益生菌联合肠内营养对艾滋病并伪膜性肠炎治疗观察

伪膜性肠炎（PMC）是一种由难辨梭状芽孢杆菌引起的结肠、小肠的急性渗出坏死性炎症,并在肠黏膜表面覆有黄白色或黄绿色的伪膜,临床上较为常见.本病常发生于腹部手术和应用广谱抗生素的患者,尤以老年人和免疫低下者多见.近年来,伪膜性肠炎发病率呈逐年上升趋势,诊断和治疗不及时极易发生中毒性巨结肠、肠梗阻及肠穿孔等严重并发症,甚至导致患者死亡.我们对26例艾滋病并伪膜性肠炎患者采用益生菌联合肠内营养治疗,取得较好的临床疗效.现将结果报道如下.     

伪膜性肠炎发病机制及诊疗的探讨

[目的]探讨伪膜性肠炎的发病机制.[方法]结合病史,对1例复发性伪膜性肠炎患者的临床症状、体征,实验室检查和肠镜及其组织病理学进行分析.[结果]以反复腹痛、腹泻为主要临床症状的伪膜性肠炎患者,多次大便培养示肠道菌群失调.[结论]抗生素致肠道菌群失调是引起伪膜性肠炎的主要原因,合理使用抗生素和恢复肠道菌群是伪膜性肠炎的主要治疗手段.     

胃肠癌术后伪膜性肠炎回顾分析

目的研究我院胃肠癌术后发生伪膜性肠炎的临床特点。 方法分析我科2010年1月至2012年12月收治的236例胃癌、结肠癌以及直肠癌术后发生伪膜性肠炎患者的临床资料。 结果236例患者所患疾病：胃癌61例,结肠癌98例,直肠癌77例。患者年龄范围35～78岁,平均年龄64.5岁。其中201例患者于术后6天内发生伪膜性肠炎。236例患者均常规予以鼻饲甲硝唑,肠道益生菌治疗,其中61例患者加用口服万古霉素治疗。233例患者治愈康复,3例死亡。 结论高龄、抗菌药物应用种类多、时间长以及术后胃酸分泌减少是术后伪膜性肠炎的高危因素。合理应用抗生素、注意早期肠内营养的应用,减少伪膜性肠炎的发生。另外,早期诊断、早期治疗以及隔离治疗对伪膜性肠炎患者是十分必要的。     

肠内营养在伪膜性肠炎中的作用

伪膜性肠炎（pseudomembranous enterocolitis,PMC）是发生在结肠及小肠的急性黏膜坏死、纤维素渗出性炎症,黏膜表面覆有黄白或黄绿色伪膜,多由于长时间应用广谱抗生素后导致正常肠道菌群失调,难辨俊状芽孢杆菌（clostridium difficile,CD）大量繁殖产生毒素而致病。该病多发生于老年人、重病患者、免疫力低下及外科大手术后等患者,病情危重,治疗不及时化广;年较高,可高达16％～22％。伪膜性肠炎的治疗在严重腹泻时应该禁食,除了药物对症治疗外,能否用肠内营养或将肠内营养作为主要治疗手段,何时开始肠内营养,较少引起临床注意,我科收治的一例重症伪膜性肠炎病人,给予肠内营养结合综合方法达到治愈,总结如下。     

重视腰椎外伤手术患者的胃肠道症状

腰椎外伤和腰椎手术患者由于腹膜后血肿和手术刺激腹腔神经丛导致不同程度的胃肠功能障碍.严重者出现肠麻痹和腹膜炎,患者出现严重腹胀、腹痛、不能进食.在此基础上术后应用抗生素时易出现抗生素相关性腹泻,严重者出现重度伪膜性肠炎.由于骨科医师对伪膜性肠炎不认识,消化科医师又对伪膜性肠炎可出现腹腔内高压甚至腹腔间隔室综合征不认识或重视观察处理不够,错过了在腹腔内高压时段抢救的最佳时机,导致患者死亡,因此对腰椎外伤和腰椎手术患者要高度重视早期胃肠道症状,及时发现抗生素相关性腹泻,尤其重度伪膜性肠炎的出现.重视腹腔内高压的有效处理,防止腹腔间隔室综合征的出现,降低死亡率.     

16例伪膜性肠炎临床分析

目的总结伪膜性肠炎的临床表现，分析讨论影响其治疗与预后的因素。方法回顾分析16例伪膜性肠炎患者的用药及临床资料。结果16例伪膜性肠炎患者中绝大部分患者有在使用广谱抗生素过程中出现腹泻、腹痛等表现，少部分在使用大量激素后出现腹泻、腹痛等表现，其发生与使用第三代头孢菌素和喹诺酮类关系最为密切。结论伪膜性肠炎多在应用抗生素或激素过程中发病，老年人、重症患者及外科大手术患者为易感人群。根据使用抗生素或激素的病史、临床表现及结肠镜下典型表现可做出临床诊断。     

伪膜性肠炎的内镜表现和临床诊治

背景：由于抗生素的广泛应用．伪膜性肠炎的发病率逐渐增加。目的：总结伪膜性肠炎患者的内镜表现和临床诊治过程．提高该病的鉴别诊断和治疗水平。方法：对2006年10月～2007年12月北京友谊医院确诊的伪膜性肠炎患者进行回顾性分析。结果：共21例患者纳入分析。12例临床表现为稀水便,9例为黏液血便。3例粪便培养球菌／杆菌比例倒置。17例内镜下表现为黏膜上散在黄色或白色椭圆形隆起：4例为黏膜上附着大片状黄褐色伪膜,伴糜烂、溃疡。确诊后所有患者均停用抗生素。10例患者仅使用微生态制剂治疗,11例在上述基础上加用甲硝唑或万古霉素。经治疗后所用患者腹泻均缓解。结论：伪膜性肠炎的临床表现除稀水便外,还可能出现黏液血便,内镜表现有特征性,对诊断具有重要意义。停用抗生素、使用微生态制剂和甲硝唑或万古霉素对伪膜性肠炎的治疗有效。     

伪膜性肠炎56例内镜及临床特点分析

伪膜性肠炎多数由难辨梭状芽胞杆菌引起，常发生于腹部手术后应用广谱抗生素者，老年人及免疫功能低下者尤为好发。回顾1998年7月∽2003年7月我院经结肠镜检查诊断的伪膜性肠炎56例，报告其内镜及临床特点如下。     

儿童艰难梭菌感染临床特征及疾病复发危险因素分析

目的 分析儿童艰难梭菌感染(CDI)的临床特征及疾病复发危险因素。方法 选择2014年9月至2022年10月于上海市儿童医院消化感染科住院治疗的138例CDI患儿的临床资料。根据治疗后疾病复发情况将患儿分为复发组(n=39)和非复发组(n=99)。比较两组临床数据资料,并通过二元logistic回归分析CDI复发的危险因素。结果 138例初发CDI患儿中男81例,女57例,中位年龄4.80岁。复发组腹泻、伪膜性肠炎和医院获得性CDI(HA-CDI)的人数比例高于未复发组,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,伪膜性肠炎和HA-CDI是促进CDI患儿复发的独立危险因素(P<0.05)。结论 伪膜性肠炎和HA-CDI是住院CDI患儿复发的独立危险因素,需引起临床医师的重视。     

艾滋病并伪膜性肠炎11例临床分析

伪膜性肠炎（PMC）是主要发生于结肠，也可发生于小肠的急性黏膜坏死性炎症并覆有伪膜，89％～100％是由难辨梭状芽胞杆菌所致。爱滋病患者易并发各种机会性感染。2003年～2009年我科共收治艾滋病并发伪膜性肠炎患者11例。现将11例患者的临床表现及结肠镜下特征分析如下。     

抗结核药物相关急性肝衰竭患儿三例并文献复习

目的: 分析儿童结核病患者发生抗结核药物相关急性肝衰竭的临床特征、治疗措施及预后。方法: 对3例发生抗结核药物相关急性肝衰竭结核病患儿的临床表现、检查结果、治疗措施及预后进行报道,并回顾分析国内外文献。以“急性肝衰竭、结核病、儿童”为检索词检索万方、维普及中国知网数据库,以“acute liver failure、tuberculosis、child/children”为检索词检索PubMed数据库,检索时间为1980年1月至2021年12月。收集包括患儿的年龄、抗结核药物治疗方案、服用抗结核药物时间、服用其他可以引起肝损伤的药物、治疗结局等信息,剔除因预防性抗结核治疗而导致肝衰竭的病例。结果: 本院收治了3例患儿,男性1例,女性2例。3例患儿结核病灶累及胸腔、腹腔,2例患儿结核病灶累及中枢神经系统。3例患儿均有低蛋白血症。经治疗后2例死亡,1例存活。通过文献复习获得6例患儿信息,加上本研究报道的3例患儿,共计9例。9例患儿年龄范围为0.25~12.80岁,年龄中位数(四分位数)为 10.70(5.02,12.70)岁。4例患儿使用H-R-E-Z(H:异烟肼,R:利福平,E:乙胺丁醇,Z:吡嗪酰胺)抗结核治疗方案,余5例使用H-R(2例)、H-R-Z(2例)、H-R-E-S(S:链霉素)(1例)。本研究中4例患儿存活,5例死亡。3例患者年龄<10岁,2例患者死亡,1例接受肝移植的患者存活。结论: 结核病患儿发生抗结核药物相关急性肝衰竭大多在使用抗结核药物治疗1个月内,且年龄越小预后越差。     

Clinical aspects of rifampicin-associated pseudomembranous colitis

Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC.     

Study of drug resistance in previously treated tuberculosis patients in Gujarat, India.

SETTING: Department of Tuberculosis and Chest Diseases and State Tuberculosis Diagnosis and Training Centre (STDTC), a DOTS centre in Ahmedabad, Gujarat State, India. The study was carried out by retrospectively reviewing patient data between January 2000 and August 2001. OBJECTIVE: To evaluate the pattern of drug resistance among previously treated tuberculosis patients who remained symptomatic or smear-positive despite receiving anti-tuberculosis drugs under DOTS for a minimum of 5 months. DESIGN: A total of 1472 pulmonary tuberculosis patients who had taken anti-tuberculosis treatment were evaluated retrospectively with respect to their drug resistance pattern by sputum culture for acid-fast bacilli (AFB) and sensitivity testing with isoniazid, rifampicin, streptomycin and ethambutol (E). RESULT: Of the 1472 patients evaluated, 804 (54.6%) were treatment failure cases and 668 (45.4%) were relapse cases; 822 patients (373 failure and 449 relapse) were culture-positive. Of these 822 patients, 482 (58.64%, 261 failure and 221 relapse) were resistant to one or more drugs. Resistance to one drug was observed in 86 patients (10.46%), to two drugs in 149 (18.13%), to three drugs in 122 (14.84%) and to four drugs in 125 (15.21%). Single drug resistance was most commonly seen with isoniazid (62 patients, 7.5%), followed by streptomycin (12 patients, 1.4%), rifampicin (eight patients, 0.97%) and ethambutol (four patients, 0.4%). Resistance to isoniazid plus rifampicin alone was seen in 76 patients (9.2%). CONCLUSION: Drug resistance is a major problem in the treatment of pulmonary tuberculosis. Detection of drug resistance patterns and treatment with second-line anti-tuberculosis drugs in appropriate regimens are necessary in the treatment of failure and relapse cases in order to reduce the emergence of multidrug-resistant tuberculosis.     

HIV-tuberculosis coinfection

Coinfection with the human immunodeficiency virus (HIV) and tuberculosis is a major public health problem throughout the world. In subsaharan Africa and Southeast Asia, as many as one third of all patients with tuberculosis also have HIV infection. These two infection interact on each other, worsening the prognosis and increasing mortality. The diagnosis of tuberculosis is sometimes difficult to establish since the clinical presentation may be incomplete, but must always be evoked and sought whenever there is the slightest doubt. These patients should be given conventional anti-tuberculosis treatment using three or four anti-tuberculosis drugs for a duration of 9 months. Overall outcome is favorable. Drug interactions between antiretroviral drugs and anti-tuberculosis drugs is a real problem, limiting the use of certain agents. The restored immunization achieved with HAART protocols involve "paradoxical" reactions which complicate patient adherence to therapy. It would be reasonable to treat tuberculosis first, then, in 6 weeks, introduce an adapted antiretroviral regimen. Prevention of tuberculosis for patients at risk should be based on rifampicin and pyrazinamid for 2 months.     

肺结核合并丙肝患者治疗方案的选择研究

目的探究肺结核合并丙肝患者的有效治疗方案。方法选取2013年1月至2015年8月我院收治的50例肺结核合并丙肝患者,采用随机数字表法将这50例肺结核合并丙肝患者均分为甲乙两组。甲组患者抗结核治疗方案为异烟肼、利福喷丁、链霉素,乙组患者抗结核治疗方案为链霉素、异烟肼、利福喷丁、吡嗪酰胺。统计、分析两组患者的肺结核治疗效果、肝功能恢复效果以及治疗过程中的不良反应发生率。结果甲组患者总有效率为92%,乙组患者总有效率为72%,两组相比,甲组患者更优(P0.05);甲组患者肝功能经治疗后15例肝功能恢复正常、8例轻度肝损伤、2例中度肝损伤,乙组患者肝功能经治疗后10例肝功能恢复正常,7例患者肝功能轻度损伤,5例患者中毒肝损伤,3例患者重度肝损伤。两组相比甲组患者更优(P0.05);研究组患者不良反应发生无统计学差异,且两组在不良反应类型上也无差异(P0.05)。结论肺结核合并丙肝患者,采用异烟肼、利福喷丁、链霉素三联抗结核药物合并丙肝病毒清除药物及保肝药物效果较好,可为临床应用所借鉴。     

The clearance of theophylline is increased during the initial period of tuberculosis treatment.

OBJECTIVE: To evaluate the effects of combined anti-tuberculosis treatment including isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide (PZA), on the pharmacokinetics of theophylline during the initial phase of treatment. DESIGN: Prospective, controlled clinical study. PATIENTS AND METHODS: Twenty patients with pulmonary tuberculosis received 7.35 mg/kg/day of aminophylline intravenously combined with anti-tuberculosis agents. The first theophylline serum concentration was measured before administration of INH, RMP, EMB and PZA, and samples were obtained once daily for 6 consecutive days after initiation of treatment. All patients in this study were non-smokers with normal hepatic and renal function, and they were not given any other drugs that could affect the clearance of theophylline. RESULTS: The concentration and half-life of theophylline was decreased and its clearance was increased significantly at days 5-7 after administration of antituberculosis agents compared to before the therapy was started. CONCLUSIONS: These results suggest that patients with asthma or chronic obstructive pulmonary disease administered combinations of anti-tuberculosis agents and theophylline during the initial phase of tuberculosis treatment should be monitored closely for changes in theophylline concentration, and that the dose of theophylline should be adjusted accordingly.     

先天性耐药结核病一例并文献复习

目的: 结合文献复习先天性结核病的临床特点以及诊治过程,旨在积累临床医师的诊疗经验。 方法: 回顾性分析西安市胸科医院2020年10月31日收治的1例先天性耐药结核病患儿及患儿母亲的临床资料,通过查阅中国知网、万方数据库、中华期刊全文数据库及PubMed数据库,以“先天性结核病”为中文关键词,以“Congenital tuberculosis”为英文关键词进行文献检索,共搜索到国内外相关文献24篇,其中2例为耐药结核病。本研究主要选取母亲行体外受精-胚胎移植(IVF-ET)后新生儿发现先天性结核病的11篇文献共17例患儿,结合本例患儿对其临床特征、诊断及治疗情况进行分析。 结果: 文献报道加上本例共18例患儿,其中2对双胞胎。本研究中患儿母亲有结核病病史或结核病密切接触史的共12例,无结核病病史以及密切接触史的4例;母亲在助孕前行结核感染筛查的5例,未进行筛查的11例。18例中16例患儿前期按“新生儿肺炎、脓毒血症、发热待查等”抗感染治疗无效后才进行结核病的筛查,发病到诊断时间范围为3~44d。先天性结核病的临床主要表现为:发热、咳嗽、呼吸困难、肝脾肿大、黄疸、呼吸暂停、腹泻、耳部流脓。胸部CT扫描结果多提示:弥漫分布的粟粒状结节影,纵隔、肺门淋巴结肿大,少量胸腔积液。本研究中15例患儿按一线抗结核方案治疗后,11例预后良好,4例因发现结核病时病情危重,死亡。3例为先天性耐药结核病,1例胃液标本行药物敏感性试验(简称“药敏试验”),结果显示“利福平”耐药,1例胃液标本药敏试验提示“异烟肼”耐药,本例药敏试验提示“异烟肼、利福平、利福喷丁、帕司烟肼”耐药。3例均给予二线抗结核治疗,未见明显药物不良反应,患儿预后良好。 结论: 先天性耐药结核病临床表现缺乏特异性,但临床症状却较为严重。二线抗结核治疗药物不良反应少,相对安全。     

四川省非结核分枝杆菌耐药分析

目的 探讨非结核分枝杆菌(non - tuberculosis mycobacterium,NTM)的流行病学特征和耐药现状,为NTM肺病的防治策略提供科学依据.方法 对2002 - 2011年四川省结核病参比实验室收集的分枝杆菌进行药物敏感性检测及菌种鉴定.对确诊为NTM病例进行流行病学分析.结果 2002 - 2011年四川省结核病参比实验室对2356个分枝杆菌菌株进行菌种鉴定,确诊为NTM的为251株,占10.65％,其中245株对异烟肼、对氨基水杨酸钠、乙胺丁醇、利福平、链霉素等常用抗结核药物存在不同程度的耐药,耐药率高达97.60％,且大多菌株同时对多种抗结核药物耐药.结论 四川省NTM对抗结核药物的耐药率高,研究、探索抗NTM的新药及更为有效的诊断方法是当务之急.