抗结核同时给予阿德福韦酯治疗慢性乙型肝炎合并肺结核的临床疗效

目的评价抗结核同时给予阿德福韦酯治疗慢性乙型肝炎合并肺结核的临床疗效。方法将2006年9月至2008年9月在我院接受抗结核药物治疗的慢性乙型肝炎患者94例,按照肺部结核病灶情况、肝功能损害程度和乙肝病毒定量指标,以同等病情匹配的原则分为治疗组和对照组,治疗组47例,应用异烟肼、利福喷汀、吡嗪酰胺、链霉素或乙胺丁醇及常规保肝药物,同时给予阿德福韦酯10mg口服,每日1次,疗程8个月。对照组47例应用与治疗组同样的抗结核及保肝药物,治疗8个月。评价治疗前后患者临床症状、肝功能、HBVDNA水平、痰菌转阴及肺部病灶吸收情况,采用U和x。检验对数据做统计学处理。结果治疗后治疗组肝损伤加重者3例（占6．4％）,对照组18例（占47．3％）,两者差异有统计学意义;治疗后治疗组临床症状出现率、HBVDNA转阴率、HBVDNA下降率、痰菌转阴率及肺部病灶吸收率均明显好于对照组,分别为6．4％与47．3％、51．1％与0．0％、48．9％与2．6％、87．2％与39．5％及95．7％与50．0％（P〈0．05）。治疗前后两组肾功能检测均正常,治疗过程中或治疗结束时未发现HBV变异耐药病例。未发现使用阿德福韦酯有明显不良反应。结论阿德福韦酯可以减少慢性乙型肝炎合并肺结核患者应用抗结核药物引起的肝损伤,安全性良好。     

肺结核合并糖尿病55例临床分析

目的探讨肺结核合并糖尿病的临床特点,及血糖控制水平与抗结核治疗的效果关系。方法对115例肺结核患者（其中有55例肺结核患者合并糖尿病）的临床资料进行回顾性分析。结果相对于单纯的肺结核患者而言,合并有糖尿病的肺结核患者其结核中毒症状更明显,结核空洞的发生率高,痰结核菌阳性率高;血糖水平控制理想者,抗结核治疗效果佳。结论肺结核合并有糖尿病的患者,结核中毒症状较重,传染性较强,控制好血糖水平有利于结核病的治疗。     

Childhood tuberculosis in Malawi: caseload,diagnostic practices and treatment outcomes

There were 22,982 cases of TB registered in Malawi in 1998, of which 2739 (11.9%) were children. Children accounted for 11.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extrapulmonary TB (EPTB). A significantly higher proportion of TB cases were diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were surveyed to determine actual diagnostic practice. This cross sectional study identified 150 children aged 14 years or below in hospital receiving anti-TB treatment, 98 with pulmonary TB (PTB) and 52 with extrapulmonary TB (EPTB). Median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a positive family history of TB. Nearly 45% had weight for age < 60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. Diagnostic difficulties make it difficult to accurately define the actual burden of childhood TB in Malawi. Diagnostic practices are poor and treatment outcomes unsatisfactory.     

Pulmonary tuberculosis--a review of clinical features and diagnosis in 232 cases

The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.     

异基因造血干细胞移植后结核感染的临床特征分析

目的 分析异基因造血干细胞移植后发生结核感染的患者的临床特征、易感因素及转归,探讨其临床诊治经验.方法 收集7例在第二军医大学长海医院血液科行异基因造血干细胞移植后诊断为结核患者的发病时间、症状、实验室检查、影像、治疗及转归情况,总结其临床特点和规律.结果 第二军医大学长海医院血液科自2004年起共进行异基因造血干细胞移植481例,其中7例患者移植后并发结核感染,女性2例、男性5例,平均年龄为(31.3±9.6)岁,移植后结核的发病率为1.46％.7例患者中肺结核5例(血行播散型2例)、结核性胸膜炎1例、结核性脑膜炎2例、膀胱结核1例.临床表现多样化,包括发热、咳嗽、尿路刺激症状、头痛.有急/慢性移植物抗宿主病病史1例,慢性移植物抗宿主病病史2例.7例患者发病后结核菌素试验(PPD)、结核抗体检测均阴性,有3例外周血结核T细胞斑点检测(T-SPOT)阳性,其中1例肺泡灌洗液涂片抗酸染色阳性.1例行膀胱镜活检病理示炎性肉芽肿,1例行肺穿刺活检病理示肉芽肿性炎症伴凝固性坏死.影像学表现:肺部CT表现为斑片状影3例,粟粒状结节影2例,胸腔积液1例;合并真菌感染1例.经抗结核治疗后临床治愈6例,死亡1例,有效率85.7％.结论 异基因造血干细胞移植患者出现感染症状时需警惕结核的发生,早期进行筛查,避免误诊、漏诊.早期诊断并及时予以正规抗结核治疗可以取得较理想的疗效.     

抗痨消渴方治疗糖尿病合并肺结核的临床疗效

目的：对采用抗痨消渴方治疗糖尿病合并肺结核的临床疗效进行分析。方法选取2012年8月～2013年4月江西省胸科医院收治的100例糖尿病合并肺结核患者,并随机将其平均分为观察组与对照组（n=50）,给予观察组患者采用抗痨消渴方进行治疗,给予对照组采用单纯西医抗结核、降血糖进行治疗,并在治疗结束后观察2组患者的临床治疗效果。结果经过治疗后,观察组患者的空腹血糖在（8.25±1.65）mmol/L,结核病疗效较好;对照组患者血糖波动大,肺结核反复出现了耐药性。结论采用抗痨消渴方进行治疗有利于提高治愈率,值得在临床上进行推广。     

菌阴肺结核患者442例的临床分析

目的 探讨菌阴肺结核患者的临床特点.方法 对2009-01～2010-12在北京结核病控制研究所门诊部登记并治疗的442名菌阴肺结核患者的临床情况进行回顾性分析.结果 442例菌阴肺结核患者中,有可疑肺结核症状者204例,占46.2%;无症状健康体检发现238例,占53.8%.418例肺部病变符合一般活动性肺结核的特点,病变范围以上叶尖后段和下叶背段多见,占94.6%;结核菌素皮试≥15 mm者367例,占83.8%,抗结核抗体阳性者277例,占72.5%.确诊后积极给予正规抗结核治疗,420例患者完成疗程,占95.0%.结论 菌阴肺结核临床表现无特殊,但本组病例大多数患者胸片表现具备一般活动性肺结核特点,故诊断仍要以胸部影像学为重要依据,同时结合其他实验室辅助检查进行综合分析和鉴别诊断,确诊后积极抗结核治疗.     

结核病人临床单耐药及风险因素回归分析

目的分析近年结核病单耐药趋势及其风险因素,为临床医务工作者早期发现耐药结核病提供参考依据。方法收集2015-2017年就诊于阜阳市传染病医院并接受住院治疗的肺结核病人的相关资料,对其四种一线抗结核药的单耐药率趋势进行分析,进一步探究单耐药相关临床特征及风险因素。结果一线抗结核药物异烟肼、利福平、乙胺丁醇和链霉素的耐药率3年均未发现上升或下降的变化趋势（P>0.05）。来源地农村、有结核接触病史、CT示肺部有空洞、双肺受累、合并有慢性阻塞性肺疾病和长期使用激素能够增加肺结核病人耐药发生的风险（P < 0.05~P < 0.01）。结论对农民、有结核接触病史、CT示有空洞、双肺受累、合并有慢性阻塞性肺疾病和长期使用激素者,需要及时做耐药检测,以对单耐药结核病人采取针对性的治疗。     

结核感染T细胞斑点试验及结核抗体检测在肺结核诊断中应用

目的 分析比较结核感染T细胞斑点试验（T-SPOT）、抗结核抗体在肺结核患者中的临床应用意义。方法 选取2017年6月1日—2018年4月1日海南医学院第二附属医院感染科收治的诊断为活动性肺结核患者84例,其中涂阳肺结核33例,涂阴肺结核51例,另选取健康体检者30例作为对照,分别对其进行结核感染T细胞斑点试验及结核抗体检测,并对两种检验方法的结果进行比较。结果 T-SPOT.TB试验及抗结核抗体检测的灵敏度分别为84.5%和34.5%,两者之间差异有统计学意义（P<0.05）,特异度分别为86.7%和83.3%,两者之间差异无统计学意义（P>0.05）;涂阳肺结核、涂阴肺结核和对照组3组之间的T-SPOT检测阳性率差异均具有统计学意义（P<0.05）,涂阳肺结核和对照组的结核抗体检测阳性率比较差异有统计学意义（P<0.05）,其余两组差异无统计学意义（P>0.05）;涂阳肺结核患者A孔和B孔的斑点数均明显高于涂阴肺结核及对照组,差异有统计学意义（P<0.05）。结论 T-SPOT.TB试验较结核抗体检测在肺结核患者诊断中具有更高的灵敏度和临床应用价值,且斑点数越高,提示肺结核可能性越大。     

环介导等温扩增技术用于结核病诊断的价值评估

目的 评估环介导等温扩增技术(loop-mediated isothermal amplification,LAMP)在诊断结核病中的应用价值.方法 以疑似活动性结核患者为研究对象.前瞻性收集患者临床标本,分装后进行荧光涂片显微镜镜检、BACTEC MGIT 960液体培养、MTB GeneXpert(Xpert)和L...     

头颈部结核病人的临床特点分析

目的：提供对头颈部结核不同临床表现的认识，并探讨其影响诊断的因素。方法：对2000—2003年的66例原发于头颈部结核病人进行回顾性分析。结果：66例病人，56例（85％）为颈淋巴结结核，4例（6％）为喉结核，2例（3％）颈椎结核，2例（3％）中耳结核，口咽结核和咽后脓肿各1例（3％）。30％的病人伴有肺或其它器官的结核；9％的病人有结核病史或为继发的结核。首诊误诊23例，误诊率近35％。结论：对无明显原因的颈部肿块更考虑到结核；针刺细胞学检查是简单有效的诊断方法；喉结核多累及声带，且并非伴有肺结核或痰液阳性；头颈部结核病人应做必要的检查以排除肺结核和其它系统结核；对有结核病史或继发的结核，应做药敏实验以减少多重抗药性。     

老年单纯肺结核与老年肺结核并发肺部真菌感染患者相关因素分析

目的比较分析老年单纯肺结核患者与老年肺结核合并肺部真菌感染患者的临床特点,旨在为临床防治肺结核并发肺部真菌感染提供科学依据。方法对2005-2010年我院收治的166例老年单纯肺结核患者(Ⅰ组)和140例老年肺结核合并肺部真菌感染患者(Ⅱ组)的临床资料及相关因素进行回顾性分析,以探讨老年肺结核合并肺部真菌感染患者的临床特点。结果Ⅱ组患者生活条件较差、年龄较大、病程较长、临床表现严重、肺内病变范围大且以空洞和纤维化改变为主;患者多次入院治疗,而且耐2种以上抗结核药物者的比例达40.2%,与Ⅰ组患者相比差异有统计学意义。结论老年肺结核患者合并肺部真菌感染的主要原因有:(1)患者年龄较大、肺结核病程较长、生活条件较差致自身机体免疫功能和抵抗力低下;(2)结核菌侵蚀肺部广泛、病变严重,致患者肺部的病理改变有利于真菌生长繁殖;(3)不规范治疗或仅经过非正规治疗及滥用广谱抗生素、糖皮质激素、免疫抑制剂等致使结核菌产生耐药性且机体免疫力下降而有利于真菌感染。     

PROLONGED FEVER DURING THE TREATMENT OF PULMONARY TUBERCULOSIS

A study was carried out to investigate the causes of prolonged fever or onset of fever, after starting anti-tubercular treatment (ATT) in sputum smear positive, HIV negative patients admitted in a Tuberculosis (TB) Sanatorium for directly observed therapy (DOT). A total of 40 patients were studied. All were males with age ranging from 22-55 years (mean 43 years). There were 22 (55%) patients with radiological extensive disease, 12 (30%) of whom had toxemia of TB (any three of the following, <90% body weight, hypoalbuminemia, hyponatremia, severe normocytic anaemia, <5mm response on tuberculin testing). Radiologically, moderately extensive disease was seen in 9 (22.5%) cases, whereas focal disease was present in another 9 (22.5%) patients. There were 28 (70%) patients who had evidence of dissemination of disease to extra pulmonary organs. It was found that fever occurred because of direct complications of TB in 22.5%, TB hypersensitivity (cold abscess) in 12.5%, drug resistance in 10% and drug reactions in 22.5%. Other diseases were the cause of fever in 32.5%. These included superadded lung infections in 15%, malaria in 7.5% anaemia in 5%. Filariasis and amoebic liver abscess in another 2.5% each. It is concluded that such fevers require a systematic and detailed investigation rather than attributing fever to drug resistance or TB toxemia alone.KEY WORDS: Prolonged fever, Pulmonary tuberculosis, Treatment     

Comparison between ELISA and ICT- MycoDot in adult pulmonary tuberculosis

The present study was conducted to see the diagnostic efficacy of serum anti-TB IgG antibody detection in adult pulmonary tuberculosis (TB) by ELISA and Immunochromatography test (ICT) method using commercially available diagnostic kit (Pathozyme TB complex and MycoDot test respectively). This case-control study included 48 cases of adult pulmonary TB within the age range of 15-65 years. Among them, 22 (45.9%) were AFB positive confirmed cases, 12 (25.0%) were AFB negative clinically diagnosed cases before treatment and 14 (29.1%) were clinically diagnosed cases on treatment. Age and sex matched 33 controls were also included, of which 19 (57.6%) were healthy and 14 (42.4%) were sick with non-specific pulmonary infection. Overall sensitivity and specificity of ELISA were 60.42% & 96.97% (p<0.001) and those of MycoDot as 72.92% & 93.94% (p<0.001). Rate of both ELISA and MycoDot positive were higher among clinically diagnosed cases on treatment with respective values as 71.42% and 85.71%. Respective values among AFB positive confirmed TB cases were 68.18% and 72.72%. As, both ELISA and MycoDot yielded be used as a confirmatory test for TB.     

恩替卡韦治疗肺结核合并慢性乙型肝炎的临床观察

目的 观察恩替卡韦对肺结核合并慢性乙型肝炎患者的疗效.方法 90例肺结核合并慢性乙型肝炎患者,随机分成抗病毒治疗组45例和对照组45例.观察抗病毒治疗对肺结核合并慢性乙型肝炎患者肝功能变化、HBVDNA及患者预后的相关性.结果 抗病毒治疗组与对照组治疗后肝功能ALT、AST、GGT、ALP、TB的变化,两组差异有统计学意义(P＜0.05);抗病毒治疗组HBVDNA转阴率为62.2％,对照组为4.44％,在治疗过程中抗病毒组无因严重肝功能损害而停止抗结核治疗者,而对照组有8例(17.8％)因严重肝功能损害而停止抗结核治疗.结论 肺结核并慢性乙型肝炎患者化疗中应用恩替卡韦抗病毒有重要意义.对改善肺结核合并慢性乙型肝炎患者的预后有重要作用.     

乌体林斯联合抗结核药治疗肺结核球的疗效观察

目的：观察乌体林斯联合抗结核药治疗肺结核球的疗效。方法：将40例肺结核球患者随机分为两组,治疗组采用乌体林斯联合抗结核药进行治疗,对照组单纯抗结核药治疗,观察比较两组肺结核球的吸收情况。结果：治疗9个月时治疗组显效率为30%,总有效率达95%;而对照组显效率为5%,总有效率为75%。结论：与单纯采用抗结核药进行治疗相比,乌体林斯联合抗结核药治疗肺结核球效果好,不良反应少。     

Tuberculosis of the genitourinary tract: imaging features with pathological correlation

The prevalence of pulmonary and extrapulmonary tuberculosis (TB) has been increasing over the past decade, due to the rising number of people with acquired immunodeficiency syndrome and the development of drug-resistant strains of Mycobacterium tuberculosis. The genitourinary tract is the most common site of extrapulmonary TB. Diagnosis is often difficult because TB has a variety of clinical and radiological findings. It can mimic numerous other disease entities. A high level of clinical suspicion and familiarity with various radiological manifestations of TB allow early diagnosis and timely initiation of proper management. This pictorial essay illustrates the spectrum of imaging features of TB affecting the kidney, ureter, bladder, and the female and male genital tracts.     

陕西省TB与HIV/AIDS双向筛查及TB/HIV患者抗结核治疗转归队列分析

目的 了解陕西省TB/HIV (结核分枝杆菌 /艾滋病病毒)双重感染防治工作。提高TB/HIV发现、治疗和管理力度,控制结核病和艾滋病的进一步传播,保护公众健康。方法 收集整理和分析2010—2017年陕西省各地上报的《TB/HIV 双重感染防治管理工作年度报表》。结果 2010—2017年,累计接受HIV抗体检测的结核病患者43 304例,检测率25.10%,HIV检测阳性数16例,阳性检出率0.04%;同期,HIV /AIDS患者中,新检出的HIV/AIDS中接受X线胸片或查痰9 666人,结核病检查率76.81%;诊断TB/HIV双重感染患者224人,结核病患者检出率2.32%;既往的HIV/AIDS中接受X线胸片或查痰24 277人次,结核病检查率80.43%;诊断TB/HIV双重感染患者105人,结核病患者检出率0.43%;结核中筛HIV/AIDS,新检出HIV/AIDS中筛结核,既往HIV/AIDS中筛结核,三组检出率两两进行对比,差别均有统计学意义（P<0.001）;共进行抗结核治疗263例,抗结核治疗率76.23%;进行抗病毒治疗256例,抗病毒治疗率74.20%;抗结核治疗的TB/HIV患者中治愈35例（17.59%）,完成疗程率141例（70.85%）,结核死亡1例（0.50%）,非结核死亡15例（7.54%）,丢失2例（1.00%）,其他5例（2.51%）。结论 双向筛查是切实有效的早期发现TB/HIV的方法,有利于提高TB/HIV的早期发现,并能提高TB/HIV双重感染患者结核病的治疗成功率、降低结核病死亡率,有效的控制TB/HIV双重感染疫情。     

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/10 ⁶ periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/10 ⁶ PBMCs] was higher than that in non-TBL patients [0 (0-30) /10 ⁶PBMCs] with a significant difference (Z=-5.306, P <0.001).Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.     

Clinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre

The aims of the study were to measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults; to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia and the usefulness of a diagnostic trial of anti-TB treatment. We prospectively examined adults with fever or a history of fever admitted to adult medical wards of QECH, Blantyre. All had blood cultured for bacteria and mycobacteria, chest x-ray and sputum smears. M. tuberculosis was the commonest blood isolate, affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; in only 6 (11%) it was not suspected. Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever, and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of TB treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short course chemotherapy on the TB ward after one month, was similar whether patients had mycobacteramia (21%) or not (32%). TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.