肺结核患者血清肿瘤坏死因子-α的变化

目前业已证实,T淋巴细胞介导的免疫反应为结核病的主要免疫反应。多种细胞因子参与其中,肿瘤坏死因子-α(TNF-α)为其中一重要因子。本文通过对活动性肺结核与非活动性肺结核及健康人比较,以及活动性肺结核治疗前及不同转归时期血清TNF-α水平的比较,观察TNF-α在肺结核患者的变化及其意义。1资料及方法1.1选取肺结核病人30例,其中活动性肺结核15例,根据病史、症状、胸片及痰结核分支杆菌涂片检查诊断,15例病人皆无抗结核治疗史,其中男9例,女6例,年龄19～58岁,平均年龄34岁,胸片示有空洞者2例。非活动性肺结核病人     

沈阳市东陵区肺结核患者治疗依从性及其影响因素

目的了解肺结核患者治疗依从现状及其影响因素,为肺结核患者综合防治提供依据和科学指导。方法以550例肺结核患者为调查对象,采用调查表对肺结核患者治疗依从情况进行调查。结果 506例患者中依从性好的有440例,占86.9%;依从性较差、不规则服药66例,占13.1%。肺结核患者依从性因素分析结果显示,年龄、病情、家庭经济收入及病人对结核病防治知识的知晓程度,对病人治疗的依从性有影响（P〈0.01）。结论加强对肺结核病人防结核宣教,重视肺结核病人的督导管理,是提高结核病人治疗依从性的主要措施。     

肺结核病人治疗依从性的影响因素分析

目的了解肺结核病人治疗依从性的影响因素。方法对曾进行抗结核治疗的患者采用问卷调查方式,了解他们规则服药情况和影响因素。结果影响病人规则服药的因素主要与病人的年龄、文化程度、家庭经济状况和对疾病知晓率有关。结论加强对结核病人及家属的防痨知识宣教,重视对老年肺结核病人的管理和家庭督导,加大对肺结核病人的治疗经费支持是提高肺结核病人治疗依从性的有效途径。     

细胞因子在初治肺结核患者血液中表达的研究

目的研究初治肺结核患者IL-2、IL-4、IL-18、IFN-γ及MMP-9的表达情况,并了解其在肺结核病治疗过程中的变化。方法应用ELLSA法检测100例初治肺结核患者治疗前后及90例健康志愿者血清IL-2、IL-4、IL-18、IFN-γ及MMP-9的表达。结果 100例结核涂阳患者,治疗2个月后79例转阴,痰菌转阴率79%;研究组与对照组比较,研究组治疗前各种细胞因子水平明显高于对照组,差异有统计学意义(P0.01);研究组治疗后IL-4、IL-18水平高于对照组,差异有统计学意义(P0.05),IL-2、IFN-γ及MMP-9与对照组比较,差异无统计学意义(P0.05);研究组治疗后各种细胞因子水平明显低于治疗前(P0.05),差异有统计学意义(P0.05);转阴患者五种细胞因子与未转阴患者间比较,差异有统计学意义(P0.05)。结论在进行抗肺结核物治疗时动态观察细胞因子水平,有利于监测肺结核病情的转归,利用细胞因子的变化趋势,可以预知治疗方案的有效性。     

耳鼻咽喉也会得结核

耳、鼻、咽、喉结核是一种传染病,多伴随着肺结核发生,如喉结核病人有75%合并有肺结核。若不及时发现,不但延误治疗,还会造成传染。所以,应积极做好防治工作。患耳、鼻、咽、喉结核的病人,一般都有与结核病人的接触史,得病后电会有消瘦、低烧、痰中带血、淋巴结肿大等表现。发生在上呼吸道的结核,传染途径有两个:一是内源性的,即来自肺结核,先传染至喉部再至咽部;二是外源性的,外界的结核杆菌先由鼻子吸人,而后传至咽部。所以喉和鼻部的结核发病率最高,其次是咽部结核。     

影响肺结核病人治疗依从性因素调查分析

目的 了解影响肺结核病人治疗依从性因素及病人服药依从情况。方法 对曾用过抗结核药品的肺结核病人采取问卷方式，了解病人规律服药情况及影响因素，评价患者对抗结核治疗依从性并总结分析。结果 病人规则服药率为49．6％，影响病人服药依从性因素多为人为主观因素，并与病人年龄，受教育程度及结核病知晓情况相关。结论 加强对结核病人及综合医院医生的防痨宣教，重视肺结核病人的督导管理，是提高结核病人治疗依从性的唯一措施。     

白细胞介素-31及其与肺结核关系的研究进展

肺结核是由结核分枝杆菌感染引起的一种常见的慢性传染性疾病，主要通过空气进行传播。当结核分枝杆菌感染人体后，可产生由T淋巴细胞介导的IV型超敏变态反应。目前认为人体感染结核分支杆菌后的病情严重程度与机体免疫水平密切相关。白细胞介素(IL)-31是一种四螺旋束型结构的新型细胞因子，属于IL-6家族中的一员。IL-31的主要由CD_4⁺T淋巴细胞特别是活化的2型辅助T淋巴细胞(Th2)分泌。IL-31的功能受体是由抑瘤素M受体(OSMR)与IL-31受体α(IL-31RA)组成的异源二聚体受体复合物。IL-31通过三条信号通路控制信号的传递，产生多种的生物学功能，如诱导促炎细胞因子的释放、调节细胞的增殖以及参与组织结构的重塑等。IL-31及其受体在瘙痒症、过敏性疾病及自身免疫性疾病的发病过程中发挥着重要的作用。在呼吸性疾病尤其是肺结核中，IL-31参与了肺结核的发生、发展，且还可促进结核空洞的形成，对诊断肺结核具有重要的潜在价值。现就IL-31的生物学功能及其与肺结核的关系方面予以综述，为早期诊断肺结核提供帮助。     

肺结核病人服药依从性控制

<正>肺结核主要是由于受到结核分枝杆菌侵入人体后,进而诱发一种慢性传染病,一般会累及多个器官,但感染最为严重和常见的是肺部,故称肺结核。关于肺结核的治疗是一个长期、漫长的过程,因此如何有效的控制和提高肺结核病人服药的依从性对于治愈该疾病就有着非常重要的意义。     

结核病复活的幽灵

结核病是由结核杆菌感染人体引起的一种慢性传染病,肺是最常感染的部位,肺结核病人占结核病人总数的90％以上。结核杆菌通过飞沫传播。排菌的肺结核病人在咳嗽、大声说话或打喷嚏时把含有结核杆菌的飞沫散播在空气中,当某个健康人吸入了带有结核杆菌的飞沫,结核杆菌就进入他的肺泡,那么他很有可能会     

肺结核病人服药依从性的护理干预

肺结核是一种严重危害人们健康的慢性呼吸道传染病,近年来,肺结核的疫情有所回升,严重危害人类的健康,亦成为严重的社会公共卫生问题。结核病长达6个月以上疗程的治疗效果取决于病人对治疗的依从性,大量研究表明,肺结核病人对治疗的不依从性普遍存在。肺结核病人治疗过程中不规范服药情况严重,病人不规范服药可导致治疗失败、结核复发、病情加重及耐药性结核菌的扩散等严重后果。因此,应提高病人及家属对肺结核的早期、     

活动性肺结核免疫耗竭及免疫治疗的研究进展

目的　利用ROC曲线评价CO2结合力（carbondioxide combining power, CO2-CP）对肝硬化食管胃静脉曲张破裂出血失血性休克患者预后的判断价值。方法　收集2018年6月—2019年6月我中心重症医学科收治的107例肝硬化食管胃静脉曲张出血休克患者的临床资料，根据临床转归将其分为生存组和死亡组，评估生存组和死亡组CO2-CP和碱剩余（base excess, BE）的水平，应用Spearman法对CO2-CP和BE进行相关性分析，应用AUC评估CO2-CP和BE对预后的判断价值。结果　生存组BE的平均水平为（-1.41±6.00）mmol/L，死亡组BE的平均水平为（-15.93±4.44）mmol/L，2组相比差异有统计学意义（t=8.570，P=0.000）。生存组CO2-CP的平均水平为（20.36±4.35）mmol/L，死亡组CO2-CP的平均水平为（10.07±2.49） mmol/L，2组相比差异有统计学意义（t=8.607，P=0.000）。CO2-CP和BE呈正相关（r=0.875，P=0.000）。CO2-CP和BE针对预后的AUC分别为0.871，0.922，95%CI分别为0.770～0.972，0.846～0.998，差异均无统计学意义（P均＞0.05）。结论　CO2-CP可较好地反映肝硬化食管胃静脉曲张破裂出血失血性休克患者代谢性酸中毒水平和预后预测。     

传染性肺结核病人密切接触者调查

[目的]了解传染性肺结核病人密切接触者结核菌感染情况和发病情况。[方法]以五莲县结核病防治所2006年1月至2007年6月登记的312例传染性肺结核病人密切接触者为调查对象,设计统一的调查表格。[结果]调查密切接触者678人,结核菌素试验阳性461人,阳性率为67．99％;查出肺结核病人8例。患病率为1．18％。[结论]传染性肺结核病人密切接触者结核菌感染率为67．99％,明显高于普通人群,对传染性肺结核病人应做到早发现、早隔离、早期规范治疗。     

肺结核合并糖尿病95例临床分析

目的研究肺结核合并糖尿病的临床特征、治疗转归等方面的特殊性,为该类患者的治疗提供依据。方法对95例肺结核合并糖尿病患者的相关资料进行分析。结果结核病病情程度与治疗前空腹血糖水平呈正相关,血糖越高结核菌涂阳检出率与空洞形成率越高;结核病治疗效果与血糖控制水平密切相关,血糖控制理想者结核病治疗效果良好。结论结核病合并糖尿病以病变严重,病情复杂,涂阳、空洞率高,疗效差为特点。积极有效的两病共治,对治愈患者结核病,减少结核病复发,控制结核病传播和流行具有重要的意义。     

江苏省无锡市慢性传染性肺结核流行病学调查

目的掌握无锡市慢性传染性肺结核（以下简称慢传）的现状，分析和探讨其形成的原因，为控制和减少慢传提供科学的依据。方法采用江苏省慢传个案调查表对调查对象进行现状和回顾性的流行病学调查，并拍摄胸片，进行痰结核菌镜检、培养和药敏试验，最后整理资料，进行统计分析。结果无锡市慢传患者的特征是年龄大、分布广、病程长、病情重、症状多、长期排菌、耐药率高、治管困难。造成的直接原因主要是不规则用药和过早停药，其次是耐药、方案不当、有并发症等。结论在抓好初治，阻断慢传来源的基础上，同时治管好复治和现有慢传患者，减少耐药菌的传播，是目前控制和减少慢传，最终解决这一老大难问题的有效途径。     

Child with tubercular meningoencephalitis, etiologically related to a microepidemic of tuberculosis in Southern Limburg by DNA 'fingerprinting']

MICROEPIDEMIC: In a child fatal tuberculous meningoencephalitis was diagnosed and the Regional Public Health Service Geleen, Limburg, the Netherlands, was notified. Source identification and contact tracing (ring investigation) did not reveal a source of the infection. In a person living in the same village pulmonary tuberculosis had been diagnosed, but there was no evident contact between both patients. When the mycobacteria from all patients with tuberculosis were typed by DNA fingerprinting, both patients belonged to the same cluster, thus identifying the infection source of the meningoencephalitis patient. In the management of the outbreak 950 persons were examined in a contact tracing survey. Of them 35 had recently been infected and four of these had recently acquired pulmonary tuberculosis. DISCUSSION: Highly infectious patients with tuberculosis are able to infect persons who cannot be found by conventional contact tracing survey as the transmission of tuberculosis is more subject to casual encounters than was hitherto believed. DNA fingerprinting is a very useful method in contact investigation of tuberculosis. In the Netherlands, therefore, the early diagnosis and treatment of symptomatic patients with infectious tuberculosis is more important to stop the transmission of Mycobacterium tuberculosis than the identification and screening of risk groups in the population.     

Leptin and energy metabolism in pulmonary tuberculosis

BACKGROUND: Pulmonary tuberculosis is the classic cause of "consumption," but the pathogenesis of such wasting is largely unknown. Animal studies in other conditions suggest that leptin may be a mediator between proinflammatory cytokine activity and wasting. OBJECTIVE: We tested whether the leptin concentration, after control for body fat mass, is higher during active pulmonary tuberculosis than after recovery and whether it correlates with energy metabolism and proinflammatory cytokine activity. DESIGN: Nondiabetic adults with pulmonary tuberculosis (n = 32) were recruited into a prospective observational study. Patients found to be antibody positive for human immunodeficiency virus were excluded from the study. Dual-energy X-ray absorptiometry, indirect calorimetry, and food intake protocols were performed at baseline and after 1 and 6 mo of tuberculosis treatment. Fasting plasma leptin, tumor necrosis factor alpha and its soluble receptor, and interleukin 6 were measured by enzyme-linked immunosorbent assay. RESULTS: Resting energy expenditure was close to Harris-Benedict predictions and did not change significantly during treatment, but energy intake increased. Leptin concentration was correlated in a log-linear fashion with percentage body fat but was independent of cytokines and energy intake. There was no significant difference in leptin, corrected for energy balance and fat mass, at baseline and after 1 and 6 mo of treatment. CONCLUSIONS: These data are compatible with recovery from anorexia or starvation without discernible hyper- or hypometabolism. The close correlation of leptin with body fat mass is similar to observations in healthy subjects. No additional influence of disease state or proinflammatory cytokine activity was found. Leptin does not appear to be a component of the immune response to human pulmonary tuberculosis, and thus it cannot account for the weight loss and anorexia associated with tuberculosis.     

肺结核病继发真菌感染69例临床分析

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的认识和合理处理。方法 回顾近5年来我科收治的3811例肺结核合并69例肺部真菌感染的资料，并进行分析。结果 合并肺部真菌感染的肺结核主要特点：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。     

CT树芽征及其伴随征象在肺结核诊断中的价值

目的评价CT树芽征及其伴随征象对肺结核诊断的价值。方法选择笔者所在医院2009年10月～2010年3月具有CT树芽征的肺部感染性疾病患者108例,经f临床证实其中肺结核42例,支气管扩张合并感染34例,感染性支气管炎32例,比较三种疾病中CT树芽征及其伴随征象的特点。结果三种疾病CT树芽征累及范围间差异无统计学意义（P〉0．05）;三种疾病CT树芽征所在部位亚段以上支气管表现异常及伴有磨玻璃灶情况比较,差异均有统计学意义（P〈0．05）。结论CT树芽征所在部位亚段以上支气管表现异常及伴有磨玻璃灶对肺结核的诊断及鉴别诊断具有重要的临床意义,值得关注。     

Dietary modulation of cytokine production and biologic functions

Cytokines play a key role as communication signals during both normal immunologic responses and pathologic conditions leading to infectious, inflammatory, and neoplastic diseases. Production and biologic function of cytokines are affected by changes in macro- and micronutrients. On the other hand, metabolic and catabolic consequences of the action of cytokines change nutrient status and the distribution of nutrients in tissues. The effect of some nutrients on cytokine production as well as some of the biologic effects of cytokines are mediated through metabolites of arachidonic acid (prostaglandins, leukotrienes, etc.). Other mechanisms involved in nutrient-induced changes of cytokines needs to be determined. Understanding the role of nutrients in cytokine production and biologic function during normal homeostasis, as well as under pathologic conditions, can help in designing proper dietary modification for the prevention and therapy of diseases.     

Matrix metalloproteases and their association to tuberculosis

Tuberculosis (TB) remains as the single most relevant bacterial infectious disease worldwide, causing nearly eight million new cases annually, with an estimated death toll close to two million people per year. The World Health Organization estimates that one third of the world population is latently infected with Mycobacterium tuberculosis (Mtb). Latent TB reactivation remains as the most common cause of new cases of active TB, given inflammation, necrosis and pulmonary cavitation lead to tissue erosion and dissemination to uninfected hosts. Current knowledge of events regulating exacerbated inflammatory responses is scarce. However, participation of components from both the infectious agent and the host is suspected. In this regard, likely candidates to participate in cavitation are matrix metalloproteases (MMPs), a family of proteolytic enzymes required for degrading and reconstructing tissue either in normal or pathological conditions, as well as for processing signaling molecules including cytokines and chemokines. Some studies have reported induction of MMPs genes in response to mycobacterial infection in cellular models, or how inhibiting MMPs action modify the course of tuberculosis infection in murine models.