肾移植术后结核病18例回顾性临床分析

目的提高对肾移植术后合并结核病的认识。方法对近5年来肾移植术后结核病18例进行回顾性分析。结果肺结核16例,合并肺外结核3例,气管内膜结核2例,症状缺乏特异性。主要通过X线平片、反复痰中找抗酸杆菌、PCR查结核杆菌DNA、穿刺活检明确诊断。有4人合并其他病原体感染。经过正规抗结核治疗后治愈16人,死亡2人。不良反应主要是肝、肾功能损害,通过调整免疫抑制剂方案,肝、肾功能可恢复正常。结论肾移植术后结核感染发生率明显增高,正规抗结核治疗有效,但需要密切监测肝、肾功能的变化,及时调整免疫抑制剂方案。     

Nd—YAG激光治疗支气管内膜结核

本文报告我院1987年5月至1990年8月用Nd-YAG激光治疗支气管内膜结核8例,其中增殖性肉芽肿型7例获治愈,瘢痕狭窄型1例无效,无明显不良反应。治疗结果初步提示,Nd-YAG激光治疗对增殖性肉芽肿型支气管内膜结核是一种新的有效方法,可加速局部病变的消除,与抗结核药物相配合,有利于彻底治愈本病。     

肺泰胶囊辅助治疗初治肺结核的临床研究

目的:评价肺泰胶囊联合抗结核西药治疗初治肺结核的临床疗效和安全性.方法:53例初治肺结核患者,随机分为试验组和对照组,38例试验组病例服用肺泰胶囊 2HL2Z/4HL2治疗6月,15例对照组病例服用安慰剂 2HL2Z/4HL2治疗6月,观察治疗2月末和6月末痰结核菌阴转X线胸片上病灶和空洞变化情况.结果:治疗2月末痰结核菌阴转率试验组为93.8%,对照组为42.9%,病灶显吸率试验组为50%,对照组为13.3%;治疗6月末两组痰菌阴转率均为100%,病灶全吸率试验组为42.1%,对照组为13.3%,空洞闭合率试验组为78.6%,对照组为28.6%.试验组均优于对照组,差异有显著性意义(P＜0.05).肺泰胶囊未见不良反应.结论:肺泰胶囊与抗结核西药联合治疗初治肺结核患者,能加速痰结核菌阴转和病灶吸收,提高空洞闭合率,是一种有效而安全的抗结核中药制剂.     

并用经纤支镜局部给药治疗支气管内膜结核20例疗效分析

本文探讨并用支气管局部给药治疗支气管内膜结核20例的疗效,结果显示临床疗效明显高于对照组,治疗2个月和5个月的痰菌阴转率分别为90％,100％,完成6个月疗程经纤支镜复查,支气管粘膜结核病变100％恢复正常,仅一例遗留支气管狭窄而至肺不张,停药后随访五年无菌阳复发。而对照组的同期痰菌阴转率分别为45％、65％,完成疗程支气管内膜仅70％恢复正常,并有4例合并支气管狭窄所至肺不张,停药随访五年菌阳复发率为10％,有显著性差异P＞0．05。     

Long term follow up of HIV-infected patients with tuberculosis treated with 6-month intermittent short course chemotherapy

BACKGROUND: Tuberculosis occurs in 60%-70% of HIV-positive persons in India. The outcome of HIV-positive patients treated with 6-month intermittent short course antituberculosis regimens in India is not well described. METHODS: This was a prospective observational feasibility study of 71 patients with HIV and tuberculosis who were treated with category I regimen of the Revised National Tuberculosis Control Programme (ethambutol, isoniazid, rifampicin and pyrazinamide thrice weekly for the initial 2 months followed by rifampicin and isoniazid thrice weekly for the next 4 months). Sputum was examined by smear and culture for Mycobacterium tuberculosis every month up to 24 months. Chest X-ray, CD4 cell count and viral load were done prior to and at the end of treatment. None of the patients received antiretroviral therapy. RESULTS: We present here the treatment response of patients with sputum culture-positive pulmonary tuberculosis to category I regimen. By efficacy analysis, among 43 patients treated with category I regimen, sputum smear conversion was observed in 79% and culture conversion in 82% at the second month. A favourable response was seen in 72% of patients. The mean (SD) CD4% fell from 12.6 (5.9) to 8.9 (4.9) (p < 0.001) with no significant change in mean (SD) CD4 cell count (169 [126] to 174 [158]; ns) at the end of treatment. Viral load change from 1.8 x 10(5) at baseline to 1.3 x 10(5) at the end of treatment was not statistically significant. Thirty-one patients, who completed the full course of treatment, were declared cured and were followed up for 24 months. Twelve had recurrent tuberculosis (39%); 16 of 43 (37%) patients had died by the end of 24 months, two-thirds due to causes other than tuberculosis. CONCLUSION: Though the early bacteriological response to intermittent short course antituberculosis regimen was satisfactory, the overall outcome was adversely affected by the high mortality (during and after completion of treatment) and recurrence rate among HIV-infected patients with tuberculosis. Immune status deteriorated in spite of antituberculosis treatment, highlighting the need for antiretroviral treatment in addition to antituberculosis treatment to improve the long term outcome. The results of this pilot study need to be confirmed by larger studies.     

百令胶囊联合抗痨药治疗肺结核62例疗效观察

目的 探讨百令胶囊与抗结核药联合治疗肺结核的疗效。方法 将122例肺结核患者随机分成治疗组为62例，观察组为60例。两组基本治疗相同，治疗组加服百令胶囊，疗程为6个月。结果 治疗组总有效率95．2％，明显高于对照组的78．3％（P〈0．01），治疗组的痰结核菌转阴率及肺结核病灶吸收率也明显优于对照组（P〈0．01）。结论 百令胶囊与抗结核药联合治疗肺结核疗效显著，安全可靠，值得临床推广应用。     

Application of Potassium Titanyl Phosphate （KTP） Laser Delivered via Bronchofiberscope in the Treatment of Endobronchial Tuberculosis

Potassiumtitanyl phosphate (KTP) laser is anewfrequency-doubled Nd :YAG (wave length =1024 mn) visible green light ( wave length =532mn) , which is now extensively employed in de-part ments of ophthal mology , ENT,and urology .Currently the chemical therapy has been used forthe treat ment of bronchial tuberculosis and the re-sults are not satisfactory . From Dec .2002 to July2004 , we used KTPlaser therapyfor the treat mentof 36 cases of endobronchial tuberculosis with sat-isfactory resu…     

支气管内膜结核误诊原因分析

目的探讨支气管内膜结核的误诊原因,提高支气管内膜结核的诊断水平。方法采用临床分析方法,对该所收治的35例支气管结核病患者进行分析。结果误治患者年龄分布主要在18～60岁,职业分布差异无统计学意义,患者自身延误诊治和医源性误诊并存,平均延误诊治时间约180d。结论支气管内膜结核往往缺乏典型的临床症状和体征,肺部常规X线检查及CT检查难以发现支气管内膜病灶,临床医生经验不足易造成误诊。     

抗结核FDC与板式组合药治疗初治肺结核转归对比分析

目的：对抗结核FDC与板式组合药治疗初治肺结核的转归进行临床对比观察,为抗结核FDC临床应用提供科学依据。方法将纳入的初治肺结核病例分为治疗组和对照组,治疗组用抗结核FDC,对照组用板式组合药,2组均采用隔日疗法方案（2H3R3Z3E3/4H3R3）。用对照研究方法观察2组治疗完成、丢失、方案更改及断药等情况。结果治疗完成率初治涂阳和初治涂阴患者均是抗结核FDC组大于板式组合药组（均＜0.05）,丢失率初治涂阳和初治涂阴患者均是抗结核FDC组小于板式组合药组（均P＜0.05）,方案变更率抗结核FDC组小于板式组合药组（P＜0.05）,断药率和断药频次均是抗结核FDC组小于板式组合药组（P＜0.05）。结论抗结核FDC有利于医务人员对患者的治疗管理和督导,在国家结核病防治规划中应用是可行的。     

经气管镜凝胶灌注初治干酪坏死型支气管内膜结核疗效评价

目的:评价在全身化疗基础上经纤维支气管镜局部注药治疗初治干酪坏死型支气管内膜结核的疗效。方法:选取确诊为初治干酪坏死型支气管内膜结核45例,分为治疗组及对照组,两组均应用全身化疗,治疗组同时行经纤维支气管镜局部灌注抗痨药物凝胶。结果:治疗组患者临床症状缓解、痰菌阴转及胸部影像学好转均优于对照组。结论:经纤维支气管局部注药治疗初治支气管内膜结核,使患者临床症状缓解加快,减轻支气管狭窄,促进肺不张的复张,改善预后。