清镇市2008—2012年涂阳肺结核患者疗效分析

目的阶段性分析评价清镇市现行化疗方案对涂阳肺结核患者的疗效,适时调整和改进控制措施。方法回顾性分析市CDC结防门诊《结核病患者登记本》中2008—2012年涂阳肺结核患者治疗2月末痰菌转阴及疗效情况。结果2008—2012年涂阳肺结核治疗丢失率为4.5%（51/1145）,其中复治涂阳患者丢失率高于初治涂阳患者。1 094例按初、复治方案治疗后,2月末痰菌转阴率90.8%,而2月末痰菌未转阴组治疗前痰菌阳性等级分组平均秩次高于转阴组。治疗前患者痰菌结果对2月末痰菌转阴有重要影响。＂治愈组＂与＂失败组＂痰菌阳性等级平均秩次类似。总治愈率为92.4%（1 011/1 094）,初治涂阳治愈率（93.3%）高于复治涂阳（88.0%）。结论现行化疗方案在我市治疗初、复治涂阳肺结核患者均能达到满意效果。     

41例治疗2月末的涂阳肺结核患者耐药性分析

目的了解治疗2月末的涂阳肺结核患者耐药情况。方法对2009年在贵港市疾病预防控制中心结核病防治科门诊就诊且治疗2月末痰涂片阳性的肺结核患者进行痰结核菌培养及药物敏感试验。结果 2009年从41例治疗2月末痰涂片阳性的肺结核患者中分离出33株抗酸杆菌,经鉴定30株为结核分枝杆菌,3株为非结核分枝杆菌;30株结核分枝杆菌药敏试验结果为:对9种抗痨药全部敏感者8株,占26.7%(8/30);对1种或1种以上药物耐药有22株,总耐药率73.3%(22/30),其中耐多药结核病人占30.0%(9/30)。结论治疗2月末涂阳的肺结核病人应及时留取痰标本做结核菌培养和药敏试验,为确诊和制定个体化疗方案提供依据。     

涂阳肺结核病人化疗期间痰菌阴转时间与菌量的监测

目的　对涂阳肺结核病人在抗结核组合药物治疗期间 ,痰中抗酸菌变化情况 ,进行监测。方法　痰标本直接厚涂片法。结果　病人痰菌阴转率随治疗时间的延长而增高。结论　痰菌阳性的持续时间与治疗前痰中含菌量多少有关     

深圳市福田区结核病控制项目实施效果分析

目的分析福田区2003-2008年结核病控制项目的实施效果。方法收集2003-2008年结核病控制项目的各类统计报表及相关资料。结果结核病控制项目治疗覆盖率达100%,接诊可疑肺结核患者12630例,发现涂阳肺结核病人2219例,免费治疗3843例,督导化疗管理率达100%,新发涂阳2月末痰菌阴转率达91.3%,3月末痰菌阴转率达95.9%,新发涂阳肺结核病人治愈率达95.7%。结论福田区结核病控制项目成效显著,发现和治愈了大量肺结核病人。加强归口管理,健全防痨网络,严格推行现代结核病防治策略是结核病控制工作的重点。     

晋江市2009-2010年肺结核痰涂片镜检结果分析

目的了解晋江市肺结核抗酸杆菌痰涂片镜检情况,保证涂片质量,提高阳性检出率。方法对2009-2010年晋江市肺结核痰涂片资料进行分析。结果初诊病人涂阳率（16.6%）高于复诊病人（3.1%）;两组均以20～40岁和40～60岁为主,其中初诊涂阳以20～40岁组最高（55.3%）;男性涂阳率高于女性。结论痰涂片镜检目前做为基层发现结核病的主要手段之一,实验室操作者应严格按要求操作,加强室内质控,定期进行盲法复检,提高痰涂片阳性检出率。     

衡阳县2009年肺结核病人AFB痰涂片阳性结果分析

目的了解衡阳县肺结核病人抗酸杆菌（AFB）检出情况,为结核病防治工作提供理论依据。方法统计分析2009年衡阳县疾控中心初诊结核病人抗酸杆菌（AFB）痰涂片检查资料。结果 2009年初诊结核病AFB痰涂片镜检共968例,发现涂阳肺结核病例440例,总涂阳率为45.5%;涂阳率以35～54岁组和55～74岁组较高,分别为47.3%和48.0%,≤14岁组最低（14.3%）（P〈0.05）;四个季度之间AFB阳性检出率差异有统计学意义（P〈0.01）,涂阳率以第四季度最高（54.5%）,晨痰检出率为44.9%,明显高于夜间痰（31.1%）和即时痰（14.3%）;男性涂阳率（46.6%）,女性（42.6%）;职业以农民为主。结论痰涂片镜检结果显示：结核病感染、发病职业以农民为主,35～74岁为肺结核发病的高峰年龄。建议加大对初、复治结核病人的痰检工作力度,发挥乡镇查痰点的作用,建立痰检质量控制系统,及时规范地治疗肺结核病人。     

湖北省综合性医院开展痰涂片检查发现结核病涂阳病人效果分析

目的了解综合性医院开展痰涂片检查发现涂片阳性病人效果。方法在40所综合医院对咳嗽、咳痰、发热3周以上或有痰中带血、咯血的肺结核疑似症状者实施痰涂片检查,发现涂阳肺结核病人。结果1年间共有10 337例肺结核疑似症状者就诊,其中有5 123例进行痰涂片检查,可疑症状者查痰率为49.56%,发现痰涂片阳性肺结核病人796例,涂阳检出率为15.54%,在发现的涂片阳性病人中87.44%是新发病人。结论综合性医院开展痰涂片检查是提高涂阳病人发现率,特别是提高新发涂阳病人发现率的有效手段。但要建立较为完备的人员培训和质量控制体系,提高阳性检出率。     

区域流动人口结核病管理

目的有效控制结核病疫情,实现全人口结核病控制。方法参照深圳市户籍和暂住人口结核病人的管治模式,将短期在深圳务工、探亲、出差等流动人口肺结核病人纳入区域流动人口结核病管理。结果 2003-2006年共接诊流动人口可疑肺结核26 852例,占全市总数的35.7%,登记流动人口活动肺结核病人1 814例,占全市总数的16.8%;流动人口新涂阳2月末痰菌阴转率87.8%,3月末痰菌阴转率93.7%;流动人口新涂阳治愈率为78.4%。结论深圳市常住人口（户籍和暂住）结核病人的管理模式同样适合短期在深圳居住的结核病人,政府应增加对流动人口肺结核病人的关注,给予更多的工作、生活和诊治方面的支持。     

常德市2007-2009年新涂阳肺结核治疗队列分析

目的了解常德市2007-2009年新涂阳肺结核治疗转归情况,为肺结核的预防控制提供相应对策。方法收集常德市2007-2009年中国疾病预防控制信息系统等有关报表资料,按《中国结核病防治规划实施工作指南》等标准进行统计分析。结果常德市2007-2009年7 866例登记新涂阳肺结核中,治疗2月末痰涂片阴转7 471例,阴转率94.98%,3月末痰涂片阴转7 584例,阴转率96.41%,治愈7 112例,治愈率90.41%,完成疗程405例,完成疗程率5.15%,失败26例,失败率0.33%。总体治愈率90%。各年份间的治疗3月末痰涂片阴转情况、结核死亡率、非结核死亡率、治疗失败率和不良反应率差异均无统计学意义（P〉0.01）。各年份之间的治疗2月末痰涂片阴转情况不太相同,治愈率有所下降（χ2=10.77,P〈0.01）,而完成疗程率在上升（χ2=63.57,P〈0.01）。结论通过建立一种有效的医生-病人-家庭-全社会参与长期有序的协作机制,大力开展健康教育。结核病防治是一项社会化的公共卫生服务工作,对新涂阳肺结核的治疗具有不间断性和长期性,要关注患者的治疗依从性[3]。需要加强治疗中的督导管理,尤其是合并有其它疾病、有药品不良反应、在多地流动、经济贫困与文化滞后等患者的管理,还有耐药/难治性耐药病例的管理。在按照《工作指南》标准方案进行一线抗痨治疗、统一管理的前提下,可以根据患者体质、其它疾病、习惯、生活劳动环境等情况给予个性化的中西医辅助治疗。     

常德市1992～1998年结核病人发现及涂阳效果分析

痰涂片阳性（简称涂阳）肺结核病人是最主要的传染源,发现和彻底治愈涂阳病人,是控制结核病疫情的关键措施。常德市１９９２～１９９８年实施世界银行贷款结核病控制项目（简称结控项目）期间共发生涂阳肺结核病人１０６１０例,其中初治涂阳４５４９例,复治涂阳６０６...     

Preventing nosocomial transmission of pulmonary tuberculosis: when may isolation be discontinued for patients with suspected tuberculosis?

OBJECTIVE: The Centers for Disease Control and Prevention and the American Thoracic Society recommend obtaining cultures of at least three sputum specimens for acid-fast bacilli (AFB) from patients in whom tuberculosis (TB) is suspected. On the basis of this, most hospitals isolate patients with suspected TB for 3 days or more until three smear (not culture) results are negative. Our objective was to evaluate the predictive value and sensitivity of these smears. DESIGN: Observational study. SETTING: Four urban medical centers. METHODS: The posttest probability of TB given sequential negative AFB smears from 274 patients isolated for suspected TB and the sensitivity of sequential AFB smears from 209 patients with positive results on culture for pulmonary TB were measured. RESULTS: The posttest probabilities of having TB given one, two, and three negative AFB smears were low: 1.1% (3 of 265; 95% confidence interval [CI95], 0.23% to 3.27%), 0.4% (1 of 262; CI95 0% to 2.1%), and 0% (0 of 260; CI95, 0% to 1.4%), respectively. Among the 209 patients with positive results on culture for pulmonary TB, 169 (81%) had an expectorated sputum specimen sent, of which 91 (54%) were positive for AFB. Forty (24%) of the 169 patients had a second expectorated sputum specimen sent after the results of the first specimen were negative; only 6 (15%) of these had positive AFB smears. None of the 10 patients in whom the first two expectorated sputum samples yielded an AFB smear without an organism had a third AFB smear that was positive. CONCLUSION: Unless there is high clinical suspicion of pulmonary TB in a specific patient, the use of three AFB smears on expectorated sputa is a rational approach to discontinuing isolation for patients with suspected TB.     

Factors associated with tuberculosis treatment default among HIV-infected tuberculosis patients in Thailand

Ensuring completion of tuberculosis (TB) treatment remains a major public health problem. In HIV-infected patients, TB is the most common severe opportunistic infection. Few studies have evaluated risk factors for TB treatment default in HIV-infected patients. We conducted a prospective, observational study of HIV-infected TB patients in Thailand. Patients underwent standardised evaluations at the beginning of TB treatment, at the end of the intensive phase and at the end of TB treatment. TB treatment outcomes were assessed according to WHO guidelines. The analysis was limited to patients who defaulted or who had treatment success. Of the 554 patients analysed, 61 (11%) defaulted. In multivariate analysis, factors associated with TB treatment default included incarceration history [adjusted odds ratio (AOR) 2.0, 95% CI 1.1-3.7), smoking (AOR 2.3, 95% CI 1.3-4.1) and having a symptom complaint score >15 (AOR 3.4, 95% CI 1.4-8.0); one marker of wealth, namely owning a refrigerator, was protective (AOR 0.4, 95% CI 0.2-0.8). Default during TB treatment was a significant problem in HIV-infected patients. Reducing default may require enhancing services for patients with a history of incarceration or smoking and designing patient-centred systems to address poverty and patient wellness.     

FIDELIS项目对湖南省涂阳肺结核病人发现的作用

目的了解FIDELIS项目对湖南省涂阳肺结核病人发现的作用。方法采用结核病人归口管理办法，对专业机构行政领导及专业人员进行结核病人归口管理操作规程、结核病人疫情报告、登记和转诊规程的培训，根据FIDELIS项目月报表统计涂阳肺结核病人数量，对项目实施前后涂阳肺结核病人发现情况进行对照分析。结果第1轮项目实施后比实施前发现的涂阳病人增长率为72．0％，其中新涂阳病人增长率为103．7％；第2轮项目实施后比实施前发现的涂阳病人数增加了2例，增长率为0．1％，其中新涂阳病人增长率为11．7％。结论FIDELIS项目对本省涂阳病人的发现有明显的促进作用。     

The trend of pulmonary tuberculosis in patients seen at DOTS clinics in the Federal Capital Territory, Abuja, Nigeria

We evaluated the pattern of sputum smear positivity and assessed the effects of directly observed treatment short course (DOTS) among tuberculosis (TB) patients at the DOTS clinics in the Federal Capital Territory (FCT), Abuja. In total, 1391 patients were seen at six microscopy and treatment centres across the FCT between January and December 2003. Their sputa were screened microscopically for the presence of acid-fast bacilli (AFB) using the Ziehl-Neelsen staining technique. In total, 296 (21.3%) patients were smear positive; 201 (67.9%) were new cases and 95 (32.1%) were follow-up cases. The highest incidence of sputum smear positivity (24.8%) was found in those aged 21-30 years and the lowest incidence (6%) was found in those aged 71 years and above. No incidence of smear positivity was recorded in children aged 0-10 years. In total, 160 of the men screened were AFB positive (75% new cases, 25% follow-up cases). In comparison, 136 women were AFB positive (59.6% new cases, 40.4% follow-up cases). During the 1-year study period, two deaths were recorded. Men pose a serious threat to public health as most of the follow-up cases result in the tubercle bacilli developing resistance to available anti-TB drugs. This study demonstrated a high prevalence of infectious TB in the population screened, and therefore underlines the need for capacity building through a multisectoral approach in the fight against the disease. Cohort analysis should be the cardinal management strategy in evaluating the effectiveness of TB control through systemic follow-up and reporting of certain indicators in treatment progress and success.     

The impact of diabetes mellitus on pulmonary TB

OBJECTIVE:To compare the clinical characteristics and laboratory results of pulmonary TB (PTB) patients with and without diabetes mellitus (DM) and the relationship between haemoglobin A1C (HbA1c) concentration and mycobacterial load at county level area in Sichuan Province, China.METHODS:A retrospective study was performed from January 2018 to July 2019 inJianyang People’s Hospital, Sichuan Province. Clinical characteristics and laboratory results of newly diagnosed TB patients were collected. Univariable and multivariable logistic regression analyses were performed. The Kruskal-Wallis test was used to compare HbA1c level and mycobacterial load.RESULTS:The final sample included 415 patients with TB, of whom 45 were diagnosed with DM (10.8%). Uni-variable logistic regression showed that PTB patients with concomitant DM were more likely to present with haemoptysis, positive acid-fast bacilli (AFB) smear, cavity, higher erythrocyte sedimentation rate (ESR), higher serum C-reactive protein (CRP), lower serum albumin (ALB), or higher fasting blood glucose (FBG). Multivariate logistic regression analyses showed that AFB smear positivity (OR 15.81, 95% CI 3.09–80.95) and FBG (OR 1.88, 95% CI 1.53–2.31) were independent risk factors of DMPTB. The mycobacterial load was heaviest when the HbA1c was 7.9 mmol/L (95% CI 7.35–11.1) and declined along with HbA1c rising up. But it has not been significantly associated with HbA1c.CONCLUSIONS:Patients with PTB over 45 years old, with haemoptysis, positive AFB, cavity, higher ESR, higher CRP, lower ALB or higher FBG are more likely to present with concomitant DM. Patients with PTB with these factors need to be targeted for DM screening. The mycobacterial load has not been significantly associated with HbA1c.     

Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance

OBJECTIVE: To identify barriers to successful tuberculosis (TB) treatment in Tomsk, Siberia, by analysing individual and programmatic risk factors for non-adherence, default and the acquisition of multidrug resistance in a TB treatment cohort in the Russian Federation. METHODS: We conducted a retrospective cohort study of consecutively enrolled, newly detected, smear and/or culture-positive adult TB patients initiating therapy in a DOTS programme in Tomsk between 1 January and 31 December 2001. FINDINGS: Substance abuse was strongly associated with non-adherence [adjusted odds ratio (OR): 7.3; 95% confidence interval (CI): 2.89-18.46] and with default (adjusted OR: 11.2; 95% CI: 2.55-49.17). Although non-adherence was associated with poor treatment outcomes (OR: 2.4; 95% CI: 1.1-5.5), it was not associated with the acquisition of multi-drug resistance during the course of therapy. Patients who began treatment in the hospital setting or who were hospitalized later during their treatment course had a substantially higher risk of developing multidrug-resistant TB than those who were treated as outpatients (adjusted HRs: 6.34; 95% CI: 1.35-29.72 and 6.26; 95% CI: 1.02-38.35 respectively). CONCLUSION: In this cohort of Russian TB patients, substance abuse was a strong predictor of non-adherence and default. DOTS programmes may benefit from incorporating measures to diagnose and treat alcohol misuse within the medical management of patients undergoing TB therapy. Multidrug-resistant TB occurred among adherent patients who had been hospitalized in the course of their therapy. This raises the possibility that treatment for drug-sensitive disease unmasked a pre-existing population of drug-resistant organisms, or that these patients were reinfected with a drug-resistant strain of TB.     

Impact of resistance to anti-tuberculosis drugs on treatment outcome using World Health Organization standard regimens

We compared treatment outcome in 410 patients with drug-susceptible tuberculosis (DS-TB) and 150 patients with drug-resistant tuberculosis (DR-TB) among 560 adult patients (> or = 15 years old) notified with smear-positive pulmonary tuberculosis between July 1997 and June 1998 in the West Province of Cameroon and treated with World Health Organization (WHO) standard regimens under field conditions. Information on treatment outcome was collected for all smear-positive TB patients having a positive culture with drug susceptibility tests performed for isoniazid, rifampicin, ethambutol and streptomycin. Treatment outcome was recorded as cured, completed treatment, failed, defaulted, died or transferred out, 332 of the 410 patients (81%) with DS-TB were cured, compared to 109/150 (72.7%) patients with DR-TB (odds ratio [OR] = 0.62, 95% confidence interval [CI] 0.40-0.99). Seven patients (1.7%) failed treatment in the DS-TB group vs. 9 (6.0%) in the DR-TB group (OR = 3.67, 95% CI 1.23-11.18). No significant difference was found in rates of death, default or transfer. Sputum smear conversion at the end of the intensive treatment phase was observed in 78.8% of the cases, drug resistance having no effect on the conversion rate. After adjusting for age, sex and resistance, the death rate was higher in patients also infected with human immunodeficiency virus (HIV). In TB cases with multidrug resistance, standard regimens result in unacceptably high failure rates (26.1%). For all other drug-resistant forms of TB, rifampicin-based short-course chemotherapy gave satisfactory results. The death toll in the West Province seems due to HIV co-infection rather than to TB alone. To prevent development of drug-resistance, the proportion of defaulters must be decreased and prevention and control strategies endorsed by the WHO and the International Union Against Tuberculosis and Lung Disease must be implemented nation-wide.     

Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated for TB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7; 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2; 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.     

2007～2009年淄博市涂阳肺结核病人密切接触者痰涂片检测分析

[目的]了解涂阳肺结核病人密切接触者痰涂片阳性检出情况,更多地发现涂阳肺结核病人。[方法]对淄博市及所辖各县疾病预防控制中心2007~2009年对发现的涂阳肺结核病人家庭和学校密切接触者痰涂片检查资料进行分析。[结果]2007~2009年累计检测561例涂阳肺结核病人的密切接触者4 828人,检出涂阳者48例,阳性检出率为0.99%。密切接触者涂阳检出率,在校中学生为1.20%,家庭成员为0.58%(P<0.05);2007~2009年分别为0.92%、0.90%、1.14%(P<0.05);<21、21~50、51~72岁的分别为1.20%、0.47%、0.83%(P>0.05)。[结论]涂阳肺结核病人,特别是在校中学生病人的密切接触者痰涂片阳性检出率较高。     

228例复治涂阳肺结核全程督导治疗的疗效

[目的]了解全程督导短程化疗对治疗复治涂阳肺结核的疗效。[方法]对228例复治涂阳肺结核病人采取全国统一的化疗方案,实施全程督导短程化疗效果进行分析。[结果]强化期2个月末痰菌阴转率为91．23％;3个月末痰菌阴转率为94．30％。全程督导完成疗程时痰菌阴转216例,临床治愈率94．74％。[结论]全程督导短程化疗对复治涂阳肺结核的治疗疗效显著。