.1009-6663.2012.06.088. doi: 10.3969/j.issn.1009-6663.2012.06.088
[99]	黄璐, 陈玲, 兰远波, 等. 超声电导药物透入治疗颈部淋巴结结核疗效与疗程观察. 贵州医药, 2016, 40(6): 635-636. doi:10.3969/j.issn.1000-744X.2016.06.033. doi: 10.3969/j.issn.1000-744X.2016.06.033
[100]	孙翠萍, 钮晓红, 陈真征. 超声电导中药透入辅助治疗颈淋巴结结核的疗效观察. 实用临床医药杂志, 2011, 15(14):61-62. doi:10.3969/j.issn.1672-2353.2011.14.026. doi: 10.3969/j.issn.1672-2353.2011.14.026
[101]	中华医学会. 临床诊疗指南:外科学分册. 北京: 人民卫生出版社, 2006.
[102]	中华医学会. 临床诊疗指南:结核病分册. 北京: 人民卫生出版社, 2005.
[103]	王直, 刘锦程, 李军孝, 等. 173例颈部淋巴结结核外科治疗效果的相关因素分析. 中国防痨杂志, 2016, 38(7):559-563. doi:10.3969/j.issn.1000-6621.2016.07.009. doi: 10.3969/j.issn.1000-6621.2016.07.009
[104]	汤中文, 倪正义. 浅表淋巴结结核病灶清除术合并淋巴漏66例的原因及处理. 实用临床医学, 2010, 11(2):42-43, 46. doi:10.3969/j.issn.1009-8194.2010.02.017. doi: 10.3969/j.issn.1009-8194.2010.02.017
[105]	蒋钰辉, 房明浩, 戴希勇, 等. 淋巴结清扫术治疗318例颈淋巴结结核的临床分析. 武汉大学学报(医学版), 2021, 42(6): 975-979. doi:10.14188/j.1671-8852.2020.0579. doi: 10.14188/j.1671-8852.2020.0579
[106]	朱珠, 施怡, 钮晓红, 等. 泽及流浸膏纳米材料干预结核性创面的临床研究——附31例临床资料. 江苏中医药, 2021, 53(3): 30-33. doi:10.19844/j.cnki.1672-397X.2021.03.012. doi: 10.19844/j.cnki.1672-397X.2021.03.012
[107]	钮晓红, 卞勇, 蒋宝平, 等, 泽及流浸膏外用安全性实验研究. 江苏中医药, 2016, 48(11):75-78.
[108]	黄金鹏, 胡国强, 傅根莲, 等. 散结软膏外涂联合抗结核化疗治疗结节型颈部淋巴结核疗效观察. 浙江中西医结合杂志, 2019, 29(9): 761-763. doi:10.3969/j.issn.1005-4561.2019.09.023. doi: 10.3969/j.issn.1005-4561.2019.09.023
[109]	朱江春, 付义, 张乐, 等. 滇重楼散外敷联合抗结核药治疗浅表淋巴结结核的近期疗效. 昆明医科大学学报, 2018, 39(1):81-84. doi:10.3969/j.issn.1003-4706.2018.01.019. doi: 10.3969/j.issn.1003-4706.2018.01.019
[110]	俞珊, 王涛, 段浩凯, 等. 外用西黄攻坚方辅助治疗颈部淋巴结结核的疗效观察. 实用临床医药杂志, 2022, 26(15): 109-113. doi:10.7619/jcmp.20214936. doi: 10.7619/jcmp.20214936
[111]	高敏行, 黄子慧, 朱思洵, 等. 泄毒生新外治法治疗溃疡型淋巴结结核的临床疗效观察. 现代中医临床, 2021, 28(5): 28-33. doi:10.3969/j.issn.2095-6606.2021.05.007. doi: 10.3969/j.issn.2095-6606.2021.05.007
[112]	邢刚. 针刺为主治疗慢性颈淋巴结肿大37例. 上海针灸杂志, 2013, 32(6): 519. doi:10.3969/j.issn.1005-0957.2013.06.519. doi: 10.3969/j.issn.1005-0957.2013.06.519
[113]	袁志明, 徐清波. 艾灸治疗瘰疬65例. 中国针灸, 2004, 24(9): 623.
[114]	郝建玲, 苏海涛, 纪力. 隔蒜灸联合西药治疗结节型颈部淋巴结结核疗效观察. 上海针灸杂志, 2019, 38(1): 86-88. doi:10.13460/j.issn.1005-0957.2019.01.0086. doi: 10.13460/j.issn.1005-0957.2019.01.0086
[115]	周峰, 温志华, 简丽萍. 微卡辅助治疗浅表淋巴结结核的临床观察. 临床肺科杂志, 2005, 10(4): 539-540. doi:10.3969/j.issn.1009-6663.2005.04.074. doi: 10.3969/j.issn.1009-6663.2005.04.074
[116]	周卫民, 李霞. 耳鼻咽喉及颈淋巴结结核临床分析. 深圳中西医结合杂志, 2018, 28(19): 154-155. doi:10.16458/j.cnki.1007-0893.2018.19.075. doi: 10.16458/j.cnki.1007-0893.2018.19.075

证据级别	具体描述	研究类型	表达字母
高级证据	非常确信真实的效应值接近效应估计,未来研究几乎不可能改变现有评价结果的可信度	随机对照试验;质量升高二级的观察性研究	A
中级证据	对效应估计值我们有中等程度的信心:真实值有可能接近估计值,但仍存在二者大小相同的可能性;未来研究可能对现有评估有重要影响,可能改变评价结果的可信度	质量降低一级的随机对照试验;质量升高一级的观察性研究	B
低级证据	我们对效应估计值的确信程度有限:真实值可能与估计值大不相同;未来研究很有可能对现有评估有重要影响,改变评估结果可信度的可能性较大	质量降低二级的随机对照试验;观察性研究	C
极低级证据	我们对效应估计值几乎没有信心:真实值很可能与估计值大不相同;任何评估都很不确定	质量降低三级的随机对照试验;质量降低一级的观察性研究;系列病例观察;个案报道	D

证据质量	推荐强度	具体描述	表达数字
高级证据	支持使用某项干预措施的强推荐	评价者确信干预措施利大于弊	1
中级证据	支持使用某项干预措施的弱推荐	利弊不确定或无论高低质量的证据均显示利弊相当	2
低级证据	反对使用某项干预措施的弱推荐		2
极低级证据	反对使用某项干预措施的强推荐	评价者确信干预措施弊大于利	1