骨关节结核发病机制的相关实验研究

目的研究骨关节结核的发病机制。方法采用不同浓度结核分枝杆菌超声裂解产物体外诱导破骨细胞的生长;通过体外颅骨吸收实验,观察不同浓度结核分枝杆菌超声裂解产物诱导破骨细胞生成和钙离子释放的关系;体内注射结核分枝杆菌超声裂解产物,从血钙浓度和组织学方面观察骨质变化。结果结核分枝杆菌超声裂解产物能够在体外诱导破骨细胞生长,且破骨细胞数量的增加依赖细菌浓度的提高。钙离子释放与细菌诱导破骨细胞的数量相关,体内注射细菌能够引起破骨细胞数量增加、钙离子释放和骨质吸收。结论骨、关节结核的发病很可能与结核菌诱导破骨细胞增生有关。     

结核分枝杆菌L-型感染与肺癌的相关性初步研究

目的:探寻结核分枝杆菌L-型(Mycobacterium tuberculosis L-forms,MTB-L)感染与肺癌发生的相关性.方法:实验设肺癌组(167例)、结核病组(65例)及非结核、非恶性肿瘤对照组(60例).对各组的手术切除组织标本,分别用IK(intensified Kinyoun's)抗酸染色检测MTB-L、经典抗酸(Ziehl-Neelsen,ZN)染色检测结核分枝杆菌(Mycobacterium tuberculosis,MTB)、原位杂交(in situ hybridization,ISH)检测MPB64基因在癌细胞核内的表达,并对部分标本进行细菌培养.结果: 肺癌组患者中MTB-L阳性率为67.1%(112/167),MTB-杆菌型的阳性率为4.2%(7/167),2者比较差异有统计学意义(P＜0.05).肺癌组与结核病组(90.8%,59/65)的MTB-L比较,差异有统计学意义(P＜0.05),与非结核、非恶性肿瘤对照组的1.7%(1/60)比较,差异有统计学意义(P＜0.05).肺癌组MPB64基因(癌细胞核内表达)的阳性率为80.2%(134/167),与结核病组的100%(65/65)比较,差异有统计学意义(P＜0.05),与非结核、非恶性肿瘤对照组的3.3%(2/60)比较,差异有统计学意义(P＜0.05).肺癌组中各组织类型、组织学分级、病理分期及淋巴结有、无转移的MTB-L检测结果之间,差异均无统计学意义(P均＞0.05),MPB64基因检测结果之间,差异均无统计学意义(P均＞0.05).有、无结核病史者MTB-L检测结果之间、MPB64基因检测结果之间,差异均无统计学意义(P均＞0.05).肺癌组47例标本培养检出人型MTB-L 27株(57.4%),返祖为原杆菌型者的有18株(66.7%,18/27).MTB-L与MTB(4.3%,2/47)检出率比较,差异有统计学意义(P＜0.05).结论:肺癌组织中MTB主要以L型存在;MTB-L的MPB64基因在肺癌组织的癌细胞核内高度表达;MTB-L与MPB64基因检测阳性率与各病理学特征及结核病史无关.     

127例胃病幽门螺杆菌L型感染与胃癌的研究

探讨了幽门螺杆菌Ｌ型感染与胃癌，癌前病变及慢生胃炎的关系。方法；用组织切片革兰染色和免疫组化法；对３６全吕，３４例细胞不典型增生，４２例慢性胃炎及１５例正常组织进行Ｈｐ－Ｌ型检测。结果：胃癌，不典型增生及慢性胃炎的ｈｐ－Ｌ型检出率分别为８０．６％，７９．４％和７３．８％，明显高于正常组织，并有统计学意义。     

127例胃病幽门螺杆菌L型感染与胃癌的研究

目的：探讨幽门螺杆菌L型（HP－L型）感染与胃癌、癌前病变及慢性胃炎的关系。方法：用组织切片革兰染色和免疫组化法，对36例胃腺癌、34例细胞不典型增生、42例慢性胃炎及15例正常组织进行HP－L型检测。结果：胃癌、不典型增生及慢性胃炎的Hp－L到检出率分别为80．6％、79．4％和73．8％，明显高于正常组织（467％），并有统计学意义（P＜0．05）。而前三种类型组织中的Hp-L型检出率无显著性差异（P＞0．05）。结论:Hp-L型感染与胃癌、癌前病变及慢性胃炎有关，且Hp-L型感染在胃癌的发生中可能起一定作用。     

胃癌、不典型增生及慢性胃炎与幽门螺杆菌L型感染关系的研究

 目的　探讨幽门螺杆菌L型 (Hp L型 )感染与胃癌、不典型增生及慢性胃炎的关系。 方法　用组织切片革兰染色和免疫组化染色法 ,对 36例胃癌、34例不典型增生、4 2例慢性胃炎及 15例正常胃黏膜进行Hp L型检测。 结果　胃癌、不典型增生及慢性胃炎的Hp L型检出率分别为 80 .6 %、79.4 %和 73.8% ,其阳性率之间无显著性差异 (P >0 .0 5 ) ,且均高于正常胃黏膜 (P <0 .0 5 )。结论　Hp L型感染与胃癌、不典型增生及慢性胃炎关系密切 ,并在胃癌的发生中起一定作用。     

脊柱结核合并脊髓损伤患者的手术治疗

目的探讨在化疗基础上,一期手术病灶清除、植骨、内固定治疗脊柱结核伴脊髓损伤的临床疗效。方法回顾性分析2003年4月至2011年4月,我科收治的脊柱结核并脊髓损伤患者42例。根据脊髓损伤神经学国际标准（americanspinalinjuryassociation,ASIA）神经功能评分进行ASIA残损分级,B级14例,C级19例,D级9例。在标准化疗基础上根据脊髓损伤发展情况,24例化疗后3～4周手术,18例化疗未达2周,但脊髓损伤症状进行性加重或脓肿较多而进行手术。采用一期病灶清除、植骨、内固定手术治疗,术后严格强化四联抗结核治疗,术后3个月改三联化疗9～15个月。神经功能障碍改善情况采用ASIA神经功能评价,对其神经功能恢复、病灶愈合及内固定情况等进行分析研究。结果所有患者随访18～40个月,平均24个月。经X线、CT或MRI检查,病灶无残留,后凸角度矫正满意,随访无明显丢失;所有病例ASIA神经功能评价最终随访均得到明显好转,术前感觉评分（90.93±35.59）,运动评分（51.04±11.86）;末次随访感觉评分（185.58±30.41）,运动评分（85.21±11.48）,和术前比较差异有统计学意义（P＜0.01）;所有病灶治愈,骨性愈合,无1例结核复发;无断钉、断棒及内固定松动、窦道形成等相关并发症。结论脊柱结核伴神经压迫多缓慢产生,症状持续时间越长、瘫痪越重,预后越差,应在标准化疗基础上尽早手术,一期病灶清除、植骨、内固定治疗,效果满意。     

子宫内膜腺癌细菌L型感染研究

应用革兰氏染色、免疫组织化学染色等技术，对５３例子宫内膜腺癌组织切片进行回顾性研究。结果发现，４４例革兰氏染色镜检出细菌Ｌ型，其阳性率（８３．０％）与免疫组化染色金葡萄Ｌ型抗原检出率（７９．２％）具一致性，ｐ〉０．０５。革兰氏染色３６例（６７．９％），是计在癌细胞胞浆内见到Ｌ型菌体。提示，细菌Ｌ型感染与子宫内膜腺癌关系密切，很可能是其致癌因子之一。     

子宫内膜腺癌细菌L型感染研究

应用革兰氏染色、免疫组织化学染色等技术，对53例子宫内胰腺癌组织切片进行回顾性研究．结果发现，44例革兰氏染色镜位出细菌L型，其阳性率（83．0％）与免疫组化染色金葡萄L型抗原值出率（79．2％）具一致性，p＞005．革兰氏染色36例（67．9％）同时在癌细胞胞浆内见到L型菌体。提示，细菌L到感染与子宫内胰腺癌关系密切，很可能是其致癌因子之一．     

鼻咽癌的p53表达与细菌L型感染的相关性研究

目的探讨细菌Ｌ型可能致癌的机制。方法用免疫组化和革兰氏染色等技术,对６９例鼻咽癌进行细菌Ｌ型和突变型ｐ５３蛋白检测,并以２０例鼻咽粘膜慢性炎作对照。结果革兰氏染色鼻咽癌细菌Ｌ型检出率为７９．７％,与免疫组化Ｌ型抗原表达阳性率（６９．６％）具有一致性（Ｐ＞０．０５）。鼻咽癌ｐ５３蛋白表达阳性率为６５．２％,与粘膜慢性炎的ｐ５３蛋白表达（１／２０）有显著性差异（Ｐ＜０．００５）,且Ｌ型阳性病人的ｐ５３蛋白表达阳性率（７８．２％）明显高于Ｌ型阴性病人（１４．３％）,两者有显著性差异（Ｐ＜０．００５）。结论细菌Ｌ型感染与突变型ｐ５３蛋白过度表达存在着相关性,提示细菌Ｌ型感染参与了ｐ５３抑癌基因的失活,基因突变可能是细菌Ｌ型致鼻咽癌作用的机制之一     

头颈部鳞癌细菌L型感染的研究

用革兰染色、免疫组织化学染色等技术，对２２６例头颈部鳞癌（鼻咽癌１０５例；喉癌８５例；扁桃体癌１４例；鼻腔、鼻窦癌２２例）进行回顾性研究。结果发现，１７７例革兰染色镜检出细菌Ｌ型，其阳性率（７８．３％）与免疫组化染色金葡萄Ｌ型抗原检出率（７３％）具有一致性（Ｐ＞０．０５）。革兰染色同时在１０４例（４６．０％）癌细胞胞浆内见到Ｌ型菌体。提示头颈部鳞癌与细菌Ｌ型感染有关。     

肺结核与肺癌相互影响的研究进展

肺结核与肺癌都严重危害着人类健康,结核病目前发病率和死亡率居高不下,而肺癌是全世界范围内最常见的死亡率较高的恶性肿瘤之一,两种疾病预后不同,但是二者从发病的原因上讲却是相互影响的,结核病慢性炎症刺激、结核分枝杆菌磷酸酶成分以及结核分枝杆菌感染引发的免疫反应都可导致肺癌的发生。肺癌发生后不恰当的治疗方式也会有利于结核分枝杆菌生长,导致肺结核的发生。面对这样全球性的重大公共卫生问题,我们将用近年来的流行病学调查和实验研究结果为两种疾病的共存阐明原因,也将为下一步结核病合并肺癌患者的治疗提供依据。     

Vitamin D and tuberculosis: a review on a hot topic

Abstract

The aim of this study is to critically summarize the available data on the correlation between vitamin D level and tuberculosis (TB) infection. A literature search covering English language articles published up to 20 October 2014 was conducted in MEDLINE database. Three hundred ninety-seven articles were initially identified, of which 147 studies were initially selected, and other 13 pertinent studies were included. A significant association between low vitamin D levels and susceptibility to TB infection has been found.     

Moxifloxacin and Gatifloxacin in an Acid Model of Persistent Mycobacterium tuberculosis

Abstract

Studies in the mouse and in humans suggest that use of moxifloxacin and gatifloxacin may shorten the duration of treatment of pulmonary tuberculosis. We describe here the in vitro findings with gatifloxacin and moxifloxacin in regimens similar to those that might be used in the treatment of tuberculosis. The bactericidal activities of moxifloxacin and gatifloxacin were measured alone and in different combinations with isoniazid, rifampicin and pyrazinamide against a 30-day, stationary phase culture, at a pH of 5.9. There was a rapid, irregular fall in colony counts during the first 4 days followed by a slower consistent kill during days 4-21 with a mean kill of ?0.36 (SD=2.74) and ?0.106 (SD=0.011) log₁₀ CFU/ml/day, respectively. The 4-21-day kill is considered the best assessment of bactericidal activity against persisting bacilli that prolong treatment. The substitution of either of the quinolones for isoniazid in the control regimen of rifampicin, pyrazinamide and isoniazid did not increase bactericidal activity with log CFU of 5.00 and 4.88, but did result in increased bactericidal action with the log CFU of 4.11 and 4.10 for moxifloxacin and gatifloxacin respectively. Moxifloxacin and gatifloxacin had closely similar activities in all drug combinations. Adding moxifloxacin or gatifloxacin to the control regimen resulted in a significant increase in bactericidal action, considered sufficient to reduce the treatment duration.     

肺结核与肺癌相关性的临床研究

肺结核发生发展主要是炎症介质反应的结果,而肺癌致病机制复杂,涉及多基因多分子的参与.肺结核患者的免疫异常、抗结核药物、瘢痕修复、慢性炎症刺激以及结核菌素的毒力均与肺癌的发生密切相关.肺结核合并肺癌患者的治疗包括联合化疗、手术以及放疗等有限手段.     

Association between tuberculosis infections and non-pulmonary malignancies: a nationwide population-based study

Background:

In addition to lung cancers, tuberculosis infections have been associated with increased risk of non-pulmonary malignancies in case reports. Our population-based study employed standardized incidence ratios (SIRs) to systemically survey non-pulmonary cancer risks after tuberculosis infections.

Methods:

Data of patients who had newly diagnosed tuberculosis, were aged 20 years or older, and had no prior cancer or tuberculosis were sampled from the Taiwan National Health Insurance database between 2000 and 2010. SIRs compared cancer incidence in patients with tuberculosis infections to the general population. SIRs of specific cancers were further analyzed with respect to gender and time after tuberculosis infections.

Results:

After a follow-up period of 28 866 person–years, 530 tuberculosis cases developed cancers compared with 256 cases in the general populations (2.07, 95% confidence interval (CI), 1.90–2.26). The SIR of non-pulmonary malignancies was also increased (1.71, 95% CI, 1.54–1.90). For males, SIRs were increased within 1 year after tuberculosis diagnosis for the following cancers: head and neck, esophageal, colorectal, liver, lung, melanomas, and Hodgkin''s disease. SIRs were increased for liver, biliary, lung, and bladder cancers beyond the first year after tuberculosis diagnosis. For females, SIRs were increased for leukemia, esophageal, and lung cancers within the first year, and only for leukemia beyond 1 year post diagnosis.

Conclusion:

Having found increased risks of several cancers that differ with gender and time after tuberculosis diagnosis, physicians may consider these factors in patients following tuberculosis diagnosis.     

非典型脊柱结核误诊脊柱肿瘤19例术后分析

目的探讨非典型脊柱结核误诊脊柱肿瘤的原因.方法对误诊脊柱肿瘤的19例非典型脊柱结核患者的临床表现,病史采集,影像学及实验室检查特点进行回顾性分析.结果由于本组病例临床表现的不典型,采集病史的不详细,对影像学检查的误区及实验室检查的非特异性,使本组19例非典型脊柱结核患者误诊为脊柱肿瘤.结论只有正确认识非典型脊柱结核的临床表现,认真仔细的采集病史,提高自身对影像学知识的学习,充分了解非典型脊柱结核实验室检查的特点,才能减少误诊的发生.     

Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: A systematic review

There has been conflicting evidence concerning the possible association between tuberculosis (TB) and subsequent risk of lung cancer. To investigate whether currently published epidemiological studies can clarify this association, we performed a systematic review of 37 case‐control and 4 cohort studies (published between January 1966 and January 2009) and a meta‐analysis of risk estimates, with particular attention to the role of smoking, passive smoking and the timing of diagnosis of TB on this relationship. Data for the review show a significantly increased lung cancer risk associated with preexisting TB. Importantly, the association was not due to confounding by the effects of tobacco use (RR = 1.8, 95% confidence interval (CI) = 1.4–2.2, among never smoking individuals), lifetime environmental tobacco smoke exposure (RR = 2.9, 95%CI = 1.6–5.3, after controlling) or the timing of diagnosis of TB (the increased lung cancer risk remained 2‐fold elevated for more than 20 years after TB diagnosis). Interestingly, the association was significant with adenocarcinoma (RR = 1.6, 95%CI = 1.2–2.1), but no significant associations with squamous and small cell type of lung cancer were observed. Although no causal mechanism has been demonstrated for such an association, present study supports a direct relation between TB and lung cancer, especially adenocarcinomas. © 2009 UICC     

Pulmonary tuberculosis increases the risk of lung cancer: a population-based cohort study

BACKGROUND:

The possible effect of pulmonary tuberculosis (TB) on subsequent lung cancer development has been suspected, but the evidence remains inconsistent. The purpose of this study was to perform a nationwide population‐based cohort study to investigate the risk of lung cancer after pulmonary TB infection.

METHODS:

This nationwide population‐based cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 5657 TB patients and 23,984 controls matched for age and sex were recruited for the study from 1997 to 2008.

RESULTS:

The incidence rate of lung cancer (269 of 100,000 person‐years) was significantly higher in the pulmonary TB patients than that in controls (153 of 100,000 person‐years) (incidence rate ratio [IRR], 1.76; 95% confidence interval [CI], 1.33‐2.32; P < .001). Compared with the controls, the IRRs of lung cancer in the TB cohort were 1.98 at 2 to 4 years, 1.42 at 5 to 7 years, and 1.59 at 8 to 12 years after TB infections. The multivariate Cox proportional hazards model revealed pulmonary TB infections (hazard ratio [HR], 1.64; 95% CI, 1.24‐2.15; P < .001) and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03‐1.14; P = .002) to be independent risk factors for lung cancer.

CONCLUSIONS:

Pulmonary infection with TB is associated with an increased risk of lung cancer. Cancer 2011. © 2010 American Cancer Society.