AIDS合并肺结核的影像诊断

目的　探讨AIDS合并肺结核的X线及CT表现。方法　对已确证的 10例AIDS病人合并肺结核的X线及CT表现进行分析。结果　AIDS患者合并肺结核表现为纵隔淋巴结肿大、不典型浸润、两肺粟粒结节。结论　AIDS病人出现纵隔淋巴结肿大 ,不典型浸润 ,两肺粟粒结节应考虑合并肺结核的可能性     

浸润型肺癌的CT诊断

目的为提高对浸润型肺癌的诊断水平。方法回顾23例经病理证实的浸润型肺癌,临床表现发病初期有咳嗽、咯痰、胸痛、咯血或痰中带血等症状,还有发热,血象偏高。首诊为肺炎16例,肺结核4例,待诊3例。结果23例浸润型肺癌的CT表现分为局限性磨玻璃影、斑状影、双肺弥漫性斑片状影3种。结论浸润型肺癌容易与肺炎、肺结核混淆,诊断应特别注意病史的采集和系列CT片的比较。对双肺斑片状影,经正规抗炎或抗结核无效的患者应考虑到浸润型肺癌的可能。     

HIV/AIDS肺部感染的影像学表现

目的 探讨HIV／AIDS合并肺部感染的X线及CT表现。方法 收集临床确证的HIV／AIDS病人中有胸部影像异常者10例,所有病例均有胸部X线及CT照片。结果 肺结核表现为肺内斑片、大片影,纵隔淋巴结肿大及肺外淋巴结肿大。军团菌肺炎为大片状影像,卡氏囊虫肺炎为弥漫性浸润及间质异常影像。结论 肺结核、卡氏肺囊虫及革兰阴性杆菌肺炎是HIV／AIDS的较常见的机会感染。HIV／AIDS病人肺内出现斑片、大片和弥漫病变,或有关淋巴结肿大时应考虑到这些疾病的可能。     

Antioxidants--effective pathogenetic agents in the combined therapy of pulmonary tuberculosis

The use of anti-oxidants (alpha-tocopherol and sodium thiosulphate in multimodality therapy of patients with infiltrative pulmonary tuberculosis raised therapeutic efficacy promoting elimination of signs of tuberculous intoxication, the onset of bacteria elimination, disintegration cavity closing, and a decrease in the frequency of residual changes. The advantage of alpha-tocopherol was shown in its administration to patients with infiltrative tuberculosis with the prevailing productive tissue reactions. alpha-tocopherol prevented the occurrence of noticeable respiratory insufficiency contributing to its elimination in patients with fibrocavernous tuberculosis.     

30例肺结核合并真菌感染临床分析

目的探讨肺结核合并真菌感染的临床特点,以提高对两病并存的临床表现和合理处理。方法回顾近10年来我院住院的肺结核合并肺部真菌感染的资料并进行分析。结果合并真菌感染的肺结核主要特点为结核病史长,年龄偏大,以浸润型和慢性纤维空洞型肺结核为主,肺部病变广泛,空洞多。病情较重,多有继发真菌感染的诱因可寻,确诊有赖于病原学检查。结论肺结核合并肺部真菌感染有增多趋势．了解其临床特点可提高对两病并存的认识。     

肺结核空洞的CT表现及病理基础

目的笔者对肺结核空洞进行CT形态学分型,分析其病理基础。探讨空洞分型在肺结核的诊断、分型及治疗中的意义。方法收集伴有空洞的肺结核病人76例,按洞壁性质将空洞分为薄壁空洞、干酪空洞和纤维空洞,所有病人均有完整的CT资料。结果①肺结核空洞的CT表现:按空洞的形态将肺结核空洞分为浸润空洞和纤维空洞两型,本组病例包括浸润空洞51例,纤维空洞25例。②肺结核空洞的动态变化:比较治疗前后结核空洞的变化,发现浸润空洞治疗后多明显好转,纤维空洞无明显变化。③肺结核空洞的病理观察:本组有9例手术切除病例,薄壁空洞和干酪空洞多与CT分类的浸润空洞吻合,纤维空洞与CT分类的纤维空洞吻合。结论肺结核空洞的CT表现有助于确定结核病的活动性、评价预后、治疗效果以及鉴别诊断。     

Specific antibodies to different mycobacterial antigens in patients with pulmonary tuberculosis]

Antibodies to three mycobacterial antigens, Soviet tuberculin and ultrasound-treated Mycobacterium tuberculosis (H37Rv) and M. bovis (BCG) were detected by enzyme immunoassay in 90 patients with pulmonary tuberculosis and 75 normal subjects. Antibody detection rates and levels were found related to the form of tuberculous process. The detection rate was rather low in focal tuberculosis and virtually the same for all the antigens (15.3 percent). In disseminated processes (infiltrative and particularly disseminated and fibrous-cavernous) antibodies are detected more often in higher titers than in local processes, and their levels are different with different antigens. The method was more sensitive with ultrasound-treated antigens of M. tuberculosis (H37RV) and M. bovis (BCG) than with PPD. Simultaneous enzyme immunoassay with three antigens detected up to 75 percent of antituberculous antibodies in infiltrative, up to 92 percent of antibodies in disseminated, and up to 100 percent of antibodies in fibrous-cavernous tuberculosis.     

The first experience with using autologous macrophages in the complex treatment of patients with destructive pulmonary tuberculosis

To correct local immunity, a suspension of autologous macrophages (AM) produced by culturing peripheral blood monocytes has been introduced in combined treatment of 15 patients with infiltrative, local disseminated, cavernous, fibrocavernous tuberculosis and tuberculoma (8, 1, 1, 4 and 1 case, respectively). AM treatment was added to the standard antibacterial and pathogenetic therapy. AM were introduced into the subsegmental bronchus at fibrobronchoscopy via a catheter inserted into the cavern-draining bronchus. The trial showed AM-promoted resolution of pulmonary tissue infiltrates and more intensive repair processes. The best results were obtained in 11 new-onset cases of pulmonary tuberculosis.     

The causes of prolonged fever in patients with infiltrative lung processes]

The authors analyze the causes of lingering fever in patients with pulmonary infiltrations. The given phenomenon is most often caused by pneumonias provoked by unusual causative agents (Legionella, Rickettsia, Mycoplasma). In such cases, administration of erythromycin is effective. In rare cases, lingering fever is induced by blocked pulmonary suppurations, pleural exudates in pneumonia patients, and infiltrative tuberculosis. Besides, there were cases, in which fever was of drug etiology.     

1990～2004年宁波市结核病监测概况

目的评价宁波市实施结核病监测15年的效果。方法对15年的监测资料进行收集整理,利用常规监测资料对病例发现和治疗效果进行分析。结果活动性肺结核登记率下降33.6%,涂阳肺结核登记率上升198.4%,活动性肺结核新登记及涂阳肺结核新登记率各上升26.0%、133.5%。肺结核死亡率下降60.0%。病例发现延误率15年中变化不明显。新发涂阳病例治愈率从91.8%下降至88.6%。流动人口肺结核新登记率和涂阳肺结核新登记率分别增加33.3%和95.8%。结论病例发现率和治愈率不断提高,传染源控制效果从25.5%增加到49.2%。应继续提高结核病控制工作效果,加强结核病的健康促进工作,普及结核病防治知识。流动人口中的结核病治疗管理问题需要重点关注。     

Errors in diagnosing pulmonary tuberculosis in general hospitals and results of treating the disease

AIM: To specify diagnostic approaches to rapidly progressive destructive pulmonary tuberculosis (RPDPT) in general hospitals and effects of the time of the diagnosis on treatment results. MATERIALS AND METHODS: History, diagnostic techniques and treatment of 162 patients with RPDPT (98 cases with cheesy pneumonia, 37 cases with rapidly progressive infiltrative tuberculosis, 27 cases with rapidly progressive disseminated tuberculosis) were studied. RESULTS: The diagnosis of tuberculosis was verified for 7 days in 56% patients, in 33% of them the diagnosis took more than 14 days. Tuberculosis was hidden under the mask of inflammatory pulmonary diseases in 60% patients, concomitant pathology--in 19%. Masks were also due to severe intoxication, multiorgan insufficiency, complications, tuberculosis of other organs. RPDPT was diagnosed primarily by x-ray examination, bacteriological test for M. tuberculosis was used in 14%. Lethal outcomes in the group of patients diagnosed for 14 days and longer occurred 2.6 times more frequently than in those diagnosed within 7 days. CONCLUSION: The analysis of the diagnostic errors resulted in design of the scheme of the diagnosis of RPDPT including cheesy pneumonia intended for use in general practice with account for possible "masks" of the disease. Basic criteria of the diagnosis are stepwise development of the disease and infiltrative-alterative changes on x-ray picture. Phthisiological alertness of general practitioners in relation to RPDPT must direct the physicians to active detection of M. tuberculosis in the sputum and close cooperation with phthisiologist in complicated diagnostic cases.     

荧光定量聚合酶链反应检测在肺结核诊断中的应用价值

目的分析荧光定量聚合酶链反应(PCR)检测支气管肺泡灌洗液(BALF)中结核分枝杆菌脱氧核糖核酸(TbDNA)在诊断肺结核中的应用价值。方法选择2018年1月-2020年1月湖南省儿童医院收治的21例肺结核患儿作为肺结核组,另外选择同时期21例排除肺结核感染的肺部疾病患儿作为非肺结核组。全部患儿均行痰涂片抗酸染色镜检、纤维支气管镜(纤支镜)痰涂片抗酸染色镜检和BALF中TbDNA荧光定量PCR检测。比较3种检测方法对肺结核诊断的特异度、敏感度、阳性预测值(PPV)和阴性预测值(NPV)。结果痰涂片抗酸染色镜检、纤支镜痰涂片抗酸染色镜检和荧光定量PCR的敏感度分别为19.05%、14.29%、76.19%,特异度分别为100.00%、100.00%、95.24%,PPV分别为100.00%、100.00%、94.12%,NPV分别为55.26%、53.85%、80.00%。荧光定量PCR检测BALF中TbDNA的敏感度明显高于痰涂片抗酸染色镜检和纤支镜痰涂片抗酸染色镜检(76.19%比19.05%、14.29%),差异有统计学意义(P<0.05);3种检测方法的特异度比较差异无统计学意义(P>0.05)。结论通过荧光定量PCR检测BALF中的TbDNA,具有快速、敏感度高、特异度高的特点,利于早期诊断肺结核,尤其是对于痰涂片检测呈阴性及无典型影像学特征的患儿,可以明显提高确诊率,其结果能够作为诊断肺结核的主要指标。     

肺结核患者的营养支持治疗及疗效评价

结核病是一种与营养不良有关的传染性疾病,在发展中国家广泛流行,特别是经济落后、生活贫困地区。由于全球结核病形势持续恶化,严重影响人民健康,使它成为了全球重要的公共卫生问题和社会问题[1]。为了评价肺结核患者的营养状况,探讨营养支持在肺结核治疗中的作用,本文对我院62     

The effects of ascorbic acid deficiency on calcium and collagen metabolism in cultured fetal rat bones.

The effects of ascorbic acid deficiency on growth and calcification of bone were studied in whole 18-day fetal rat radii and ulnae cultured in a chemically defined medium. Ascorbic acid deficiency decreased the formation of labeled hydroxyporline from labeled proline in both bone shafts and cartilage ends while incorporation of tryptophan was maintained. Dry weights and collagen content of bone and cartilage were decreased, but calcification was not affected. The optimun initial concentration of ascorbic acid for collagen synthesis was 200 mug/ml. The effect of ascorbic acid was not antagonized by glucoascorbic acid or replaced by dithiothreitol. Decreased collagen synthesis in ascorbic acid deficiency could not be ascribed to loss of available peptidyl proline hydorxylase. Formation of underhydroxylated collagen and its release into the medium accounted for much of the decrease in hydroxylated collagen in ascorbic acid deficient bones. Nevertheless, the total newly synthesized collagen, as measured by collagenase digestion, was still decreased. Similar effects were exerted by alpha, alpha'-dipyridyl which also inhibited general protein synthesis. Ascorbic acid did not stimulate proline incorporation into collagen in the presence of alpha, alpha'-dipyridyl.     

Measurement of tuberculostearic acid in sputa, pleural effusions, and bronchial washings. A clinical evaluation for diagnosis of pulmonary tuberculosis

Gas chromatography/mass spectrometry combined with selected ion monitoring was used to measure tuberculostearic acid (TSA), in sputum, pleural effusion, and bronchial washing. The detection limit corresponded to the amount of TSA eluted from as low as 10(3) tubercle bacilli. Sputa were collected from 169 patients with active pulmonary tuberculosis, 35 clinically suspected to be active, 53 with obsolete pulmonary tuberculosis, and 160 with pulmonary diseases other than tuberculosis. TSA was positive in 90% of the patients with active pulmonary tuberculosis (152/169) and 71% of the clinically suspected cases (25/35), respectively. In contrast, less than 10% of the patients with obsolete tuberculosis or other pulmonary diseases had a positive TSA. Pleural effusions and bronchial washings were also collected from patients with active tuberculosis and from those with other diseases, as the controls. TSA in pleural effusions and bronchial washings was detected in 24 of 32 patients and 15 of 22 patients with active tuberculosis, respectively. In those with pulmonary diseases other than tuberculosis, only 8.7% of pleural effusion (4/46) and 4.3% of bronchial washing samples (3/69) showed a positive TSA. Therefore, the measurement of TSA is useful as a rapid and sensitive method for diagnosing pulmonary tuberculosis.     

Comparison of ascorbic acid concentrations in granulocytes and lymphocytes

The author measured the ascorbic acid concentration (microgram/10(8) cells) in leukocytes from fourteen healthy male subjects aged 20 to 28 years. The mean values were 10.9 (range 3.7 to 15.8) in granulocytes and 88.5 (range 35.3 to 122.2) in lymphocytes. These findings suggest that ascorbic acid metabolism in lymphocytes differs from that in granulocytes. In the second experiments the changes in ascorbic acid concentrations were measured in the course of an ascorbic acid loading test to a 33-year-old healthy male volunteer, in which increasing doses (1, 3, 5, 10 g/day X 7 days) were weekly loaded for 4 successive weeks and the ascorbic acid concentrations were examined at the end of each week. As the loading dose increased, ascorbic acid concentration in lymphocytes decreased during the 4 week period while the counterpart value in granulocytes stayed essentially constant. The present findings suggest the differences in ascorbic acid metabolism between granulocytes and lymphocytes.     

γ-干扰素释放试验在结核病诊断中的临床价值

目的：比较分析γ-干扰素释放试验（IGRAs）、结核菌素皮肤试验（TST）、抗酸染色和培养在结核病患者中的诊断性能,评价IGRAs用于结核感染诊断的临床价值。方法用四种方法分别对60例肺结核患者、54例非结核肺疾病患者和35例健康体检者进行检测,以两两比较其诊断性能的差异。结果IGRAs对肺结核病的诊断特异性为89．9％,灵敏度为88．3％（53/60）,灵敏度显著高于TST（66．7％）、抗酸染色（31．7％）和分枝杆菌培养（46．7％）,而且对活动性肺结核的诊断灵敏度更是高达93．8％。结论IGRAs具有灵敏度高、特异性高、检测快速等特点,是一种逐渐替代传统TST方法的结核诊断的新的辅助试验。     

The immune stressor effects of T-regulatory cells under infiltrative tuberculosis of lungs

The article deals with the characteristics of sup-population composition of T-regulator: cells with suppressor activity and production of immunoregulatory cytokines suppressing immune response (IL-10, TGF-beta) in patients with infiltrative tuberculosis of lungs. It is proved that the leading role in formation of immunodepression and tuberculin anergy under infiltrative tuberculosis of lungs is played by T-regulatory, cells with phenotype CD4+CD25+Foxp3+. It is demonstrated that the immunodepression mediated by cytokine production is connected with increasing of both basal and BCG-induced secretion of IL-10 on the background of decrease of level of production of TGF-beta by mononuclear leukocytes in vitro.     

血清总胆汁酸和前白蛋白联合检测在肺结核病中的临床意义

目的探讨血清总胆汁酸（TBA）和前白蛋白（PA）联合检测在肺结核病中的临床应用价值。方法采用循环酶法和免疫透射比浊法分别检测406例肺结核病人治疗前后血清TBA和PA，同时检测丙氨酸氨基转移酶（ALT）及天门冬氨酸氨基转移酶（AST）作为对比。结果在肺结核病人治疗1个月后血清TBA和PA检测结果较治疗前结果差异有最著性意义（P〈0．01），ALT和AST均较治疗前升高（P〈0．05）；随着疗程的延长，血清PA显著降低（P〈0．01）．而TBA显著升高（P〈0．01）：治疗后1个月血清PA和TBA的异常率分别为89．9％和56％，与ALT和AST的异常率相比较有显著性差异（P〈0．01）．治疗3个月后，血清ALT和AST的异常率（98％、99％）和TBA的异常率（83％）的差异有显著性意义（P〈0．05）。结论联合检测血清TBA和PA对判断抗结核治疗后早期肝功能损伤有重要临床意义，可作为抗结核治疗后检测肝功能的常规指标。     

社区医院因症就诊发现肺结核合并耳鼻咽喉结核的临床分析

目的 探讨结核病在耳鼻咽喉和颈部的表现,提高肺结核诊断率.方法 回顾性分析138例已经菌培养抗酸染色,病理学检查或诊断性治疗确诊为肺结核但有误诊或合并耳鼻喉及颈淋结其他病症患者的临床表现,寻找无典型肺结核症状体征病人的耳鼻咽喉症状体征.结果 73.77%的病例首次就诊时误诊为耳鼻咽喉或淋巴结慢性炎症,16例误诊为良性肿瘤,全部病例经正规全程抗结核药物治疗后痊愈.结论 了解不典型肺结核在耳鼻咽喉的临床表现可减少误诊漏诊,提高肺结核患者的发现率.