糖尿病合并严重肺结核的预后

２６例糖尿病并肺结核患者发生器官衰竭，死亡２１例，总病死率为８０．８％。各器官衰竭的频率依次为肺、心血管、胃肠道，而以心血管衰竭病死率最高（９３．３％）。２个、３个脏器衰竭病死率分别为５７．１％和８５．７％，４个及４个以上脏器衰竭病死率则高达１００％。结果表明糖尿病并肺结核时一旦出现器官衰竭常有较高的病死率。衰竭脏器越多，病死率越高。     

Sarcoidosis and sacroiliitis, a case report

Sarcoidosis is a multisystem disorder of unknown etiology characterized by the presence of non-caseating granulomas in the organs affected. Sarcoid arthropathy is a rare manifestation, and sacroiliitis is an unusual first manifestation of the disorder.     

Sarcoidosis accompanied by systemic lupus erythematosus and autoimmune hepatitis

A 52-year-old woman was admitted to our hospital for further examination of blurred vision, abnormal lung shadows and an elevated level of angiotensin-converting enzyme. Sarcoidosis was suspected, however, careful history taking revealed the existence of photosensitivity and polyarthralgia. Laboratory tests showed lymphocytopenia, liver dysfunction, hypergammaglobulinemia, and positive anti-nuclear, anti-double stranded DNA and anti-smooth muscle antibodies. Liver biopsy examination showed chronic active hepatitis. She was diagnosed with the triplex of sarcoidosis, systemic lupus erythematosus and autoimmune hepatitis. Marked improvement was noted after corticosteroid therapy.     

Sarcoidosis complicated by cirrhosis and hepatopulmonary syndrome

Sarcoidosis is a multisystem disorder commonly affecting the lungs, but also the liver, with cirrhosis and portal hypertension occurring in fewer than 1% of cases. Although hepatopulmonary syndrome (HPS) is seen in 15% to 20% of patients with cirrhosis of varying causes, it has rarely been associated with sarcoidosis. Also, although a brain abscess is not uncommon in patients with discrete pulmonary arteriovenous malformations, it is rarely seen in patients with the much smaller intrapulmonary vascular dilations that characterize HPS. A patient with an unusual series of uncommon sarcoidosis complications, including cirrhosis with HPS, brain abscess and finally Nocardia meningitis, is reported. The possibility of HPS should be considered in sarcoidosis patients with liver involvement, if gas-exchange abnormalities are out of proportion to the degree of lung involvement. These patients may also be susceptible to a cerebral abscess by paradoxical embolization, and to opportunistic infections due to cirrhosis.     

Clinical analysis of chronic renal function failure accompanied by pulmonary tuberculosis]

In 592 patients with chronic renal function failure (CRFF), 31 were accompanied by pulmonary tuberculosis, the incidence was 5.2%. The incidence of the First Affiliated Hospital of Sun Yat-sen University (6.6%) is higher than that of Zun Yi District Hospital (3.9%). The difference may be associated with dialysis therapy and regional TB natural population incidence. The data also showed that accompanied TB may be a reversible factor of deteriorating CRFF. Details of diagnosis and treatment of CRFF accompanied by TB are presented.     

糖尿病并肺结核与单纯肺结核患者临床分析比较简

目的 探讨肺结核并糖尿病的临床特点.方法对我院2009 年1 月至2012 年12月期间收治的108例糖尿病合并新发肺结核的病例,与同期收治的120例非糖尿病新发肺结核病例临床特点予以比较分析.结果 与单纯新发肺结核患者相比,糖尿病并发肺结核的患者,临床症状如咳嗽、咳痰、发热、体重减轻等多见（P〈0.01）,咯血者多达46.2%（χ2 =14.78,P〈0.01）;患者全身营养状况差,低蛋白血症多见（χ2=13.69,P〈0.01）,贫血多见（χ2=15.20,P〈0.01）;肺部易形成空洞（χ2=11.802,P〈0.01）,病变重、范围广（χ2=7.562,P〈0.01）;结核菌阳性率高（χ2=14.556,P〈0.01）,排菌量大（χ2=16.70,P〈0.01）.结论 肺结核合并糖尿病患者有其临床特点,因其病情严重,发展快,结核菌阳性率高,因而是肺结核人群的重点监测、管理对象.     

慢性乙型肝炎合并肺结核的研究进展

HBV合并结核分枝杆菌感染近年被逐渐关注,不仅在于其高发率,更源于合并感染后各自病原体对原有疾病演变、预后、治疗效果及毒副作用甚至病原体耐药变异等诸多方面产生异常影响。针对慢性乙型肝炎合并肺结核患者的发病状况﹑发病机理以及治疗进展进行概述,为进一步的研究提供新思路。     

肺结核并发多器官功能障碍综合征53例临床分析

目的探讨影响肺结核并发MODS病死率的主要因素。方法回顾性分析53例肺结核并发MODS患者资料,对筛选出的与30 d病死率相关的各项因素进行单因素分析及Logistic多元回归统计分析。结果单因素分析结果表明APACHEⅡ评分、肺结核病灶范围、血清白蛋白含量、肺结核并发症为肺结核并发MODS的30 d病死率的危险因素。肺结核病灶范围、低血清白蛋白、衰竭器官数目及肝衰可以作为肺结核并发MODS的独立预后因素。结论肺结核病灶累及范围、低血清白蛋白、衰竭器官数目及肝功能衰竭在肺结核并发MODS的预后中起着重要的作用。     

肺结核并发肺部感染的危险因素分析

目的　探讨肺结核患者并发肺部感染的相关危险因素及病原菌特点。方法　选取2017年3月—2019年3月我院收治的179例肺结核患者作为研究对象,观察患者并发肺部感染情况。采集肺部感染患者肺泡灌洗液、痰液等标本进行病原菌分离鉴定;采用Logistic回归分析影响肺结核患者并发肺部感染的相关危险因素。结果　179例肺结核患者中肺部感染82例,感染率为45.81%。Logistic回归分析显示,病程≥4年、合并糖尿病、长期使用糖皮质激素、长期使用广谱抗生素、复治肺结核和侵入性操作为影响肺结核患者并发肺部感染的危险因素。82例肺部感染患者分离病原菌83株,以革兰阴性菌为主,共58株,占69.88%。结论　肺结核患者并发肺部感染以革兰阴性菌为主,病程≥4年、合并糖尿病、长期使用糖皮质激素、长期使用广谱抗生素、复治肺结核和侵入性操作为影响肺结核患者并发肺部感染的危险因素。     

肺结核合并肺曲菌球病的外科治疗

目的总结肺结核合并肺曲菌球病的诊断和外科治疗经验。方法对经手术治疗的24例肺结核合并肺曲菌球病患者的临床资料进行分析。结果 24例患者术前确诊率为37.5%(9/24)。行肺叶切除术20例,全肺切除术4例,19例同时行肥厚胸膜切除术。全组无手术死亡。术后并发症8例(33.3%),分别为胸腔出血1例,支气管胸膜瘘3例,包裹性液气胸2例,肺不张2例。术后随访22例,患者无肺曲菌球病复发。结论肺结核合并肺曲菌球病术前确诊率低;手术切除病变肺叶及肥厚胸膜是治疗肺结核合并肺曲菌球病的有效方法。