青年肺癌病例误诊分析（X线与手术病理对照）

作者分析了39例青年肺癌病例X线误诊情况．误诊为肺炎21倒；结核14倒；炎性假瘤、纵隔肿癌、错构瘤．支气管囊肿各1例．认为误诊的主要原因是：1思维方法不当，受府人年龄因素干扰；2未详细分析X线征象；3 X线征象与临床资料结合不紧，缺乏鉴别诊断的经验：4 X线和临床表现不典型；5检查手段不充分．     

皮肤结核临床观察分析

目的 提高对皮肤结核病诊断的警惕和认识能力.方法 对112例皮肤结核的临床特点、辅助检查、病理组织学检查.结果 皮肤结核临床表现多样,不典型,极易误诊为其它皮肤病,最后行组织病理检查、病原学检查、PPD试验或诊断性抗结核治疗确定诊断.结论 皮肤结核病程长,组织病理检查、病原学检查、PPD试验或诊断性抗结核治疗对结核病的诊断有极大帮助.     

系统性红斑狼疮的胸部X线表现研究(附46例报告)

目的探讨系统性红斑狼疮的胸部X线表现,提高对红斑狼疮胸部X线的诊断水平。方法对46例经临床及病理证实的系统性红癍狼疮患者的胸部X线表现进行分析研究。结果约86．9％的系统性红斑狼疮患者胸部X线异常,多数显示肺间质改变,部分间或有肺实质改变;约50％患者累及胸膜;约66％病人心影有异常改变。结论系统性红斑狼疮较易侵及肺部血管及心血管,胸部X线表现形式多样化,了解并掌握系统性红斑狼疮常见胸部X线表现。为临床诊断和治疗提供重要价值。     

CT检查在粉尘肺职业监护中的应用价值

目的探析CT检查在粉尘肺职业护理监护中的应用价值。方法选择120例粉尘肺患者与60例健康者,均给予胸部X线检查及相同条件下进行胸部CT检查,比较X线检查与CT检查在粉尘肺职业监护中诊断敏感度、特异度及准确度。结果 X线检查诊断尘肺108例(假阳性11例),CT增强扫描诊断尘肺113例(假阳性3例)。CT增强扫描检查诊断尘肺敏感性、特异性、诊断符合率分别为91.67%、95.00%、92.78%,显著高X线检查的80.83%、81.67%、81.11%(P0.05)。结论相较于X线检查,CT检查能够提高诊断尘肺病诊断效能,在尘肺职业病监护中效果更好,值得推广     

以聚合OT为抗原用酶联免疫吸附试验诊断活动性结核病的研究

结核病是长期危害人民健康的严重疾患之一。目前我国的疫情仍然比较严重。全国每年死于结核病的人数将近30万,比其它各种传染病死亡人数的总和还多。另外每年还有上百万人因患结核病而丧失劳动能力。因此,这种现状亟待改变。而现有诊断方法,对发现病人和确定诊断均不很理想。有的阳性检出率低,费时长(如:细菌学检查,开放性结核痰菌培养加涂片的阳性率,在有经验的专科医院不过40%;细菌培养需4—8周才能有结果);有的可靠性差(如X线)。特别是对肺外结核的确诊更为困难。故在1982年全国结核病防治学术会议上,提出了从免疫的角度寻找特异性血清学     

人体细胞免疫时辰的探讨

旧结核菌素试验(简称OT试验),常常被人们用于临床观测是否感染过结核病。以反应阴性、阳性来确定要否接种卡介苗和进一步查明体内结核的感染灶。     

肺内孤立结核瘤在X线胸片中的诊断

目的：讨论在X线胸片中肺内孤立结核瘤与球形肺炎、肺癌等其它孤立病变易误诊的鉴别诊断。方法分析109例肺内孤立结核瘤在X线胸片的表现，分析其诊断及鉴别诊断。结果在结核瘤等其它肺野内孤立结节的诊断与鉴别诊断中，孤立结节的边缘特征(分叶、毛刺)、内部结构(空泡征、空气支气管征、结节内透亮影)、周围改变(卫星灶)等表现。结论对X线胸片影像表现的细心观察，结合临床诊疗与实验室结果，对肺内孤立结节病变不难诊断与鉴别诊断。     

肌电图在腰椎间盘突出症诊断上的应用

腰椎间盘突出症是腰腿痛最常见的病因之一,本病虽然结合临床表现,依据X线片、CT、MRI及椎管造影等影像学检查即可做出明确诊断;但本文对该病进行肌电图检查的目的,旨在探讨肌电图在腰椎间盘突出症诊断上的应用价值及临床意义。根据我们对30例腰椎间盘突出症患者的肌电图检查结果报道如下。     

螺旋CT结合钼靶X线在乳腺癌早期诊断中的应用

目的 分析螺旋CT结合钼靶X线在乳腺癌早期诊断中的应用价值。方法 选取2017年4月~2018年4月至我院就诊的乳腺癌患者80例,均接受螺旋CT检查与钼靶X线检查,以病理检查为标准,比较两种检查方法单独检查及联合检查的准确率。结果 钼靶X线检测阳性率及CT检查阳性率均较病理检查阳性率低,差异有统计学意义（P＜0.05）;钼靶X线联合CT检查阳性率与病理检查阳性比较,差异无统计学意义（P＞0.05）;单独采用螺旋CT、钼靶X线与二者联合诊断检测乳腺癌的特异度比较,差异无统计学意义（P＞0.05）;钼靶X线的检测准确率低于联合诊断 （P＜0.05）,而螺旋CT与联合诊断的检测准确率比较,差异无统计学意义（P＞0.05）;联合诊断的灵敏度为96.00%,高于单独使用钼靶X线的84.00%及螺旋CT 的85.33%,差异有统计学意义（P＜0.05）。结论 螺旋CT与钼靶X线二者联合应用相较于二者单项诊断,其在准确率、灵敏度上具有一定优势,可以作为临床乳腺癌早期诊断的可靠手段。     

全数字化乳腺X线、高频超声联合MRI对乳腺癌的早期诊断价值分析

目的探讨全数字化乳腺X线、高频超声联合MRI对乳腺癌的早期诊断价值。方法选择我院2014年12月到2018年5月就诊收治的行全数字化乳腺X线、高频超声、MRI检查的94例乳腺癌患者作为研究对象,比较全数字化乳腺X线、高频超声、MRI检查及三者联合检查的符合率及诊断乳腺癌的敏感性、特异性。结果全数字化乳腺X线、高频超声联合MRI检查乳腺癌符合率高于全数字化乳腺X线、高频超声、MRI检查任意单一检查的符合率(P0.05);单一检查乳腺癌符合率由高到低顺序为MRI、全数字化乳腺X线、高频超声(P0.05);全数字化乳腺X线、高频超声联合MRI检查敏感性、特异性、阳性预测值、阴性预测值均高于全数字化乳腺X线、高频超声、MRI任意单一检查的敏感性、特异性、阳性预测值、阴性预测值(P0.05)。结论全数字化乳腺X线、高频超声联合MRI检查对于乳腺癌患者有较好的早期诊断价值,可有效提高早期诊断率及敏感性。     

Correlation between culture of Mycobacterium tuberculosis and detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis

A retrospective study was done to correlate culture of Mycobacterium tuberculosis and detection of mycobacterial antigen in cerebrospinal fluid (CSF) by an inhibition enzyme-linked immunosorbent assay (ELISA). M. tuberculosis was cultured from CSF of 14 out of 70 patients with a clinical diagnosis of tuberculous meningitis (TBM). Mycobacterial antigens were demonstrated in CSF specimens by inhibition ELISA in all 14 culture-positive patients with antigen concentrations of 14.5-295 ng/ml (mean 158.8 ng/ml). Thus there was positive correlation between the detection of mycobacterial antigen and isolation of M. tuberculosis. Based on this observation, 56 CSF specimens from culture-negative patients with clinically diagnosed TBM were examined for mycobacterial antigen and the data were compared with those from culture positive patients. ELISA gave positive results in 38 specimens, with antigen levels of 12.5-280 ng/ml (mean 152.6 ng/ml). In 70 CSF specimens from patients with non-tuberculous neurological disease (control group), ELISA results were negative. Thus, detection of mycobacterial antigen in CSF specimens by inhibition ELISA had a specificity of 100% and a sensitivity of 67.8% for the diagnosis of TBM and is of potential value in the laboratory diagnosis of TBM.     

早期诊断结核性脑膜炎的新方法:检测浓缩脑脊液中CFP-10和ESAT-6

目的:应用酶联免疫吸附试验检测浓缩的脑脊液中结核分枝杆菌特异性抗原培养滤液蛋白10(CFP10)和6000早期分泌性抗原靶(ESAT-6),评价其在结核性脑膜炎(TBM)早期诊断中的价值。方法:应用ELISA测定46例临床诊断为TBM和56例非TBM患者脑脊液原液及经透析袋浓缩10倍的脑脊液浓缩液中CFP10和ESAT-6。结果:TBM患者脑脊液原液CFP10检测敏感度为13.04%、特异度为100.00%,ESAT-6的敏感度为13.04%、特异度为100.00%;而浓缩液CFP10的敏感度为78.26%、特异度为96.42%,ESAT-6的敏感度为76.09%、特异度为98.18%。结论:应用反透析方法浓缩脑脊液,使用抗CFP10和ESAT-6 ELISA检测脑脊液CFP10和ESAT-6能显著提高其敏感度,是一种简单、快速早期诊断结核性脑膜炎的有效辅助方法。     

Intrathecal synthesis of immunoglobulin G and Mycobacterium tuberculosis-specific humoral immune response in tuberculous meningitis.

Local synthesis of immunoglobulin G (IgG) in the central nervous system was investigated in 10 patients with tuberculous meningitis (TBM), 15 patients with aseptic meningitis (AM), and 15 patients with pulmonary tuberculosis only (PTBO). The IgG synthesis rate for patients with TBM was 56.4 +/- 18.9 mg/day (mean +/- standard deviation), which was significantly higher than that for patients with AM (8.0 +/- 6.7 mg/day, P < 0.001) and that for patients with PTBO (7.5 +/- 4.4 mg/day, P < 0.001). Therefore, the increased IgG synthesis rate in the central nervous system provided supporting evidence for differentiating the diagnosis of TBM from that of AM (sensitivity, 100%; specificity, 83.3%). Simultaneous measurement by enzyme-linked immunosorbent assay of IgG seroreactivity to lipoarabinomannan and purified protein derivative antigens in cerebrospinal fluid (CSF) demonstrated seropositivity in all 6 patients with TBM, 4 of 15 patients with AM, and 4 of 10 patients with PBTO. All patients showing false-positive reactivity in CSF demonstrated seropositivity in sera and normal ranges for IgG synthesis rates in CSF. Also, the semiquantitive measurement of IgG antibody (Ab) titers in these patients demonstrated higher IgG Ab titers in serum than in CSF except for one patient with a highly elevated albumin quotient, suggesting a leaky blood-brain barrier. The results strongly suggested that the Mycobacterium tuberculosis-specific IgG Abs were diffusible through the blood-brain barrier, which addresses the pitfall of serological tests for the early diagnosis of TBM. The serological detection of IgG Abs to lipoarabinomannan and purified protein derivative antigens in CSF could be misleading in the presence of simultaneously elevated of IgG Abs in serum.     

SPA-ELISA在结核病血清学诊断中的初步应用

应用SPA-ELISA检测94例活动性肺结核患者和53例非结核患者及125名健康人血清中的抗PPD-IgG水平。结果显示结核患者特异性抗体水平显著高于对照组(P<0.01)。如OD值以0.21(+2SD)作为活动性肺结核的阳性判定标准,则本法敏感性为86.2％,特异性为96.0％,提示可作为活动性肺结核的辅助诊断方法,并可用酶联SPA取代酶联羊抗人IgG。     

Diagnosis of tuberculous meningitis by enzyme-linked immunosorbent assay to detect mycobacterial antigen and antibody in cerebrospinal fluid

Enzymed-linked immunosorbent assay (ELISA) was used to detect mycobacterial antigen and antimycobacterial antibody in cerebrospinal fluid (CSF) specimens of 50 patients with tuberculous meningitis (TBM) and 50 patients with non-tuberculous neurological diseases (control group). The assay gave no false negative results in 10 culture-positive patients with TBM. Detection of mycobacterial antigen in CSF is more sensitive and specific for the diagnosis of TBM than detection of antibody. ELISA should be considered as one of the alternative methods in the laboratory diagnosis of TBM, particularly in culturenegative patients with TBM.     

Immunodiagnosis of tuberculous meningitis: detection of antibody reactivity to antigens of Mycobacterium tuberculosis and Cysticercus cellulosae in cerebrospinal fluid tuberculous meningitis patients by ELISA

Enzyme-linked immunosorbent assay (ELISA) was standardized and evaluated for detection of antibody response in cerebrospinal fluid (CSF) to antigens of Mycobacterium tuberculosis and Cysticercus cellulosae. Sonicated extracts of heat killed M. tuberculosis H37Rv and C. cellulosae were prepared and used in ELISA to detect respective antibody response in CSFs for a definitive diagnosis as to tuberculous meningitis (TBM)/neurocysticercosis (NCC). ELISA was performed in a total of 201 CSF samples, which include Group I: chronic infections of the central nervous system (CNS) with possible diagnosis of TBM, tuberculoma, or NCC (n = 70), and Group II: control group of patients with infectious neurological (n = 19), non-infectious neurological (n = 82), and non-infectious non-neurological conditions, i.e., spinal anaesthesia CSFs (n = 30). Specificity in this study was 99.9% and no true cross-reactivity between antimycobacterial antibodies and C. cellulosae antigens and vice-versa was observed. However, in 17.14% of CSFs (12/70), both antimycobacterial and anticysticercal antibodies were detected, 50% of these cases were diagnosed as TBM. But none of the proven NCC cases showed presence of antimycobacterial antibodies. Results of this study would indicate that it would be beneficial if both antibody and antigen responses are detected in CSFs to infectious aetiologies such as M. tuberculosis, C. cellulosae, and C. neoformans in order to enhance the diagnostic accuracy and proper management, as these diseases are highly endemic in underdeveloped and developing countries.     

Diagnosis of spirochetal meningitis by enzyme-linked immunosorbent assay and indirect immunofluorescence assay in serum and cerebrospinal fluid.

The antibody response against a spirochetal strain isolated from Swedish Ixodes ricinus ticks was determined by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay of cerebrospinal fluid (CSF) and serum specimens from 45 patients with chronic meningitis. Samples of CSF, serum, or both from patients with various infections of the central nervous system, multiple sclerosis, syphilis, or infectious mononucleosis and from healthy individuals served as control samples. Probable spirochetal etiology could be demonstrated for 41 of 45 (91%) patients with clinical symptoms of chronic meningitis. Approximately 25% of the patients had significantly elevated titers of antibody to the spirochete in CSF but not in serum. The highest diagnostic sensitivity, 91%, was demonstrated by measurement of CSF antibodies and calculation of a spirochetal CSF titer index, which is the ratio of (ELISA titer in CSF/ELISA titer in serum) to (albumin in CSF/albumin in serum) and which also considers the degree of blood-CSF barrier damage. The highest specificity, 98%, was obtained by calculation of a CSF titer index. Patients with short duration of disease were especially prone to be antibody negative in serum but positive in CSF. Significant rise in serum antibody titers was seldom demonstrated in patients treated with antibiotics. It is concluded that measurement of CSF antibodies, especially by ELISA, is a highly sensitive and specific method for the immunological diagnosis of spirochetal meningitis.     

A study of Mycobacterium tuberculosis antigen and antibody in cerebrospinal fluid and blood in tuberculous meningitis

Radioimmunoassay (RIA) techniques have been evaluated to detect specific tubercular antigen (TB Ag) and antitubercular antibody (TB Ab) in CSF and serum of patients with tuberculous meningitis (TBM). A solid-phase RIA using H37RV sonicate antigen of Mycobacterium tuberculosis, anti-BCG antibody, and staphylococcal protein A was standardized. TB Ag and TB Ab levels were noted to be significantly elevated in cerebrospinal fluid (CSF) as well in circulating immune complexes (CIC) isolated from serum samples of TBM patients as compared to control group (P less than 0.01). Detectability of disease by demonstrating elevated TB Ag and/or TB Ab levels in either CSF or CIC or both was 95%. There was no correlation between individual levels of TB Ag and TB Ab in CSF and in circulation. A follow-up study in patient over a period of 4-12 weeks revealed that TB antigen and/or TB Ab persisted in the majority of the cases for several weeks despite chemotherapy.     

Evaluation of BioFM liquid medium for culture of cerebrospinal fluid in tuberculous meningitis to identify Mycobacterium tuberculosis

The present study was designed to evaluate the sensitivity and specificity of liquid culture medium (BioFM broth) for the diagnosis of tuberculous meningitis (TBM) in cerebrospinal fluid (CSF). CSF samples from 200 patients (TBM group = 150 and non-TBM group = 50) were tested for culture of Mycobacterium tuberculosis in BioFM liquid culture medium. Out of 150 TBM cases, 120 were found to be culture positive, indicating a sensitivity of 80% in BioFM broth within 2-3 weeks of inoculation. Positive cultures were also observed for CSF from 32 (64%) out of 50 non-TBM patients in BioFM liquid culture medium within 4 days of sample inoculation. Therefore, according to our study, BioFM broth system yielded 80% sensitivity [95% confidence interval (CI): 67-93%] and 36% specificity (95% CI: 57-98%) for TBM diagnosis. Our results indicate that although BioFM broth allows the detection of positive cultures within a shorter time, it has a high potential for contamination or for the coexistence of M. tuberculosis and non-tuberculous meningitis (NTM). This coexistence may go undetected or potentially lead to erroneous reporting of results.     

Comparative evaluation of early diagnosis of tuberculous meningitis by different assays

Cerebrospinal fluid (CSF) and peripheral blood (PBL) were sampled multiple times from 25 patients with a clinical diagnosis of tuberculous meningitis (TBM) and 49 controls, including 27 patients with other infectious diseases of the central nervous system and 22 patients with other noninfectious neurological diseases. We used an enzyme-linked immunospot assay (ELISPOT) to detect anti-Mycobacterium bovis BCG antibody-secreting cells in CSF and PBL, PCR to detect a repeated insertion sequence (IS6110) specific for Mycobacterium tuberculosis in CSF, and an enzyme-linked immunosorbent assay (ELISA) to detect anti-BCG antibodies in CSF and PBL. In the meantime, culture of CSF from every TBM and control patient was done on Lowenstein-Jensen medium. ELISPOT proved to be the most valuable test, with a sensitivity of 84.0% and a specificity of 91.8%, and showed a sensitivity of 100.0% with the CSF specimens obtained within 4 weeks after the onset of TBM. The numbers of CSF anti-BCG immunoglobulin-secreting cells tested by ELISPOT were even higher in the early phase of TBM and declined while the disease was going on (P = 0.008), which allowed an early diagnosis to be made. The sensitivities of PCR and ELISA were only 75.0% and 52.3%, respectively; and the specificities were 93.7% and 91.6%, respectively. Culture of CSF on Lowenstein-Jensen medium was the least sensitive (16%) compared to the sensitivities of the other three assays. Our results demonstrate that the ELISPOT technique is worthy for routine use in the laboratory to support the clinical diagnosis of TBM.