住院肺结核病人并嗜肺军团杆菌肺炎的临床观察

目的 了解住院肺结核病人嗜肺军团杆菌感染的情况及探讨肺结核合并军团菌肺炎的特点。方法 对285例住院肺结核病人并肺内感染者,进行嗜肺军团菌血清抗体法检查（血试管凝集法）。结果 住院肺结核病人嗜肺军团杆菌感染占肺结核并肺内感染中的2．5％（7／285）,所有患者均采用红霉素治疗,疗程为3－4周,同时服用利福平（其中1例因为耐多药结核,未服用RFP）,均临床治愈出院。结论 住院肺结核病人并军团菌肺炎患者虽较少,确诊后治疗效果也较好,但也应引起重视,以减少误诊。     

天津市监狱局囚犯中肺结核病人的DOTS管理及效果分析

目的　评价监狱系统囚犯肺结核病人实施DOTS管理及治疗效果。方法 对2000年天津市监狱局囚犯中发现确诊的369例肺结核病人,实行直接面视下的短程化疗管理(DOTS),并分析其病情转归。结果 初治涂阳肺结核治愈率为93.8%,复治涂阳治愈率为69.2%;涂阳病人规律服药率为92.7%;涂阴病人规律服药率为90.1%。涂阳肺结核病人占全部确诊肺结核病人的14.9%;因释放停止治疗的肺结核病人占7.1%。结论 对监狱系统囚犯肺结核病人实施DOTS管理并取得了一定的成绩。     

肺结核病人中人类免疫缺陷病毒(HIV)感染的检测

目的　了解住院肺结核患者中HIV感染及艾滋病(AIDS)发病状况。方法 对2151例住院肺结核患者常规采用HIV抗体ELISA法检测进行初筛,阳性者抽血复验,并由广东省防疫站HIV检测中心确定。结果 2151例中HIV(+)7例,阳性率3.25‰,男性5例,女性2例。通过静脉吸毒血源性感染3例,多性伴4例。结论 对肺结核患者的HIV感染高危对象进行HIV抗体检测,有助于HIV/AIDS的早期发现和及时采取有效的控制措施。     

中山市老年肺结核患病情况分析

目的　探讨中山市老年肺结核患病情况。方法 为因症就诊及转诊到我所的疑似肺结核病人进行抗酸杆菌涂片检查和X线胸片检查 ,对诊断为肺结核的病人资料进行统计分析。结果 老年肺结核所占比例为 2 4 .2 % ,涂阳比例为 79.5%。结论 需重视老年肺结核病的控制工作。     

肺结核患者外周血T淋巴细胞亚群与核仁组成区嗜银蛋白的关系及临床应用的研究

目的　探讨肺结核患者T淋巴细胞亚群与核仁组成区嗜银蛋白(AgNORs)的关系,并动态观察临床应用的价值。方法 采用碱性磷酸酶抗碱性磷酸酶(APAAP)法及AgNORs测定方法,对98例肺结核患者,39例肺炎患者和41名正常人分别测定外周血T淋巴细胞亚群和AgNORs,并对71例初治肺结核患者进行了动态观察。结果 肺结核患者的CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺比值均明显降低,CD₈⁺升高;AgNORs的I.S%值明显降低,与健康人及肺炎患者相比有显著性差异(P<0.01)。随着肺结核患者病情的好转此两项指标逐渐上升。结论 肺结核患者T淋巴细胞亚群与AgNORs检测结果一致,可动态地反映结核病人的免疫状态,并与病情发展呈良好的相关性,可作为指导治疗的参考。     

抗结核药物预防煤尘肺并发肺结核的效果观察

目的　了解煤尘肺病人预防性服用异烟肼、利福平以减少煤尘肺病人并发肺结核的情况。方法 用双盲法将Ⅰ、Ⅱ期煤尘肺病人随机分为三组,分别服用异烟肼、利福平和安慰剂。结果 通过5年观察显示服异烟肼和利福平两组煤尘肺病人合并肺结核者明显低于服用安慰剂组(P<0.01)。结论 给予对煤尘肺患者实施预防性服用异烟肼、利福平可有效地减少肺结核的发生。     

耐药性肺结核的手术治疗(附36例报告)

目的　探讨耐药肺结核的手术适应症及手术时机。方法 对1990～1997年我院收治的7000肺结核和36例耐药肺结核已手术治疗的病人的手术效果进行回顾分析。结果 36例肺结核病人,临床治愈率94%,痰菌阴转率84%,并发症发生率为13%。结论 对部分耐2～3种药的肺结核病人选择外科治疗仍是可行的,可提高耐药肺结核的治愈率,耐4种以上的肺结核病人术后并发症发生率高,应慎重选择。     

浙江、广东省耐药监测项目中耐药肺结核治疗现况研究

目的　探讨耐药监测项目中初始耐药与获得性耐药肺结核病人的耐药情况与在完成规范短程化疗方案时的治疗效果,为初始与获得性耐药肺结核病人的管理与治疗提供参考依据。方法 对浙江和广东两省纳入结核病耐药性监测项目的肺结核病患者以比例法测定耐药情况并在短程督导化疗下观察耐药肺结核病人的治疗结果。分析完成规范短程化疗方案的耐药肺结核病人225例的耐药与治疗情况。结果 初始耐药肺结核病人149例,其中耐单药87例,耐多药62例;获得性耐药肺结核病人76例,其中耐单药者38例,耐多药38例。初始耐单药肺结核病人治愈率94.3%;耐多药肺结核病人治愈率88.7%;获得性耐单药肺结核病人治愈率92.1%,耐多药肺结核病人治愈率63.2%。结论 对耐单药的肺结核病人继续应用原规范短程化疗方案,仍可获得较好的治疗效果,而耐多药肺结核病人特别是获得性耐多药肺结核病人的治疗效果较差。对耐药肺结核病人,应结合胸部X片检查以及结核菌培养等综合判断疗效。建议组织开展全国性的肺结核病耐药性的基线调查;开展耐药结核病,特别是耐多药结核病治疗的进一步研究,组织对耐多药结核病治疗的试点;加强结核病痰细菌学检查和药物敏感性试验的质量控制。     

深圳市肺结核病人发现模式研究

目的　研究深圳市病人发现的现行模式。方法 通过行政干预、卫生医疗单位与结防机构配合,提高发现肺结核病人的能力。结果 1996—2001年,深圳市92.9%的肺结核病人以因症就诊方式就诊,其中,71.5%肺结核病人由综合医院转诊到结防机构;全市卫生医疗单位肺结核可疑肺结核病人转诊到位率平均达97.7%以上,结防机构接诊的可疑肺结核病人71.9%,以上由各医疗卫生单位转诊。至2001年,户籍人口涂阳新登记率34.87/10万,掌握率达67.0%。结论 深圳市目前发现肺结核病人的模式掌握病人率高。     

肺结核并发肺曲菌球47例外科治疗

目的　探讨肺曲菌球与肺结核的关系及其诊断和治疗;方法 对13年经外科手术治疗的47例肺结核合并曲菌球病人进行回顾性分析;结果 男性31例,占66.0%,病程>5年27例。咯血症状突出,41例,占87.2%。47例肺结核合并曲菌球中,术前明确诊断32例,占68.1%,漏误诊率31.8%。45例治愈,占95.7%,死亡2例,占4.2%。术后并发症10例,分别为胸腔感染、支气管胸膜瘘、肺炎、肺不张、支气管哮喘、呼吸衰竭和失血性休克。结论 肺曲菌球病见于肺结核空洞患者,在长期规律抗结核治疗后仍反复咯血,漏诊率较高,手术治疗为首选,效果较好。     

2016—2020年广州市耐药结核病患者不良治疗结局状况及其影响因素分析

目的: 分析广州市耐药结核病患者不良治疗结局状况及其相关影响因素。 方法: 采用回顾性队列研究的方法,从《中国结核病管理信息系统》中导出2016年1月1日至2020年12月31日在广州市胸科医院登记治疗的符合选例要求的677例耐药结核病患者病案数据,分析不良治疗结局的发生情况及其影响因素。 结果: 677例研究对象中,193例(28.5%)治疗成功、280例(41.4%)在治、204例(30.1%)出现了不良治疗结局(包括13例因发生不良反应停止治疗、9例失败、32例死亡、150例失访)。其中,发生不良治疗结局患者的中位生存时间为729d。基于完整数据集的Cox模型多因素分析显示:广州市外户籍、合并糖尿病、省间流动和年龄增长是耐药结核病患者发生不良治疗结局的危险因素[分别为HR(95%CI)=1.74(1.21~2.49),P=0.002;HR(95%CI)=1.59(1.10~2.32),P=0.015;HR(95%CI)=2.29(1.26~4.18),P=0.007;HR(95%CI)=1.01(1.00~1.03),P=0.011],耐多药是保护因素[HR(95%CI)=0.53(0.36~0.79),P=0.002]。 结论: 耐药结核病患者的不良治疗结局发生率较高,应加强对耐药结核病患者的治疗和长期管理,特别是其中合并糖尿病、流动自外省、年龄更大、因户籍所限不能享受本市医疗优惠待遇的患者。     

γ-干扰素对免疫低下小鼠结核分支杆菌感染的影响

目的　观察、评价γ干扰素(IFNγ)对免疫功能低下小鼠结核分支杆菌感染的影响和疗效。方法 将DBA/2小鼠90只按免疫功能正常和免疫功能低下2种状态分别制成小鼠结核分支杆菌感染模型。随机分组给予IFNγ或IFNγ单克隆抗体治疗,检测肺组织菌落计数,观察治疗后生存率。结果 免疫正常组小鼠无死亡,第2周、第4周菌落数分别为(51.5±17.5)×10³cfu/mL、(106.3±41.0)×10³cfu/mL。免疫低下组8只死亡,菌落数分别为(163.7±61.7)×10³cfu/mL、(768.3±206.5)×10³cfu/mL,免疫低下+IFNγ组3只死亡,菌落数分别为(54.2±21.3)×10³cfu/mL、(212.7±80.7)×10³cfu/mL,免疫低下组与免疫低下+IFNγ组比较有显著性差异。免疫正常小鼠给予IFNγ抗体后肺组织菌落数增多,与对照组比较有显著性差异。结论 IFNγ增强宿主免疫功能,对结核分支杆菌感染小鼠产生保护效应,适用于免疫功能低下宿主合并结核感染的辅助治疗。     

中药蛇蝎对颈结核性淋巴结炎患者免疫功能影响及疗效观察

目的　探讨中药蛇蝎对颈结核性淋巴结炎患者免疫功能的调节作用和临床疗效。方法 60例规范抗结核化疗后复发结核性颈淋巴结炎患者随机分成两组,治疗组 30例,单服中药,对照组30例规范抗结核治疗 (2DRtZE 7DRtE),于治疗前和治疗后各时间段检测外周血T淋巴细胞亚群,并判断两组的治疗效果。结果 两组治疗 6个月后T淋巴细胞亚群比较,治疗组改善 20例,对照组改善 5例,有显著性差异 (P＜0.01)。治疗组总有效率 90% (2730),治愈率 53.3% (1630)分别与对照组总有效率 36.7% (1130),治愈率 10% (330)比较均有显著性差异 (P＜0.01)。结论 中药蛇蝎对规范抗结核化疗失败的结核性淋巴结炎患者的细胞免疫功能有调理作用,并提高治愈率,在溃疡愈合、淋巴结消肿及改善影像学方面均优于对照组 (P＜0.01)。     

Comparative study on the effects of hepatic arterial embolization with Bletilla striata or Gelfoam in treatment of primary hepatic carcinoma

AIM: To study the safety and efficacy of hepatic arterial embolization (HAE) with Bletilla striata powders containing traditional Chinese herbs in the treatment of primary hepatic carcinoma (PHC). METHODS: From May 1990 to September 1993, 106 patients with PHC were treated by HAE with different types of Bletilla striata powders (n = 56) or Gelfoam powders (n = 50) under clearly specified conditions. We analyzed the effects and complications associated with these two types of treatment. RESULTS: The Bletilla striata powders produced extensive and permanent proximal embolization of the hepatic artery, and stimulated the formation of collateral circulation. Treatment could be stopped for as long as 6-12 mo, and there was obvious evidence of tumor necrosis and shrinkage. The patient survival rates at 1, 2, and 3 years were 81.9%, 44.9%, and 33.6%, respectively, and the mean survival time without a serious complication was 19.8 mo. Patients in the Bletilla striata group displayed better clinical effects from their treatment when compared with patients in the Gelfoam group. CONCLUSION: Bletilla striata powders are superior to Gelfoam powders when used for angioembolus in patients with hepatic carcinoma.     

福建省非结核分枝杆菌菌种分布及其流行病学特征初步研究

目的 了解福建省非结核分枝杆菌菌种分布及流行病学特征,为福建省制定非结核分枝杆菌病防治策略提供科学依据。方法 收集2016—2018年福建省11个结核病耐药监测点190例疑似非结核分枝杆菌病的菌株标本采用荧光PCR熔解曲线法进行菌种鉴定。应用Excel 2016与SPSS 24.0软件对数据进行整理与分析,采取非参数检验分析不同特征患者感染的非结核分枝杆菌菌种分布特征,应用卡方检验比较胞内分枝杆菌与非胞内非结核分枝杆菌病患者间特征差异性,以P<0.05为差异有统计学意义。结果 共检出161例非结核分枝杆菌感染者,其中除8例未鉴定出具体感染的菌种外,153例由8种菌种感染。主要以胞内分枝杆菌(60.9%,98/161)和脓肿分枝杆菌(19.9%,32/161)为主。感染非结核分枝杆菌患者平均年龄(57.3±13.0)岁,以男性(70.2%,113/161)、本地户籍(87.0%,140/161)、农民工(72.7%,117/161)、汉族(97.5%,157/161),以及沿海城市(77.6%,125/161)为主。感染胞内分枝杆菌和非胞内非结核分枝杆菌患者占比最高的均是45~60岁年龄组[分别为63.3%(62/98)和57.2%(36/63)];性别均以男性居多[分别为71.4%(70/98)和68.3%(43/63)];职业均以农民工居多[分别为76.5%(75/98)和66.7%(42/63)];户籍均以本地居多[分别为88.8%(87/98)和84.1%(53/63)];现住址均以沿海居多[分别为74.5%(73/98)和82.5%(52/63)];胞内分枝杆菌与非胞内非结核分枝杆菌比较,差异均无统计学意义(χ ²值分别为4.202、0.185、1,879、0.731、1.431,P值均>0.05)。感染胞内分枝杆菌患者与非胞内非结核分枝杆菌患者中汉族所占比率分别为100.0%(98/98)和93.7%(59/63),差异有统计学意义 (χ ²=4.029,P<0.05)。结论 福建省非结核分枝杆菌感染患者主要以汉族、本地户籍、男性、中老年人、农民工居多;菌种分布以胞内分枝杆菌为主,其次为脓肿分枝杆菌;除民族外,胞内分枝杆菌与非胞内非结核分枝杆菌感染者社会人口学特征差异无统计学意义。     

Is neutrophil gelatinase associated lipocalin useful in hepatitis C virus infection?

AIM: To evaluate neutrophil gelatinase associated lipocalin(NGAL) in patients infected by hepatitis C virus(HCV) before and during treatment with directly acting antivirals(DAAs).METHODS: NGAL was measured in a group of patients with chronic HCV infection ranked, at baseline, by age, gender, anti-hypertensive therapy, HCV viral load, liver fibrosis stage and, either at baseline or after 1 year, estimated glomerular filtration rate(e GFR). Then, NGAL and e GFR evolutions were monitored in a subgroup of patients who started antiviral therapy with DAAs. Differences of median NGAL levels were evaluated through Wilcoxon-Mann-Whitney test for nonparametric data. Differences in dichotomous variables were evaluated through χ~2 test. At baseline, a univariate regression analysis was conducted to verify if NGAL values correlated with other quantitative variables [age, fibrosis four(FIB-4), AST to platelet ratio index(APRI), and e GFR]. RESULTS: Overall, 48 patients were enrolled, 8 of them starting HCV treatment. At baseline, statistically significant differences were found in median NGAL values only between patients with e GFR 60 mL/min vs patients with e GFR ≥ 90 mL/min. Differences in NGAL were not significant among patients ranked by HCV viral load, FIB-4 score and APRI, when patients with NGAL 118.11 ng/d L were compared with those of NGAL ≤ 118.11 ng/d L, not statistically significant differences were present for age, gender, chronic kidney disease classification and liver fibrosis(P 0.05). Linear correlation was found between NGAL and both age(P = 0.0475) and e GFR(P = 0.0282) values. Not statistically significant predictions of NGAL at baseline were demonstrated for e GFR evolution 1 year later. Interestingly, in the 8 patients treated with DAAs, median NGAL significantly increased at week 12 compared to baseline(P = 0.0239).CONCLUSION: Our results suggest that NGAL should be further evaluated as an adjunct marker of kidney function in these patients.     

Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

AIM: To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting (CABG). METHODS: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, biologic characteristics and operative management. Classic coagulation parameters and rotational thromboelastometry (ROTEM) profiles were determined preoperatively for both groups and the same heparin treatment was administered. ROTEM profiles (INTEM and EXTEM assays) were analyzed, both for traditional parameters, and thrombin generation potential, expressed by area-under-curve (AUC). RESULTS: There was no significant difference between rates of major bleeding between patients treated with aspirin alone, compared with those treated with aspirin and clopidogrel (12% vs 16%, P = 0.77). In the 14 cases of major bleeding, pre-operative classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 Ohm*min) than non-bleeders (6568 ± 548 Ohm*min) (P < 0.0001). CONCLUSION: We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of antiplatelet treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding.     

Standard triple versus levofloxacin based regimen for eradication of Helicobacter pylori

AIM: To compare the eradication rates for Helicobacter pylori (H. pylori) and ulcer recurrence of standard triple therapy (STT) and levofloxacin based therapy (LBT). METHODS: Seventy-four patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori infected on 3 mo follow up were randomized to receive either the STT group comprising of amoxicillin 1 g bid, clarithromycin 500 mg bid and omeprazole 20 mg bid or the LBT group comprising of amoxicillin 1 g bid, levofloxacin 500 mg bid and omeprazole 20 mg bid for 10 d each. The H. pylori eradication rates, side effects, compliance and the recurrence of ulcer were assessed in the two groups at 3 mo follow up. RESULTS: Thirty-four patients in the STT group and 32 patients in the levofloxacin group presented at 3 mo follow up. H. pylori eradication rates were similar with STT and the LBT groups on intention-to-treat (ITT) analysis (69% vs 80%, P = 0.425) and (79% vs 87%, P = 0.513) by per-protocol (PP) analysis respectively. Ulcer recurrence in the STT and LBT groups on ITT analysis was (20% vs 14%, P = 0.551) and (9% vs 6%, P = 1.00) by PP analysis. Compliance and side effects were also comparable between the groups. A complete course of STT costs Indian Rupees (INR) 1060.00, while LBT costs only INR 360.00. CONCLUSION: H. pylori eradication rates and the rate of ulcer recurrence were similar between the STT and LBT. The LBT is a more economical option compared to STT.     

含丙硫异烟胺和对氨基水杨酸方案治疗耐多药结核病患者致甲状腺功能减退症的临床分析

目的 分析含丙硫异烟胺(protionamide,Pto)和(或)对氨基水杨酸(para-aminosalicylic acid,PAS)方案治疗耐多药结核病(multidrug resistant tuberculosis,MDR-TB)致甲状腺功能减退症(简称“甲减症”)的发生情况及治疗效果。方法 收集2017年10月1日至2019年6月30日成都市公共卫生临床医疗中心结核科入院及门诊就诊的MDR-TB患者,符合纳入排除标准且使用含Pto 和(或)PAS抗结核方案治疗者336例。依据抗结核药物使用情况分为两组,其中仅含Pto治疗方案的患者91例(简称“Pto组”),含Pto和PAS治疗方案的患者245例(简称“Pto+PAS组”)。所有患者均在抗结核药物治疗前及第1、3、6、9、12、18、24个月分别进行甲状腺功能检查,分析甲状腺功能减退症的发生率、出现时机,以及采用优甲乐治疗的时机、治疗率及治疗剂量、疗效情况。结果 336例MDR-TB患者中,药物性甲减症的发生率为28.87%(97/336),其中4例出现黏液性水肿、2例出现乏力伴脱发经检查甲状腺功能后确诊,其余91例患者均无明显自觉症状,均在复诊检测甲状腺功能时发现。 Pto+PAS组甲减症的发生率[32.24%(79/245)]明显高于Pto组[19.78%(18/91)](χ²=5.020,P=0.025),男性甲减症的发生率[24.07%(52/216)]明显低于女性[37.50%(45/120)](χ²=6.772,P=0.009)。发生药物性甲减症的比率随治疗时间的延长而下降,用药后1.5个月内、3个月内、3~6个月内、6个月后的占比分别为40.20%(39/97)、24.74%(24/97)、17.53%(17/97)、17.53%(17/97);Pto+PAS组在1.5个月内甲减症的发生率 [46.83%(37/79)]明显高于Pto组[11.11%(2/18)](Fisher确切概率法,P=0.018)。78例甲减症患者需要采用优甲乐治疗,Pto+PAS组需要采用优甲乐治疗的比率 [84.81%(67/79)]明显高于Pto组[61.11%(11/18)](χ²=5.227,P=0.022)。优甲乐最终使用剂量分别为49例(62.82%)≤50μg/d、20例(25.64%)51~75μg/d、9例(11.54%)>75μg/d;其中4例Pto+PAS组患者使用优甲乐剂量超过125μg/d后甲减症仍控制不佳而停用Pto及PAS,其余74例患者均达到治疗效果。结论 MDR-TB患者采用含Pto联合PAS方案较单含Pto方案治疗更易出现甲减症,抗结核药物治疗前3个月甲减症发生率高,需密切监测甲状腺功能。采用优甲乐治疗的药物性甲减症患者,如果在不同剂量治疗后效果较好而不必停用Pto及PAS。     

MBL免疫治疗结核病小鼠的实验研究

目的观察甘露聚糖结合凝集素(mannan-binding lectin,MBL)对结核分枝杆菌感染小鼠的免疫治疗作用。方法将BALB/c小鼠18只随机分成MBL免疫治疗组、微卡治疗组和结核菌感染对照组,每组6只。小鼠感染结核分枝杆菌后第14、21、28 d各组腹腔内分别注射MBL、微卡和生理盐水。治疗结束后第3周处死小鼠,观测各组小鼠体质量以及肺、脾脏湿重,观察肺脏病理改变,取肺、脾组织进行结核菌培养和菌落计数。结果治疗后第3周,治疗组小鼠体质量和脾脏质量高于对照组,肺脏质量低于对照组,且肺部病变较轻。MBL减轻结核病小鼠体质量下降,减少结核病小鼠肺和脾脏结核菌数量。结论MBL对结核病小鼠具有一定的免疫治疗作用。