Tuberculosis in patients infected with human immunodeficiency virus 1. A retrospective multicentre study of 123 cases in France. The Groupe des Infectiologues du Sud de la France.

In order to study the epidemiological, clinical, and progressive characteristics of TB in HIV-infected individuals, a retrospective study was conducted in nine infectious disease centres of university hospitals located in the southern half of France. Among the 5730 HIV-seropositive in- and out-patients, 123 (2.1 per cent) had TB (121 infections caused by M. tuberculosis, 2 by M. bovis). Tuberculosis was pulmonary in 53 patients (43.1 per cent), extrapulmonary in 36 patients (29.3 per cent), and combined in 34 patients (27.6 per cent). There was no statistically significant difference among these three locations as to the mean CD4 count/mm3 (160 +/- 17), the type of antituberculosis therapy, the length of treatment (10.8 +/- 0.6 months) and the outcome. Fifty-two (45.2 per cent) patients received an initial antituberculosis therapeutic regimen of four drugs: isoniazid, rifampicin, ethambutol, pyrazinamide; 54 (46.9 per cent) were started on three drugs: isoniazid, rifampicin, ethambutol; and nine (7.8 per cent) received a two-drug combination: isoniazid, rifampicin. Fourteen of 75 patients subsequently received secondary preventive therapy. The mean follow-up time was 252 +/- 290 days. Clinical healing was obtained in 57.7 per cent of patients. Forty-six patients died, 33 during treatment: 23 from AIDS and eight from TB (in the first 3 weeks of treatment). Five patients suffered from relapses due to poor treatment compliance. Patients had a good prognosis if tuberculosis was diagnosed early.     

Patterns of Insulin Dependence in an African Diabetic Clinic

SUMMARY Analysis of the age of onset of diabetes amongst insulin-treatedpatients in a large African diabetic clinic revealed a bimodaltype of distribution, 23 per cent having an age of onset before30 years and 77 per cent with onset at 30 years of age. All66 of the young insulin-treated group (21.7±4.8 years(mean±1 SD)), and a random selection of 50 older insulin-treatedpatients (49.7±10 years), were studied. The older groupwere better controlled (HbA₁ 8.4±1.7 per cent vs. 10.8±2.6per cent, p<0.001), on lower doses of insulin (49±23vs. 71±23 u/day, p<0.001) and had higher body massindex (26.0±5.6 vs. 21.8±3.5, p<0.001). SerumC-peptide (0.24±0.15 vs. 0.07±0.10 nmol/l, p<0.0001),and C-peptide/glucose ratio (2.57±2.65 vs. 0.56+0.98nmol/mmolx 10², p<0.001) were very significantly higher inolder patients. Patients with later onset disease thus had betterpreservation of pancreatic function, higher body mass indexand better glycaemic control on lower doses of insulin. Thesefeatures suggest that older insulin-treated patients could infact be ‘Type 2’ or non-insulin dependent patients,and the condition may be controllable with diet and/or oralhypoglycaemic agents, at least in some.     

Pharmacokinetic interaction between rifampicin and the once-daily combination of saquinavir and low-dose ritonavir in HIV-infected patients with tuberculosis

OBJECTIVES: To assess plasma steady-state pharmacokinetics (PK) of rifampicin, isoniazid, saquinavir and ritonavir in HIV and tuberculosis (TB) co-infected patients, and investigate potential interactions between TB drugs and protease inhibitors (PIs). METHODS: Open-label, single-arm, sequential PK study including 22 patients with HIV infection and TB. During the first 2 months, patients received rifampicin, isoniazid and pyrazinamide, with or without ethambutol (first PK study, n = 22). Then patients stopped pyrazinamide and ethambutol and started once-daily antiretroviral therapy (ART) with didanosine, lamivudine, ritonavir (200 mg) and saquinavir (1600 mg) (second PK study, n = 18). Patients stopped all TB drugs after 9 months continuing the same ART (third PK study, n = 15). Differences between TB drug parameters in the first and second PK studies, and between PI parameters in the second and third PK studies were used to assess interactions. RESULTS: Rifampicin and isoniazid pharmacokinetics did not change substantially with saquinavir and ritonavir. A significant 39.5%, 34.9% and 48.7% reduction in median saquinavir AUC(0-24), C(max) and C(trough), respectively, was seen with rifampicin and isoniazid. Ritonavir AUC(0-24), C(max) and C(trough) decreased 42.5%, 49.6% and 64.3%, respectively, with rifampicin and isoniazid. CONCLUSIONS: There was a significant interaction between saquinavir, ritonavir and rifampicin, with reduction in median plasma concentrations of saquinavir and ritonavir. Saquinavir should be given with caution in patients receiving rifampicin. Twice-daily dosing or higher saquinavir doses in once-daily administration should be tested to obtain more appropriate plasma levels.     

Iron Metabolism in Haemodialysis Patients: A STUDY OF THE MANAGEMENT OF IRON THERAPY AND OVERLOAD

Some dialysis units replace iron losses in patients on maintenancehaemodialysis treatment (MHDT) with parenteral iron becauseof doubts about adequate intestinal iron absorption. Recentexperiences in Oxford indicate that this can lead to potentiallydangerous iron loading. Sixty-four of 120 MHDT patients hadserum ferritin levels >1000 µg/l and there was a goodcorrelation between these levels and the number of years ondialysis. A retrospective post-mortem study of 22 MHDT patientsshowed significant amounts of iron in liver and spleen and infive cases there was myocardial iron loading. Five MHDT patientswith iron loading were given desferrioxamine intravenously atdialysis. Iron was chelated but with some difficulty. Iron absorption, using ⁵⁹Fe and the total body counter, wasfound to be similar in both the MHDT patients with iron deficiency(mean ± S.E.M.; 42·5 ± 5·8 per cent)and iron deficient subjects without renal disease (45·3± 1·86 per cent). In iron replete MHDT patientsiron absorption (8·1 ± 2·6 per cent) didnot differ significantly from normal controls (14·9 ±1·6 per cent) while it was reduced in iron loaded MHDTpatients (5·4 ± 0·7 per cent). There wasa good correlation between red cell indices and iron storesin MHDT patients and haemoglobin values in 15 iron deficientMHDT patients rose significantly when treated with oral iron. These findings indicate that the control mechanisms which relateiron absorption to body iron stores are intact in patients onMHDT. Oral iron therapy is recommended and can be monitoredusing red cell indices. Prolonged parenteral iron treatmentis unnecessary and potentially dangerous.     

Determinants of rifampin, isoniazid, pyrazinamide, and ethambutol pharmacokinetics in a cohort of tuberculosis patients

Evaluation of sources of pharmacokinetic variation can facilitate optimization of tuberculosis treatment regimens by identification of avoidable sources of variation and of risk factors for low or high drug concentrations in patients. Our objective was to describe the pharmacokinetics of rifampin, isoniazid, pyrazinamide, and ethambutol in a cohort of tuberculosis patients established on first-line treatment regimens and to evaluate the determinants of pharmacokinetic variation. Plasma concentration-time profiles were determined for each of the drugs in 142 patients with drug-sensitive pulmonary tuberculosis after 2 months of daily treatment in hospital. Pharmacokinetic measures were described by noncompartmental analysis. Multiple linear regression was used to evaluate the patient and the treatment factors associated with variation of the area under the concentration-time curve from 0 to 8 h. Several factors independently associated with variations in antituberculosis drug concentrations were identified: human immunodeficiency virus infection was associated with 39% and 27% reductions for rifampin and ethambutol, respectively; formulation factors were determinants of rifampin and isoniazid bioavailability; female patients had increased rifampin and isoniazid concentrations but reduced ethambutol concentrations; older patients had higher levels of isoniazid and ethambutol; patients with a history of previous antituberculosis treatment had lower ethambutol concentrations; and the dose per kilogram of body weight was associated with the concentrations of all four agents. Further studies are required to assess the implications of variations in antituberculosis drug concentrations for efficacy and safety before decisions are made to change the dosing strategy in patients at risk.     

Hyperthyroidism in the Land of Graves: Results of Treatment by Surgery, Radio-iodine and Carbimazole in 837 Cases

A review of the outcome of treatment by subtotal thyroidectomy,radio-iodine and carbimazole of 837 patients with hyperthyroidismseen consecutively over the period 1954–78 inclusive ispresented. The age and sex distribution, the male to femaleratio, the ABO blood group distribution and the prevalence ofpernicious anaemia and diabetes mellitus in these patients wasalso analysed. Life-table data showed that the five-year andten-year cumulative relapse rates following a two-year courseof carbimazole (n = 162) were 56 per cent and 62 per cent; followingsurgery (n = 266), 6 per cent and 10 per cent and followingradio-iodine (n = 43), 3 per cent and 14 per cent. Five-yearand ten-year cumulative hypothyroid rates after surgery were10 per cent and 18 per cent, and after radio-iodine 10 per centand 30 per cent. Hypothyroidism did not occur after carbimazoletherapy. Of 31 patients who took carbimazole for less than twoyears (mean 11 months, range 6–19 months), 91 per centhad relapsed at five years. Of 79 patients treated for longerthan two years (mean 3.8 years, range 2–14 years), relapserates at five and eight years were 49 per cent and 62 per cent.Nine patients (3.4 per cent) suffered permanent vocal cord paralysisand five (1.9 per cent) had permanent hypocalcaemia. The male/female ratio was 9.9 to 1, with a peak female prevalencebetween 25 and 30 years and a peak male prevalence between 40and 45 years. The ABO blood group distribution among patients did not differsignificantly from the distniution in the general population(x² = 13.4, p = 0.2). Forty-seven patients (5.6 per cent) had diabetes mellitus andthyrotoxicosis whilst two patients (0.23 per cent) had diabetes,thyrotoxicosis and pernicious anaemia.     

Newer Techniques in the Diagnosis and Treatment of Proximal Bile Duct Carcinoma--an Analysis of 41 Consecutive Patients

The clinical course of 41 consecutive patients with primarybile duct carcinoma at or near the liver hilum was analysedto determine whether the outcome was improved by newer techniquesof diagnosis and treatment. The age range was wide, with onethird under 50 years. The only aetiological factor identifiedwas long-standing ulcerative colitis (present in 9·8per cent of patients). In one third of patients initial symptomswere misleading. The tumour had been missed in 11 (61 per cent)of 18 patients undergoing an exploratory laparotomy at otherhospitals, despite operative cholangiography. None had pre-operativepercutaneous cholangiography which was shown to be the bestinvestigatory technique, giving the correct diagnosis in allcases in whom it was performed. Greyscale ultrasonography wasuseful and endoscopic retrograde cholangiography less so. Median survival in those treated by surgical T- or U-tube drainage(21 patients) or bypass (three) was nine months from diagnosis,as opposed to three months in the 36·5 per cent of patientsin whom biliary drainage was not obtained. Radiotherapy, includinginsertion of a radioactive iridium wire through the tumour viaa T- or U-tube, or percutaneously, was performed in nine patientsand improved the duration of survival compared with tube drainagealone. The new percutaneous techniques offer a useful alternativeto surgery for palliative drainage and radiotherapy. ^*Present address: The William Harvey Hospital, Ashford, Kent     

A case of isoniazid-induced liver injury diagnosed by use of the DLST,and successful reintroduction of isoniazid for pleural tuberculosis

A 54-year-old woman was admitted for pleural tuberculosis diagnosed by right chest pain and cough. She received combination antituberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, liver damage was observed 15 days after initiation of therapy (aspartate aminotransferase (AST) 248 IU/l, alanine transaminase (ALT), 132 IU/l). The patient was given glycyrrhizinate intravenously, but liver damage gradually increased (AST 628 IU/l, ALT 467 IU/l) and all tuberculosis drugs were ceased. We diagnosed drug-induced liver damage due to isoniazid according to results of the drug lymphocyte stimulation test. We successfully reintroduced rifampicin and streptomycin, and carried out desensitization therapy for isoniazid without liver injury recurrence. Reintroduction of a drug suspected to cause drug-induced liver injury is generally not recommended; however, our experience suggests that isoniazid, a first-line antituberculosis drug, may be reintroduced after desensitization.     

浙江省衢州市结核分枝杆菌耐药监测调查

目的 了解浙江省衢州市结核分枝杆菌临床分离株耐药状况, 为结核病的防治提供参考依据。 方法 收集2010年全年衢州4县2区6家医院肺结核就诊病例痰标本,用改良罗氏培养基进行病原分离,鉴别培养基培养法进行菌型鉴定。对分离到的结核分枝杆菌采用比例法对4种一线抗结核药物,异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB),和二线抗结核药物氧氟沙星(OFX)、卡那霉素(KM)进行药物敏感性检测,用 SPSS 11.0统计软件进行统计分析。 结果 371 株结核分枝杆菌对4种一线抗结核药物,INH、RFP、SM和 EMB全部敏感的菌株为292株(78.71%),对二线抗结核药物OFX和KM全部敏感的菌株为337株(90.84%);耐药菌株89株(23.99%),其中,单耐药菌株51株(13.75%),耐多药菌株21株(5.66%),多耐药株14株(3.77%),广泛耐药株3株(0.81%)。结核分枝杆菌对4种一线药物INH、RFP、SM和 EMB的耐药率分别为15.36%(57/371)、7.01%(26/371)、11.86%(44/371)和3.23%(12/371);对2种二线药物OFX和KM的耐药率分别为7.82%(29/371) 和2.42%(9/371)。326例初治患者的耐药率为INH 10.12%(33/326)、RFP 2.45%(8/326)、SM 8.90%(29/326)、EMB 1.23%(4/326)、OFX 3.68%(12/326)、KM 1.53%(5/326),非耐药80.98%(264/326),耐多药1.84%(6/326);45例复治患者的耐药率为INH 53.33%(24/45)、RFP 40.00%(18/45)、SM 33.33%(15/45)、EMB 17.78%(8/45)、OFX 37.78%(17/45)、KM 8.89%(4/45),非耐药40.00%(18/45),耐多药33.33%(15/45)。 结论 衢州市结核分枝杆菌的耐药情况较为严重,每种药物复治患者的耐药率均明显高于初治患者,在制定结核病防控策略时应给予充分重视,同时进一步加强高质量的全程监督短程化疗。     

Plasmodium falciparum Hyperparasitaemia: use of Exchange Transfusion in Seven Patients and a Review of the Literature

During the last 15 years, at least 35 patients with severe falciparummalaria or babesiosis have recovered following treatment byexchange of up to 10 1 of blood. In a patient treated in Manchester,a parasitaemia of 2.10 x 10⁶ µl (42 per cent) was virtuallyeliminated over eight hours by a 3.5 litre exchange blood transfusion.However, the equipment and amounts of compatible blood requiredfor total exchange are rarely available in areas endemic formalaria and the risks of the procedure, including transfusion-relatedinfections, are high. Partial exchange transfusion with oneto two litres of blood carried out over two to seven hours,reduced Plasmodium falciparum parasitaemias of 0.33–1.48x 10⁶/µl (13–38 per cent) to 0.11–0.81 x 10⁶(4–17 per cent) in six Thai patients who were receivingintravenous quinine. The reduction in parasitaemia ranged from0.13–0.67 x 10⁶ µl (9–12 per cent) withinsix hours. During the same period, parasitaemia in 13 patientswith cerebral malaria treated with chemotherapy alone showedlittle reduction from initial levels of 0.20–1.74 x 10⁶/µl(11–42 per cent). One of the patients who were treatedwith exchange transfusion died with intractable hypotensionbefore the procedure could be completed and two others developedoliguric renal failure which was controlled by peritoneal dialysis.Partial exchange transfusion is a promising and practical alternativeto total exchange where facilities are limited. It deservesfurther assessment in the rural tropics.     

Use of Liver Function Tests as Predictors of Rifampicin Metabolism in Cirrhosis

Normal subjects taking rifampicin regularly, show a fall inserum and urinary drug concentrations from enzyme inductionand increased biliary excretion. In cirrhosis, hepatocellulardysfunction and impaired biliary excretion may prevent thesechanges, but there is little information on how the drug shouldbe prescribed in such patients. Serum and urinary rifampicinconcentrations were therefore measured in thirteen patientsand five controls during a seven-day course (600 mg/day). In controls, peak serum concentrations on Day 7 were lower thanon Day 1 (7·0 ± 3·0 and 8·0 ±1·0 µg/ml respectively) and this was also the casefor nine cirrhotic patients with mild impairment of liver function(6·0 ± 1·0 and 11·0 ± 2·0µg/ml (p < 0·02). In both groups there was anaccompanying fall in urinary rifampicin excretion due to a decreasein desacetylrifampicin excretion. In the remaining four cirrhoticpatients, peak serum rifampicin levels rose from 11·0± 5·0 to 17·0 ± 6·0 µg/mland urinary excretion of desacetylrifampicin did not fall. Althoughvalues for serum albumin and prothrombin time were of limitedvalue in predicting drug accumulation, pretreatment levels ofbilirubin exceeding 50 µmolg/ml were present in all fourpatients showing an increase in serum rifampicin concentration.Furthermore, only in this group was there a rise in serum bilirubinduring treatment, almost certainly the result of competitionbetween rifampicin and bilirubin for hepatic uptake and excretion.In patients with cirrhosis, bilirubin concentrations exceeding50 µmol/l should be an indication for reduction in rifampicindosage.     

Clinical Features, Complications and Mortality in Type 1 (Insulin-Dependent) Diabetic Patients in Addis Ababa, Ethiopia, 1976-1990

Clinical features, complications and prognosis of 431 consecutivelyregistered Ethiopian Type 1 (insulin-dependent) diabetic patientsseen in the Diabetic Clinic in Yekatit 12 Hospital in AddisAbaba, Ethiopia, from 1976–1990 are reported. Male:femaleratio was 1.4:1; mean age at diagnosis was 18.1 years (confidenceinterval (CI) 1.6) in women and 21.4 (CI 1.2) in men. A historyof ketoacidosis at some time was present in 38 per cent, in11 per cent at diagnosis of diabetes. Tuberculosis was the mostcommon complicating illness, occurring at some time in 16.5per cent of patients. In addition, 9.5 per cent (CI 4 per cent)were known to have diabetic retinopathy, 6.0 per cent (CI 2per cent) nephropathy and 7.9 per cent (CI 2 per cent) neuropathyat their last clinic visit. During the 15 years of the study,9.7 per cent of the patients have died, with a mean durationof diabetes at death of 9.2 years (CI 1.8), and an overall mortalityrate of 15.5/1000 person-years of diabetes. Five-year survivalwas 96 per cent (CI 3 per cent), 15-year survival 82 per cent(CI 9 per cent), and 20-year survival 63 per cent (CI 17 percent), calculated using the Cox proportional hazards model;prognosis was better in those diagnosed at a younger age (p=0.029)and in those with a body mass index of > 19 kg/m² on treatment(p=0.096).     

2013-2018年浙江省丽水市结核病患者一线抗结核药物耐药分析

目的了解2013-2018年浙江省丽水市结核病患者对一线抗结核药物的耐药情况,为结核病疫情控制提供参考依据。方法收集2013-2018年浙江省丽水市结核病病例,分离菌株并进行菌型鉴定,测定结核分枝杆菌对异烟肼、利福平、链霉素、乙胺丁醇4种一线抗结核药物敏感性。结果共测定1883株结核分枝杆菌的耐药性,其中初治肺结核患者1770株,复治肺结核患者113株,总耐药率为17.15%,耐多药率为5.74%。初始耐药率是15.42%(273/1770),低于获得性耐药率的44.25%(50/113);初治肺结核患者耐药顺位链霉素>异烟肼>利福平>乙胺丁醇;复治患者耐药顺位为异烟肼>利福平>链霉素>乙胺丁醇。结论丽水市肺结核患者总的耐药率和耐多药率低于全省及全国耐药基线调查及丽水市上一轮的监测数据,但是耐多药形势仍较为严峻。     

In vitro inhibitory effect of antituberculosis drugs on clinical and environmental strains of Coccidioides posadasii

OBJECTIVES: The aim of the present study was to evaluate the in vitro effect of the first-line antimicrobial drugs for pulmonary tuberculosis against the fungal pathogen Coccidioides posadasii. METHODS: The in vitro activities of rifampicin, isoniazid, pyrazinamide and ethambutol against clinical and environmental strains of C. posadasii were determined in accordance with the CSLI M38-A macrodilution method. The antimicrobials were tested alone or in combinations of two or more drugs. RESULTS: With the exception of pyrazinamide, all of the tested drugs interfered with the in vitro growth of C. posadasii. The 2 day MIC ranges of the tested drugs were as follows: rifampicin 1,060-4,250 mg/L; isoniazid < or =250 mg/L; ethambutol < or =620 mg/L. Pronounced in vitro synergism was demonstrated for combined antituberculosis drugs. The combination of rifampicin plus pyrazinamide was the only one that did not inhibit fungal growth. CONCLUSIONS: The present study showed that the first-line antituberculosis drugs, alone or in combinations, interfered with the vegetative growth of C. posadasii strains in vitro. Further studies in a murine model will need to be conducted in order to evaluate the in vivo effect of antituberculosis drugs on Coccidioides spp.     

Assessment of Gall Bladder Dynamics, Cholecystokinin Release and the Development of Gallstones During Octreotide Therapy for Acromegaly

The development of gallstones is a well recognized complicationof therapy with the long-acting somatostatin analogue, octreotidein patients with acromegaly. A group of nine acromegalic patientswas treated with octreotide at doses of 300–600 µgdaily for 8 months and the changes in fasting and post-prandialcholecystokinin release, and gall bladder motor function (determinedby a radiosotopic technique) were assessed at regular intervals.In addition the development of any gallstones was determinedby serial ultrasonography. Fasting cholecystokinin levels showedno significant change over 6 months, whereas the post-prandiallevels demonstrated a significant decrease (p<0.01) duringtherapy, yet remained significantly higher than fasting levels.Twenty-four hours after commencing therapy gall bladder ejectionfraction was decreased by 57±23 per cent and gall bladderejection rate decreased by 63±19 per cent compared tothe pretreatment values, whereas after 6 months, therapy a markedreduction in gall bladder ejection fraction (>35 per cent)and gall bladder ejection rate (>40 per cent) persisted inonly four of nine patients. Three of these four patients withpersistently impaired gall bladder motor function were subsequentlyshown to have developed either gallstones or biliary sludgeduring the course of therapy. We conclude that treatment with octreotide is associated withan impaired post-prandial release of cholecustokinin in allacromegalis patients, but gallstones only develop in those patientswho, in addition, have evidence of a persistently impaired gallbladder motor response to cholecyustonini.     

Study of Lupus Nephritis in Males

Clinical and pathological findings were studied in 23 male patientswith lupus nephritis who were followed up for a period of 41±36months after renal biopsy. Age at renal biopsy was 31±14years and 19 patients (83 per cent) were between 15 and 50 yearsold. C3 and C4 levels were below normal in 23 (100 per cent)and 16 (70 per cent) respectively, CH₅₀ was <25 u/ml in 67per cent, and antinuclear and anti-DNA antibodies were foundin 87 per cent and 82 per cent respectively. Serum albumin levelincreased from 2.9±0.8 g/dl to 3.7±0.8 g/dl duringthe follow up period (p<0.01), while urinary protein decreasedfrom 2.0±2.3 g/day to 1.4±2.5 g/day. There wasa significant improvement in the degree of haematurai (p <0.01),but serum creatinine levels showed no change (mean 1.5 mg/ml).Active proliferative lupus nephritis of, moderate or severedegree was observed in 65 per cent of patients at the initialbiospsy. A trend to regression in this activity was seen inmost serial biopsies, but the chronicity index showed a slightincrease. These data demonstrate that systemic lupus erythematosusin males, in comparison to our previous report of the diseasein female patients, is accompanied by more active nephritis,but that is follows a benign course with therapy.     

Mycobacterium resistance to antimycobacterial reagent

This study was carried out in the tuberculosis laboratory of the Institut National d'Hygiène in Rabat, Morocco, in 1997. The aim was to determine the percentages of drug-resistant strains by using 150 antibiograms. Six antimycobacterial medications were used as tuberculosis treatment: isoniazid (INH), streptomycin (STM), rifampicin (RIF), ethambutol (EMB), kanamycin (KAN) and p-amino-salicylic acid (PAS). The cultures were plated onto a simple agar (Lowenstein-Jensen) plate containing different concentrations of drugs. This test demonstrated the presence of major antimycobacterial (INH, RIF, STM)-resistant strains of Mycobacterium tuberculosis in the following percentages respectively: 34.6 per cent, 33.1 per cent and 26.1 per cent and 80 per cent, 70 per cent and 40 per cent in the case of atypical mycobacteria. The association of INH/RIF showed the highest percentage (27.6 per cent) for Mycobacterium tuberculosis and 70 per cent for atypical strains, whereas, when we associate INH/RIF/STM, the resistance rate becomes 17.69 per cent for Mycobacterium tuberculosis and 25 per cent for atypical mycobacteria. The resistance in question was a secondary or acquired resistance because the tested strains were isolated from patients who had not responded to standard tuberculosis treatment.     

肝炎病毒感染对抗结核治疗时患者肝功能的影响

【目的】观察合并肝炎病毒感染的结核患者服用抗结核药物后对肝功能的影响。【方法】单纯结核杆菌感染的患者525例,结核杆菌合并肝炎病毒感染43例。两组患者前4个月采用异烟肼、利福平、吡嗪酰胺、乙胺丁醇治疗,后2个月采用异烟肼、利福平治疗,观察抗结核治疗对肝功能的影响。【结果】单纯结核杆菌感染组发生急性药物性肝炎54（10．3％）例,结核杆菌合并肝炎病毒感染组发生急性病毒型肝炎20（46．5％）例,两组有显著性差异（P〈0．05）。急性病毒性肝炎肝功能损害严重（AST：210．6±77．4vs387．4±90．6,P〈0．05;ALT：207．3±45．3vs372．6±88．1,P〈0．01）,肝功能恢复时间延迟（27．4±13．5vs41．4±18．3,P〈0．05）。【结论】抗结核杆菌的药物对结核杆菌合并肝炎病毒患者的肝脏毒性较强,治疗过程中定期复查肝功能;抗结核治疗前应该常规检测肝炎病毒。     

2017-2020年黑龙江省佳木斯市肺结核患者耐药情况分析

  目的   了解黑龙江省佳木斯市肺结核患者的耐药情况,为结核病疫情防控提供可靠的参考依据。   方法   收集2017 — 2020年黑龙江省佳木斯市结核病参比实验室接收的575例分枝杆菌培养阳性患者菌株进行菌种鉴定,采用固体比例法进行药物敏感度测试,分析异烟肼、利福平、乙胺丁醇、链霉素、氧氟沙星、卡那霉素的药敏试验结果。   结果   总耐药率为35.29%（198/561）,初治患者总耐药率为32.35%（143/442）,复治患者总耐药率为46.22%（55/119）,两者间差异有统计学意义（χ2=7.893,P=0.005）;总耐多药率为10.16%（57/561）,初治患者耐多药率为7.92%（35/442）,复治患者耐多药率为18.49%（22/119）,两者间差异有统计学意义（χ2=11.473,P=0.01）。 结核分枝杆菌菌株耐药率顺位分别是链霉素（22.82%,128/561）、异烟肼（19.25%,108/561）、利福平（15.69%,88/561）、氧氟沙星（6.77%,38/561）、乙胺丁醇（6.6%,37/561）、卡那霉素（2.14%,12/561）。   结论   2017 — 2020年佳木斯市肺结核病耐药情况较严重,特别是利福平耐药患者的比例较高,应尽早发现耐药结核病患者并进行针对性规范化治疗管理,避免耐药结核病的传播。     

Long-term Results Following 131I Treatment for Graves' Disease in Hong Kong Chinese--Discriminant Factors Predicting Hypothyroidism

The clinical outcome of 1028 Hong Kong Chinese patients withGraves' disease treated with radioiodine therapy and followedfor a mean of 9.85±4.84 years (range 2–20) wasanalysed. Retreatment was required by 413 patients (40.2 percent), with 134 patients (13.0 per cent) requiring more thantwo ¹³¹I doses. One hundred and eighty-nine patients receivedcarbimazole after ¹³¹I until euthyroidism was achieved. Thecumulative incidence of hypothyroidism at one, five, 10 and15 years was 9.6 per cent, 31.4 per cent, 53.8 per cent and65.8 per cent, respectively. The average incidence of hypothyroidismafter the first two years was 3.3 per cent per annum. Stepwiselogistic regression analysis of pretreatment variables suggestedthat a combination of adjunctive carbimazole therapy, absenceof ophthalmopathy and longer effective half-lives of ¹³¹I wereof value in predicting which patients were less likely to developpermanent hypothyroidism. However, the probability of accuratelypredicting permanent hypothyroidism based on the present modelwas only 60 per cent. We believe that no single pretreatmentvariable, or combination of variables, predicts long-term hypothyroidismwith sufficient confidence to justify the use of a ‘formula’approach for prescribing ¹³¹I therapy for Graves' disease.