Clinical evaluation of patients with pulmonary tuberculosis during the past 10 years in our hospital

The background of patients who died of active pulmonary tuberculosis during 10 year's period (1989 to 1998). Of 973 tuberculosis patients, 76 patients died, of which 56 died of non-tuberculosis, and 20 died of tuberculosis. A total of 12 patients died within 3 months after being hospitalized. The period from hospitalization to death was significantly shorter in tuberculosis patients with independent gait failure, original treatment, without tuberculosis medical history, and no drug resistance. We considered that in tuberculosis death, severe tuberculosis itself is the cause of early death, and recurrence and drug resistance patients are the most serious problems in later deaths.     

上海市男男同性性传播AIDS病人的临床流行病学研究

目的通过对上海艾滋病(AIDS)抗反转录病毒治疗(ART)病人的流行病学研究,为国家艾滋病防治专家提供基本信息,针对不同地区因地制宜采取侧重点不同的防控措施。方法采集662例男性病人的相关信息,分为同性性传播组和非同性性传播组进行相关数据的统计学分析。结果通过同性性传播感染的男性病人为318例(48.04%),且占男性病人的比例由2005年的38.71%上升至2010年的57.14%。开始ART时的年龄分别为同性性传播组(36.14±11.05)岁,非同性性传播组(45.80±11.08)岁,差异有统计学意义(P<0.01)。婚姻状况方面前者未婚为198例(62.26%),后者为56例(16.28%),差异有统计学意义(P<0.01)。两组已婚的病人中均有配偶感染的情况。在学历方面,两组差异有统计学意义(P<0.01),具有大专及以上学历的病人前者137例(43.08%),后者36例(10.47%)。在病人发现感染至治疗时间间隔方面,两组分别为(10.43±15.83)个月和(10.76±17.80)个月,差异无统计学意义(P=0.802)。结论因同性性传播途径感染的病人的比例迅速上升,均为年轻且具有较高学历的国家有用人才,应引起各参与防治工作人员的重视,采取更有效的方式和模式来减少未采取保护措施的肛交(UAI)的发生。男男同性恋尚不能得到社会的承认,有些人不得不结婚生子,因此在关注男男同性恋的同时,也应该关注其婚姻状况,以及其配偶可能感染的问题。     

北京地区25年来消化性溃疡及胃癌发病情况的演变

目的探讨25年来十二指肠球部溃疡(DU)、胃溃疡、胃癌及幽门螺杆菌(Hp)感染在胃镜检查中发生的改变。方法分析1980年1月至2004年12月于我院进行胃镜检查的所有病例,共计104987例。选择全部DU、胃溃疡、经病理证实的胃癌病例为研究对象,分为10～<20岁、20～<30岁、30～<40岁、40～<50岁、50～<60岁、60～<70岁、70～<80岁及≥80岁8个年龄组。结果DU共13684例,平均检出率为13.03%,1999年以后呈下降趋势;胃溃疡共4398例,平均检出率为4.19%,1996年以后呈下降趋势;胃癌共1732例,检出率波动于1.02%～2.36%之间,平均为1.68%,无明显变化。检出DU、胃溃疡、胃癌的平均年龄1980年时分别为39.9岁、47.2岁和55.5岁,2004年分别为43.3岁、55.2岁和61.1岁,其平均年龄均呈上升趋势。Hp的平均检出率为43.54%,1995年以后呈下降趋势。结论DU、胃溃疡、胃癌的检出年龄呈上升趋势;DU、胃溃疡及Hp的检出率近年呈下降趋势,胃癌的检出率无明显变化。     

Clinical evaluation of causes of death in patients with pulmonary tuberculosis

PURPOSE: We evaluated the cause of death in patients with active tuberculosis. OBJECT AND METHOD: 40 patients (male 32, female 8, mean age 76 years old), died under treatment for tuberculosis during 1999 to 2002 in our hospital, were analized. We compared patients' backgrounds, complications, extent of pulmonary tuberculosis, and outcome of the treatment between 40 died cases and 162 patients who were supposed to be successfully treated by cohort analysis (control group). RESULTS: 17 cases died of tuberculosis and 23 cases died of non-tuberculous diseases. Pneumonia occupied the top (9 cases) in the latter group. Died cases were higher in age and showed larger performance status score than the control group. Further, laboratory findings revealed poorer nutritional conditions and higher inflammatory reactions in the died group. The duration of symptoms before admission seemed to be longer in the died group, however, the difference with the control was not significant. All of the died group had complications and the rate of having liver diseases and cerebrovascular diseases was higher than that of the control group. Furthermore, the extent of lung lesions was more extensive in the died group. The frequency of changing drugs due to side effects was higher in the died group, therefore, the proportion of cases completed the standard treatment was lower in the died group. DISCUSSION AND CONCLUSION: Impossibility of continuing the standard treatment gave unfavorable impact in the died cases rather than the delay in their admission. Due to the above reasons, negative conversion of their sputum culture was difficult, and they died of tuberculosis directly or indirectly. Some of the patients who died of pneumonia (non-tuberculous death) might be included in cases died of tuberculosis.     

The diagnosis and therapy of tuberculosis during the past 100 years

Methods for the radiographic diagnosis of tuberculosis have improved from simple fluoroscopy to computerized tomography. Although direct smear examination is still the most widely used bacteriological method of diagnosis, cultural methods with selective liquid media are sensitive and rapid. The use of antituberculosis drugs has changed tuberculosis from a disease with about a 50% mortality, treated by measures to collapse the affected lung lesions and by rest for the patient, to a condition successfully curable by chemotherapy. Key steps in the development of modern chemotherapy regimens were the demonstrations in clinical trials that (1) streptomycin was effective; (2) combination of drugs prevented the emergence of drug-resistant Mycobacterium tuberculosis; (3) chemotherapy under domiciliary conditions was effective and did not put family members at risk of infection; (4) patient compliance could be assisted by fully supervised intermittent regimens, or more effectively, by (5) shortening treatment by the introduction of rifampin and pyrazinamide, the two most potent sterilizing drugs, into the regimens. Regimens were divided into an initial intensive phase, while bacterial populations were high, and a longer continuation phase to complete sterilization. Pyrazinamide was shown to sterilize only in the intensive phase. The treatment of nonpulmonary tuberculosis followed the same plan, but when bacterial populations are low, fewer drugs are required in combination.     

5种病原学检测方法在肺结核病诊断中的应用评价

目的 评价涂片法(AFS)、罗氏培养法(L-J)、环介导等温扩增法(LAMP)、多色半巢式荧光定量PCR(Xpert MTB/RIF)、线性探针技术(LPA)对肺结核病的诊断价值。方法 选取2016年1月— 2018年3月陕西省结核病防治研究所和汉中市第二人民医院就诊的258例肺结核可疑症状者作为研究对象,同时应用AFS、L-J、LAMP、Xpert MTB/RIF、LPA对所有研究对象的同一份痰样本进行检测,以临床诊断为标准,分组计算5种病原学检测方法的阳性率;以培养和鉴定为金标准,计算4种方法的敏感度和特异度,并结合受试者工作特征 (ROC)曲线进行分析比较。结果 在肺结核病组中LAMP(73.30%)、Xpert MTB/RIF(77.27%)、LPA(70.45%)的阳性率均显著高于AFS(46.02%)和L-J(58.52%),差异均有统计学意义;以培养和鉴定为金标准,AFS、LAMP、Xpert MTB/RIF、LPA的敏感度分别为68.93%、93.20%、97.09%、92.23%;特异度分别为93.55%、74.84%、75.48%、83.23%;ROC曲线下的面积分别为0.812、0.840、0.863、0.877,P均< 0.05。结论 5种病原学检测方法对肺结核病的诊断均具有较好的辅助作用;与AFS和L-J相比,LAMP、Xpert MTB/RIF、LPA具有较高的阳性检出率,有助于传染源的早期发现。     

Death rate and causes of death in RA patients during a period of five years

Patients with rheumatoid arthritis, 500 males and 500 females, aged 40 years or over, together with an age and sex matched control population, were observed over a 5-year period. During the follow-up 176 RA patients and 107 controls died. The most common causes of death in RA patients were cardiovascular diseases (86 patients), renal failure (33 patients), infections (23 patients), and malignant neoplasms (21 patients); in the controls, the corresponding data are cardiovascular diseases (53), malignant neoplasms (30), infections (9), and accidents (8).     

Clinical evaluation of the cause of death in patients with active pulmonary tuberculosis

We made a clinical analysis of the cause of death of forty deceased patients with active pulmonary tuberculosis who were admitted to Kawasaki Medical School Hospital, Kawasaki Medical School Kawasaki Hospital, and Asahigaoka Hospital during the period from January 1996 to December 2001. The age of 40 deceased patients (29 males/11 females) ranged from 55 to 93 years old, and were mostly bedridden. Underlying diseases existed in all except one case, and they were respiratory diseases in 9 patients and non-respiratory diseases in 34 patients. Laboratory findings revealed poor nutritional conditions. The diagnosis of pulmonary tuberculosis was established within one month from the appearance of symptoms in over half of these patients because most of them were smear positive for Mycobacterium tuberculosis. None of the strains of Mycobacterium tuberculosis isolated from these patients were multidrug resistant for antituberculous drugs and only one strain was completely resistant for Rifampicin. Radiological findings of the tuberculosis were bilateral in 30 patients. Consolidation shadows without cavity were noted in 22 patients, and extension within the unilateral lung field was observed in 24 patients. Regarding the cause of death, advanced pulmonary tuberculosis was the cause in 17 patients and non-tuberculous diseases were the cause in 23 patients. There were 15 patients with bacterial superinfections such as bacterial pneumonia, 4 with malignancy, and 4 with other disease. The number of pulmonary tuberculosis patients in poor general and nutritional condition has been increasing with the aging of the Japanese population. Treatment for pulmonary tuberculosis has been successful in most cases, however, the number of the deaths unrelated to tuberculosis including those due to bacterial superinfection has been increasing. Therefore, treatment should be considered against resistant microoganisms such as MRSA.     

肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽（82．5％）、咳痰（80．4％）、发热（45．4％）、不同程度咯血或血丝痰（23．7％）等为主要症状，胸部CT以肺不张或膨胀不全（44．2％）及浸润增殖性病灶（37．9％）为主要表现，并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现，痰涂片或培养检查抗酸杆菌阳性率较高（63．9％），尤其在多叶段浸润增殖病灶患者中其阳性率高达83．3％。纤支镜检查以主支气管及叶支气管开口受累显著（64．8％），多气管支气管受累患者达81．4％，且多种支气管镜下表现类型并存，纤支镜刷检抗酸杆菌、组织活检阳性率分别为55．9％、69．4％。接受纤支镜介入治疗的患者仅有18例，其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗，5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段，镜下可见多气管支气管受累，且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。     

肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽(82.5%)、咳痰(80.4%)、发热(45.4%)、不同程度咯血或血丝痰(23.7%)等为主要症状,胸部CT以肺不张或膨胀不全(44.2%)及浸润增殖性病灶(37.9%)为主要表现,并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现,痰涂片或培养检查抗酸杆菌阳性率较高(63.9%),尤其在多叶段浸润增殖病灶患者中其阳性率高达83.3%。纤支镜检查以主支气管及叶支气管开口受累显著(64.8%),多气管支气管受累患者达81.4%,且多种支气管镜下表现类型并存,纤支镜刷检抗酸杆菌、组织活检阳性率分别为55.9%、69.4%。接受纤支镜介入治疗的患者仅有18例,其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗,5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段,镜下可见多气管支气管受累,且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。