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Abstract：
Background: Tuberculosis (TB) and sarcoidosis are two common granulomatous diseases involving lymph nodes. Differential diagnosis is not always easy because pathogen demonstration in tuberculosis is not always possible and both diseases share clinical, radiological and histological patterns. The aim of our study was to identify factors associated with each diagnosis and set up a predictive score for TB. Methods: All cases of lymph node tuberculosis and sarcoidosis were retrospectively reviewed. Demographics, clinical characteristics, laboratory and imaging data, and microbiological and histological results were collected and compared. Results: Among 441 patients screened, 192 patients were included in the final analysis. The multivariate analysis showed that weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia were significantly associated with TB. A risk score of TB was built based on these variables and was able to discriminate TB versus sarcoidosis with an AUC of 0.85 (95% CI: 0.79-0.91). Using the Youden\'s J statistic, its most discriminant value (-0.36) was associated with a sensitivity of 80% and a specificity of 75%. Conclusions: We developed a score based on weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia with an excellent capacity to discriminate TB versus sarcoidosis. This score needs still to be validated in a multicentric prospective study.
摘要：
背景：结核（TB）和结节病是两种常见的肉芽肿性疾病，累及淋巴结。鉴别诊断并不总是容易的，因为结核病中的病原体显示并不总是可能的，并且两种疾病在临床上都具有相同的意义。放射学和组织学模式。我们研究的目的是确定与每种诊断相关的因素，并建立结核病的预测评分。方法：回顾性分析所有淋巴结结核和结节病的病例。人口统计,临床特征,实验室和成像数据，收集并比较微生物学和组织学结果。结果：在接受筛查的441例患者中，最终分析包括192例患者。多变量分析表明，体重减轻，坏死性肉芽肿,正常血清溶菌酶水平和高丙种球蛋白血症与TB显著相关。基于这些变量建立TB的风险评分,并且能够区分TB与结节病,AUC为0.85(95%CI:0.79-0.91)。使用尤登的J统计量，其最大判别值(-0.36)与80%的敏感性和75%的特异性相关.结论：我们制定了基于体重减轻的评分，坏死性肉芽肿,正常的血清溶菌酶水平和高丙种球蛋白血症，具有出色的区分结核病和结节病的能力。这一分数仍需在多中心前瞻性研究中得到验证。
