肺结核患者血浆和胸水中抑瘤素-M检测及临床意义

目的探讨血浆和胸水中抑瘤素-M在肺结核中的变化及其临床意义。方法应用双抗体夹心ELISA法检测24例健康体检者、21例活动性肺结核患者血浆和10例结核性胸膜炎胸水中OSM的水平。结果肺结核患者血浆中OSM水平低于健康对照组,差异有统计意义;结核性胸膜炎患者胸水中OSM高于肺结核患者血浆中OSM水平,差异有统计意义。结论OSM是局部病灶炎症反应的重要作用因子,可能参与了肺结核的免疫发病机制。     

微小RNA在肺动脉高压发病机制中的研究进展

肺动脉高压是一种致命性疾病,缺氧、炎症、遗传等各种病因导致肺血管重塑、肺动脉压力升高,最终导致右心衰竭,甚至死亡.但目前对肺动脉高压的发病机制并不清楚,尚无治愈肺动脉高压的药物.近年来,微小RNA在许多疾病病理和生理过程中发挥的作用引起了人们的关注,许多研究表明微小RNA有逆转肺血管重塑,从而治愈肺动脉高压的可能.本文就研究较多的微小RNA在肺动脉高压的发病机制,尤其是参与血管重塑的几条通路的研究进展作一综述.     

肺结核合并Poncet病2例报告并文献复习

目的分析肺结核合并Poncet病的诊断、鉴别诊断和治疗。方法通过病例报告和文献复习,总结肺结核并发Poncet病的发病机理和临床特点。结果提高对肺结核合并Poncet病的认识,减少误诊误治。结论肺结核并发关节炎的临床表现时要重视Poncet病的诊断,并与风湿性、类风湿性或其他感染性关节炎进行鉴别。     

Pulmonary and osteoarticular tuberculosis

Tuberculosis is an important illness with an increasing prevalence in the last years in part due to AIDS. Considered primarily a pulmonary disease, tuberculosis can also affect almost any body system (nervous, genitourinary, and gastrointestinal as well as bones and joints) through lymphohematogenous spread. The authors present a case of pulmonary and osteoarticular tuberculosis diagnosed simultaneously.     

基于“肺与大肠相表里”探讨肠道菌群与肺结核关系的研究进展

肺结核是常见的呼吸道传染疾病,肠道菌群紊乱是肺结核的常见合并症。肠道菌群紊乱会加重肺结核的病理损伤。从中医病机角度,二者之间的关系体现了“肺与大肠相表里”的经络理论、津液理论及气机升降理论。从生物学机制角度,肠道菌群可通过调节宿主固有免疫和适应性免疫,产生抗结核作用的代谢产物以限制肺结核进展;肺结核导致的肠道菌群改变或与血液循环及淋巴循环相关;抗结核药物治疗对肠道菌群的影响或与药物杀菌性相关。肠道菌群的相关疗法对肺结核诊疗具有一定临床价值。通过增加肠道益生菌、粪菌移植、合理使用抗结核药物、改善饮食结构等方法可调节肠道菌群以达到辅助治疗肺结核的目的。本文中,笔者将结合既往文献进行综述。     

Hematogenous reseeding of the lung in low-dose,aerosol-infected guinea pigs: unique features of the host-pathogen interface in secondary tubercles

The ability to study the early events in the pathogenesis of pulmonary tuberculosis in guinea pigs following very low dose (3-5 cfu) infection by the respiratory route has revealed that early (10-14 days) extrapulmonary dissemination results in reseeding of previously uninfected lobes of the lung by the hematogenous route. Thus, in every guinea pig, the lung is challenged twice, once by the airway and 2-3 weeks later by the circulatory system. The so called "secondary" pulmonary lesions which result from the bacillemia differ fundamentally from the primary lesions, in part, because the host has already developed a strong T cell mediated immunity when the hematogenous reseeding occurs. Secondary lung lesions in non-vaccinated guinea pigs behave similarly to primary lung lesions in previously vaccinated guinea pigs. Since the secondary, blood-borne lesions are thought to be the "reactivatable foci" which result in reactivation tuberculosis following prolonged persistent infection, it is important to understand the nature of the host-pathogen interaction in secondary lesions. The guinea pig model provides a unique opportunity to examine both the microbial and host factors which constitute that interface.     

复治肺结核病诊断和治疗专家共识

复治肺结核病是国家结核病控制规划中的重要环节,也是我国结核病控制的难点。复治肺结核病患者的情况较为复杂,原有复治肺结核病的治疗方案目前已不合时宜,应重新审视复治肺结核病分类及诊治。为此,同济大学附属上海市肺科医院、首都医科大学附属北京胸科医院、中国防痨协会和《中国防痨杂志》编辑委员会共同组织国内专家就复治肺结核病的分类、诊断、治疗等内容反复讨论并形成《复治肺结核病诊断和治疗专家共识》,以规范我国复治肺结核病的诊疗,提升复治肺结核病的治疗效果。     

《肺结核影像诊断标准》解读

肺结核病仍然是当今危害人类健康的重大传染病,尤其在新型冠状病毒肺炎流行的背景下,保持和加强结核病服务是实现全民健康覆盖和恢复卫生系统总体进程的重要组成部分,并能确保应对结核病和新型冠状病毒肺炎的协同防控作用.肺结核影像诊断标准的制订和发布,对肺结核的精准分型、影像学诊断与鉴别诊断、疗效评价等具有极其重要的意义,同时也是...     

细胞因子基因多态性与肺结核并发糖尿病易感性的相关性研究

探索细胞因子γ-干扰素(IFN-γ)+874A/T位点、白细胞介素(IL)-10 -1082G/A位点和-592A/C位点基因多态性与肺结核并发糖尿病(pulmonary tuberculosis and diabetic mellitus,PTB-DM)易感性的关系,以及遗传危险因素在PTB-DM发病机制中的作用,为PTB-DM高危人群基因多态性筛查提供理论依据。     

Vascular endothelial growth factor levels in active pulmonary tuberculosis

BACKGROUND: Vascular endothelial growth factor (VEGF) is a mediator with potent angiogenic, mitogenic, and vascular permeability-enhancing activities that are specific for endothelial cells. Intense angiogenesis has been found in active pulmonary tuberculosis lesions. OBJECTIVES: To determine whether active pulmonary tuberculosis is associated with increased serum levels of VEGF compared with inactive tuberculosis and VEGF levels in healthy subjects, and to assess the changes in serum VEGF levels before and after therapy. DESIGN: Prospective clinical study. SETTING: Chest clinic of a university hospital, Eskisehir, Turkey. PATIENTS AND MEASUREMENTS: Serum VEGF levels of 44 patients with active pulmonary tuberculosis, 24 patients with inactive pulmonary tuberculosis, and 20 healthy subjects were determined. RESULTS: VEGF levels were increased in active pulmonary tuberculosis patients (mean [+/- SD] VEGF level, 598.03 +/- 298.25 pg/mL) compared to both inactive pulmonary tuberculosis patients (mean VEGF level, 296.98 +/- 115.31 pg/mL) and control subjects (mean VEGF level, 339.67 +/- 74.65 pg/mL). The increase in VEGF level observed in patients with active tuberculosis was statistically significant when compared with levels in two other groups (p < 0.001 for both). Serum VEGF levels were statistically different before treatment and after treatment in 10 patients who were observed from diagnosis to the end of treatment (p < 0.01). CONCLUSIONS: Increased serum VEGF levels may be an indicator of active pulmonary tuberculosis, since levels were higher in patients with active pulmonary tuberculosis and were lower after successful treatment. The role of VEGF-mediated angiogenesis in the pathogenesis and progression of pulmonary tuberculosis lesions should be further elucidated.     

哮喘与肺结核的关系探讨

目的　探讨哮喘与肺结核关系。方法 在河南省结核病流行病学调查的同时进行河南省哮喘流行病学调查。结果 肺结核病人的哮喘患病率为2.3%,非肺结核组的哮喘患病率为1.0%;肺结核病人中的哮喘患病率是非肺结核组的2倍。哮喘病人中的肺结核患病率为1.2%,非哮喘组的肺结核患病率为0.5%;哮喘病人的肺结核患病率为非哮喘的2倍多。结论 肺结核易并发哮喘,哮喘亦易并发肺结核,二者互为促发因素。     

Diagnosis of pulmonary tuberculosis in connection with the guideline for community-acquired pneumonia

The decision when to make chest X-ray examination is important for early diagnosis of pulmonary tuberculosis and community-acquired pneumonia as well. And for early diagnosis of pulmonary tuberculosis, differential diagnosis with community-acquired pneumonia is important. For this reasons, guideline for the diagnosis and treatment of community-acquired pneumonia should include when to make chest X-ray examination, and how to exclude the possibility of pulmonary tuberculosis. For example, empiric choice of anti-microbial for apparent pneumonia should be an agent without anti-tuberculosis effect. Clinical evaluation of the effect of anti-microbial should be done carefully, because pulmonary tuberculosis can be clinically improved spontaneously. In the guideline for the diagnosis and treatment of community-acquired pneumonia could include the above-mentioned views on early diagnosis of pulmonary tuberculosis, the guideline could be much more helpful for the tuberculosis program.     

慢性阻塞性肺疾病急性加重期合并肺结核患者外周血清中IL-6、TNF-α和IFN-γ水平变化及临床意义

目的 探究慢性阻塞性肺疾病急性加重期(AECOPD)合并肺结核患者外周血清中IL-6、肿瘤坏死因子α(TNF-α)和干扰素γ(IFN-γ)水平变化及临床意义.方法 将研究对象分为AECOPD合并肺结核组、AECOPD组、肺结核组和健康对照组,根据肺结核患者影像学检查结果将肺结核患者分为单侧病变组、双侧病变组、无空洞组和有空洞组,根据AECOPD合并肺结核患者治疗后的情况分为好转组和恶化组.采用ELISA法检测各组患者血清中的IL-6、TNF-α和IFN-γ水平.结果 AECOPD合并肺结核组血清中的IL-6和TNF-α水平显著高于AECOPD组和肺结核组(P＜0.05);单侧病变组患者血清中的IL-6、TNF-α和IFN-γ的水平显著低于双侧病变组(P＜0.05);无空洞组患者血清中的IL-6、TNF-α和IFN-γ的水平显著低于有空洞组(P＜0.05);病情好转组治疗后IL-6、TNF-α和IFN-γ水平显著低于治疗前(P＜0.05).结论 IL-6、TNF-α和IFN-γ在AECOPD合并肺结核的发病机制中起着一定的作用,其外周血清中水平的动态变化在一定程度上可以反映AECOPD合并肺结核病情的发展与转归.     

Association of pulmonary tuberculosis and HLA in south India

In 204 patients with smear-positive pulmonary tuberculosis HLA-A10, B8 and DR2 were more frequently found than in 404 control subjects (p = 0.01); the greatest attributable risk (0.29) was associated with HLA-DR2. The radiographic extent of disease was also associated with HLA-DR2 (p = 0.0001). In 152 patients with smear-negative pulmonary tuberculosis, the frequencies of HLA-A10 and B8, but not DR2, were greater in the control subjects (p = 0.001 and 0.01 respectively). HLA-DR2 may be involved in the pathogenesis of advanced pulmonary tuberculosis. Study of endogamous, genetically disparate populations (caste) revealed other HLA associations (A3, B12 and DR4) unique to them, suggesting that genes linked with the HLA complex might also be significant in the pathogenesis of tuberculosis.     

肺结核合并呼吸衰竭54例临床分析

目的：探讨肺结核合并呼吸衰竭的发病机制及治疗对策。方法：回顾分析54例肺结核合并呼吸衰竭。结果：54例合并肺部感染40例（74.1％）。I型呼衰35例（64.8％），Ⅱ型呼衰19例（35.2％）。结论：呼吸衰竭是肺结核严重的并发症，需加强营养支持、基础疾病治疗和免疫治疗。     

肺泡蛋白沉着症合并肺结核1例报道并文献复习

目的　探讨肺泡蛋白沉着症合并肺结核的发病机制,诊断及治疗方法。方法 回顾性分析1例肺泡蛋白沉着症合并肺结核患者临床资料并复习相关文献。结果 患者表现为咳嗽、咳痰、活动后气促、潮热、盗汗,在经纤支镜肺活检等检查后诊断为肺泡蛋白沉着症合并肺结核,给予抗结核治疗及经纤支镜肺泡灌洗后病情明显改善。结论 肺泡蛋白沉着症合并肺结核的情况应引起重视,诊断可依据临床表现、影像学、肺功能、纤支镜活检结果等综合判断。主要治疗方法为抗结核治疗及肺泡灌洗。     

初次治疗的肺结核患者血清IL-17检测及意义

目的研究Th17细胞相关因子IL-17在肺结核发病机制中的作用。方法用ELISA法分别测定初治涂阳肺结核患者治疗前组（22例）、治疗1个月组（18例）、治疗6个月组（16例）的IL-17、IFN-y和IL-4水平。以20例健康志愿者为正常对照组。统计分析比较各组间细胞因子水平的差异及相互相关性。结果IL-17、lL-4水平,治疗前组高于治疗1个月组、治疗6个月组及正常对照组（均P〈0．05）;治疗1个月组高于治疗6个月组及正常对照组（均P〈0．05）;而IFN-1水平与前两者恰恰相反。治疗6个月组与正常对照组三者水平差异均无统计学意义（均P〉0．05）。各组中IL-17水平与IFN-y、IL-4水平均无相关性（P〉0．05）。结论人体感染结核杆菌后,IL-17增高。经过抗结核治疗,IL-17水平逐渐降低。提示IL-17在肺结核发病机制中可能起着非常重要的作用。     

脊柱结核的早期诊断研究进展

脊柱结核多继发于肺结核,晚期可形成较大的椎旁脓肿、窦道,易并发神经系统疾病,严重时甚至可导致截瘫,因而早期诊断具有重要意义。近年来,随着对脊柱结核研究的不断深入,在疾病的早期诊断方面不断有新的发现。笔者就脊柱结核早期诊断的研究进展进行综述。     

初次治疗的肺结核患者血清IL-17检测及意义

目的研究Th17细胞相关因子IL-17在肺结核发病机制中的作用。方法用ELISA法分别测定初治涂阳肺结核患者治疗前组（22例）、治疗1个月组（18例）、治疗6个月组（16例）的IL-17、IFN-y和IL-4水平。以20例健康志愿者为正常对照组。统计分析比较各组间细胞因子水平的差异及相互相关性。结果IL-17、lL-4水平,治疗前组高于治疗1个月组、治疗6个月组及正常对照组（均P〈0．05）;治疗1个月组高于治疗6个月组及正常对照组（均P〈0．05）;而IFN-1水平与前两者恰恰相反。治疗6个月组与正常对照组三者水平差异均无统计学意义（均P〉0．05）。各组中IL-17水平与IFN-y、IL-4水平均无相关性（P〉0．05）。结论人体感染结核杆菌后,IL-17增高。经过抗结核治疗,IL-17水平逐渐降低。提示IL-17在肺结核发病机制中可能起着非常重要的作用。     

Autophagy: a core cellular process with emerging links to pulmonary disease

Autophagy is a highly conserved homeostatic pathway by which cells transport damaged proteins and organelles to lysosomes for degradation. Dysregulation of autophagy contributes to the pathogenesis of clinically important disorders in a variety of organ systems but, until recently, little was known about its relationship to diseases of the lung. However, there is now growing evidence at the basic research level that autophagy is linked to the pathogenesis of important pulmonary disorders such as chronic obstructive pulmonary disease, cystic fibrosis, and tuberculosis. In this review, we provide an introduction to the field of autophagy research geared to clinical and research pulmonologists. We focus on the best-studied autophagic mechanism, macroautophagy, and summarize studies that link the regulation of this pathway to pulmonary disease. Last, we offer our perspective on how a better understanding of macroautophagy might be used for designing novel therapies for pulmonary disorders.