AIDS合并结核病50例分析

目的提高对AIDS合并结核病的认识.方法对1995-2002年在本院就诊的50例AIDS合并结核病进行回顾性分析.结果①分型:原发性肺结核2例,血行播散性肺结核6例,继发性肺结核20例,结核性胸膜炎12例,其他肺外结核10例(其中淋巴结结核8例);②T细胞亚群:50例结核病发病时CD4 细胞计数为5～370/μl,平均CD4 为107±106/μl,其中22例原发性肺结核和继发性肺结核,平均CD4 155±127/μl.28例血行播散性肺结核、结核性胸膜炎和肺外结核平均CD4 为64±60/μl,与单纯的原发性肺结核和继发性肺结核相比,差异具有显著性(P=0.013);③治疗:22例同时接受联合抗病毒治疗和抗痨治疗,胸片完全吸收为3～9个月,时间为4.5±3.5个月.CD4 T淋巴细胞由基线水平上升到200/μl约需要4～26个月,时间为12.5±8.6个月.结论AIDS合并结核病以肺外结核和血行播散性肺结核多见,CD4 T淋巴细胞越低,结核病临床表现越不典型.联合抗病毒治疗和抗结核病治疗能显著改善患者的预后,但需多联合,长疗程.     

血行播散性肺结核362例临床分析

目的分析血行播散性肺结核临床特点。方法回顾分析鞍山市千山医院1998—2007年住院患者362例血行播散性肺结核患者临床特点、治疗、预后等。结果以青壮年为多,占62.0％,老年患者有上升趋势,占21.0％。临床症状发热占86.1％,呼吸道症状以咳嗽、乏力、气促、盗汗、胸痛等症状居多,伴有结脑者有头痛、恶心、呕吐等。临床确诊时间：30d以内占50.3％,少数病人至4个月以上确诊。痰菌阳性率37.8％。PPD试验阳性反应58.6％,血清抗结核抗体阳性44.8％。急性血行播散性肺结核68.5％,亚急性和慢性血行播散性肺结核31.5％。胸部X线典型粟粒性肺结核阴影占68.5％,并发肺外结核占40.0％。非结核并发症占68.2％。经联合抗结核治疗同时治疗并发症。除结脑脑疝死亡2例外,余者均好转。结论血行播散性肺结核症状严重,常合并其他脏器结核病,必须给予高效、敏感抗结核药治疗,并对肺外结核病、并发症亦予以积极治疗,并辅以营养与支持疗法,能获得满意疗效。     

血行播散型肺结核48例临床分析

目的分析血型播散型肺结核临床特点，为预防和控制血行播散型肺结核提供参考依据。方法回顾分析我院2001年1月～2006年12月收治的48例血行播散型肺结核病人的发病年龄，临床特征、治疗及预后。结果血行播散型结核发病以青壮年人群为主；发病人群集中为住校中学生、农村贫困人口和外出务工人员；发热是本病最突出表现，反复进行肺部X线和／或CT检查有利于早期诊断；合理抗结核化疗与综合治疗相结合，是治疗的关键。结论加强对农村贫困人口、住校中学生、外出务工人员结核病防治知识宣传，改善其生活条件，将有利于控制血行播散型肺结核的发生；加强对综合医院医务人员结核病防治知识培训，血行播散型肺结核治愈率会大大提高。     

艾滋病合并结核病的临床分析

目的　探讨艾滋病合并结核病的临床特点。方法 对1998年至2002年11例艾滋病合并结核病进行临床分析。结果 (1)艾滋病感染途径:输血感染者8例,其他途径各1例。(2)合并肺结核病6例,其中继发性肺结核3例,原发性肺结核1例,血行播散性肺结核2例;合并肺外结核5例,其中结核性心包积液、结核性脑膜炎各2例,胸腔积液1例;合并多重感染者5例。(3)11例1:2000PPD试验均为阴性。(4)治疗:7例抗病毒与抗结核联合治疗,临床表现明显改善;3例仅抗结核治疗者中1例有效、2例死亡;1例未经任何治疗,6月死亡。结论 艾滋病合并结核病临床表现多样,血行播散性肺结核多,肺外结核多,多重感染多见,抗病毒与抗结核联合治疗有效。     

艾滋病合并结核病的临床分析

目的 探讨艾滋病合并结核病的临床特点。方法 对1998年至2002年ll例艾滋病合并结核病进行临床分析。结果 (1)艾滋病感染途径：输血感染者8例，其他途径各1例。(2)合并肺结核病6例，其中继发性肺结核3例，原发性肺结核1例，血行播散性肺结核2例；合并肺外结核5例，其中结核性心包积液、结核性脑膜炎各2例，胸腔积液1例；合并多重感染者5例。(3)11例1：2000PPD试验均为阴性。(4)治疗：7例抗病毒与抗结核联合治疗，临床表现明显改善；3例仅抗结核治疗者中1例有效、2例死亡；1例未经任何治疗，6月死亡。结论 艾滋病合并结核病临床表现多样，血行播散性肺结核多，肺外结核多，多重感染多见，抗病毒与抗结核联合治疗有效。     

肺外结核病诊治进展

概述肺外结核病(Extra-pulmonary)是指结核分枝杆菌感染了肺部以外的脏器而引起的临床结核病，约占全部结核病人总数的10～30％。我国结核病分类卫生行业标准(WS196-2001)将结核病分为五种类型，即原发性肺结核(含胸内淋巴结结核)、血行播散性肺结核、继发性肺结核、结核性胸膜炎以及其他肺外结核病。“其他肺外结核病”按部位及脏器命名，如：     

胚胎移植妊娠期血行播散型肺结核2例

体外受精和胚胎移植技术（in vitro fertilizationembryo transfer，IVF—ET）是使不孕症患者获得妊娠的重要措施。但是，IVF-ET过程和妊娠也使并发血型播散型肺结核的机率增加。妊娠合并血行播散型肺结核起病较急，病情重，危害大，涉及两代人的健康及生命，而妊娠及分娩是育龄妇女发生血行播散型肺结核的重要诱因[1]。2009年至2010年，我院发现2例胚胎移植妊娠期血行播散型肺结核，     

妊娠期合并肺结核诊治时机与产妇预后的关系

目的　探讨妊娠期合并肺结核诊治时机与产妇预后的相关性。方法 对明确诊断的妊娠期合并肺结核患者48例进行回顾性分析,按诊治时机分为两组,产前诊治组21例和产后诊治组27例,分别统计产妇预后情况。结果 产后诊治组血行播散型肺结核发生率55.6% (15/27),合并结核性脑膜炎的发生率44.4% (12/27),均显著高于产前诊治组的9.5% (2/21)和0 (0/21),P均为＜0.005;产后诊治组死亡率18.5% (5/27),显著高于产前诊治组的0(0/21),P＜0.05。结论 妊娠期合并肺结核,产前诊治可减少产妇重症结核的发生率和死亡率。     

艾滋病合并结核病的诊断与治疗

目的 探讨艾滋病合并结核病的临床特点和治疗方法 .方法 对1995～2000年期间在本院诊断的10例艾滋病合并结核病的患者进行分析.结果 (1)临床分型血行播散型肺结核合并结核性脑膜炎3例,淋巴结结核4例(其中肠系膜淋巴结结核1例、纵隔淋巴结结核+颈部淋巴结结核1例、颈部淋巴结结核2例),原发型肺结核3例,同时合并其它机会性感染如卡氏肺孢子虫肺炎(PCP)等.(2)免疫功能检测和结核菌素试验CD+4(2～87)×106/L,其中7例CD+4＜50×106/L,平均CD-4(33±13)×106/L.10例结核菌素(PPD)试验均阴性.(3)治疗5例联合抗结核+高效抗逆转录病毒治疗(HLAART),5例单用抗结核治疗,其中HAART组CD+4细胞上升明显,与单独抗结核治疗相比,差异有显著性(P＜0.05).结论 CD+4细胞下降可能是艾滋病并发结核病的主要原因.结核菌素试验对诊断无帮助.艾滋病合并结核病的患者,血行播散型肺结核多、肺外结核多、合并症多、临床表现复杂多样、治疗时间长.联合高效抗逆转录病毒治疗能缩短病程,改善艾滋病合并结核病的预后.     

系统性红斑狼疮伴结核分枝杆菌感染42例临床分析

目的 探讨系统性红斑狼疮(SEE)患者伴结核分枝杆菌感染的临床特点.方法 回顾性分析452例SLE患者在应用糖皮质激素和免疫抑制剂治疗过程中出现结核分枝杆菌感染的临床资料.结果 452例SLE患者中42例(9.29%)在住院期间被确诊为活动性结核,单纯浸润犁肺结核11例(26.19%);肺外结核31例(73.81%),其中有10例(23.81%)未找到结核感染病灶,8例(19.05%)血行播散型肺结核,6例(14.29%)结核性脑膜炎,2例(4.76%)胸腔结核,2例(4.76%)腹腔结核,1例(2.38%)淋巴结核,1例(2.38%)骨结核,1例(2.38%)肾结核.42例结核感染患者有狼疮肾炎38例,血清白蛋白低40例,有结核病史10例,白细胞低14例,血糖升高14例.抗结核治疗起效时间一般在1周以上,最长可达4周.死亡2例,均为血行播散型结核.结论 应用糖皮质激素及免疫抑制剂治疗SLE的过程中,结核分枝杆菌感染的发病率明显升高,以重症结核和肺外结核为多.既往有结核病史、狼疮肾炎等SLE患者,町能易感染结核分枝杆菌.     

体外受精和胚胎移植后妊娠合并急性粟粒性肺结核的临床特点

目的总结体外受精和胚胎移植（IVF-ET）后妊娠发生急性粟粒性肺结核的临床特点。方法回顾性分析2001年1月至2005年12月在浙江大学医学院附属妇产科医院生殖中心接受IVF-ET后妊娠并发粟粒性肺结核的6例临床资料。结果IVF-ET后妊娠并发粟粒性肺结核患者的临床表现多不典型，以发热为主要表现，呼吸道症状隐匿。胸部影像学表现以粟粒性结节和浸润性改变为主。平均于移植后53．2d发病，1例人工流产终止妊娠，其余5例均在发病后2～4周内发生自然流产。结论发热为急性粟粒性肺结核的主要临床表现，IVF-ET后妊娠发生粟粒性肺结核的妊娠结局差，对抗炎治疗无效的发热患者应警惕肺结核，尽早行结核病的相关检查。     

15例妊娠并发结核病孕产妇的临床分析

收集重庆市公共卫生医疗救治中心结核科2017年1月1日至2019年9月30日期间收治的15例妊娠并发结核病孕产妇的临床资料,对其临床表现、就诊延迟情况、影像学表现、免疫应答状况、治疗效果、胎儿结局等进行总结。(1)临床表现:患者以发热、乏力和咳嗽为主,结核性脑膜炎患者以头痛为主要临床表现。(2)就诊延迟情况:12例患者存在不同程度就诊延迟,最短延迟时间20d,最长延迟时间252d,中位就诊延迟时间为78d。(3)影像学表现:胸部CT扫描4例患者可见双肺多叶段斑片状渗出影或空洞影,12例见双肺弥漫性粟粒、小结节状影,10例并发单侧或双侧胸腔积液或胸膜增厚。11例并发结核性脑膜炎患者行头颅MRI,显示脑实质结节、斑片状病灶9例,脑膜增厚8例,脑组织水肿2例,脊髓膜增厚1例。(4)免疫应答:10例CD4 ⁺ T淋巴细胞计数降低,9例CD8 ⁺ T淋巴细胞计数降低,11例CD4 ⁺/CD8 ⁺比值下降。(5)治疗效果:14例患者经抗结核药物治疗后病情好转,1例因重症结核性脑膜炎住院时间延长。(6)胎儿结局:自然受孕胎儿10例,流产1例,死产1例,分娩8例(死于结核性脑膜炎患儿2例,健康胎儿6名);辅助生殖技术受孕胎儿7例,流产2例,分娩5例(健康胎儿3例,死于结核性脑膜炎患儿2例)。综上所述,妊娠并发结核病孕产妇免疫应答低下,并发血行播散性肺结核多见;结核分枝杆菌易经血液播散引起肺外结核,以结核性脑膜炎常见。妊娠并发结核病孕产妇就诊延迟现象严重,及时规范的治疗可使孕产妇和胎儿获益。     

A study on low performance status cases of pulmonary tuberculosis in the elderly

The subjects consisted of 42 patients aged over 60 years, whose performance status (PS) was grade 3 or 4, and who had been admitted for pulmonary tuberculosis at National Chiba-Higashi Hospital between 1997 and 1998. The average age (+/- SD) of the 34 men and 8 women was 77.6 (+/- 8.5) years (range, 60-91 years). The mean stay in the hospital of the improved patients was 166.6 days (range, 57-303 days), and the mean survival period from admission to death was 43.4 days (range, 2-179 days in died patients). On admission to our hospital, 26 cases were sputum smear positive, 8 cases were smear negative and culture positive, and 8 were negative both on smear and culture. The cavity was observed in 30 cases (71.4%) on the chest X-ray. The laboratory data on admission revealed low nutritional condition. The mean serum total protein, albumin, and cholesterol level on admission were 6.2 (+/- 0.82) g/dl, 2.7 (+/- 0.62) g/dl, and 143.0 (+/- 41.9) mg/dl. Most of the patients had a difficulty in taking foods, and 20 cases (47.6%) were performed parenteral nutrition by central venous catheter. 23 cases (54.8%) received oxygen therapy by facial mask or nasal tube. The most common cause of low PS on admission was pulmonary tuberculosis in 14 cases (33.3%), followed by cerebrovascular diseases in 11 cases, and orthopedic disease in 8 cases. The proportion of patients whose cause of low PS was not due to lung tuberculosis increased with age. Observing the mortality by the route of administration of antituberculosis medications on admission, 19 (55.9%) of 34 cases who could take drugs per oral route died. One (50.0%) of 2 cases who were administered drugs through gastric tube died, and all (100.0%) of 5 cases who could not take drugs per oral route and were injected isoniazid and streptomycin died. One case who could not administer any drug died. 16 cases improved and 26 cases died, of whom the most common cause of death was pulmonary tuberculosis in 11 cases (42.3%), followed by bacterial pneumonia in 5 cases, and cerebrovascular disease in 3 cases. The mortality by the PS on admission were as follows: 10 (47.6%) of 21 cases with PS 3 died. 16 (76.2%) of 21 cases with PS 4 died. 16 (6.4%) of 249 cases aged over 60 years with PS 0, 1 or 2, and were admitted for pulmonary tuberculosis at the same hospital during the same period died. This study confirms that the prognosis of low performance status patients of pulmonary tuberculosis in the elderly was significantly poor. We have to detect tuberculosis patients in the early stage, and give them antituberculosis medications per oral route as far as possible.     

The causes of death in patients with non-MDR pulmonary tuberculosis in our hospital

We studied the causes of death in 295 patients (mean (+/- SD) age 70.5 +/- 13.2 y.o.) with active non-MDR pulmonary tuberculosis who died in our hospital between 1991 and 1999. A hundred and twenty eight patients (43.4%, group A) died of tuberculosis, while 167 patients (56.6%) of other accompanying diseases. In 46 patients of the latter (15.6%, group B), pulmonary tuberculosis gave an unfavorable impact on their clinical course. In these patients the extent of pulmonary tuberculosis on chest roentgenograph was similar with the remaining 121 patients who also died of the accompanying diseases (41.0%, group C) and was less severe than those of the group A patients. Their nutritional conditions measured by serum albumin and choline-esterase level on admission, however, were as low as those of the group A patients and distinctly worse than those of the group C patients. Most patients of groups A and B died within 3 months after admission, while less than half patients of group C died during the same period. The age frequency distribution of the patients in groups B and C had a single peak in the age group 70 to 89, while that in group A showed two peaks, one similar peak as in groups B and C, and another peak in the age group 50 to 59. The numbers of homeless patients, of the patients with extensive cavitary lesions, and of the patients who died of ARDS (Adult Respiratory Distress Syndrome) or severe pneumothorax in group A were the most also in the age group 50 to 59, indicating that the patients' delay in admitting to hospitals was the major cause of high motality in this age group. As to detailed causes of death in group A, patients died of respiratory failure (32 cases), emaciation (28 cases), progression of pulmonary tuberculosis (20 cases), ARDS (15 cases), tuberculosis-related diseases such as pneumothorax, hemoptysis, and DIC (24 cases). In groups B and C patients died of organ failure (36 cases), infectious diseases (33 cases) and malignancy (30 cases). The total number of died patients has increased, and the proportion of cases dying of ARDS and infectious diseases has increased statistically significantly recently.     

妊娠合并肺动脉高压149例临床分析

目的：分析综合外科ICU（SICU）收治的妊娠合并肺动脉高压（pulmonary arterial hypertension,PAH）行终止妊娠手术患者的临床特征,为临床处理提供参考。方法：回顾性分析安贞医院SICU从2004年5月至2012年12月收治的妊娠合并PAH行终止妊娠手术的患者临床资料,包括孕龄、NYHA心功能分级、心脏并发症、产科并发症、肺动脉高压危象（pulmonary hypertensive crisis,PHC）发病率及治疗结局。结果：共收集资料完整的149例PAH孕产妇临床资料,将PAH分为轻度肺动脉收缩压（sPAP40～49 mmHg,1 mmHg=0.133 kPa）、中度（sPAP 50～74 mmHg）和重度（sPAP≥75 mmHg）。其中,轻度组30例、中度组33例和重度组86例。9例患者死亡,病死率6.0%,均为重度PAH患者。与轻、中度PAH组相比较,重度PAH组患者妊娠平均年龄、孕龄差异有统计学意义（P〈0.05）、NYHA心功能分级重、ICU停留时间长;随着孕龄增加,重度PAH患者比例降低;重度PAH组患者围术期心脏并发症（急性心力衰竭、围术期NYHA分级,较妊娠前NYHA分级下降幅度≥2级和心源性死亡）发病率升高,差异有统计学意义（P〈0.05）;16例患者并发PHC,发病率为10.7%;产科并发症发生（妊娠期高血压综合征和产后出血）与PAH程度无相关性。结论：妊娠合并PAH患者终止妊娠手术围术期各种并发症发生率较高,重度PAH显著影响患者结局。提示加强重度PAH孕产妇围术期ICU处理质量,可有利于改善妊娠合并PAH患者的治疗结局。     

老年肺结核87例临床分析

目的了解老年肺结核发生发展机制,观察老年肺结核的临床特点、诊断经过及治疗效果。方法通过对87例老年肺结核的临床表现、分型、实验室检查、误诊情况、合并症及并发症,分析老年肺结核诊治过程。结果本组87例中初治者66例,复治者21例;初治者66例中52例（78．8％）肺结核症状明显好转。全组87例中死亡者14例（16．1％）,其中2例死亡于结核中毒症状重,2例死亡于大咯血休克,3例死亡于呼吸衰竭,7例因合并肺癌而死亡。结论老年肺结核的临床表现不典型,容易漏诊和误诊,且并发症多,病程迁延,复治病例多,药物治疗效果差,临床应加重视。     

11例妊娠或产褥期重症结核病患者的临床治疗效果分析

目的 探讨妊娠或产褥期重症结核病的临床特点和治疗结局。 方法 回顾性分析2017年9月至2019年9月长沙市中心医院(长沙市肺科医院)结核重症科收治的11例妊娠或产褥期重症结核病患者,其中妊娠期患者9例,产褥期患者2例,总结其临床特征及母婴治疗转归。 结果 早期妊娠患者共2例,均于适当时间终止妊娠;中期妊娠患者共4例,1例继续妊娠并足月分娩,1例于适当时间终止妊娠,1例在治疗过程中流产,1例病情进展迅速,孕妇与胎儿均死亡;晚期妊娠患者共3例,1例坚持妊娠并足月分娩,2例坚持妊娠并早产;成功分娩的6例患者(包括入院前分娩2例,入院后分娩4例)均与新生儿隔离治疗。11例患者均予以积极的抗结核药物及相应的辅助支持治疗,其中10例好转并出院,1例死亡;11例患者共成功分娩6名新生儿,其中足月分娩2名,早产4名,新生儿均无结核感染表现,均未行母乳喂养。 结论 妊娠或产褥期重症结核病对母婴健康危害极大,加强对该病临床特点的认识,采取合理的治疗方案,可获得较为理想的治疗效果。     

Active pulmonary tuberculosis in patients with lung cancer

To clarify the features of the coexistence of active pulmonary tuberculosis in patients with lung cancer, we analyzed clinical data on 25 cases with coexisting lung cancer and active pulmonary tuberculosis encountered at Tokyo National Chest Hospital during the period from 1991 to 1998. There were 23 men and 2 women, with a mean age of 70 years. The incidence of lung cancer among patients with active pulmonary tuberculosis at our hospital was 0.7 per cent, while the incidence of active pulmonary tuberculosis in untreated lung cancer patients at our hospital was 1.9 per cent. We classified the 25 cases into 2 groups as follows: (1) tuberculosis sequential to lung cancer (11 cases) and (2) tuberculosis concurrently detected with lung cancer (14 cases). All patients in the former group were transferred from other hospitals after diagnosing the coexistence of pulmonary tuberculosis during the management of lung cancer. Histological types of lung cancer were squamous cell carcinoma in 12, adenocarcinoma in 9, and small cell carcinoma in 4, and as to the disease stage, stages III to IV were predominant. Analysis on relationship of chest X-ray findings between lung cancer and pulmonary tuberculosis revealed that in general, the location of lung cancer and tuberculosis seemed to be independent. Tuberculosis in the sequential group was more extensive and severer than in the concurrent group. In the concurrent group, treatment for tuberculosis was successful except for one case, and coexisting tuberculosis did not seem to affect the course of lung cancer among this group. However, in the sequential group, 5 patients died within 3 months, 2 of them died of tuberculosis. We consider that in the management of lung cancer, physicians should consider the possibility of coexistent active pulmonary tuberculosis and should not make delay in the diagnosis of active pulmonary tuberculosis.     

妊娠合并心脏病伴肺动脉高压患者妊娠结局分析

目的:探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局。方法:2005年6月至2010年6月我院收治44例妊娠合并心脏病伴肺动脉高压患者,根据肺动脉压力分为轻度组20例,中度组7例,重度组17例,分析各组心功能级别、终止妊娠方式及母儿结局。结果:①轻度组心功能Ⅰ～Ⅱ级15例,中度组心功能Ⅲ～Ⅳ级5例,重度组心功能Ⅲ～Ⅳ级15例。②轻度组足月产11例,新生儿平均体质量(2 929±575)g,早产5例;中度组足月产1例,早产3例;重度组足月产2例,早产10例。2例极低体质量早产儿院外死亡。③28例以剖宫产终止妊娠。④孕产妇病死率为7%,医源性流产率为27%。结论:随着肺动脉压力升高,心功能Ⅲ～Ⅳ级的发生率随之增加,早产及小于胎龄儿发生率明显增加;剖宫产是适宜的分娩方式。     

妊娠合并急性胰腺炎的临床特征——附6例报道及文献复习

目的探讨妊娠合并急性胰腺炎AP的病因、临床特点、诊断、治疗及预后。方法将我院6例患者和文献检索的94例患者分为A、B两组,观察患者发病时的孕龄、孕周、诱因、病因、BMI、临床表现、生化指标、治疗结果及预后。结果两组中重症AP(SAP)41例,轻症AP(MAP)59例。其中79例孕中晚期发病,11例产后发病,临床上有不同程度腹痛、恶心、呕吐,部分患者症状不典型,血淀粉酶轻度升高或正常,33例血脂明显升高,48例发病与胆道疾病有关;A组BMI孕后较孕前上升16.90%;两组中29例剖腹探查,71例保守治疗,其中内镜治疗4例,31例孕妇顺产,其中1例为SAP;孕妇死亡率为9%,胎儿24%,孕妇胎儿均死亡6%,死亡原因多为并发MSOF。结论高脂血症、胆道疾病、孕后体重增长过快是发病的主要因素;重症多,死亡率高,妊娠中晚期发病率高,临床表现复杂,易误诊;内科保守治疗为主,适时终止妊娠,外科介入为基本治疗原则;控制体重、血脂和胆道疾病的发作,合理饮食,对预防本病具有重要意义。