不同疗程含异烟肼、利福平方案对尘肺结核近远期疗效观察

目的探讨以ＨＲ为主不同疗程化疗方案对菌阳尘肺结核的近远期疗效。方法将７９例菌阳病例分为９月组（Ｍ９：２ＳＨＲＺ／７ＨＲＥ）、１２月组（Ｍ１２：２ＳＨＲＺ／１０ＨＲＥ）、１８月组（Ｍ１８：２ＳＨＲＺ／１０ＨＲＥ／６ＨＲ），分别采用不同方案治疗。疗效考核以痰菌为主要依据。满疗程随访５～８年。结果Ｍ９、Ｍ１２、Ｍ１８组满疗程痰菌阴转率分别为８３％、９６％、９５％，随访期间痰菌复阳率分别为４１％、４％、５％，其中随访１～４年痰菌复阳率分别为６％、８％、２％、２％，第５～８年无复阳病例。结论１２月方案（２ＳＨＲＺ／１０ＨＲＥ）对复治菌阳尘肺结核有效；随访时间以４～５年为宜。     

系统性红斑狼疮中枢神经系统病变的诊断及治疗

目的 对系统性红斑狼疮（ＳＬＥ）患中枢神经系统病变（ＣＮＳ）的诊治经验进行总结,方法 对北京协和医院１７１例有ＣＮＳ的ＳＬＥ住院病例进行回顾性分析。结果（１）１７１例发病时ＳＬＥ病程为（２．２１±１．８７）年,１６３例（９５．３％）伴狼疮活动;（２）１５１例行脑脊液检查,异常１３８例（９１．４％）。其中蛋白,压力及白细胞增高分别为１１３．６９及５１例,糖降低仅６例;（３）对有ＣＮＳ的ＳＬＥ,头     

全程督导短程间歇化疗方案治疗涂阳肺结核近远期效果观察

目的观察全程督导短程间歇化疗方案治疗涂阳肺结核的疗效。方法对１２５例初治和２４９例复治涂阳肺结核患者，分别采用２Ｈ３Ｒ３Ｚ３Ｓ３（Ｅ３）／４Ｈ３Ｒ３（异烟肼：Ｈ，利福平：Ｒ，吡嗪酰胺：Ｅ，链霉素：Ｓ，乙胺丁醇：Ｅ）和２Ｈ３Ｒ３Ｚ３Ｓ３Ｅ３／６Ｈ３Ｒ３Ｅ３化疗方案，实施全程督导化疗、管理。结果总完成治疗率为９９．７％；初、复治患者满疗程痰菌转阴率分别为９６．７％和８４．８％；经３年随访，细菌学复发率初治患者为１．８％，复治患者为１０．２％。结论全程督导短程间歇化疗方案对控制结核病具有简便、经济和高效的实用价值。     

五个月短程化疗及六个月全程间歇方案治疗菌阳肺结核的临床对照研究

目的考核利福喷丁（Ｌ）的疗效；缩短疗程或全程间歇以减少用药次数；观察全程应用吡嗪酰胺（Ｚ）对疗效及毒副反应的影响。方法以利福平（Ｒ）为对照，采用５个月疗程方案（Ⅰ组２ＳＨＲＺ／３Ｒ２Ｈ２Ｚ２，Ⅱ组２ＳＨＲＺ／３Ｌ１Ｈ２Ｚ２）、６个月全间歇方案（Ⅲ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｚ２，Ⅳ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｅ２），观察Ｚ的全程应用结果，巩固期以乙胺丁醇（Ｅ）为对照。３６６例初治菌阳肺结核随机分入以上４组。结果（１）３３９例完成疗程者中３２９例治疗成功，满疗程时痰菌阴转率Ⅰ～Ⅳ组分别为９７０％、９４１％、１０００％、９７２％。Ｘ线病灶有效率依序为９６０％、９７６％、１０００％和９４４％。５个月组与６个月组空洞关闭率分别为７７％及７６％。各组相互比较均无显著性差异（Ｐ＞０．０５），未见严重副作用。（２）３０５例完成３年随访，Ⅰ、Ⅱ、Ⅲ、Ⅳ组细菌学加Ｘ线复发分别为２、３、６和３例。结论本研究结果进一步证明Ｌ是长效、高效、安全、便于督导的新药；巩固期用Ｚ无必要；现有基本药物合理联用有可能缩短疗程为５个月，值得进一步研究。     

肺结核球及干酪病灶的活血化瘀治疗

本文报告我院１９９０～１９９５年间采用ＺＨＲＺＳ（Ｅ）／４ＨＲＥ（Ｚ）化疗方案并用复方丹参活血化瘀治疗肺结核球及大块干酪病灶５６例与单纯化疗５２例的结果，分析表明：化疗＋活血化瘀的６个月综合疗效：有效率（显效 有效）为９６．４％，单纯化疗组则为７６．９％，二者经卡方检验 Ｐ＜ ０．０５，具有差异性。经 ２～５年的随访，活血化瘀组有 １２例（２１． ４％）达到临床治愈，无一例复发。单纯化疗组有 ６例行外科手术治疗，另有４例复发（７．７％）。由此可见该法临床运用安全有效。对肺结核球及干酪病灶的非手术治疗开辟了一条新途径，值得进一步探讨。     

初治涂阳肺结核门诊全监短程化疗研究

９３例初治涂阳培阳结核病人用２ＲＨＺ／Ｒ２Ｈ２方案按设计要求完成了治疗随访，所有病人采用门诊全监化疗，继续期疗期为痰培养阴转后巩固５个月，总疗期６－９个月（平均６．５个月），１例（１．１％）治疗失败，停药后２４个月随访期内３例（３．３％）复发，总失败一复发率为４．３％，４例（４．１％）因药物副反应更改方案。研究结果表明，对实施门诊全监化疗的地区，大部分病人可采用这种高效，安全，费用低的方案。     

结核性胸膜炎超短程化疗效果观察

本文将１９８８年１２月～１９９３年１２月入院的１２４例结核性胸膜炎随机分为４月超短化组２Ｓ（Ｅ）ＺＲＨ／２ＲＨ方案５９例和６或９月短化组２Ｓ（Ｅ）ＺＲＨ／４ＨＲ方案５９例、２ＳＲＨ／７ＲＨ方案６例进行治疗的对比研究。结果：４月短化组疗效肯定。对完成疗程的５２例随访１～５．５年，无一例复发或出现肺内外结核，达到与６月短化相同的效果。     

肺结核球及干酪病灶的活血化瘀治疗

本文报告我院１９９０￣１９９５年间采用２ＨＲＺＳ（Ｅ）／４ＨＲＥ（Ｚ）化疗方案并用复方丹参活血化瘀治疗肺结核球及大块干酪病灶５６例与单纯化疗５２例的结果，分析表明：化疗＋活血化瘀的６个月综合疗效：有效率（显效＋有效）为９６．４％，单纯化疗组则为７６．９％，二者经卡方检验Ｐ〈０．０５，具有差异性。经２￣５年的随访，活血化瘀组有１２例（２１．４％）达到临床治愈，无一例复发。单纯化疗组有６例行外科手术治     

结核抗体检测的临床价值

我们应用结核抗体ＥＬＩＳＡ法检查了５６例临床怀疑肺结核的病人,５０名健康查体者,肺结核病人１５例并与Ｘ线及痰涂片检查比较,现将结果报告如下;１材料与方法１．１资料来源：肺结核病人１５例,门诊怀疑肺结核患者５６例,健康查体者５０例。１．２检查方法：所有受检者均取２．５ｍｌ静脉血,分离血清,检测其血清中的结核抗体,同时做Ｘ线及痰涂片检查。结核抗体检测采用ＥＬＩＳＡ法,严格按操作规程进度。２结果（１）１５名经临床确诊的肺结核病人结核抗体、Ｘ线、痰涂片检查,其结果阳性率分别为９３．３％（１４／１５）,７…     

系统性红斑狼疮肺、胸膜损害110例

目的 探讨系统性红斑狼疮（ＳＬＥ）的肺、胸膜损害。方法 回顾性分析１４６例住院ＳＬＥ患者的Ｘ线胸片结果，结果 发现肺、胸膜改变１１０例（占７５．３％），包括胸腔积液５４例（３６．５％），多发片状浸润阴影２８例（１９．２％），网状或网状结节阴影５２例（４７．３％），泡性肺水肿２例（１．８％），节段性肺不张４例（７．６％）。结论ＳＬＥ患者应常规定期Ｘ线检查，以便早期发现肺，胸膜改变。     

Trends in drug-resistant tuberculosis in National Higashisaitama Hospital, 1994-2001

To know the prevalence of resistance to four first-line anti-tuberculosis drugs, we reviewed the results of drug-susceptibility tests of patients with tuberculosis who were admitted to our hospital from 1994 to 2001. Among patients with no prior chemotherapy against tuberculosis, the complete resistance rate was 1.9% for INH, 0.81% for RFP, 5.1% for SM, 0.81% for EB, and 0.32% for multiple drug-resistance (MDR). The acquired resistance rate was 9.7% for INH, 11.5% for RFP, 7.3% for SM, 2.4% for EB, and 6.1% for MDR. There was no significant increase in the prevalence of drug resistance between the first half (1994-1997) and the latter half (1998-2001) of the investigation periods. Compared with the previous reports, our results indicated no increase in the prevalence of drug resistance in tuberculosis patients with no prior treatment and the decrease of prevalence in patients with prior treatment of tuberculosis. A multi-drug regimen consisted of INH, RFP, PZA and EB or SM, which is currently considered as a standard regimen of tuberculosis chemotherapy and used quite widely, does not seem to induce the increase of drug-resistant tuberculosis.     

174株结核分枝杆菌耐药情况分析

目的分析我所183株痰培养阳性菌株的耐药情况。方法采用药敏比例法对183株阳性菌株进行菌种鉴定及药物敏感性试验。结果共分离出174株结核分枝杆菌,且4种一线抗结核药物异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)的总耐药率为25.3%,耐多药率为8.0%。4种抗结核药物的耐药率由高到低依次为SM、INH、EMB、RFP。结论陕西省结核耐药情况仍较严重。     

134例老年肺结核患者痰结核菌耐药情况分析

目的探讨老年肺结核患者痰结核菌的耐药情况。方法采用ＢＡＣＴＥＣ法对１３４例老年痰菌阳性肺结核患者痰结核分支杆菌做耐药性检测。结果老年肺结核患者初始耐药率为３６８％，显著低于获得性耐药率的７５９％（Ｐ＜００１）；耐异烟肼（ＩＮＨ，Ｈ）、利福平（ＲＦＰ，Ｒ）、链霉素（ＳＭ，Ｓ）前者亦明显低于后者（Ｐ＜００１）。初治组耐２和３种药比例为６６％和５３％，与复治组的２２４％和２７７％相比差异有显著性（Ｐ＜００１）。至少耐异烟肼和利福平两种药的比例，初治组为９２％，显著低于复治组的５００％（Ｐ＜００１）。结论老年人肺结核耐药情况严重，尤其是获得性耐药和耐多药比例偏高，应引起足够重视     

难治性肺结核分支杆菌耐药性和药物依赖性的实验观察

目的探讨难治性肺结核分支杆菌耐药性和药物依赖性。方法对难冶性肺结核病人痰标本培养分离的分枝杆菌65株（例），进行低浓度、高浓度抗结核药物的耐药性和依赖性实验观察。结果65株分枝杆菌对SM、INH和RFP三种药物均耐药，EMB耐药率也较高（75．4％和69．2％）。分枝杆菌对sM依赖率分别为38．5％，INH为26．2％，RFP为18．5％，EMB为10．8％；同时依赖两种药物者为15．4％，三种药物为12．3％，四种药物为4．6％。结论难治性肺结核具有很高的耐药性和较高的依赖性。     

原发耐药对初治涂阳肺结核控制影响评价的探讨

目的　了解不同类型原发耐药病例的短程化疗效果,以此为基础,评价不同原发耐药率地区原发耐药对初治涂阳肺结核控制的影响。方法 回顾分析北京市1996-2001年登记的初治涂阳培阳并有原发耐药性检测结果经复核资料完整的肺结核334例,按药物敏感性不同分为4组,Ⅰ组:HRSE敏感组;Ⅱ组:耐H、S、E中任何1至3种药;Ⅲ组:耐R或同时耐S、E但不耐H;Ⅳ组:同时耐RH或以上药物为耐多药(MDR-TB)组。以各组的短程化疗近期失败率为基础,计算不同情况原发耐药率地区的加权失败率。结果 Ⅱ组失败率4.26%,与Ⅰ组1.04%相比无统计学差异,Ⅲ组、Ⅳ组失败率分别为11.11%、30.00%,与Ⅰ组相比均有显著性差异(P<0.05)。原发耐药使北京、浙江、河南3地区近期治疗失败率分别增加了0.83百分点、1.76百分点、5.92百分点。结论 原发耐药对治疗效果的影响,主要决定于耐R,特别是耐RH的水平;对本地区的影响主要决定于原发耐R,特别是耐RH率的高低。     

2001 至 2005年澳门地区耐药结核病的流行趋势分析

目的分析中国澳门地区2001至2005年结核病的耐药情况。方法选取近5年澳门地区新发结核病患者及复治结核病患者结核分枝杆菌分离株进行4种抗结核药物（异烟肼、利福平、链霉素、乙胺丁醇）的耐药性测定。结果1460株结核分枝杆菌的总耐药率为16．2％（236株），其中初始和获得性耐药率分别为15．0（203／1357）和32．0（33／103）；耐多药率为3．2％（47／1460），其中初始和获得性耐多药率分别为2．3％（31／1357）和15．5％（16／103）；4种抗结核药物的耐药率由高到低依次为异烟肼（11．5％）、链霉素（9．5％）、利福平（3．6％）、乙胺丁醇（2．5％）；耐1种、2种、3种和4种药物的初始耐药率分别为9．9％、2．9％、1．0％和1．2％，获得性耐药率分别为12．6％、3．9％、8．7％和6．8％。近5年新发和复治患者的耐药率没有上升趋势（χ2值分别为0．27和0．03，P均〉0．05）；不同性别和年龄组间初始耐药率的差异无统计学意义（χ2=5．7，P〉0．05）。结论本次流行病学调查结果与1996至1999年澳门地区结核病流行病学调查资料比较，获得性耐药率和获得性耐多药率显著下降，差异有统计学意义（χ2值分别为6．04和7．47，P均〈0．05），但初始耐药率和获得性耐药率高于2004年第3次全球多国耐药监察结果，仍处于高耐药水平，尤其是耐多药率较高的问题，应引起重视。     

河南省结核病耐药监测实验室质控分析

目的评价河南省结核病耐药监测中实验室工作质量。方法南朝鲜西太区跨国参比室（ＳＲＬ）对河南省结核病防治研究所参比室（ＰＲＬ）先后进行了３次自ＳＲＬ至ＰＲＬ及１次自ＰＲＬ至ＳＲＬ的药敏试验质控，菌株是含耐药及敏感的结核分支杆菌临床分离菌株。试验的４种药物为链霉素、异烟肼、利福平及乙胺丁醇，采用ＬＪ培养基、比例法。结果３次自ＳＲＬ至ＰＲＬ的质控试验中，４药大部分敏感性大于特异性，且异烟肼及利福平的敏感性均为１００％；异烟肼在３次试验中平均准确性达９８％，利福平虽然在第一次质控中准确性仅７０％，但在随后两次质控中均达９３％。与西太区同步质控的其他国家参比室结果（含河南ＰＲＬ）相比，除西太区链霉素特异性较河南高外（８４％比７５％，Ｐ＜０．０５），余特异性之间、敏感性之间无显著性差异。自ＰＲＬ至ＳＲＬ的质控试验显示出与自ＳＲＬ至ＰＲＬ类似的特征，链霉素、异烟肼及利福平的一致性均达９０％以上。结论河南省耐药监测的实验室工作质量符合监测指南要求。     

420例肺外结核的分支杆菌培养、菌型鉴定及药敏分析

目的了解肺外结核的分支杆菌培养、菌型及药敏情况。方法取肺外结核病灶中的坏死物质作分枝杆菌培养、菌型鉴定及药物敏感性试验。结果420例中培养阳性67例，阴性353例；人型分支杆菌60例，牛型6例，龟分支杆菌1例；结核分支杆菌中，无耐药32例，耐药34例；初始耐药28例，获得性耐药6例；耐1～4药分别为17、7、4、6例，其中同时耐INH和RFP 10例；耐INH、RFP、SM、EMB、PAS分别为19、14、11、13、7例．龟分支杆菌均耐药。结论肺外结核培养阳性率15．95％，结核分支杆菌中，耐药率51．5％。初始耐药率42．4％，获得性耐药率9．1％。耐1～4药率分别为25．6％、10．6％、6．1％、91％，其中同时耐INH和RFP 15．2％。INH、RFP、SM、EMB、PAS的耐药率分别为28．8％、21．2％、16．8％、19．8％、10．6％，人型分支杆菌89．6％、牛型9．0％、龟分支杆菌1．6％。     

A case of drug-resistant pulmonary tuberculosis treated successfully following disappearance of rifampicin resistance after 17 years' chemotherapy

A female who first acquired pulmonary tuberculosis in 1962 when she was 25 years old, admitted to the National Hiroshima Hospital in 1982. Her sputum has been smear positive for acid-fast bacilli for 3 years before admission in spite of continuous antituberculous chemotherapy, and were resistant to isoniazid (INH) and rifampicin (RFP). She was treated with a regimen containing ethambutol (EB), prothionamide (TH) and enviomycin (EVM) but continued to be culture positive. Though she was treated with various regimens which include one to three sensitive drugs, her sputum continued to be positive for M. tuberculosis in the following 14 years. During the course, resistance to EB, TH, cycloserine (CS) and streptomycin (SM) emerged. Resistance to RFP temporarily retracted in 1988, but her sputum was bacilli negative only for 2 months after the addition of RFP to previous regimen, and followed by resurgence of RFP resistance. In 1992, data of drug sensitivity tests showed sensitivity to TH, CS and RFP in turn, which were not used for 3 to 5 years. In 1993, she was treated with RFP, TH and EVM successfully and continued to be bacteriologically negative for 7 years so far. Drug resistance to M. tuberculosis is induced by inappropriate chemotherapy as seen in this case. Regimens with less than three drugs without RFP and INH was not only insufficient to get cure but, what was worse, also induced additional resistance to used drugs. The reason of successful chemotherapy in this case was spontaneous disappearance of drug resistance to RFP and TH. This case suggests that the disappearance of drug resistance is possible, when drugs are not used for more than a few years, hence the successful treatment could be expected. However it must be emphasized that the drug resistance is produced by incorrect treatment as seen in this case, and its prevention is of the prime importance.     

The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance]

The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.