对比乳腺结核与非乳腺结核患者的实验室检查数据，探讨乳腺结核的最佳诊断方法。

收集2014年12月至2019年3月武汉市肺科医院收治的147例疑似乳腺结核患者的临床资料进行回顾性分析。根据最终病理诊断，分为乳腺结核组(48例)及非乳腺结核组(99例)。比较2组患者的基线资料及实验室检查数据。年龄为正态分布的定量资料，以±s表示，2组比较采用t检验。红细胞沉降率(ESR)、超敏C反应蛋白(hCRP)为偏态分布的定量资料，以M(P₂₅~P₇₅)表示，采用Wilcoxon符号秩检验进行组间比较。病灶位置、结核菌素实验(PPD)、T细胞斑点试验(T-SPOT)、结核抗体(TB-Ab)、结核菌脱氧核糖核酸(TB-DNA)、结核菌核糖核酸(TB-RNA)、利福平耐药实时荧光定量核酸扩增检测(X-pert MTB/RIF)、结核涂片(STB)、结核菌培养(CTB)结果等定性资料以例数(%)表示，采用配对χ²检验进行组间比较。在乳腺结核患者中，采用Kappa一致性检验分析各种结核诊断方法检测结果之间的一致性。

乳腺结核与非乳腺结核患者在年龄、性别及病灶分布方面比较，差异无统计学意义(t＝ 0.427，P＝0.567; P＝1.000; χ²＝0.844, P＝0.933)。乳腺结核组及非乳腺结核组外周血中ESR及hCRP比较，差异无统计学意义[13.5(11.0~30.7)mm/h比13.0(10.0~25.0)mm/h，Z＝1.945，P＝0.163；8.5(5.0~20.7)mg/L比9.0(6.0~22.0)mg/L，Z＝0.480，P＝0.488), 3种结核相关无创检查(PPD、T-SPOT、TB-Ab)结果比较，差异无统计学意义(P＝1.000、0.664、0.272)，而5种病原学检测方法(X-pertMTB/RIF、TB-DNA、TB-RNA、CTB及STB)结果比较，差异有统计学意义(P＝0.031，0.016，<0.001，<0.001，<0.001)。在48例乳腺结核患者中，TB-Ab与T-SPOT的检测结果之间一致性较差(Kappa＝-0.339，P<0.001)；TB-RNA、CTB及STB与X-pert MTB/RIF的检测结果之间一致性较差(Kappa＝-0.200，P＝0.005; Kappa＝-0.152，P＝0.012; Kappa＝-0.159，P＝0.003)。肉芽肿性病变伴干酪样坏死是乳腺结核特征性病理改变。

临床上通过ESR、hCRP水平鉴别乳腺结核较为困难，推荐组织病理学及病原学检查共同鉴别诊断乳腺结核。

To compare the laboratory data of patients with breast tuberculosis and non-tuberculosis diseases, and explore the optimal diagnostic method for breast tuberculosis.

The clinical data of 147 patients with suspected breast tuberculosis in the Wuhan Pulmonary Hospital from December 2014 to March 2019 were collected for a retrospective analysis. According to the final pathological diagnosis, there were 48 cases of breast tuberculosis (tuberculosis group) and 99 cases of other breast diseases (non-tuberculosis group). The baseline data and laboratory data were compared between two groups. The quantitative data of normal distribution (age) were expressed as ±s, and compared by t test. The quantitative data of skewed distribution [erythrocyte sedimentation rate(ESR)and hypersensitive C-reactive protein(hCRP)] were expressed as M (P₂₅-P₇₅) and compared by Wilcoxon signed rank test. Count data [lesion position, results of purified protein derivative(PPD), T cell spot detection(T-SPOT), tuberculosis antibody(TB-Ab), tuberculosis deoxyribonucleic acid (TB-DNA), tuberculosis ribonucleic acid (TB-RNA), gene X-pert multidrug-resistant tuberculosis/rifampicin (X-pert MTB/RIF), smear of tubercle bacillus (STB), culture of tubercle bacillus (CTB)] were expressed as cases (%) and compared with paired χ² test between two groups. In breast tuberculosis patients, the Kappa test was used to analyze the consistency between the results of different diagnostic methods.

There was no significant difference between tuberculosis group and non-tuberculosis group in age, gender and lesion position (t=0.427, P=0.567; P=1.000; χ²=0.844; P=0.933). No significant difference was observed in ESR and hCRP levels in peripheral blood between tuberculosis group and non-tuberculosis group [13.5 (11.0-30.7) mm/h vs 13.0 (10.0-25.0) mm/h, Z=1.945, P=0.163; 8.5 (5.0-20.7) mg/L vs 9.0 (6.0~22.0) mg/L, Z=0.480, P=0.488). The results of three non-invasive examinations (PPD, T-SPOT and TB-Ab) presented no significant difference between two groups (P=1.000, 0.664, 0.272), while the results of five etiological methods (X-pertMTB/RIF, TB-DNA, TB-RNA, CTB and STB) showed a significant difference (P=0.031, 0.016, <0.001, <0.001, <0.001). In breast tuberculosis patients, the result of TB-Ab showed a poor consistency with that of T-SPOT (Kappa=-0.339, P<0.001); the results of TB-RNA, CTB and STB showed a poor consistency with those of X-pert MTB/RIF (Kappa=-0.200, P=0.005; Kappa=-0.152, P=0.012; Kappa=-0.159, P=0.003). The specific pathological changes in breast tuberculosis were granulomatous lesions and caseous necrosis.

It is difficult to distinguish breast tuberculosis from other diseases by ESR and hCRP. Clinically, the combination of etiological and histopathologic examinations is recommended for differential diagnosis of breast tuberculosis.