云南省非结核分枝杆菌流行状况及病原谱分析

目的 分析云南省非结核分枝杆菌（NTM）流行状况及NTM病原谱和优势菌群,为云南省NTM的有效防治提供参考依据,以适应临床诊治工作需求。方法 对云南省2009、2013—2015年收集的5 406例临床分离分枝杆菌进行结核分枝杆菌复合群（MTC）与NTM鉴别,对鉴定为NTM的菌株进行菌种鉴定。结果 在5 406例临床分离分枝杆菌中共鉴别出NTM菌株87株,其中非结核分枝杆菌患者以男性为主,40岁以上患者多见。20~39岁患者占所有患者的18.39%,40岁以上占80.46%;患者的民族以汉族为主（占80.46%）,其次是彝族（8.05%）。优势流行的菌种前4位为胞内分枝杆菌、脓肿分枝杆菌、鸟分枝杆菌、偶发分枝杆菌,肺结核高中低疫情地区NTM分离率差异有统计学意义,且肺结核疫情与NTM分离率呈负相关。结论 云南省NTM分离率低,肺结核疫情高的地区非结核分枝杆菌分离率低,反之则高,地区差异明显,因此应加强NTM流行状况监测,同时结合优势菌种优化诊治流程,为临床早诊断、早治疗提供帮助。     

免疫受损状态下非结核分枝杆菌感染的临床研究

目的：探讨免疫受损状态下并发肺部非结核分枝杆菌（NTM）的感染率、菌种构成、临床特点和治疗。方法：对结核内科分枝杆菌培（+）的免疫受损患者,进行菌种鉴定及药敏试验,分析NTM感染病例的临床资料。结果：105例免疫受损患者从痰、支气管冲洗液中检出可确定的NTM感染18例（17.1%）,分离出NTM菌株40株,其中鸟-胞内分枝杆菌复合群（MAC）5例,MAC +玛尔摩1例,龟-脓肿分枝杆菌3例,龟-偶发分枝杆菌1例,苏尔加+脓肿分枝杆菌1例,堪萨斯分枝杆菌2例,玛尔摩分枝杆菌1例,耻垢分枝杆菌2例,胃分枝杆菌1例,次要分枝杆菌1例。耐药性高,8例治疗5例好转,10例未治或弃治,4例死亡。结论：免疫受损状态下并发NTM的感染率较为严重,其菌种比较集中在MAC及快生长群（RGM）,存在复合群感染、混合感染的特点。临床表现无特异性,肺部病变分布广泛,呈多形态改变,呈高度耐药性,由于基础疾病的存在治疗更加困难。 [关键词] 非结核分枝杆菌;结核分枝杆菌 ; 免疫受损     

重庆市流行非结核分枝杆菌菌种鉴定及感染人群特征

目的 了解重庆地区非结核分枝杆菌（NTM）流行的优势菌种和NTM感染人群的特征。方法 回顾分析2016年7月—2017年12月在重庆市公共卫生医疗救治中心就诊,并经分枝杆菌菌种PCR-反向点杂交法鉴定为NTM和NTM混合感染的患者资料。结果 95例NTM感染病例,单一NTM感染共 80例,其中快生长分枝杆菌（RGM）2种,脓肿分枝杆菌31例（38.75%）,偶发/猪分枝杆菌14例（17.50%）;慢生长分枝杆菌（SGM）5种,胞内分枝杆菌25例（31.25%）,鸟分枝杆菌5例（6.25%）,戈登分枝杆菌3例（3.75%）,堪萨斯分枝杆菌2例（2.50%）;分枝杆菌混合感染共15例,其中TB和NTM 混合感染11例, NTM混合感染4例。单一NTM感染病例中,男性多于女性,胞内分枝杆菌感染者男性比例最高。而NTM混合感染者中,性别比例均接近1∶1。单一NTM感染者主要集中于20~<30岁和40~<60岁之间,而TB和NTM混合感染者在30~<50岁之间最多。脓肿分枝杆菌感染者主要在20~59岁之间,胞内分枝杆菌感染者主要分布于40~<79岁之间,偶发/猪分枝杆菌的患者集中于60岁以下。结论 重庆市NTM的主要流行优势种类以脓肿分枝杆菌和胞内分枝杆菌为主,感染者男性多于女性,以20~<30岁和40~<60岁之间最多,对于不同种类的NTM,感染者的年龄分布和性别比例有所不同。     

88例非结核分枝杆菌的药敏实验分析

非结核分枝杆菌病是指由非结核分枝杆菌（（NTM）所引起的疾病。NTM病多继发于慢性肺病,如慢性阻塞性肺病、支气管扩张、肺尘埃沉着病和肺结核等是HIV和AIDS的常见并发症,也可是因消毒不严而引发的院内感染[1-2]。非结核分枝杆菌（NTM）病和肺结核病在临床症状、X光片、CT片、痰涂片或痰培养抗酸杆菌阳性等方面都十分相似,如果不能做到菌种鉴定这一步检查,     

盐城市2012年度分枝杆菌菌型与药敏结果分析

目的：了解盐城市致病分枝杆菌的菌型以及对抗结核药敏感性,以指导结核病治疗。方法：收集全市2012年度培养出的全部596株分枝杆菌菌株,采用《结核病诊断实验室检验规程》中的菌种鉴定法和药敏试验的比例法,进行菌种的初步鉴定和药敏试验。结果：非结核分枝杆菌（nontuberculous mycobacteria,NTM）57株（9.56%）;牛型分枝杆菌5株（0.84%）;结核分枝杆菌（tuberculous mycobacteria,MTB）534株（89.60%）。 NTM 总体耐药率为98.25%,耐多药率为85.96%;牛型分枝杆菌对一线抗结核药全部敏感;MTB总体耐药率为30.52%,其中复治患者总体耐药率为46.43%（39/84）,耐多药率为30.95%;初治患者总体耐药率为27.56%（124/450）,耐多药率为10.22%。结论：盐城市肺部分枝杆菌感染的患者,病原菌有NTM、MTB以及牛型分枝杆菌,NTM的耐药情况严重,MTB的总耐药率与耐多药率均相当高。     

应用PCR-反向斑点杂交快速鉴定分枝杆菌菌种

目的：应用聚合酶链反应-反向斑点杂交法（PCR-RDBHA）快速鉴定分枝杆菌至种的水平。方法：以分枝杆菌rpoβ基因编码序列为靶基因,应用PCR-RDBHA检测126株分枝杆菌临床分离株。以PCR-DNA测序为对照,对经PCR-RDBHA鉴定为非结核分枝杆菌（NTM）的临床分离株进行PCR-DNA测序。结果：126株临床分离株中,经鉴定115株（91.3%）为结核分枝杆菌复合群（MTC）,11株（8.7%）为NTM。NTM中,4株胞内分枝杆菌,1株堪萨斯分枝杆菌,1株戈登分枝杆菌,2株瘰疬分枝杆菌,3株脓肿分枝杆菌。11株NTMPCR-RDBHA与PCR-DNA测序结果一致。结论：PCR-RDBHA能鉴定分枝杆菌临床分离株至种的水平,方法简便、快速,结果准确,具有良好的临床应用价值。     

分枝杆菌检测鉴定方法研究进展

<正>1 非结核分枝杆菌概况非结核分枝杆菌(non-tuberculous mycobacteria,NTM)又称环境分枝杆菌或结核以外分枝杆菌,是指除结核分枝杆菌复合群和麻风分枝杆菌以外的分枝杆菌[1],在自然界和人为环境中均可生长,广泛存在。迄今为止,已有约200种NTM物种被鉴定为人类致病菌,可引起广泛的感染,其中肺部感染占65%～90%[2]。肺部NTM感染通常是由原发性肺部疾病引起,相比之下,     

基因芯片技术对非结核分枝杆菌肺病的诊断价值

目的 探讨基因芯片法对非结核分枝杆菌（NTM）肺病的诊断价值。方法 选择河南省胸科医院2020年9月至2021年3月收治的高度疑似肺结核患者200例进行回顾性分析。200例患者均行荧光支气管镜,同时采取管镜下灌洗液标本,对灌洗液标本进行基因芯片检测。以MGIT 960液体培养[对硝基苯甲酸（PNB）]为参照,分析基因芯片方法对NTM检测的敏感度、特异度和检测结果。结果 200例患者中,基因芯片法鉴定出NTM阳性22例（11.0%）,结核分枝杆菌复合群（MTC）阳性154例（77.0%）,MTC阴性24例（12.0%）。其中22例NTM中,11例胞内分枝杆菌病（50.0%）,9例脓肿分枝杆菌病（40.9%）,1例堪萨斯分枝杆菌（4.5%）,1例鸟分枝杆菌（4.5%）;MGIT960液体培养（PNB）培养出NTM 23例（11.5%）,MTC 152例（76.0%）,阴性25例（12.5%）。以MGIT 960液体培养试验结果为参考标准,基因芯片法检测出NTM的敏感度为86.9%(20/23),特异度为98.9%(175/177),两者有较高一致性。而基因芯片可以分出菌型,所用时间更短。结...     

非结核分枝杆菌肺病18例误诊分析

<正>非结核分枝杆菌(NTM)肺病是由除结核分枝杆菌复合群(包括人结核分枝杆菌、牛分枝杆菌、非洲分枝杆菌、田鼠分枝杆菌)和麻风分枝杆菌以外的NTM引起的疾病。NTM存在土壤、草木、沼泽等腐烂物质中,随着对NTM肺病的广泛研究和细菌分离技术的不断提高和普及,人们对NTM有深入的认识。近年来,NTM有逐年升高的趋势,1990年为4.9%,2000年第四次全国结核病流行病学调查NTM的比例明显增加,     

2013—2021年杭州某综合医院非结核分枝杆菌肺病流行状况分析

目的 分析杭州市结核病定点诊治医院2013—2021年非结核分枝杆菌（nontuberculosis mycobacteria,NTM）肺病的流行状况,为杭州市该病的临床防治诊疗及流行病学提供依据。方法 收集2013—2021年浙江大学医学院附属杭州市胸科医院结核科及呼吸与危重症医学科收治的疑似肺结核患者,经抗酸杆菌涂片及BACTEC MGIT960确诊为分枝杆菌感染,采用实时荧光聚合酶链反应（polymerase chain reaction,PCR）检测结核分枝杆菌复合群（Mycobacterium tuberculosis complex,MTB）与NTM的菌群鉴定,对鉴定为NTM的菌株采用HAIN基因分型鉴定法及DNA微阵列技术进行菌种鉴定,并对感染者的相关资料进行总结分析。结果 2013—2021年,从37 520例疑似肺结核患者标本中分离出NTM菌株1257株,检出率从2013年的0.8%上升到2021年的6.7%。患者中男性占50.76%,女性占49.24%。年龄分布上,60~79岁的中老年患者最多,占55.0%。2013年检出3种NTM菌种,分别是胞内分枝杆菌、脓肿分枝杆菌和龟/脓肿分枝杆菌;2021年菌种分布达13种,前三位分别是胞内分枝杆菌、龟/脓肿分枝杆菌和鸟分枝杆菌。结论 2013—2021年杭州地区NTM检出率持续升高,感染人群以男性、60~79岁的中老年为主,感染菌种以胞内分枝杆菌、龟/脓肿分枝杆菌和鸟分枝杆菌为主。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.