菏泽市2004～2006年结核病痰涂片检查结果分析

目的:了解菏泽市结核病痰涂片检查状况,改进技术,提高结核病人的发现率。方法:统计分析三年来菏泽市结核病痰涂片检查资料。结果:2004～2006年共做痰检46250例,涂阳病人8874例,总涂阳率为19.2%;15～34岁组最高(28.2%),35～54岁组次之(19.7%),14岁以下组最低(1.7%),男性高于女性,不同县区之间痰涂片检查涂阳率有较大差异。结论:菏泽市青壮年结核病感染率和带菌率较高,易引起传播。为提高结核病人的发现率,建议适当扩大接受痰检病人的覆盖面,增加痰检病人与肺结核病人的比例;加强实验室人员的技术培训,提高痰检质量;科学评价结核病病人的发现指标,合理增加经费投入,保障结核病网络实验室的有效运行。     

Pretreatment sputum smear grade and smear positivity during follow-up of TB patients in Ahmedabad,India

In Ahmedabad, India, a retrospective record review was undertaken among 2842 sputum smear-positive tuberculosis patients registered for treatment from April to September 2011 to assess the association of pretreatment sputum smear grade with sputum positivity and the additional yield of a second sputum sample during each follow-up examination. Respectively 39%, 26%, 28% and 7% of patients had pretreatment sputum grade 3+, 2+, 1+ and scanty. The higher the pretreatment sputum grade, the higher the proportion found positive during various follow-up periods. Overall, the additional yield of the second sputum sample was <2%; it did not vary with pretreatment smear grading.     

Determinants of patient delay among tuberculosis cases in Spain

BACKGROUND: Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS: Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS: A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION: Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.     

1999-2004年痰涂片阳性肺结核检出结果分析

目的了解1999年1月-2004年12月广州市经济技术开发区医院痰涂片阳性肺结核患者的检出率，以加强对结核病的防治。方法回顾性分析门诊及住院患者的痰涂片检查结果。痰涂片采用不需要加热的Kinyoun石碳酸复红染色法。结果1999—2004年各年痰涂片阳性率分别为儿．41％，11．19％，12．36％，15．65％，15．79％，16．15％；后3年痰涂片阳性率为15．90％，明显高于前3年的阳性率11．70％（P〈0．05）。绪论该区肺结核患病率有上升趋势，应加大预防控制措施的力度。     

儿童下呼吸道感染痰涂片与痰培养结果一致性研究

目的比较儿童下呼吸道感染痰涂片与痰培养结果,了解痰涂片的实验室诊断价值,同时对痰培养感染病原菌的分布及耐药性进行分析,以指导临床合理用药。方法收集2014年3—5月某院915份下呼吸道感染住院患儿的合格痰标本,涂片后进行革兰染色,同时对痰标本进行细菌培养、鉴定及药敏试验,将革兰染色镜检结果与培养结果进行比较。结果痰涂片与痰培养结果总体符合率为67.43%(617份),痰培养阳性率为65.90%(603份);分离病原菌730株,其中居前3位者分别是副流感嗜血杆菌(36.17%)、肺炎链球菌(24.38%)、卡他莫拉菌(13.29%)。产β-内酰胺酶率:副流感嗜血杆菌、流感嗜血杆菌、卡他莫拉菌分别为44.70%(118/264)、45.83%(11/24)、93.81%(91/97)。肺炎链球菌对大多数抗菌药物较敏感,对红霉素、四环素、复方磺胺甲口恶唑耐药率高,未发现对万古霉素、利奈唑胺、莫西沙星耐药的菌株。结论痰涂片具有一定的实验室诊断价值,痰培养同时应做涂片革兰染色,临床医生可根据常见病原菌的药敏结果合理用药,减少耐药菌的产生。     

免疫磁珠分离涂片和PCR检测痰内结核分枝杆菌的诊断价值研究

目的：探讨免疫磁珠分离涂片染色镜检法和免疫磁珠分离-PCR法对痰标本中结核分枝杆菌的诊断价值。方法：利用纯化的兔抗H37Rv血清包被磁珠,对痰中结核分枝杆菌进行分离,再进行涂片和PCR检测。结果：免疫磁珠分离涂片法比直接涂片法（χ2=40．83,P=0．039）、免疫磁珠分离-PCR法比常规PCR（χ2=23．31,P〈0．01）的灵敏度高。结论：免疫磁珠分离涂片法和磁珠分离-PCR法因操作简单、阳性率高,适宜在临床上推广使用。     

2010 - 2017年重庆市流动人口新涂阳肺结核患者流行病学特征分析

目的 分析2010 - 2017年重庆市流动人口新涂阳肺结核患者的流行病学特征,为制定流动人口结核病防治策略提供科学依据。方法 利用重庆市结核病患者管理信息系统资料, 对2010 - 2017年重庆市流动人口新涂阳肺结核患者2 769例的人群、地点和时间分布进行统计分析。结果 2010 - 2017年重庆市新涂阳肺结核患者57 740例,其中流动人口新涂阳肺结核患者2 769例,占全市新涂阳肺结核患者总数的4.8 %(2 769/57 740),呈逐年上升趋势（χ2趋势= 408.430, P＜0.01）;不同年龄组流动人口患者中 , 15 ～24岁年龄组占比最高;男性患者占 64.8 %(1 793/2 769),女性患者占 35.2 %(976/2 769);流动人口患者以、家政家务及待业（27.3%）、农民（22.1%）、学生（10.7%）为主,而学生患者又是以大中学生为主;主城9区流动人口新涂阳患者占全市39个区县流动人口新涂阳患者总数的 69.2 %(1 916/2 769); 3 - 5月、9月份患者数较多。结论 通过分析流动人口新涂阳肺结核患者登记特征 ,明确流动人口中的重点防控地区和人群,对制定流动人口结核病防控策略具有重要意义。     

Coverage of HIV testing among pregnant women in Catalonia, Spain: a comparison of self-reporting with medical records

BACKGROUND: to estimate the coverage of HIV testing during pregnancy in Catalonia, to identify factors associated with testing during pregnancy and to assess the recording of screening in medical records and the women's awareness about being tested. METHODS: A survey was carried out in 2000 among pregnant women attending hospital, with face-to-face interview 24-48 hours post-delivery, and review of the medical records. RESULTS: Out of 2,132 participants, 76% were from public and 24% from private hospitals. Medical records showed that 88.3% of the participants had a HIV test (94% in public, 71% in private hospitals), while for 3.7% and 18.5% in private and public, respectively, this information was not documented. Overall, 67% of women reported having been tested for HIV during that pregnancy, and unawareness of having been tested was detected in 10.7%. Educational level and prenatal care are determinants for being tested. CONCLUSION: Catalonia has a good coverage of HIV testing among childbearing women, although it is lower in private hospitals. Frequently prenatal HIV testing is not documented in medical records and women are unaware of it. Improving the prenatal care and tailoring these programmes to specific populations, like migrants or marginalized groups, will result in a better understanding of HIV prevention and in an increase in HIV testing before delivery.     

重庆市痰涂片阳性肺结核患者不规则服药现状及相关因素分析

目的了解重庆市痰涂片阳性(涂阳)肺结核患者不规则服药现状及相关因素分析。方法按照社会经济发展水平和地理条件随机抽取重庆市40个区县中的4个区县,采用系统抽样方法抽取4个样本县结核病防制机构的新登记涂阳结核患者共405例进行入户调查。拟合多因素logistic回归模型探讨结核病患者不规则服药的危险因素。结果有效的401例涂阳肺结核病患者中不规则服药率为12.47%。不规则服药的前三位原因为:药物副作用(38.30%)、经济困难(23.40%)和因症状好转而停药(23.40%)。多因素logistic回归分析结果显示,自感经济负担、患病前是否知道结核病和对症状消失后能否停药的认知程度与是否规则服药之间存在有统计学意义的关联。结论结核病知识欠缺的患者更容易发生不规则服药情况,自感经济负担是影响结核病患者是否规则服药的一个重要因素。     

2012－2017年陕西汉中市结核病实验室痰涂片镜检数据分析

目的 了解汉中市2012－2017年肺结核抗酸杆菌痰涂片结果及变化情况,分析涂阳肺结核患者特征。 方法 从中国结核病管理信息系统、结核病实验室登记本中收集整理痰涂片镜检数据,并对6年来肺结核患者痰涂片镜检结果进行数据分析。 结果 6年来痰涂片阳性率从6.48%下降到4.42%,各年发病率差异有统计学意义(P<0.05),各县区痰涂片阳性率差异有统计学意义(P<0.05),各年龄组间涂阳结核病患者阳性差异有统计学意义(P<0.01),涂阳肺结核患者男女构成比差异有统计学意义(P<0.01);45~54岁年龄组患者数最多,占涂阳肺结核患者的19.60％,其次为55~64岁年龄组,占17.04％;男性肺结核患者数多于女性,男、女患者比平均为2.82:1。 结论 汉中市2012－2017年结核病疫情呈下降趋势,男性与中老年肺结核患者是防控的重点人群。     

Did successfully treated pulmonary tuberculosis patients undergo all follow-up sputum smear examinations?

To assess response to anti-tuberculosis treatment as per national guidelines, a retrospective record review was undertaken in four districts of Andhra Pradesh, India, in December 2009 to determine whether pulmonary tuberculosis (PTB) patients reported as successfully treated (cured or treatment completed) underwent all scheduled follow-up sputum smear examinations. In a quarterly cohort of 3000 PTB patients reported as successfully treated, 1847 (61.5%) underwent all follow-up sputum examinations, with a higher proportion of new cases (65%) than retreatment cases (45%). The mid-continuation phase follow-up sputum examinations were commonly missed, and 11% patients had not undergone end-of-treatment follow-up sputum examinations.     

2005～2010年西宁市城东区肺结核患者痰涂片镜检监测分析

目的探索西宁市城东区肺结核患者痰涂片镜检特点。方法对2005～2010年期间西宁市城东区肺结核患者痰涂片的镜检检测结果进行回顾性分析。结果痰涂片镜检结果方面,2005~2010年初诊涂阳率平均为22.17%,复诊涂阳率平均为1.21%,二者比较差异具有统计学意义(χ2=58.60,P﹤0.01);在不同性别涂阳率方面,男性病例涂阳率为27.01%,女性为13.85%,二者比较男性涂阳率显著高于女性涂阳率,差异有统计学意义(χ2=29.40,P﹤0.01);在不同年龄涂阳率方面,各年龄组病例涂阳率比较差异有统计学意义(P﹤0.01);不同痰性状涂阳率方面,最高阳性率为脓性痰的19.87%,最低为水样痰的1.81%,不同痰性状之间的涂阳率比较差异有统计学意义(P﹤0.01)。结论应加强肺结核患者痰标本采集的质量控制,以提高结核杆菌的检出率,尤其是青壮年男性患者,应作为镜检的重点人群。     

涂阳肺结核患者密切接触者感染防护现状

目的对痰涂片阳性（涂阳）肺结核患者密切接触者的感染防护情况进行调查,进一步做好结核感染预防控制工作。方法采取现场调查和问卷调查的方式,对54例涂阳肺结核患者的125名密切接触者进行调查。结果涂阳肺结核患者的家属、同事和同学对结核感染预防控制知识的平均总知晓率分别为65.80%、74.05%、70.53%,不同密切接触者的平均总知晓率差异无统计学意义（χ2=3.96, P=0.151）。125名肺结核密切接触者管理措施、环境控制（环境通风、环境物品消毒、患者痰液消毒）及个人防护实施人数百分率分别为96.00%、64.80%、59.20%,措施合格率分别为80.00%、74.90%、31.08%;不同类型接触者防护措施实施人数百分率比较,差异有统计学意义（χ2=29.32,P=0.002）;实施防护措施的合格率差异无统计学意义（χ2=1.85,P=0.416）。结论涂阳肺结核密切接触者自我防护意识淡薄,防护措施不到位,存在感染风险,应加强结核感染预防控制知识及措施的健康教育。     

Ｔ ＳＰＯＴ．ＴＢ、痰涂片和ＴＢ ＤＮＡ 平行检测在结核病中的诊断评价

摘要：目的　评价Ｔ ＳＰＯＴ．ＴＢ、痰涂片及ＴＢ ＤＮＡ３种检测方法在结核病中的诊断价值。方法　选取１０３
例结核病患者,同时选取４５例非结核患者作为对照,应用３种方法平行检测,比较其对结核病的诊断效
果。结果　无论结核总体组、肺结核组, 还是肺外结核组,Ｔ ＳＰＯＴ．ＴＢ 的阳性率和敏感度（８８．３５％、
９１．４３％和８１．８２％）以及ＡＵＣ 均为最高（０．８７５、０．８９０和０．８４２）,痰ＴＢ ＤＮＡ 次之,痰涂片最低;特异
度比较,痰涂片最高（１００％）、Ｔ ＳＰＯＴ．ＴＢ 次之（８６．６７％）、痰ＴＢ ＤＮＡ 最低（７７．７８％）;３ 组中Ｔ
ＳＰＯＴ．ＴＢ与痰ＴＢ ＤＮＡ 阳性率比较,χ
２＝１５．６４６、６．２９５、１０．８８２,犘＝０．０００、０．０１２、０．００１;胸水ＴＢ
ＤＮＡ 的阳性率（９３．９４％）显著高于痰ＴＢ ＤＮＡ 的阳性率（４２．４２％） （χ
２＝２０．１８４,犘＝０．０００）。结论　
Ｔ ＳＰＯＴ．ＴＢ有较好的敏感度和特异度,对结核病的诊断具有较高的价值;胸水ＴＢ ＤＮＡ 检测对于结核性
胸膜炎不失为可选择的诊断方法。
关键词：分枝杆菌,结核;Ｔ 细胞斑点试验;痰涂片;聚合酶链反应;诊断性试验
中图分类号：Ｒ５２　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０５ ０４７３ ０４     

糖尿病合并涂阳肺结核79例分析

糖尿病与结核病常合并存在,素有“姐妹病之称”。近年来,糖尿病病人中结核病患病率要比非糖尿病人群高4～8倍,且两种疾病相互影响。现对本中心门诊诊治的79例糖尿病合并涂阳肺结核病人进行分析,探讨其临床特点。     

痰涂片革兰染色对重症监护室医院获得性肺炎早期诊治的意义

目的评价痰涂片革兰染色在重症监护室（ICU）医院获得性肺炎（HAP）患者中早期临床诊断及指导用药的意义和价值。方法对某院ICU 2011年3月-2012年2月疑诊医院获得性肺炎的289例患者,经人工气道抽取下呼吸道痰标本,分别进行痰涂片革兰染色镜检和病原学培养,对培养出来的病原菌进行菌种鉴定,比较两种方法的检验结果。结果送检痰标本890份,其中合格标本790份,合格率为88.76%。共培养出病原菌520株（65.82%）,其中革兰阴性（G-）菌330株,革兰阳性（G+）菌130株,真菌60株。痰涂片革兰染色镜检与病原菌培养结果比较,两者符合率为72.15%（570/790）,两种方法检测结果差异无统计学意义（χ2=1.818,P=0.2000）;痰涂片革兰染色镜检诊断敏感性为80.77%（420/520）,特异性为55.56%（150/270）,阳性预测值为77.78%（420/540）,阴性预测值为60.00%（150/250）。结论合格的下呼吸道痰标本革兰染色镜检能够协助HAP 的早期诊断与治疗。     

Epidemiology of cardiovascular disease risk factors in Catalonia (Spain)

Cardiovascular disease is one of the most important public health problems in developed countries. We have studied the epidemiology of the following cardiovascular disease risk factors in a random sample (n = 704) of the adult population of Catalonia (Spain): hypercholesterolemia ( 6.1 mmol/1 or 240 mg/dl), hypertension (SBP 160 and/or DBP 95 mmHg), low HDL-cholesterol concentrations (< 0.9 mmol/l or 35 mg/C), hypertriglyceridemia (> 2.8 mmol/1 or 250 mg/dl), obesity (BMI > 30), smoking and history of diabetes and coronary heart disease.Two percent of participants had hypertriglyceridemia, 3% had a history of coronary heart disease, 4% a history of diabetes, 6% low HDL-cholesterol concentrations, 12% were obese, 20% had hypertension, 24% had hypercholesterolemia and 36% were smokers. 58% of hypertensive individuals had been previously detected, 46% were currently on treatment, and 21% had their blood pressure controlled (SBP < 160 and DBP < 95 mmHg).Correlation and multiple regression analyses were used to investigate the association between cardiovascular risk factors. Multiple linear regression analysis showed independent correlations between risk factors. Prevalence of hypercholesterolemia, obesity and diabetes was higher and prevalence of smoking was lower in hypertensives than normotensives. The odds ratio was 3.68 (95% CI = 2.07–6.54) for hypercholesterolemia, 3.26 (95% CI = 1.52–7.02) for obesity, 3.81 (95% CI = 1.09–7.02) for diabetes and 0.40 (95% CI = 0.22–0.70) for smoking. The adjusted odds ratio was statistically significant for hypercholesterolemia (OR = 2.74, 95% CI = 1.01–3.75).The prevalence of cardiovascular risk factors was similar to that observed in other Mediterranean communities. The association between cardiovascular risk factors shows that there are biological interrelations between risk factors that influence the development of arteriosclerosis.     

From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam

BACKGROUND: In early 2001 there were indications that tuberculosis (TB) was increasingly becoming a problem among drug addicts and homeless persons in Rotterdam, after a periodical screening was discontinued in 1997. A contact investigation around a homeless drug addicted man in Rotterdam with infectious pulmonary TB is described. Contact investigation: A total of 507 drug addicts, homeless persons, and staff of facilities for these risk groups were examined with tuberculin skin testing (TST) and chest radiography. DNA fingerprinting of mycobacteriological cultures through Restricted Fragment Length Polymorphism methodology and molecular epidemiology investigation through cluster analysis were performed. Outcome: TST showed an infection prevalence of 29%, especially among staff of services for drug addicts and homeless persons. Six persons with active intrathoracic TB were identified. Cluster analysis demonstrated no relation with the initial case but showed intense transmission of TB among drug addicts and homeless persons in Rotterdam by multiple sources. As a consequence of the findings, a proposal to the Council of the City of Rotterdam resulted in the re-introduction of a comprehensive TB screening programme among these risk groups with mobile digital X-ray units (MXUs). CONCLUSION: This contact investigation gradually obtained the characteristics of a screening of drug addicts and homeless persons. Novel technologies, such as MXUs, facilitate appropriate and efficient outreach approaches to TB control among difficult-to-reach groups. This method and knowledge of individual fingerprints and clusters of TB patients are indispensable for underpinning proposals for change of local TB control strategies and convincing local authorities of the rationale.