2011—2020年重庆市结核病防治经费投入与效益产出分析

目的 评估重庆市2011—2020年结核病防治经费投入产生的社会效益。方法 收集《传染病监测系统》中2011—2020年重庆市登记涂阳肺结核患者（初治涂阳和复治涂阳）治疗转归情况和肺结核患者劳动人口比例,历年各级政府结核病防治经费投入,历年全市人均国内生产总值（gross domestic product,GDP）等数据,采用常用卫生经济学方法评估10年间结核病防治经费投入的社会效果、社会效用和社会效益。结果 2011—2020年,全市共投入结核病防治经费约3.60亿元,成功治疗涂阳肺结核患者60 924例,避免45.69万名健康人受传染,挽救43.41万个伤残调整生命年（disability adjusted life year,DALY）,为社会节约医疗费用3.26亿元,挽回社会经济损失约176.25亿。保持目前的设施设备和人员条件不变,每投入787.70元即可避免1名健康人被传染,每投入829.16元即可挽救1个DALY,每额外投入1元即可产生49.87元的经济效益。结论 10年间重庆市结核病防治经费投入产生了较大的卫生经济效益,建议各级政府继续加大结核病防治经费投入。     

化疗联合乌体林斯治疗复治性肺结核30例短期疗效分析

目的：观察和分析乌体林斯在复治性肺结核治疗中疗效,促进结核病早期愈合,方法：采用随机分组法,将60例复治性肺结核分为乌体林斯治疗组（A组30例）和对照组（B组30例）,A组HLZE＋乌体林斯治疗3个月,B组HLZE治疗3个月,结果：治疗3个月后,A组痰涂片阳转阴率53％,痰菌培养阳转阴率56％,B组痰涂片阳转阴率21％,痰菌培养阳性阴率17％,痰菌转阴率A组显著高于B组。（P＜0．05）,A组X线病灶吸收率60％,B组病灶吸收率30％,A组显著高于B组（P＜0．05）,结论：乌体林斯能增强复治性肺结核患者抗痨药物的效果,有助于痰菌阴转,病灶吸收好转,疗效明显高于单用抗痨药物的患者。     

肺结核合并糖尿病36例临床分析

目的 :探讨糖尿病对肺结核抗痨疗效的影响。方法 :通过对 36例肺结核患者糖尿病疗效的观察 ,分析肺结核患者病灶、空洞和痰菌变化情况。结果 :在 2 9例糖尿病好转患者中 ,肺结核病灶吸收好转率、空洞缩小或关闭率、痰菌阴转率分别为 96.6%、93 .8%、92 .9% ;7例糖尿病恶化 ,其病灶好转吸收率仅为 14.3% ,无 1例空洞缩小或关闭 ,痰菌持续阳性 ,2例死亡。两组病灶吸收率及痰菌阴转率经统计分析有显著性差异 ( p <0 .0 1)。 结论 :糖尿病与肺结核互有不利影响 ,糖尿病治疗结果对肺结核患者预后有重要影响。因此 ,建议对所有肺结核及糖尿病患者常规进行血糖和胸部x线检查。     

纤维支气管镜检查确诊的气管、支气管结核41例分析

目的：通过分析纤维支气管镜下气管,支气管结核的表现,引起临床医生对此病的重视,提高诊断率,避免误诊和漏诊。方法：采用Olympus纤维支气管镜对气管,支气管进行常规检查,根据需要进行活检,刷检和灌洗。结果：41例中33例经活检,刷检和灌洗证实为结核,8例经抗结核治疗后病变吸收证实为结核。结论：纤维支气管镜检查及活检是目前诊断本病的重要方法。     

泰宁县584名儿童结核菌素试验结果分析

目的：了解我县儿童接种卡介苗接种的免疫情况。方法：1999年7－8月,以城区范围内卡介苗接种16周以后的1－4岁儿童为对象进行结核菌素试验,72小时后查验反应结果。注射部位硬结反应≥5mm为阳性反应,同时记录儿童接种卡俚苗后的卡痕大小。结果：我县城区1－4儿童结核菌素试验阳转率为45．9％,其中0－岁组儿童结核菌素是性转变达88．9％,对结核病的免疫水平较低。结核菌素试验阳性率性别间无显性差异。止痕＜5mm的儿童,1－4岁年龄组的结核菌素阳性转率逐渐增大,结论：城区中存在一定的传染源,对阳性转率较低的原因应进行探索并提出预防方法和措施。     

686例痰阳肺结核病人短程直接督导化疗效果观察

目的 为观察短程直接督导化疗(dots)对痰阳肺结核病人的治疗效果。方法 统计分析我县防疫站门诊1993—1999年686例痰阳肺结核病人的治疗结果。结果 686例痰阳肺结核病人中：初治痰阳病人496例,治愈487例,治愈率98、1％,复治痰阳病人190例,治愈175例,治愈率为92.1％。结论 痰阳肺结核病人采用(dots)方法治疗,病人由村医生直接治疗,治疗中乡镇医生管理,督导6次以上,县卫生防疫站督导员督导3次以上,实践证明,短程直接督导化疗能提高痰阳肺结核病人的治愈率。     

The safety of BCG revaccination: A systematic review

IntroductionRevaccination with Bacillus Calmette-Guérin (BCG) vaccine is not generally recommended due to a lack of proven efficacy of repeat doses for protection against tuberculosis. However, there is a growing interest in the use of BCG vaccine for its ‘off-target’ effects which might involve revaccination. We did a systematic review of the safety of BCG revaccination.MethodsMEDLINE (1946 to March 2020) and the BCG World Atlas (updated 2017) were searched, limiting to studies of BCG administration by the intradermal or percutaneous route. Adverse events as well as patient and vaccine characteristics were reviewed.ResultsThe search identified 388 articles, of which 24 met the inclusion criteria. These reported 22 studies comprising eight randomised trials, four case-control studies, four observational studies and six case series or reports. Overall, there was evidence for a small increase in the rate of mild local and systemic reactions. No serious adverse events were reported in immunocompetent individuals.ConclusionsEvidence to date suggests that revaccination with BCG vaccine carries minimal risk. Future studies of BCG vaccine for novel applications should report adverse event data stratified by prior BCG vaccination status.     

ESX-5-targeted export of ESAT-6 in BCG combines enhanced immunogenicity & efficacy against murine tuberculosis with low virulence and reduced persistence

Tuberculosis (TB) is the leading infectious cause of death globally. The only licensed TB vaccine, Bacille Calmette–Guérin (BCG), has low efficacy against TB in adults and is not recommended in people with impaired immunity. The incorporation of the Mycobacterium tuberculosis (Mtb) secretion system ESX-1 into BCG improves immunogenicity and protection against TB in animal models, which is associated with the secretion of the ESX-1-dependent protein ESAT-6. However, the resulting strain, BCG::ESX1^Mtb, has been deemed unsafe as a human vaccine, due to prolonged persistence and increased virulence in immunocompromised mice. In this study, we describe a new recombinant BCG strain that uncouples the beneficial aspects of ESAT-6 secretion from the detrimental ESX-1effects on virulence and persistence. The strain was constructed by fusing the ESAT-6-encoding gene esxA to the general secretion signal for the mycobacterial type VII secretion pathway protein PE25. This new strain, BCG::ESAT6-PE25SS, secretes full-length ESAT-6 via the ESX-5 secretion system, which in contrast to ESX-1 is also present in BCG. In vivo testing revealed that ESX-5-targeted ESAT-6 export, induces cytosolic contact, generates ESAT-6-specific T cells and enhances the protective efficacy against TB disease, but is associated with low virulence and reduced persistence in immunocompetent and immunocompromised mice. Additionally, compared to BCG::ESX1^Mtb and parental BCG, mucosal administration of BCG::ESAT6-PE25SS is associated with more rapid clearance from the lung. These results warrant further studies to evaluate BCG::ESAT6-PE25SS as a potential live attenuated vaccine candidate for TB.     

基于Prophet等时间序列季节模型的肺结核发病预测及对比分析

目的 探索河南省2014—2019年肺结核发病趋势及季节性特征,比较Prophet模型、ARIMA季节模型和Holt-Winters模型的拟合及预测效果,为肺结核防控提供科学依据。方法 基于河南省2014年1月至2018年12月肺结核月发病数据,建立Prophet模型、ARIMA季节模型和Holt-Winters模型,采用2019年1月至12月肺结核月报告发病数据验证预测效果。评价指标选取均方根误差（RMSE）、平均绝对百分比误差（MAPE）、平均绝对误差（MAE）、平均置信区间宽度、真实值超出置信区间个数。结果 模型拟合结果显示,河南省肺结核发病呈逐年下降趋势,每年3—5月达到发病高峰,2月和10月出现低谷;Prophet模型拟合及预测表现最优,评价指标RMSE、MAPE、MAE、平均置信区间宽度均低于另外两个模型,Holt-Winters模型次之,ARIMA(0,1,1)×(0,1,1)12模型拟合及预测效果相对较差。结论 Prophet模型具有较高的拟合预测准确度和精确度,可以很好地捕捉河南省肺结核发病趋势,模型拟合结果对肺结核防控工作具有一定指导意义。     

Can what have we learnt about BCG vaccination in the last 20 years help us to design a better tuberculosis vaccine?

The BCG vaccine will, in 2021, have been in use for 100 years. Much remains to be understood, including the reasons for its variable efficacy against pulmonary tuberculosis in adults. This review will discuss what has been learnt about the BCG vaccine in the last two decades, and whether this new information can be exploited to improve its efficacy, by enhancing its ability to induce either antigen-specific and/or non-specific effects. Many factors affect both the immunogenicity of BCG and its protective efficacy, highlighting the challenges of working with a live vaccine in man, but new insights may enable us to exploit better what BCG can do.