结核菌素皮试阴性的菌阳肺结核34例临床分析

1994年1月～1998年12月间,我们共发现结核菌素皮试呈阴性而痰结核菌检查(涂片、培养)阳性的肺结核患者34例。现把有关资料总结如下。1　临床资料11　一般资料　该组病例34例,占同期菌阳肺结核患者的196%(34/173),均经临床表现、Ｘ线胸片及痰结核菌检查确诊为菌阳肺结核患者。在就诊时,均常规进行过结核菌素皮肤试验。34例患者中,男19例,女15例;年龄21～82岁,平均435岁;浸润型肺结核27例,血行播散型病变3例,慢性纤维空洞型4例。发病时间15天到1年半不等,平均在3个月以上。其中25例曾首诊于综合医院,22例进行过结核菌素皮试,因皮试阴性而排除…     

太原市某高校学生入学体检中PPD检查结果分析

1资料和方法 1．1资料2004年-2007年新生入校PPD试验结果。2004年-2007年在校学生结核病新登记资料。2007年2月对结核病发病较多的一座学生公寓楼采取了主动发现的方式。1．2方法主动发现病人的方法：①PPD试验：全部学生左前臂皮内注射PPD0．1ml，72h查验结果，测量局部皮肤硬结直径。记录结果=（横径＋竖径）／2（mm），硬结≥5mm为阳性，5mm≤硬结≤20mm为一般阳性，硬结≥20mm或有水疱、坏死、淋巴管炎为强阳性。②胸透，摄片，查痰：全部学生胸透，胸透有异常的摄x线片并查3次痰涂片（夜间痰、清晨痰、即时痰）找抗酸杆菌。③诊断标准：痰涂片镜检有阳性，x线胸片有活动性肺结核病变阴影者为涂阳病人；痰涂片镜检3次均为阴性，x线胸片有活动性肺结核病变阴影的为涂阴肺结核病人，由病案讨论会集体确诊。     

北京部队某部结核病患病情况调查分析

对北京部队某部１７０６人结核病患病情况进行了调查。结果表明，结核菌素试验阴性７４６人，阳性８８１人，感染率５４．１５％，城镇入伍官兵高于农村入伍官兵。共发现结核病患者４例，痰菌阳性１例，患病率２４６／１０万，痰涂片阳性患病率６１／１０万。本结果高于１９８２年北京部队及１９９０年北京地区流行病调查结果。提示：结核病仍是危害部队健康的疾病之一，应引起各级卫生部门的重视：（１）把好新兵入伍关，防止结核病患者进入部队；（２）新兵入伍后普查结核菌素试验，阴性者接种卡介苗；（３）加强因症就诊工作，做到早发现，早治疗；（４）痰阳性者应住院治疗；（５）加强健康教育，提高官兵自我防护意识。     

1100份痰标本结核杆菌涂片镜检与培养结果分析

结核病的细菌学检查是发现传染源的主要手段,是结核病诊断和疗效评价的可靠标准[1]。本文对1100份痰标本结核杆菌的涂片镜检法和培养法结果进行分析,探讨影响痰涂片和培养结果的各种因素,以期提高痰涂片和培养的阳性率。对象与方法1对象2008年来杭州市预防保健门诊部就诊的可疑肺结核患者的1100份痰菌培养登记的标本。2方法采用萋—尼氏抗酸染色法,按照《结核病诊断细菌学检验规程》步骤操作。结果1痰涂片镜检与培养结果1100份痰标本,直接涂片镜检阳性(涂阳)226份,占20·55%;其中初诊病例778份,初诊病例阳性195份,占25·06%。分枝杆菌培养阳性344份,占31·27%;其中初诊病例778份,初诊病例阳性282份,占36·25%;涂阳培阴32份,占4·10%;涂阴培阳150份,占19·30%。见表1。表1痰涂片镜检与培养结果(例)培养涂片阳性初诊复诊涂片阴性初诊复诊合计阳性179 15 103 47 344阴性16 16 480 244 756合计195 31 583 291 11002耐药试验共做药敏试验47例。涂阳培阳20例,其中耐多药5例,占25·0%;耐一药11例占55·0%。涂阴培阳27例,其中耐...     

肺结核防治攻略：熟知决定传染3原因

传染决定性原因之一：痰涂片检查排菌 结核病是呼吸道传染病．传染源是肺结核病人。但是．每个肺结核病人的传染性大小又有所不同。经过研究．证明痰涂片检查排菌（阳性）的肺结核病人对其接触者传染性最大．痰涂片检查不排菌（阴性）的肺结核病人对其接触者传染性很小。因此．痰涂片检查排茵的肺结核病人是结核病主要传染源．是结核病防治工作的重要对象。     

糖尿病并发肺结核病患者痰菌阳性相关因素分析

目的：探讨和分析糖尿病并发肺结核病痰涂片和培养检查阳性的相关因素。方法：收集并整理1991—2002年天津市结核病控制中心登记的糖尿病并发结核病患者的资料，分析痰涂片和培养检查阳性患者和阴性患者一般情况及病情特征的异同。结果：患者确诊年龄越大，痰菌阳性率越低；初治者菌阳率高，复治患者菌阳率低；随着空洞数的增加，检出痰菌阳性率增大；与Ⅲ Ⅴ型组相比，浸润型肺结核(Ⅲ型)和慢性纤维空洞型肺结核(Ⅳ型)患者痰菌阳性率增高，结核性胸膜炎(Ⅴ型)痰菌阴性率增加；患者有咳嗽、发热、咳痰等症状，痰菌阳性率增加。结论：糖尿病合并肺结核患者痰涂片或培养检查结果与确诊年龄、结核复发、空洞数、肺结核型别及结核症状等指标有统计学联系。     

影响肺结核痰菌涂片阳性检出率的有关因素调查报告

目的：调查肺结核病人痰液标本性状对痰涂片检查阳性率的影响因素,为提高痰检质量提供参考依据。方法：采用世界卫生组织（WHO）所推荐的标准Ziehl—Neelsen法。结果：干酪样痰336例,查痰菌阳性182例,阳性率为54．2％;血痰148例,查痰菌阳性47例,阳性率为31．8％;黏液痰3154例,查痰菌阳性889例,阳性率为28．2％;唾液1308例,查痰菌阳性30例,阳性率为2．3％;不同性状痰液的涂阳检出率有显著性差异（x^2=759．7,P〈0．005）。结论：痰涂片镜检是发现结核病传染源最主要的手段,痰涂片的质量是提高结核病检出率的关键。     

盐城市盐都区某中学结核病疫情的调查处理

目的了解盐城市盐都区某中学学生结核病流行及结核菌感染情况，为结核病防治工作提供依据。方法对该中学1620名在校学生进行结核菌素皮试和胸部X线检测调查，并作流行病学统计分析。结果被调查的学生PPD试验的阳性率为48．3％；首发病例班级PPD试验的阳性率（87．5％）高于其他班级（47．0％）（Χ^2=30．53，P〈0．01）；新发现3例涂阴活动性肺结核。结论PPD试验是学校发现结核病的必要辅助诊断方法。根据试验结果对学生采取不同的防治措施，可有效地控制结核病在学校的传播和流行。     

3种方法检测肺结核患者痰标本结果分析

目的比较3种检测方法对肺结核患者痰菌检出率,探索噬菌体生物扩增法提高肺结核病患者结核菌阳性检出率的可行性。方法对同1例肺结核患者的痰标本,采用直接厚涂片法、结核分枝杆菌培养法和噬菌体生物扩增法检测结核分枝杆菌。结果在150例肺结核患者痰标本中,直接厚涂片法检出菌阳26例（检出率为17．3％）,痰结核分枝杆菌培养阳性33例（检出率为22．0％）,噬菌体生物扩增法阳性85例（检出率为56．7％）,噬菌体扩增法阳性检出率高于直接厚涂片法和分枝杆菌培养法（χ^2=51．8,38．8,P〈0．01）。结论噬菌体生物扩增法可提高肺结核病例的痰菌检出率。     

湖南省结核病控制（卫V）项目痰检质量评价与分析

目的 为了准确并及时发现和找出病人，严格控制痰涂片质量，提高涂阳结核病人的发现率。方法 在项目进行中的每一年都随机对部分项目县痰涂片进行抽样检查，并与项目县上报的自检结果进行比较分析。结果 湖南省卫V项目启动时的1992年，结核病可疑者检出率仅为10．23％，痰检阳性率为21．29％；项目结束时的2001年，结核病可疑者检出率和痰检阳性率分别为20．11％和32．53％，均有明显提高（χ^2=1502．7、234．2，P均〈0．01）；痰涂片制片合格率为93．12％，假阳性率为0．69％，假阴性率为0．93％。结论 湖南省卫V项目期间，由于注重痰检质量，结核病可疑者检出率痰检阳性率都有明显提高，涂片制片合格率、假阴性率和假阳性符合率都达到了国家项目所规定的质量要求。     

Performance of Quantiferon for the diagnosis TB

Objectives

The aim of the study was to evaluate the performance of Quantiferon Gold-In-Tube^® (QFN) for the diagnosis of tuberculosis (TB) during hospitalization in an infectious diseases department.

Patients and methods

QFN was performed in 245 patients recently hospitalized for suspected TB. Subsets of patients underwent tuberculin skin tests (TST), and microbiological cultures were performed.

Result

TB was diagnosed in 57 (23%) patients: pulmonary in 23 (40%), extrapulmonary in 16 (28%), and disseminated in 18 (32%). Seventeen (30%) of these TB patients were immunocompromised, including 12 with HIV infection. The sensitivity of QFN was 74%, its specificity 56%, its positive predictive value 43% and negative predictive value (NPV) 92%. The sensitivity was similar in pulmonary and extrapulmonary TB but lower in disseminated TB, although not significantly so. The sensitivity was also lower (P = 0.04) in immunocompromised patients. The specificity was lower in migrants than in native French patients (P = 0.01), and lower in patients with a history of TB than in those without (P < 0.001). Finally, combining culture with QFN significantly increased the sensitivity (P = 0.008), and produced a higher NPV, as for the combination with TST, but not significantly different than with QFN alone.

Conclusion

The performance of QFN was weak in this context, especially in subgroups at high risk for latent TB. However, combined negative results of QFN or TST and culture could be useful to rule out active TB.     

Tuberculosis screening in private physicians' offices, Pennsylvania, 1996

OBJECTIVE: To assess tuberculin skin testing practices of physicians after community-wide screening of 1400 children exposed to a pediatrician with active tuberculosis (TB). DESIGN: A self-administered questionnaire. SETTING: Medium-sized city in eastern Pennsylvania. PARTICIPANTS: Pediatricians and family practitioners seeing pediatric patients. MAIN OUTCOME MEASURES: Percentages of physicians who followed published recommendations for placement and reading of TB skin tests published by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). RESULTS: Questionnaires were completed by 60/80 (75%) physicians. The 60 physicians had practiced a mean of 17 years (range 3-38 years), and only one did not do TB skin testing for pediatric patients. The 59 physicians doing TB skin testing reported routinely tuberculin testing more than 900 children per month. Only 8/59 (14%) physicians followed published guidelines for placement and reading of tuberculin tests. Those physicians screened 158 (17%) of the pediatric patients undergoing TB skin testing in a typical month. CONCLUSION: In this community where a highly publicized TB case prompted massive pediatric screening, most physicians seeing children in private practice do not follow standard TB skin testing guidelines. Increased understanding of how private-practice physicians learn about and decide to use recommended standards are needed if tuberculin tests are to be correctly performed and TB appropriately diagnosed.     

比较T细胞斑点试验、痰噬菌体联合结核菌素试验对诊断肺结核的价值

目的比较结核感染T细胞斑点试验(T-SPOT.TB)、痰噬菌体联合结核菌素试验(PPD)对肺结核疾病的诊断价值。方法选取本院2017年5月-2018年12月在院内已确诊肺结核的患者60例为肺结核组;已确诊非肺结核的就诊者52例为非肺结核组,均行T-SPOT.TB、痰噬菌体和PPD联合检测;比较不同检测方法对诊断肺结核灵敏度与特异度的差异。结果单项检测中,肺结核患者T-SPOT.TB的阳性率最高(86.67%),其次是痰噬菌体、PPD;非肺结核受试者T-SPOT.TB的阳性率最高(36.54%),其次是PPD、痰噬菌体。三者联合检测的肺结核和非肺结核阳性率最高,且与其他任何一项单项检验的阳性率相比差异均有统计学意义(P <0.05)。3种方法结合检测,灵敏度、特异度、阳性检测值、阴性检测值、准确度均高于任何一项单项检验值(P <0.05)。结论 T-SPOT.TB的灵敏度和特异度均优于后2项,痰噬菌体与结核菌素试验的检测准确度无明显差异,因此可结合三者共同对肺结核进行检测,以此提高诊断效果。     

How to detect and diagnose TB

Health workers have four main tools at their disposal for detecting tuberculosis (TB) in patients: clinical symptoms, tuberculin testing, x-ray of the chest, and sputum smear microscopy. The two main detection tools for children are tuberculin skin test and chest x-ray. Signs and symptoms of TB to look for in adults are persistent cough (3 weeks), blood in the sputum, persistent chest pain (1 month), increasing weakness and weight loss, and past history of TB or treatment for cough. TB treatment should not begin until a positive sputum smear is confirmed in cases of pulmonary TB. Health workers should suspect TB if children younger than 5 are in close contact with someone who has confirmed TB, have a strongly positive tuberculin test, and have clinical signs and symptoms. Further tests are usually needed to confirm the diagnosis. In many areas, tests are impossible so health workers need to diagnose TB based on history, physical examination, and clinical symptoms. TB is difficult to diagnose in children because TB is either limited inside the lung or located outside the lungs. Malnourished children with TB usually have a negative tuberculin test. Malnourished children displaying signs of TB or whose X-ray suggests TB should be treated. A recent BCG vaccination can yield a weak positive tuberculin test result. TB signs and symptoms in children are nonspecific. General signs to look for are: unexplained weight loss, anorexia, failure to thrive and gain weight, at least 2 episodes of unexplained fever, swollen lymph nodes (especially in children with HIV), and persistent cough or wheeze (2 weeks). Specific signs depend on the site of infection: whole body, brain or spine, lungs, bones and joints, skin or mucous membranes. This article contains instructions on how to do the tuberculin skin test and sputum smear microscopy.     

The presence of a booster phenomenon among contacts of active pulmonary tuberculosis cases: a retrospective cohort

Background  

Assuming a higher risk of latent tuberculosis (TB) infection in the population of Rio de Janeiro, Brazil, in October of 1998 the TB Control Program of Clementino Fraga Filho Hospital (CFFH) routinely started to recommend a two-step tuberculin skin test (TST) in contacts of pulmonary TB cases in order to distinguish a boosting reaction due to a recall of delayed hypersensitivity previously established by infection with Mycobacterium tuberculosis (M.tb) or BCG vaccination from a tuberculin conversion. The aim of this study was to assess the prevalence of boosted tuberculin skin tests among contacts of individuals with active pulmonary tuberculosis (TB).     

Tuberculin skin test conversion among medical students at a teaching hospital in Rio de Janeiro, Brazil.

OBJECTIVE: To describe the cumulative incidence of and risk factors for tuberculosis (TB) infection among medical students. DESIGN: In 1999, a cohort study of medical students with negative results (induration < 10 mm) on tuberculin skin test (TST) was performed. Students who had undergone two-step testing in 1998 were retested. SETTINGS: University and teaching hospital and referral center for TB and acquired immunodeficiency syndrome, and the Health Sciences Building of the Medical School of the Federal University of Rio de Janeiro, Brazil. PARTICIPANTS: A sample of 618 consecutive medical students with negative TST results who had been tested 12 months before were approached. Information about sociodemographic characteristics, bacille Calmette-Guérin vaccination history, and potential exposures to TB was obtained using a standardized questionnaire. Four hundred fourteen (67%) students completed the study. Students were at two different levels of their training programs (juniors = no contact with patients; seniors = intensive contact with patients). RESULTS: Of 414 participants, 16 (3.9%; 95% confidence interval, 1.06% to 12.1%) had converted to a positive reaction after 1 year. In a multivariate logistic regression analysis, higher level of clinical training was confirmed to be an independent factor associated with TST conversion (odds ratio, 4.77; 95% confidence interval, 1.01 to 22.46; P= .048). CONCLUSION: Senior medical students are at increased risk of Mycobacterium tuberculosis infection in this setting. Therefore, a program of routine tuberculin skin testing and specific TB infection control guidelines are needed for this population.     

基于结核分枝杆菌多表位抗原的诊断试剂研制及临床评价

目的:基于结核分枝杆菌多表位抗原研制的新型结核免疫诊断试剂进行临床评价,评价其灵敏度和特异性,探讨其应用价值。方法:采用建立的间接ELISA方法,分别检测结核病和肺部其他疾病及健康人群血清样品。结果:508份肺结核患者样品中,检出阳性433份,灵敏度85.23%(433/508),健康人523份中,检出阳性49份,特异性90.63%(49/523)。结论:研制的新型的结核抗体免疫诊断试剂灵敏度高,特异性强,可用于结核感染的大规模筛查试验。     

酶联免疫斑点试验快速检测结核分枝杆菌感染的应用评价

目的评价γ干扰素释放实验(IGRA)诊断活动性结核病的价值。方法选取130例胸片异常的出入境人员,根据胸片是否存在活动性病变将研究对象分为试验组(60例)和对照组(70例),采取IGRA检测试剂盒T SPOT.TB,测定结核杆菌特异抗原刺激反应的效应T淋巴细胞数量,结合实验室痰菌涂片和培养结果评价该技术对活动性肺结核的筛查价值。结果T-SPOT.TB在筛查临床诊断的活动性肺结核患者中的敏感性与结核菌素皮肤试验(TST)接近,分别为73.3%比78.3%特异性显著优于TST试验(结核菌素皮肤试验),为60%和27.3%;在痰菌检查阳性的活动性肺结核确诊患者和痰菌检查阴性的对照组受试者中,T-SPOT.TB诊断活动性肺结核患者的敏感性和特异性进一步提高,与TST试验相比,敏感性为93.1%比75.9%,特异性为62.7%比35.8%。结论T-SPOT.TB检测活动性肺结核的敏感性高,优于传统的TST方法,提示该技术可用于在临床疑似结核病患者中快速筛查活动性肺结核。     

重组结核分枝杆菌16ku-38ku-ESAT-6融合蛋白的血清学评价

目的 以重组结核分枝杆菌16 ku-38 ku-ESAT-6融合蛋白(以下简称重组蛋白)为包被抗原,探讨该抗原对结核病的诊断价值.方法 结核组105例、对照组45例(包括非结核病患者25例及健康体检者20例),以重组蛋白作为包被抗原,采用酶联免疫吸附试验(ELISA)检测150例受检者血清中的重组蛋白抗体水平,得出各组之间的吸光度值及阳性率,并与结核分枝杆菌抗体胶体金法诊断试剂盒的检测结果进行比较,以此来评价重组蛋白对结核病的诊断价值,并建立受试者工作特征(ROC)曲线评价系统.结果 重组蛋白检测对照组的阳性率为6.67%(3/45),与试剂盒检测阳性率[51.11%(23/45)]比较差异有统计学意义(P＜0.01),结核组阳性率为59.05%(62/105),与试剂盒检测阳性率[64.76%(68/105)]比较差异无统计学意义(P＞0.05).结核组与对照组的吸光度值分别为2.22±0.58、1.35±0.24,两组比较差异有统计学意义(t=6.06,P＜0.01);重组蛋白检测结核病的敏感度、特异度、阳性预测值及阴性预测值分别为59.05%、93.33%、95.38%、49.41%.应用ROC曲线分析,得出曲线下面积为0.751,cutoff值为2.52,此时敏感度及特异度分别为65.4%、84.8%.结论 重组蛋白检测血清结核抗体具有较高的特异度,可以更好地区分结核病患者群与非患者群,可以作为结核病诊断的备选抗原之一.

Abstract：

Objective To investigate the diagnostic value of 16 ku-38 ku-ESAT-6 protein in tuberculosis (TB). Methods ELISA was used for measuring the level of recombinant 16 ku-38 ku-ESAT-6 protein in 105 TB patients (TB group,26 patients with smear-positive, 79 patients with smear-negative) and 45 controls (control group, 20 healthy volunteers and 25 subjects with pulmonary diseases other than TB). The value of the antigen for diagnosis of TB in serodiagnosis was assessed, and ROC curve evaluation system was established. Results In control group, the positive rate of anti-recombinant 16 ku-38 ku-ESAT-6 protein and commercialization of TB antibody test kit had significant difference [6.67% (3/45) vs. 51.11% (23/45)](P＜0.01);but in TB group, there was no significant difference [59.05%(62/105) vs. 64.76% (68/105)](P＞0.05). The optical density value in TB group and control group was 2.22 ± 0.58 and 1.35 ± 0.24,and there was significant difference(t = 6.06,P＜ 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of the test was 59.05%,93.33%,95.38%,49.41% respectively. Analyzed by ROC curve, the area under the curve was 0.751, the- value of cutoff was 2.52, and sensitivity and specificity was 65.4% and 84.8%. Conclusions Recombinant 16 ku -38 ku -ESAT-6 protein of mycobacterium tuberculosis has higher specificity, and it can significantly distinguish TB and non-TB. So it might be selected as one of diagnosis antigens of TB.     

Prevalence of latent tuberculosis infection in German radiologists

Healthcare workers have an increased risk of tuberculosis infection compared with the general population. There have been few attempts to quantify the prevalence of latent tuberculosis infection amongst German healthcare workers, due to inadequacy of the current tuberculin skin test (TST). Therefore, it was our aim to investigate the prevalence of latent tuberculosis in this cohort using a tuberculosis-specific ELISpot (T-SPOT.TB) test and to compare the performance of this test to that of the TST. Ninety-five healthy participants working in departments of radiology were examined by ELISpot, lymphocyte transformation test and TST. For cellular in-vitro tests, tuberculosis-specific peptides and purified protein derivate (PPD) were used as antigens. These tests were combined with a questionnaire on prior tuberculosis exposure. Out of 95 healthcare workers, only one (1%) was defined as positive by T-SPOT.TB, 92 (97%) by PPD-ELISpot, 78 (82%) by PPD-lymphocyte transformation test and 32 (34%) by TST. Multivariate analysis showed that the TST was significantly affected (P<0.0001 and P=0.001, respectively) by foreign birth and prior skin testing. The T-SPOT.TB test results were independent of foreign birth, prior skin testing and prior vaccination against tuberculosis. In contrast to the TST, T-SPOT.TB appears to be an accurate and useful tool to track tuberculosis infection in this at-risk group. With only one of 95 participants having acquired latent tuberculosis, these preliminary results argue for a low incidence of latent tuberculosis in German radiologists.