温州地区52例新型冠状病毒肺炎治愈患者的临床特征分析

目的分析温州地区新型冠状病毒肺炎（COVID-19）治愈患者的临床特点,为了解该病的病程及病情特点提供参考。方法以2020年1月24日至2月24日在温州市中心医院治愈的52例患者为研究对象,其中男28例（53.8%）,女24例（46.1%）;年龄11～85（43.5±13.8）岁;武汉返温州患者29例（观察组）,非武汉返温州患者（对照组）23例。分析两组患者的临床、实验室及影像学资料,归纳、总结病情特点。结果52例患者潜伏期2～21（7.8±4.4）d;入院时体温正常13例（25.0%）,最高体温40℃,平均体温恢复正常时间（4.1±3.6）d;病毒转阴所需时间6～24（14.5±4.7）d;平均住院日（18.4±5.1）d。临床表现有咳嗽伴或不伴咳痰、发热、胸闷、头痛、咽痛、呼吸困难、恶心、呕吐、腹泻、全身乏力及四肢关节疼痛。观察组重症患者8例（27.6%）,对照组重症患者2例（8.7%）。观察组平均年龄、体温恢复正常时间［（48.0±10.9）岁、5（2.0,7.0）d］大于对照组患者［（37.8±15.3）岁、3（0.0,0.5）d］,C反应蛋白［22.8（7.1,45.3）mg/L］高于对照组患者［7.3（2.2,20）mg/L］,差异均有统计学意义（均P＜0.05）。结论COVID-19患者年龄跨度大,临床症状不典型,武汉返温州患者病情相对较重,早期诊治有助于患者康复。     

温州市非结核分枝杆菌菌种的地域分布特点

【目的】了解温州市11个区县呼吸道非结核分枝杆菌(NTM)的菌种分布情况。【方法】对2014年1月至2017年5月分离鉴定的NTM菌株,利用16S rRNA和hsp65基因测序或基因芯片进一步鉴定至种。【结果】菌种鉴定为NTM 293株(已剔除重复菌株),NTM种类达15种,以鸟分枝杆菌复合群(MAC)和脓肿分枝杆菌占绝对优势(89.4%,262/293),其他菌种仅占10.6%(31/293)。分离NTM菌株数居前6位的区县依次为鹿城(28.7%,84/293)、瓯海(13.7%,40/293)、乐清(12.6%,37/293)、永嘉(11.6%,34/293)、苍南(10.6%,31/293)和瑞安(9.6%,28/293)。鹿城、龙湾、瓯海、瑞安、永嘉和平阳等6个区县的前3位菌种均依次为胞内分枝杆菌、脓肿分枝杆菌和鸟分枝杆菌,胞内分枝杆菌是除苍南外各区县最常见的菌种。【结论】温州市各区县的NTM菌种主要为胞内分枝杆菌、脓肿分枝杆菌和鸟分枝杆菌,地域分布存在一定差异。     

妊娠期妇女甲型H1N1流感15例临床分析

甲型H1N1流感是一种由新型流感病毒感染所致的急性呼吸道传染病,传染性强,病情进展迅速.妊娠妇女作为甲型H1N1流感重症病例的高危人群,更应引起重视.为尽快了解其相关特性,总结防治经验,笔者对温州市第二人民医院收治的15例甲型H1N1流感妊娠期妇女进行了分析.     

环丝氨酸致癫痫发作四例

 我国是结核病高负担的国家,耐药结核病一直是临床治疗的难点和基础研究的热点。环丝氨酸（D-Cycloserine）因与现有抗结核药物无交叉耐药性和肝毒性小,近年来用于耐药结核分枝杆菌的治疗逐渐增多。但其不良反应也不容忽视,现就4例患者在使用环丝氨酸过程中出现癫痫进行报道,以引起临床医生的重视。     

结核分枝杆菌感染对非小细胞肺癌患者调节性免疫细胞的负向调节作用

目的探讨结核分枝杆菌感染对非小细胞肺癌患者调节性免疫细胞的负向调节作用。 方法选择2014年3月到2018年3月温州市中心医院就诊的非小细胞肺癌合并结核分枝杆菌感染患者为感染组（10例）,单纯非小细胞肺癌患者为肿瘤组（10例）,同期选择10例健康体检者为对照组。采用免疫组织化学法检测Ki-67增殖水平;采用流式细胞术检测CD4⁺CD25⁺Foxp3⁺调节性T（Treg）细胞和CD19⁺IL-10⁺调节性B（Breg）细胞的比例。 结果肿瘤组Ki-67的比例为（35 ± 4）%,感染组为（66 ± 6）%,感染组Ki-67的比例显著高于肿瘤组（t = 4.068,P < 0.001）。三组肺癌合并结核患者外周血CD4⁺CD25⁺Foxp3⁺Treg细胞、CD19⁺IL-10⁺Breg细胞比例的比较,差异均有统计学意义（F = 69.400,P < 0.001;F = 16.090,P < 0.001）。且与肿瘤组CD4⁺CD25⁺Foxp3⁺Treg细胞比例[（0.41 ± 0.03）%、（0.21 ± 0.03）%、（1.03 ± 0.08）%]、CD19⁺IL-10⁺Breg细胞比例[（0.429 ± 0.021）%、（0.268 ± 0.013）%、（0.783 ± 0.111）%]比较,对照组均显著降低,而感染组均显著升高（P均< 0.05）。 结论非小细胞肺癌合并结核分枝杆菌感染患者外周血中Treg细胞和Breg细胞比例显著升高。     

拉米夫定预防结核性胸膜炎合并乙型肝炎患者激素治疗后的乙型肝炎病毒再激活

HBV感染者应用糖皮质激素容易导致HBV再激活,其临床后果轻重不一[1].临床上结核性胸膜炎合并HBV感染者较为常见,在抗结核治疗时加用糖皮质激素,可引起HBV再激活,易发生急性肝炎甚至暴发性肝功能衰竭.本研究旨在对拉米夫定预防结核性胸膜炎合并HBV感染患者糖皮质激素治疗引起HBV再激活进行探讨.     

血型播散型肺结核120例临床分析

目的回顾性调查血型播散型肺结核的临床特点。方法收集温州市第二人民医院2007年1月至2011年2月住院的120例初治成人血型播散型肺结核患者为血型播散组,选择同期住院浸润型肺结核患者120例为对照组,对两组患者的临床资料进行回顾性分析。结果血型播散型肺结核以青壮年居多,近年老年患者渐有增多趋势,60岁以上者29例（24.1%）。血型播散型肺结核痰标本涂片查抗酸杆菌阳性较浸润性肺结核低（P〈0.01）。血型播散型肺结核血清抗结核抗体阳性率较浸润性肺结核低（P〈0.01）。痰标本涂片抗酸杆菌检查阴性,血清抗结核抗体阴性易对早期诊断造成干扰。血型播散型肺结核患者以发热为主要症状,因结核菌由血液传播,易合并肺外结核（44.2%）,其中合并结核性脑膜炎的比例最高（29.2%）,2例重症结核性脑膜炎患者因脑疝死亡。血型播散型肺结核并发脑膜炎的比例较浸润性肺结核高（P〈0.01）。结论对于发热原因待查的患者,需动态观察胸CT或胸片变化,对于伴有头痛或脑膜刺激征阳性者,应及时进行腰椎穿刺术,进一步检查,早期诊断,积极治疗,是降低病死率的关键。     

拉米夫定联合还原型谷胱甘肽预防乙型肝炎病毒携带者抗结核的肝损害研究

Objective To explore the preventive effect of liver damage treated by lamivadine joint reduced glutathione for the tuberculosis patients with HBV infection. Methods 90 cases of tuberculosis patients with HBV infection were randomly divided into three groups (A, B, C), each group contained 30 cases. Patients in group A were treated by lamivudine combined with reduced glutathione to protect the liver before anti-tuberculosis treatment. Group B were treated with reduced glutathione. Group C were treated with Yiganling tablets. Both the liver function and serum HBV DNA levels before anti-tuberculosis treatment and 1 month and 2 months after treatment were observed and recorded. Results The cases of liver damage in group A, B, C were 1, 12, 18 respectively, there were statistical differences between group A and group B, group C (χ2 = 11.882, 22.259, P < 0.01). The cases of discontinued treatment due to different causes in group A,B,C were 0,4,11 respectively, there were statistical differences between group A and group B,group C(χ2 = 4.286, P < 0.05; χ2 = 13.469, P < 0.01). The cases of discontinue treatment in the no antivirus group were much more than the antivirus group. There were also statistical differences in both liver damage and discontinued treatment between group B and group C(χ2 = 5.455,4.356, P < 0.05). There was no statistical difference of baseline HBV DNA level between group A and group B (P > 0.05), and also no statistical difference between group A and group C ( P > 0.05), but there were statistical differences in HBV DNA level between group A and group B, as well as group A and group C after 1-month and 2-month therapy( t = - 6.542, - 6.746 and t = - 9.358, - 10.085, P < 0.01). Conclusions Tuberculosis patients coinfected with HBV can use reduced glutathione to prevent liver damage while antitubercular therapy, and simultaneous application of lamivudine therapy can restrain HBV replication and improve the prognosis obviously.     

温州地区重症甲型H1N1流行性感冒的临床特征与治疗分析

目的 了解温州地区住院重症甲型H1N1流行性感冒(流感)的临床特征并探索临床有效的治疗方法.方法 分析住院的42例重症甲型H1N1流感病例临床资料,总结重症甲型H1N1流感的临床特点及发展规律.结果 42例重症甲型H1N1流感病例均以发热、咳嗽起病,39例有咳痰,其他依次为咽痛、畏寒等;WBC正常或降低,C反应蛋白升高30例,血细胞沉降率增快30例,40例患者出现肺部影像学改变.所有患者常规予奥司他韦抗病毒治疗,并及时予有效抗菌药物治疗及对症处理,均未使用糖皮质激素.对有基础疾病者给予相应的对症治疗.3例患者予抗真菌治疗,3例妊娠患者适时终止妊娠.结论 重症甲型H1N1流感病情进展快,迅速累及下呼吸道,应在出现发热症状后尽早诊断和治疗,预后良好.

Abstract：

Objective To investigate the clinical features and effective treatment of patients with severe type A H1N1 flu in Wenzhou. Methods The clinical data of 42 hospitalized patients with severe type A H1N1 flu were analyzed and the clinical features were summarized. Results A total of 42 patients with severe type A H1N1 flu all began with fever and cough. The symptoms of expectoration, pharyngalgia, chilly accounted for 92. 9%, 90. 5% and 42. 9%, respectively. The peripheral leucocyte counts were normal or reduced. C-reactive protein and erythrocyte sedimentation rate levels both increased in 30 patients (71.4%). About 95.2% (40/42) patients had changes of pulmonary imaging. All of the patients were treated with oseltamivir and effective antibiotic drugs as well as symptomatic management. No patients was treated with glucocorticoid. The patients with underlying diseases were given proper treatment. Three cases were treated with antifungal therapy and 3 pregnant patients were timely terminated of pregnancy. Conclusions Severe type A H1N1 flu progresses rapidly and the lower respiratory tract is involved soon after onset. Therefore, the patient should be diagnosed early and treated promptly after presenting fever, which will lead to good prognosis.