肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽(82.5%)、咳痰(80.4%)、发热(45.4%)、不同程度咯血或血丝痰(23.7%)等为主要症状,胸部CT以肺不张或膨胀不全(44.2%)及浸润增殖性病灶(37.9%)为主要表现,并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现,痰涂片或培养检查抗酸杆菌阳性率较高(63.9%),尤其在多叶段浸润增殖病灶患者中其阳性率高达83.3%。纤支镜检查以主支气管及叶支气管开口受累显著(64.8%),多气管支气管受累患者达81.4%,且多种支气管镜下表现类型并存,纤支镜刷检抗酸杆菌、组织活检阳性率分别为55.9%、69.4%。接受纤支镜介入治疗的患者仅有18例,其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗,5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段,镜下可见多气管支气管受累,且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。     

肺结核合并支气管结核103例临床及纤支镜检查结果分析

目的探讨肺结核合并支气管结核患者的临床及纤支镜检查特点。方法回顾性分析103例肺结核合并支气管结核患者的临床资料,观察患者纤支镜检查前临床漏诊及误诊情况,比较纤支镜涂片检查、纤支镜活组织病理检查和痰涂片检查抗酸杆菌阳性率的差异。结果肺结核合并支气管结核患者临床症状有咳嗽、咳痰、发热、不同程度咯血或痰中带血;纤支镜检查前临床误诊率、漏诊率均较高;纤支镜涂片检查、纤支镜活组织病理检查和痰涂片检查抗酸杆菌阳性率比较差异有统计学意义（P均〈0.05）。结论肺结核合并支气管结核患者临床表现无特异性,纤支镜检查是其重要的诊断手段。     

支气管结核继发于肺结核的因素分析

目的探讨支气管继发于肺结核的因素。方法纤支镜检查肺结核患者224例,分为肺结核继发支气管结核组128例和单纯肺结核组96例,比较两组患者临床表现和纤支镜检查结果等方面特点。结果两组在性别、年龄、肺结核类型、胸部X线、CT表现、纤支镜下支气管树变化、PPD皮试和痰涂片抗酸杆菌阳性率等方面有差别P<0.01或P<0.01。结论支气管结核继发于肺结核主要与内分泌、咳痰效果、纵隔淋巴结结核浸润邻近支气管、痰排菌量、变态反应等因素有关。行纤支镜检查对支气管肺结核的诊治有决定意义。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993－2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查，治疗结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69．2％（72／104）。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84．6％。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

经纤维支气管镜下球囊扩张术治疗结核性支气管狭窄

目的探讨经纤维支气管镜（纤支镜）球囊扩张治疗结核性支气管狭窄的疗效及安全性。方法对13例结核性支气管狭窄的患者实施经纤支镜球囊扩张术,同时对有结核活动的患者给予全身抗结核及经纤支镜局部注入抗结核药物。结果13例中10例扩张成功,狭窄段支气管直径由扩张前的（2.7±1.3）mm增加到扩张后的（5.8±1.7）mm（P<0.01）。3例失败。对扩张成功的10例患者进行618个月随访,10例患者术前有6例抗酸杆菌阳性,痰菌全部转阴;10例患者狭窄支气管均保持通畅。13例患者有8例术中诉轻度胸痛,均未见严重的并发症发生。结论经纤支镜球囊扩张术治疗结核性支气管狭窄是一项安全、有效和简便的方法,对于支气管狭窄引流不畅、痰抗酸杆菌反复阳性患者球囊扩张术可能为有效的治疗方法之一。     

导管扩张术在重度狭窄支气管中的应用

目的探讨扩张导管在重度狭窄支气管中的应用价值。方法经纤支镜检查发现15例重度狭窄支气管病例，使用规格为Fr．5／3型德国ENDO—FLEXGmbh产胆道扩张导管。狭窄支气管经扩张导管扩张后注入异烟肼100mg，丁胺卡那霉素100mg，地塞米松2mg。每次纤支镜检查动态监测扩张后支气管的变化以及胸片的变化。结果经纤支镜以及导管扩张后冲洗、注药，高热3例热退。肺不张3例，其中2例肺复张，1例反复少量咯血病例咯血停止。8周后，15例有8例（53．3％）扩张后管口仍维持大于Fr．5，6例闭塞，1例反复发作。15例病例所属肺组织的结核病灶和阻塞性感染病灶均明显好转，3例空洞闭合。实验室检查12例痰抗酸杆菌涂片＋快速培养阳性复查均转为阴性。12周后，15例病例有8例扩张后管口仍维持大于Fr．5，7例闭塞。5（83．3％）例空洞闭合，1例无变化。1例左上肺肺不张。结论重度狭窄支气管导管扩张术以利脓液的排出，借助于纤支镜和导管可以抽吸深部的脓液和注药，达到治疗肺结核缓解临床症状，也可为下一步球囊扩张创造有利的条件。     

纤维支气管镜下球囊扩张治疗结核性气道狭窄的护理配合

目的探讨纤维支气管镜（纤支镜）下球囊扩张治疗结核性气道狭窄的护理配合。方法总结我院2008年4月以来7例结核性气管支气管狭窄患者在气管插管全麻下球囊扩张的护理配合。结果 7例均顺利完成,无1例发生严重并发征。结论术前充分准备、术中医护配合、术后密切观察是保证纤支镜下球囊扩张成功治疗结核性气道狭窄的重要措施。     

经纤支镜诊断菌阴肺下野结核60例及其误诊分析

目的 探讨纤维支气管镜检查在菌阴肺下野结核中的诊断价值及其误诊中的临床意义。方法 对60例曾经被误诊，后经纤支镜检查确诊的肺下野结核的临床资料进行回顾性分析。结果 60例患者纤支镜下表现：中、下叶支气管粘膜慢性炎症最多见，分别为25例(41．7％)和20例(33．3％)，其次为管口狭窄7例(11．7％)。四种方法联合检出的60例肺结核中，单纯刷检抗酸杆菌阳性37例(61．7％)；刷检 支气管肺泡灌洗(BAL)阳性46例(76．7％)；BAL 镜检后痰检 组织活检诊断肺结核52例(86．7％)。结论 纤支镜检查能提高菌阴肺下野结核的诊断率，刷检、灌洗、组织活枪及镜查后痰检可互相补充以提高诊断的阳性率，避免误诊。     

纤维支气管镜对支气管内膜结核的诊断与治疗价值

目的：探讨纤维支气管镜检查对支气管内膜结核的诊断与治疗价值。方法：总结15448例经纤支镜检查细菌学和（或）病理学证实的295例支气管内膜结核的临床、X线表现和纤支镜下特征以及全身化疗加局部治疗对支气管内膜结核的治疗作用。结果：纤支镜检查发现异常283例，异常表现以充血水肿最多达22例，占78．10％，次为肉芽结节、溃疡及疤痕出血等。病变表现见坏死物复盖28例，支气管有不同程度狭窄91例。283例中，共进行刷检274例，阳性率89．42％，活检174例，阳性率42．53％，二相比差异非常显（P＜0．01）。全身化疗＋纤支镜下局部给药对支气管内膜结核有较好的治疗作用。结论：纤支镜检查对支气管内膜结核的诊断与治疗有较大的价值。     

经纤维支气管镜诊治支气管结核临床分析

目的探讨经纤维支气管镜诊断、治疗支气管内膜结核的价值。方法 47例患者采用日本Olympus BF-P20型纤维支气管镜刷片检查抗酸杆菌和病理检查诊断为支气管内膜结核,并于纤支镜下局部多点注射异烟肼治疗。结果 47例患者根据纤支镜下表现可分为浸润型9例,溃病型16例,增殖型15例和纤维狭窄型7例;发病部位:左上叶气管受累10例,左舌叶气管受累10例,左下叶气管受累9例,右上叶气管受累7例,右中叶气管受累6例,右下叶气管受累5例;经纤支镜局部注射药物治疗后症状好转,糜烂、坏死、溃疡、息肉病灶消散。结论纤支镜检是支气管内膜结核最重要的检查方法之一。经纤支镜多点药物局部注射治疗是支气管内膜结核有效治疗手段。     

Lingual tuberculosis revealing disseminated tuberculosis

INTRODUCTION: Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS: We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION: Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.     

Delayed tuberculosis diagnosis and tuberculosis transmission.

SETTING: Tuberculosis (TB) patients and their close contacts reported to the Maryland Department of Health and Mental Hygiene from 1 June 2000 to 30 November 2001. OBJECTIVES: A recent prospective study found that 49% of pulmonary TB patients had total treatment delays > or = 90 days. This cohort was analyzed to determine the association between total treatment delay and TB transmission. DESIGN: TB patient data were collected as part of a prospective cohort study; contact data were collected from local health departments. RESULTS: Close contacts of 54 US-born patients (n = 310) and those of 70 foreign-born cases (n = 393) received tuberculin skin tests (TSTs). Among contacts of US-born patients with a total treatment delay of > or = 90 days, 40% had positive TSTs vs. 24% contacts of patients with shorter delays (aOR 2.34; P = 0.03). Other patient factors associated with TST positivity among contacts of US-born cases were black race (aOR 3.03; P = 0.05), sputum smear positive for AFB (aOR 3.29; P = 0.01) and chest radiograph with cavitation (aOR 3.11; P = 0.01). No associations were observed between foreign-born patients and risk of TST positivity among their contacts. CONCLUSION: Among US-born patients, delay in TB diagnosis is associated with greater transmission of infection to contacts and could be used independently of other index patient factors to identify contacts at greatest risk of TB infection.     

Newer diagnostics for tuberculosis and multi-drug resistant tuberculosis

PURPOSE OF REVIEW: This article will review some of the recent developments for the rapid diagnosis and detection of drug resistance in tuberculosis. RECENT FINDINGS: Tuberculosis remains one of the major causes of death from a single infectious agent worldwide. Of great concern for tuberculosis control is the emergence of drug resistance since there is no cure for some multidrug-resistant strains of M. tuberculosis, and there is concern that they may spread around the world, stressing the need for additional control measures such as new diagnostics and better drugs for treatment. Recent advances in molecular biology and a better understanding of the molecular basis of drug resistance have provided new tools for rapid tuberculosis diagnosis. Other non-conventional diagnostic approaches have also been proposed. Nucleic acid amplification techniques, both commercial and in-house, and non-molecular methods are being evaluated. The overall accuracy of most of these tests is promising and some of them can be easily implemented in clinical mycobacteriology laboratories. SUMMARY: New genotypic and phenotypic methods for rapid diagnosis and detection of drug resistance have been developed and tested both in M. tuberculosis strains as well as in clinical samples. Further controlled evaluations are necessary in high-endemic countries for their eventual implementation in the routine diagnostic systems.     

结核分枝杆菌肝素结合血凝黏附素与结核病

结核分枝杆菌肝素结合血凝黏附素是一种表面蛋白,有3个功能结构域,其C末端在翻译后进行甲基化修饰,与其免疫特性相关.可结合硫酸化糖,可通过补体C3介导与巨噬细胞的结合,与上皮细胞结合在肺外结核发病中有重要作用.通过对其细胞免疫及体液免疫作用的研究发现,其在诊断中有较好的作用,在免疫预防及免疫治疗中有广阔的应用前景.