结核分支杆菌热休克蛋白DNA疫苗研究进展

结核病(tuberculosis,TB)是一种由结核分支杆菌(Mycobacteria tuberculosis,MTB)引起的人兽共患的慢性传染病,可累及全身多个脏器,但以肺结核(pulmonary tuberculosis,PTB)最为常见。由于MTB 耐药株出现、HIV合并MTB感染以及大规模高危人群流动,因而造成TB的全球流行。据WHO估计,2000年全球11B感染人数20亿,发病人数1000万,死亡人数350万;2000年第四次全国结核病流行病学抽样调查发现我国TB感染人数5.5 亿,活动性肺结核人数600万,死亡人数25万,TB 已成为我国乃至世界危害最严重的疾病之一。     

尘肺合并肺结核患者心理健康与社会支持相关性分析

<正>尘肺(pneumoconiosis)是由于各类有机和无机粉尘的吸入,并在肺内潴留而引起的慢性进行性肺组织弥漫性纤维化的全身性疾病,《我国卫生健康事业发展统计公报》数据显示,2017年尘肺占我国新报告职业病病例总数的84.84%,累积报告85万例以上,是患病率最高的职业病~([1])。尘肺缺乏有效治疗手段,其进行性的弥漫性肺组织纤维化,导致呼吸系统防御功能下降,同时巨噬细胞因吞噬肺尘而裂解死亡,     

Evaluation of T-SPOT.TB assay in the diagnosis of pulmonary tuberculosis within different age groups

<正>Objective To evaluate the value of T-SPOT.TB assay in the diagnosis of pulmonary tuberculosis within different age groups.Methods We analyzed 1 518 suspected pulmonary tuberculosis(PTB)patients who were admitted to the Beijing Chest Hospital from November 2012to February 2014 and had valid T-SPOT.TB tests before     

2型糖尿病合并肺结核患者感染新型冠状病毒病例报告

<正>2型糖尿病（type 2diabetes mellitus,T2DM）患者由于免疫功能低下，增加了其罹患肺结核（pulmonary tuberculosis,PTB）的风险，并且与不良治疗结局密切相关。在2型糖尿病合并肺结核（T2DM-PTB）的患者中，合并新型冠状病毒肺炎（简称“新冠肺炎”）的病例很少报告。为此，笔者报道1例成年T2DM-PTB合并重型新冠肺炎患者的临床表现及实验室检查结果，以为临床治疗提供参考。     

血糖血脂异常对肺结核合并2型糖尿病的影响分析

目的 探讨血糖血脂异常与肺结核(PTB)合并2型糖尿病(PTB-T2DM)的相关性,为降低PTB患病率提供新思路。方法 收集2020年9月至2021年8月于深圳市慢性病防治中心就诊的PTB病例90例(PTB组)、2型糖尿病(T2DM)病例90例(T2DM组)和PTB-T2DM病例90例(PTB-T2DM组),三组合并为试验组,本中心体检门诊就诊的健康人群60例为对照组。收集试验组和对照组全血和血清标本,采用HPLC法检测抗凝全血以测定HbA1c的百分含量,酶比色法检测血清空腹血糖(FBG)、总胆固醇(CHOL)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平,分析血糖血脂控制水平与PTB患病的关联。结果 T2DM组年龄最大,平均(57.34±9.52)岁,T2DM组和PTB-T2DM组HbA1c和FBG控制不理想的人数比例均显著高于对照组和PTB组(均P<0.05);PTB组、T2DM组和PTB-T2DM组的CHOL和LDL-C升高的人数比例均显著高于对照组(均P<0.05),T2DM组和PTB-T2DM组的TG升高的人数比例显著高...     

γ-干扰素释放试验诊断痰涂片阴性肺结核患者效果评价

目的:探讨全血γ-干扰素释放试验(IGRA)在痰涂片阴性肺结核(PTB)快速诊断中的应用价值。方法:选择可疑PTB患者,均进行IGRA、结核菌素试验(TST)、胸部X线片和高分辨率CT(HRCT)检查,根据最终临床诊断分为PTB组和非PTB组,比较各检测手段单独和联合的诊断效能。结果:共133例患者纳入分析,其中确诊PTB 54例,非PTB 79例,2组首诊症状组间比较差异有统计学意义(P0.05),PTB组咳痰低于非PTB组,而胸痛、体重下降PTB组高于非PTB组;IGRA敏感度和阴性预测值均高于其他检查方法(P0.05),特异度、阳性预测值和准确率各检测手段均差异无统计学意义(P0.05);IGRA与TST、CT联合诊断时敏感度、阳性预测值、阴性预测值和准确率无明显增加,但特异度分别从62.4%下降到36.3%和46.7%(P0.05);IGRA与TST、CT三者联合检测时,特异度从62.4%下降到27.1%(P0.05)。结论:IGRA对诊断痰涂片阴性的PTB患者敏感度和阴性预测值均高于其他诊断方法,但与其他方法联合不能提高诊断效能。     

四联抗结核化疗联合N-乙酰半胱氨酸对慢性阻塞性肺疾病合并肺结核患者的影响

目的 探讨四联抗结核化疗联合N-乙酰半胱氨酸(N-acetyl cysteine,NAC)对慢性阻塞性肺疾病(chronic obstructive pulmo-nary disease,COPD)并肺结核(pulmonary tuberculosis,PTB)患者免疫功能、炎性细胞因子、肺功能及生活质量的影响.方法 ...     

人类免疫缺陷病毒感染/艾滋病合并肺结核患者与无HIV感染肺结核患者分枝杆菌药敏结果对比分析

目的回顾性分析肺结核患者(PTB)与人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)合并PTB患者的分枝杆菌药敏和菌株鉴定结果,期望为HIV感染/AIDS合并PTB患者早期有效抗结核治疗提供数据参考。方法搜集重庆市公共卫生医疗救治中心结核科和感染科2013年1月1日至2013年12月31日期间1708例无HIV感染PTB患者和106例HIV感染/AIDS合并PTB患者临床资料,统计分枝杆菌药敏试验和菌株鉴定的结果,分析耐药特征,采用卡方检验,以P0.05为差异具有统计学意义。结果无HIV感染PTB组与HIV感染/AIDS合并PTB组的总耐药率、初治耐药率、复治耐药率差异均有显著统计学意义(P均0.01);HIV感染合并PTB组耐药率12.5%(2/16)与AIDS合并PTB组耐药率24.4%(22/90)差异无显著统计学意义(P0.05)。结论该中心收治的痰结核培养阳性患者中,HIV感染/AIDS合并PTB患者耐药趋势远低于PTB患者,HIV感染合并PTB组耐药状况与AIDS合并PTB组大体一致。     

应重视乙型肝炎合并肺结核的临床诊断与治疗

乙型肝炎病毒(hepatitis B virus,HBV)感染和结核杆菌(mycobacterium tuberculosis,MTB)感染迄今依然是分别居于我国法定病毒性传染病和细菌性传染病榜首的重大疾患.由此导致的慢性乙型肝炎(chronic hepatitis B CHB)和肝硬化(liver cirrhosis,LC)、肝癌(hepatocellular carcinoma,HCC)以及肺结核病(pulmonary tuberculosis,PTB)对人类健康威胁巨大.随着HBV和MTB感染的持续流行及慢性化病例的不断增加,CHB合并PTB正逐渐成为新的社会问题.合并感染后其疾病过程、机体伤害、治疗药物选择、治疗效果、耐药状态与药物不良反应等均有别于二者之一的单纯感染,尤其对临床预后、病原治疗、抗结核药物所致肝损伤(antituberculosis drug induced liver injury,ATLI)甚至诱发耐多药结核(multidrug-resistan pulmonary tuberculosis,MDR-TB)等方面的负性影响,正成为临床新的棘手难题.本文就二者合并感染的发病情况及其临床发现、不良后果、目前诊疗中存在的问题及合并感染的抗痨治疗、抗HBV与护肝治疗特点进行了总结.并结合国内目前的诊疗现状,就如何提高合并感染的治疗效果提出进一步建议.     

少数民族地区肺结核患者并发糖尿病的流行病学特征

<正>糖尿病(DM)并发肺结核(PTB)二病互为因果〔1〕。湖南西部的湘西土家族苗族自治州,少数民族人口占70%以上,经济文化相对落后,更是"因病致贫"。而目前该地区尚无相关报道,本研究旨在了解该地区PTB-DM的流行病学特点。1资料与方法1.1调查对象我校附属医院2009~2010年PTB住院患者1 011例,其中PTB-DM 52例(完整资料)为观察组,随机选取同     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.