肺结核病人在结防机构与非结防机构治疗情况的调查分析

目的 分析结核病人在结防机构与非结构机构的治疗效果及费用，方法 随机抽样调查６个县的２６８例肺结核病人，分析其在不同机构的治疗及费用情况。结果 结防机构病人治愈率高于非结防机构，而费用却低于非结防机构，结论 应用加强结核病归口管理，使结核病人能在结防机构进行治疗。     

怀柔区2007—2008年非结防机构网络直报肺结核病人追踪及核实情况分析

目的分析怀柔区非结防机构网络直报肺结核病人及疑似肺结核病人追踪及核实结果,加强我区对确诊肺结核病人的归口管理。方法审核分析疾病预防控制中心结核科《结防机构对网络报告肺结核病人追踪及核实登记本》的资料。结果2007年1月—2008年12月怀柔区非结防机构网络直报肺结核或疑似病人242人,主动就诊168人,追踪74人,追踪到位63人,追踪到位率85.1%,总体到位231人(95.5%)。核实情况,确诊活动性肺结核133人,结核性胸膜炎7人,排除活动性肺结核诊断99人。在怀柔区结防所登记治疗肺结核109人,在怀柔结防所登记后转回原籍11人,在北京胸科医院治疗8人,本市其他区结防所治疗管理15人。结论做好追踪及核实网络直报肺结核和疑似肺结核肺结核病人,是发现肺结核病人并对其进行归口管理的重要手段以确保肺结核病人得到及时规律的治疗。     

湖北省非结防机构网络报告疑似肺结核病人转诊与追踪情况分析

现代结核病控制的核心内容包括提高病人发现、加强病人归口管理;而非结防机构对肺结核病人/疑似肺结核病人的转诊,以及结防机构对非结防机构转诊未到位病人的追踪是病人发现与管理的重要途径。本文就我省2004—2006年9月非结防机构网络报告肺结核病人/疑似肺结核病人转诊与追踪情况进行分析,以探求提高病人发现、加强病人归口管理的方法。     

乐亭县2008年非结防机构网络直报肺结核病人追踪情况分析

为提高肺结核病人的发现率,卫生部要求医疗单位将疑似或确诊的肺结核病人统一转到结核病防治机构治疗管理,同时在疾病监测信息报告管理系统中报告。对3d内未到结核病防治定点机构就诊的病人,结防人员必须对病人追踪到位。本文对2008年乐亭县非结防机构网络直报肺结核病人的追踪情况分析如下。     

2007~2012年周口市非结防机构网络直报肺结核疫情情况分析

目的对2007~2012年周口市非结防机构网络直报肺结核疫情进行分析,探讨非结防机构在结核病防治工作中的作用及加强结防机构与非结防机构在结核病防治工作中的方法。方法对2007~2012年周口市非结防机构网络直报月报表及肺结核患者转诊追踪情况进行分析。结果 (1)2007~2012年周口市非结防机构网络直报率报告率在20.55~25.81/10万,平均22.14/10万;(2)2007~2012年周口市非结防机构网络直报肺结核疫情转诊到位率61%~65%;(3)2007~2012年周口市非结防机构网络直报肺结核疫情追踪率98.4%,追踪到位率在57.9%~97.9,平均77%;(4)2007~2012年周口市非结防机构网络直报肺结核疫情总体到位率平均91.2%;(5)自2007年起,非结防机构肺结核患者发现率逐年上升,对活动性肺结核患者及涂阳肺结核患者的发现贡献率总体呈上升趋势。结论非结防机构在肺结核患者发现工作中起到重要作用,规范开展非结防机构网络直报肺结核患者转诊追踪工作,能有效提高肺结核患者发现水平。     

湖北省非结防机构网络报告疑似肺结核病人转诊与追踪情况分析

现代结核病控制的核心内容包括提高病人发现、加强病人归口管理;而非结防机构对肺结核病人/疑似肺结核病人的转诊,以及结防机构对非结防机构转诊未到位病人的追踪是病人发现与管理的重要途径.……     

广东省2005—2008年非结防机构网络直报肺结核病人转诊与追踪情况分析

目的分析广东省2005—2008年非结防机构网络直报肺结核病人转诊和追踪情况,探讨提高病人发现水平的措施。方法收集广东省2005—2008年中国结核病控制工作月报表、季报表进行分析。结果2005—2008年广东省各非结防机构网络直报肺结核/疑似肺结核病人的转诊到位率和追踪到位率分别为42.5%和39.0%,总体到位率为64.9%。追踪到位的疑似病人中52.8%被确诊为肺结核。网络直报病人中菌阳、菌阴和未查痰病人的转诊到位率分别为66.9%、58.0%和37.9%;结防机构追踪到位的疑似病人中菌阳、菌阴和未查痰病人的肺结核确诊率分别为97.6%、79.8%和43.6%。结论非结防机构在肺结核病人的发现中起重要作用。建立规范化的结核病登记、报告及转诊工作制度,提高网络直报病人的查痰率,将提高肺结核病人发现水平。     

2005—2008年新疆非结防机构网络直报肺结核病人转诊与追踪情况分析

目的 分析新疆2005-2008年非结防机构网络直报肺结核病人转诊与追踪情况,探讨提高病人发现水平的措施。 方法 收集2005-2008年新疆“中国结核病控制工作月报表”进行分析。 结果 2005-2008年新疆各级非结防机构网络直报肺结核/疑似肺结核病人的转诊到位率和追踪到位率分别为32.5%和54.1%,总体到位率为63.4%。追踪到位的疑似病人中69.2%被确诊为肺结核患者,网络直报病人中菌阳、菌阴和未查痰病人的转诊到位率分别为41.9%、26.0%和34.3%;结防机构追踪到位的疑似病人中菌阳、菌阴和未查痰病人的肺结核确诊率分别为 96.0%、80.8%和53.8%。 结论 非结防机构在肺结核病人的发现中起重要作用,建立规范化的结核病登记、报告及转诊工作制度,提高网络直报病人的查痰率,将提高肺结核病人发现水平。     

石家庄市区2009年非结防机构网络直报肺结核病人追踪情况分析

为提高肺结核病人的发现,卫生部要求医疗卫生单位将疑似或确诊的肺结核病人统一转诊到结核病防治机构治疗管理,同时,在疾病监测信息报告管理系统中报告,到位的病人及时确诊,未到位的病人进行追踪。本文对2009年石家庄市区非结防机构网络直报肺结核病人追踪情况分析如下。     

2004—2007年南宁市区非结防机构网络直报肺结核病人转诊与追踪评价

现代结核病控制的核心内容包括提高病人的发现、加强病人归口管理。而非结核病防治（结防）机构对肺结核病人或疑似肺结核病人的转诊，以及结防机构对非结防机构转诊未到位病人的追踪是病人发现与管理的重要途径。2004年1月国家启动了新的传染病网络直报系统，为我国肺结核病人的发现提供了最佳信息平台。南宁市区从2004年起按属地管理原则，由结防机构根据网络直报系统来了解病人转诊到位情况，对未到位病人开展追踪，现将2004—2007年南宁市区肺结核病人转诊与追踪工作情况分析如下。     

Diagnostic delay in a multi-organ tuberculosis immunocompetent patient: a case report

A 67-year-old immunocompetent male presented with intermittent fever for 3 months associated with urinary incontinence, altered bowel habits and history of loss of appetite and weight. He was treated as having enteric fever at various clinics in the city by different physicians. On evaluation the patient was found to have disseminated tuberculosis with involvement of the lungs, eyes, testes, brain, bone, kidneys, liver, spleen and possibly the gastrointestinal tract. This paper reports a case of disseminated tuberculosis to many organs with significant diagnostic delay more than twelve decades after the discovery of the tuberculosis bacillus by Robert Koch.     

Epidemiological hazardousness of patients with renal tuberculosis]

A total of 408 nephrotuberculosis patients detected in a large industrial city for the period of 1975-1989 and 645 subjects from their family and residence surroundings were subjected to a current and retrospective epidemiological examination to evaluate the epidemiological danger presented by the patients sick with active tuberculosis of the urinary organs. Washings collected from the various objects in 100 apartments of these patients were studied for M. tuberculosis in the genitourinary and pulmonary departments of a tuberculosis hospital. Nephrotuberculosis patients, including bacilli carriers, are only the potentially dangerous sources of tuberculosis infection. The volume of antiepidemiologic and preventive measures in the family--apartment foci formed by such patients should be lessened at the expense of reduction of disinfectant measures, the volume of chemoprophylaxis, public health service patronage and of the number of subjects from group IV of dispensary record.     

结核分支杆菌诱导宿主细胞肌动蛋白重排和表达改变

目的：研究结核分支杆菌感染对宿主细胞肌动蛋白的影响。方法：应用共聚焦显微镜及Western blot技术观察被结核分支杆菌H37Ra、H37Rv感染的巨噬细胞在感染后6h、12h和24h纤丝状肌动蛋白（F－肌动蛋白）的形态分布及肌动蛋白表达变化。同时用未感染及H37Rv死菌处理的巨噬细胞作对照。结果：结核分支杆菌H37Ra、H37Rv感染巨噬细胞后诱导宿主细胞F－肌动蛋白聚集并抑制肌动蛋白的表达，有毒株H37Rv较无毒株H37Ra能更早地产生这种效应，而用H37Rv死菌处理的巨噬细胞肌动蛋白不受影响。结论：结核分支杆菌在感染宿主细胞的过程中，可能通过分泌某些蛋白或因子影响细胞的肌动蛋白，达到逃避宿主细胞杀伤的目的。     

Future tuberculosis care in Japan

In Japan, the care of patients with tuberculosis has been mainly dependent on the state of hospital wards. The number of patients that have tuberculosis has steadily declined over the years, and we are now on the way to low prevalence state of tuberculosis. However there is a need for discussion about how future care for patients with tuberculosis should take place. The problems of present tuberculosis care system are as follows: (i) there is inefficiency and difficulty in maintaining the tuberculosis wards because of the declining number of patients and specialists; (ii) there are difficulties in treating complications such as renal insufficiency which requires blood dialysis, delivery, psychiatric diseases in tuberculosis beds; (iii) there is a high proportion of elderly patients that require substantial nursing care and long-term admission in the hospital; (iv) there is not only insufficient patient care but also financial support for patients with socioeconomic problems such as foreign-born worker or homelessness, (v) in addition to the medical care for patients of MDR-TB being insufficient, there are also inappropriate environment and amenities for long-term hospitalization. Moreover the public subsidy system for medical treatment requires patients to pay 5% of expense cost in the outpatient clinic. The following points should be discussed for the future tuberculosis care system: (i) general hospitals should take more part in caring for patients with complications and there should be a close cooperation among general hospitals, tuberculosis specialists and the administration; (ii) there should be a limited number of hospitals maintained for the integrated treatment of MDR-TB including surgical treatment and suitable circumstances for long-term hospital care. Additionally, there should be a system of detention for non-adherent patients or home isolation for adherent patient; (iii) there should be reinforcement of public commitment for patients with socioeconomic problems or MDR patients such as public subsidized full coverage of medical expense, free treatment in regional health centers     

肺外结核影像学诊断的回顾与展望

肺外结核包括多系统、多脏器、多部位、多种类型的结核病变,诊断较肺结核相对困难,但及时、正确的诊断是患者得以正规及有效治疗的前提,影像学检查在病变发现、诊断、鉴别诊断和观察病变动态方面具有重要作用.常规影像学检查（超声、X线、CT、MRI及骨扫描）对肺外结核病变的诊断及治疗效果的观察具有肯定的价值,同时亦有局限性.随着影像学技术的迅猛发展,除了病变形态学研究外,分子影像和功能成像等技术已成为国内外的研究热点和发展趋势,在肺外结核尤其是中枢神经系统结核的诊断与鉴别诊断中具有重要意义.     

Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment

No difference in the number of serious adverse events was reported in previous clinical trials in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patients treated with TNF-alpha blockade, but a patient died because of disseminated tuberculosis. A tuberculosis reactivation in a patient with IBD and anti-TNF-alpha treatment has been recently reported. Very recently 70 cases of tuberculosis were reported from the FDA Adverse Event Reporting System. We report a case of pulmonary miliary tuberculosis in a RA patient treated with TNF-alpha blockade. The important role of TNF-alpha in defence against tuberculosis and possible mechanisms of anti-TNF-alpha agents impairing tuberculosis immune response are discussed.     

抗结核组合药对HBVM阳性肺结核病人肝功能影响的观察

目的　观察抗结核组合药对HBVM阳性肺结核病人肝功能的影响。方法 比较HBVM阳性和阴性肺结核病人组合药治疗前后肝功能损害情况。结果 HBVM阳性病人肝损率比阴性者明显增高(P<0.01);其中“模式Ⅰ”与“模式Ⅱ”病人肝损率差异不显著(P>0.05),而“模式Ⅰ+Ⅱ”病人肝损率比“模式Ⅲ”高(P<0.05)。结论 组合药致肝功能损害,HBVM阳性病人比阴性多见,尤以“模式Ⅰ、Ⅱ”病人更易发生,可能与用药前肝脏病理损害严重程度有关。应慎用组合药并积极采取综合措施防范。     

一例多发性骨关节结核并发皮肤结核患者的诊治过程分析

多发性骨关节结核并发皮肤结核非常罕见,临床早期诊断困难。作者通过临床多学科协作诊治1例全身多发性骨关节结核并发皮肤结核患者,对诊治过程进行深入的分析讨论,希望增强临床医生对不典型多发性骨关节结核并发皮肤结核的重视与认识,同时提高诊断与治疗能力,以利于早期发现、早期治疗。     

Association of a pulmonary, breast and cerebral tuberculosis

INTRODUCTION: The concomitant unexpected arrival of a breast tuberculosis and cerebral tuberculomas to a same immunocompetent patient has not been ever described in the literature. EXEGESIS: We report the case of an non-HIV-infected woman who presented a pulmonary, breast tuberculosis and intracranial tuberculomas. Investigation for acid-fast bacilli in sputum and cerebrospinal fluid was negative. The patient received an antituberculous therapy for 15 months, which led to the disappearance of the cerebral lesions. CONCLUSION: Our case was particular by the affected organs, the absence of immunodeficiency and the favorable outcome.     

New cases of tuberculosis of respiratory organs during phases of reverse development in children

Out of 313 preschool children treated in a specialized children's hospital for local tuberculosis, 23.6% of cases were first diagnosed in phases of reverse development. 12.8% of children cured spontaneously. Local activation as infiltration of intrathoracic lymph nodes and dissemination to the lungs and other organs occurred in 8.1 cases. The activation was seen both in children with spontaneously cured tuberculosis and those after chemoprophylaxis. It is concluded that all the children with newly detected tuberculosis in reverse phase, irrespective of previous chemoprophylaxis, should be treated in hospital with subsequent observation of the phthisiologist.