ELISA测定抗结核菌素纯蛋白衍生物LgG诊断小儿结核病

为了探讨小儿结核病的血清学诊断方法,作者用ELISA法检测了216例健康儿童及63例结核病患儿微量耳垂血中抗结核菌素纯蛋白衍生物抗体(抗PPDIgG)水平.结果:健康儿童抗PPDIgG随着年龄增长而增高.学龄前儿童及学龄儿童抗PPDIgG水平与PPD皮试反应状态无明显关系.患儿组的抗PPDIgG水平显著高于同年龄对照组.如果以健康儿童95％位数的OD值为正常值上限,本试验检查患儿的特异性为95％,敏感性在结核感染儿、3月至7岁及至12岁结核病患儿分别为50％,72.5％和72.7％.作者认为本法可以做为小儿结核病的辅助诊断方法.     

深圳市结核分枝杆菌耐药监测疫情趋势分析

目的 监测耐药肺结核的流行情况和趋势，评价本市结核病控制效果。方法 按WHO／IUAT（（结核病耐药指南》的要求对新登记的涂片阳性肺结核病人进行耐药肺结核监测，所选例数不低于全年登记的涂片阳性肺结核病人的40％。结果 监测涂片阳性病例2250例，涂片培养均阳性者2168例；平均耐药率为34．9％，链霉素耐药最高，达24．1％；耐多药率为5．5％，耐药病人主要集中在青壮年。结论 本市结核耐药水平较高，明显受到外来人口的影响，全市推行DOTS策略，是降低区域耐药结核的重要措施。     

脊柱结核治疗中的内固定应用

目的：评价内固定在脊柱结核治疗中的应用价值。方法：2001～2003年采用侧前方手术病灶清除加内固定系统治疗胸、腰椎脊柱结核患者16例，其中后路病灶外内固定12例（TSRH钉棒横桥系统5例，TSRH钩棒横桥系统7例），前路病灶野内Z-Plate钉板内固定系统4例，椎体间皆采用自体植骨融合。所有患者均采用标准化疗方案。术后随访18～24个月（平均20个月）。结果：16例患者切口均Ⅱ-甲愈合，1例并发单侧胸膜外后方脊旁积液（自愈）．无结核病灶复发，椎体间植骨均获融合，无内固定失败。有脊髓压迫表现者，Frankel评分均获提升。结论：传统脊柱结核手术与内固定系统结合应用具有病灶清除彻底、固定坚强、能矫正畸形、融合率高、减少卧床时间、安全的早期功能锻炼、总体医疗费用降低以及后期并发症低等优点，而复发率保持不变，具有很高的临床应用价值。     

聚合酶链反应—增强化学发光检测结核分枝杆菌

目的 探讨微孔板杂交技术结合增强化学发光（ECL）检测结核分枝杆菌（MTB）。方法 同时应用聚合酶链反应（PCR）－ECL、PCR－比色法与PCR电泳检测60例活动性肺结核和54例健康对照痰标本，比较结果。结果 PCR－ECL、PCR－比色法与PCR电泳总阳性率分别为76.7%、63.3%、50.0%，其中PCR－ECL阳性率显著高于PCR电泳（P＜0.05)；对涂片阳性标本，阳性率分别为85.7%、85.7%、71.4%，差异无显著性（P＞0.05)；对涂片阴性标本，阳性率分别为73.9%、56.5%、43.5%，PCR－ECL阳性率高于PCR电泳（P＜0.05)。另外PCR－ECL、PCR－比色法与PCR电泳特异性分别为92.6%、96.3%、96.3%，差异无显著性（P＞0.05)。结论 PCR－ECL灵敏度高，能提高临床标本MTB检出率，尤其是对涂片阴性痰标本，并且该方法操作简单，结果客观。     

肺结核与肺癌并存43例

目的：探讨肺结核怀癌并存的早期诊断方法。材料与方法：对43例确诊为肺结核与肺癌并存的临床资料进行回顾,中种诊断方法的特点与利弊。结果：通过痰脱落细胞病检11例（25.58%）、胸水脱落细胞病检4例（9.30%）、淋巴结活检11例（25.58%）、纤支镜刷片或活检5例（11.63%）、经皮肺穿刺活检2例（4.65%）、手术切除病检10例（23.26%）。结论：肺结核与肺癌并存时诊断难度较大,应综合运用上述检查手段,发挥它们之间的优势互补作用,以提高肺结核与肺癌并存时的早期诊断率。     

肠杆菌基因间重复序列PCR指纹图谱技术分析结核分枝杆菌流行情况

目的利用肠杆菌基因间重复序列为引物的聚合酶链反应（enterbacterial repetitive intergenic consensus-PCR，ERIC-PCR）分型技术分析我市结核分枝杆菌流行情况。方法收集2003年9月至2006年5月门诊痰菌阳性标本，培养并提取DNA做ERIC—PCR指纹图，并利用RAPDPHYLIP及Treeview软件对其进行聚类分析。结果122株临床分离株产生42种不同的指纹图，聚类分析结果显示可分为3簇，成簇率76、2％。指纹图谱与患者年龄、菌株的耐药性及耐药种类有关。结论ERIC—PCR具有不需已知核酸序列，分辨效果好，简便快捷等优点，是进行分子流行病学调查的有效工具。我市结核病呈高水平传播，主要为耐药菌株并以中青年患者传播为主。     

Sonographic septation in lymphocyte-rich exudative pleural effusions: a useful diagnostic predictor for tuberculosis.

OBJECTIVE: The purpose of this study was to evaluate the role of the sonographic features of lymphocyte-rich exudative pleural effusions in the differential diagnosis of tuberculosis and lung cancer in an area with a high incidence of tuberculosis. METHODS: Medical records of patients undergoing chest sonography between January 2003 and June 2005 (30 months) were reviewed retrospectively. The enrolled patients included 73 with lung cancer-related pleural effusions and 93 with tuberculous pleural effusions. The sonographic appearances of the pleural effusions were defined in terms of 4 patterns: anechoic, homogeneously echogenic, complex septated, and complex nonseptated. RESULTS: Among the 73 lung cancer-related pleural effusions, there were sonographic appearances of an anechoic pattern in 11% (8/73), a complex septated pattern in 4% (3/73), and a complex nonseptated pattern in 85% (62/73). In 93 tuberculous pleural effusions, there were sonographic appearances of an anechoic pattern in 12% (11/93), a complex septated pattern in 47% (44/93), and a complex non-septated pattern in 41% (38/93). Apparently, a complex septated pattern in the sonographic appearance of lymphocyte-rich pleural effusions is a useful diagnostic predictor for differentiating tuberculosis from lung cancer (95% confidence interval, -0.57 to -0.29). If we define the complex septated pattern in the sonographic appearance of lymphocyte-rich exudative pleural effusions as a predictor for tuberculous pleural effusions, we can achieve sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio values of 47%, 96%, 94%, 59%, and 12, respectively. CONCLUSIONS: A complex septated pattern in the sonographic appearance is a useful predictor of tuberculosis in lymphocyte-rich exudative pleural effusions.     

Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis

Although patients with risk factors for tuberculosis have increased with the increased use of immunosuppressive therapy, there have been few reports about differences in clinical findings between immunocompromised patients and nonimmunocompromised patients with pulmonary tuberculosis. Therefore, we investigated differences between the clinical features of immunocompromised patients with pulmonary tuberculosis and those of nonimmunocompromised patients in the past decade. We analyzed findings in 840 patients (312 immunocompromised and 528 nonimmunocompromised) with pulmonary tuberculosis who were found to be culture-positive for Mycobacterium tuberculosis between January 1997 and December 2006. The characteristic clinical findings of the immunocompromised patients, compared with findings in the nonimmunocompromised group, were as follows: (1) an increase in the number of patients with respiratory symptoms during the period of follow-up of underlying diseases; (2) an increase in the number of patients in a hyponutritional state and with a negative response for the tuberculin skin test; (3) an increase in the number of microbiologically smear-positive sputum specimens; (4) an increase in the number of patients with atypical radiological findings, such as a few cavities or calcification, bilateral and expansive consolidation, miliary shadows, and mediastinal and/or hilar lymphadenopathy ; (5) an increase in the number of patients with misdiagnosed pneumonia at admission; and (6) an increase in the mortality rate. We concluded that, among the immunocompromised patients with pulmonary tuberculosis, there were many patients with atypical radiological findings and with smear-positive findings for acid-fast bacilli examination that was carried out to isolate M. tuberculosis (which had become infectious). We must perform the acid-fast bacilli examination for patients who have a fever and continuous cough, and antituberculous drugs should be administered as soon as possible when the results are positive.