老年慢性阻塞性肺病合并肺结核的临床分析

目的探讨老年慢性阻塞性肺病合并肺结核的临床特点及治疗措施。方法回顾分析自2005年5月至2009年12月间,共收住老年COPD合并结核患者160例的临床资料。结果在积极抗结核治疗及抗炎、对症、支持、免疫治疗下,本组患者中除15例抗感染治疗无效发生痰窒息和呼吸衰竭、心力衰蝎死亡,其余患者在肺结核好转同时,肺部感染均好转。结论老年合并COPD患者由于常年慢性咳嗽、咯痰、气喘,当并发结核感染时,缺乏结核典型症状,早期临床上常被原发病掩盖,致使诊断被延误,导致误诊。内科医师应提高警惕,在不能明确是否合并结核病的情况下,应慎用或禁用激素,以防结核病恶化播散。     

结核分支杆菌耐药结果分析

结核病是国家重点控制的传染病之一,尤其是耐多药结核病的出现已成为结核病疫情上升和难以控制的一个重要原因。随着结核病的蔓延,人们越来越重视其治疗,了解和掌握结核分支杆菌的耐药性是保证治愈结核病的一个关键问题,而实验室的药物敏感性试验数据给临床提供了有力的证据,对治疗结核病，治愈结核患者起着重要的作用。     

生物制剂在结核病免疫治疗中的应用

［摘要］近年来，结核病的免疫治疗取得了一定的进展。结核病免疫治疗的适应对象主要为初、复治结核病并发免疫功能低下者，重症肺结核，耐药和耐多药结核病等。目前常用的生物制剂有母牛分枝杆菌菌苗、草分枝杆菌菌苗、卡介菌多糖核酸、转移因子、胸腺素、白细胞介素 2等，介绍了这些生物制剂在结核病免疫治疗中的作用机制、使用方法、不良反应、注意事项、临床疗效、应用前景等。     

无创正压通气治疗急性呼吸衰竭的临床分析

结核病是由结核杆菌感染引起的慢性传染病。结核杆菌可能侵入人体全身各种器官，但主要侵犯肺脏，称为肺结核病。自从有了抗结核病的化学药物以后，结核病的治疗已经不是困难的问题。特别在现代结核病控制策略下，能使95％以上的肺结核患者获得治疗的成功。但是，加世纪90年代初，在全球范围内又出现结核病流行的大回升，而耐药结核、耐多药结核及超级耐药结核有可能成为一种不治之症，甚至比癌症更可怕。形势的严峻及耐药结核的产生给我们敲响警钟。现将导致结核病治疗失败的原因及其对策分析如下。     

结核病治疗对骨关节结核病发病率的影响

目的：初治骨外结核病的治疗对骨关节结核患病率的影响。方法：调查1998年河北省胸科医院骨科住院骨关节结核病人216例，有骨外结核病史者38例，均在综合医院治疗。结果：无正规初治骨外结核病患者关节结核发病率是正治疗者的13．5倍。结论：结核病归口管理、合理化疗，是降低骨关节结核发病率的有效措施。     

获得性免疫缺陷综合征患者的结核病诊疗进展

结核分枝杆菌感染是人免疫缺陷病毒(HIV)感染者最常见的机会性感染之一,并且是导致其死亡的主要原因.结核分枝杆菌能促进HIV复制,而HIV感染又是结核病发病的独立危险因素,并且可促使结核病由潜伏感染进展为活动性结核.本文着重介绍HIV合并结核分枝杆菌感染者结核病的诊断及其抗结核治疗进展.     

结核病的实验室诊断与结核菌耐药性检测方法研究进展

<正>结核菌的耐多药问题和人类免疫缺陷病毒(HIV)/结核双重感染是当今全球结核病控制的主要难题之一。早期、有效的结核病诊断,对结核、非结核分枝杆菌的鉴别,对耐多药结核菌的发现和治疗,是全世界结核病控制工作的重点。随着分子生物学技术的发展,结核病在传统诊断方法的基础上,又提供了许多新的途径。结核病的实验室诊     

潜伏结核感染的诊疗进展

结核病是由结核分枝杆菌感染引起的传染性疾病,控制结核病的关键是检测潜伏结核感染人群并预防结核病的传播。目前国际上没有潜伏结核感染的诊断金标准,预防性治疗方案的具体应用也没有统一规定。本文将对潜伏结核感染的不同检测方法和预防性治疗方案进行综述,其中3个月异烟肼、利福平或利福喷丁[3HR(L)]方案疗程短,不良反应小,费用低,治疗效果好,患者依从性高。     

脊椎结核外科治疗新进展

我国是全球22个结核病高负担国家之一,结核病例数居世界第2位,仅次于印度,结核菌感染率为44．5％。目前我国结核病人估算有600多万人,主要集中在25岁及以上人群,每年约有13万人死于结核病,死亡平均年龄在55．2岁,其中骨关节结核占结核病的13％,脊柱结核占骨关节结核的75％。脊柱结核因造成骨质破坏、椎体塌陷、肉芽组织形成,甚至发生病理性骨折等容易对脊髓形成压迫,对人体危害较大。在积极抗结核治疗基础上行外科手术是治疗脊柱结核的有效方法。本文就脊柱结核的外科治疗进展做一综述。     

住院结核患者的健康教育

结核病是呼吸道传播的慢性传染病,严重危害着我国人民群众的身体健康,已成为较严重的公共卫生问题和社会问题,给个人、家庭、社会和国家带来沉重的负担.1993年WHO发出紧急呼吁--全球结核病处于紧急状态.随着直接面视下短程化疗（DOTS）项目的开展,我国结核病疫情得到了有效控制,结核病免费治疗项目的全面铺开,使我国结核病的发现率明显提高,符合免费抗结核治疗的患者得到了及时规范的治疗和管理,与此同时,耐药性结核、重症结核、需住院及手术治疗的难治性结核患者也大量增加,在严格执行现代结核病控制策略的化学药物治疗的前提下,住院结核患者的健康教育显得尤为重要.     

Global clinical trials for the treatment of TB with thioridazine

Current evidence shows that thioridazine (THZ) is ready for global clinical evaluation, while some of its derivatives and other efflux pump inhibitors reach the end stage of preclinical evaluation. In this paper, a clinical trial plan is described that investigates the antituberculosis potency, the safety profile and the role of THZ and/or its derivatives in the treatment of TB in humans, both in patients infected with drug sensitive strains as in patients infected with multi or extensive drug resistant strains of Mycobacterium tuberculosis and some of the patents related to thioridazine are also discussed.     

Host-pathogen interactions in latent Mycobacterium tuberculosis infection: identification of new targets for tuberculosis intervention

Mycobacterium tuberculosis (M. tuberculosis) is one of the worlds' most successful and sophisticated pathogens. It is estimated that over 2 billion people today harbour latent M. tuberculosis infection without any clinical symptoms. Since most new cases of active tuberculosis (TB) arise from this (growing) number of latently infected individuals, urgent measures to control TB reactivation are required, including more effective drugs and new TB vaccines. The currently widely used BCG vaccines, as well as most new generation TB-vaccines that are being developed are designed as prophylactic or as BCG-booster vaccines. Unfortunately, many of these vaccines are unlikely to be effective in individuals already latently infected with M. tuberculosis. Here we argue that detailed analysis of M. tuberculosis genes that are switched on predominantly during the latent stage of infection may lead to the identification of new M. tuberculosis targets for drug and vaccine development. First, we will describe essential host-pathogen interactions in TB with particular emphasis on TB latency and persistent infection. Subsequently, we will focus on a novel group of late-stage specific genes, encoded by the M. tuberculosis dormancy (dosR) regulon, and summarize recent studies describing human T-cell recognition of these dormancy antigens in relation to (latent) M. tuberculosis infection. We will discuss the possible relevance of these new classes of antigens for new TB intervention strategies.     

Latent tuberculosis: is there a role for thioridazine?

Approximately 1/3 of the world's population is infected with Mycobacterium tuberculosis. In the vast majority of cases this results in latent not active disease. Latent disease is defined as a positive reaction to tuberculin antigens but without any further clinical symptoms. Models have been developed to study latent tuberculosis with the two most prominent being the in vivo murine model and the in vitro Wayne model. In both cases M. tuberculosis undergoes a change in its respiratory profile as it shifts down to a nonreplicating state. However in both the mouse and the Wayne model, dormant M. tuberculosis is sensitive to the phenothiazine thioridazine. This antibiotic has several targets, and the main one is respiration. There is a growing burden of multidrug resistant and extensively drug resistant tuberculosis. Treatment of these cases is expensive with high mortality. We propose that thioridazine alone, or with other antibiotics, be used to treat drug resistant latent tuberculosis. The advantages are that thioridazine is inexpensive, effective against drug resistant tuberculosis, well characterized and unlikely to induce drug resistance. The disadvantages include possible side effects, although these should be rare at the doses and length of time of treatment. Recent patents involving analogs of thioridazine suggest this class of drugs may hold great promise for the future treatment of the most drug resistant strains.     

肺结核并肺部G^-杆菌感染患者60例临床分析

目的探讨肺结核并肺部G^-杆菌感染的临床特点及治疗。方法回顾并分析我院一年来收治的肺结核合并肺部G^-杆菌感染60例的临床资料。结果肺结核合并肺部G^-杆菌感染常见的为铜绿假单胞菌、大肠埃希菌、产硷假单胞菌及肺炎克雷白杆菌。病例的临床特征为结核病史长,年龄偏大,合并肺外结核及其他合并症多;肺部病变广泛,空洞多,多有应用广谱抗菌素及皮质激素史;对常用抗菌药物敏感率较低;确诊有赖于病原学检查。结论肺结核合并肺部G^-杆菌感染近些年有增多趋势,了解其临床特点可提高对两症并存病例的诊治水平。     

Organizational Issues in Conducting Tuberculosis Screening at a Syringe Exchange Program

There has been a rise in tuberculosis (TB) cases in the United States and there is a potent link between human immunodeficiency virus (HIV) and tuberculosis. In New York City it is estimated that 40% of the 200,000 injecting drug users are infected with HIV. In addition, the tuberculosis case rate is approximately four times the national average, and one third of these cases occurred in those persons infected with HIV. Drug users have a high prevalence of latent tuberculous infection and are at high risk for progression to active tuberculosis. Drug users are at high risk for both HIV and TB. Although studies have shown the value of incorporating TB services into drug treatment programs, the majority of drug users in the United States are not in drug treatment. We have been evaluating the feasibility of conducting TB screening and directly observed TB preventive therapy for active injecting drug users at a syringe exchange program in New York City. This paper describes issues relating to the implementation of the TB screening program and discusses general and operational issues relevant to integrating medical and public health programs into existing programs serving drug using individuals.     

Targeting the human macrophage with combinations of drugs and inhibitors of Ca2+ and K+ transport to enhance the killing of intracellular multi-drug resistant Mycobacterium tuberculosis (MDR-TB)--a novel, patentable approach to limit the emergence of XDR-TB

The emergence of resistance in tuberculosis has become a serious problem for the control of this disease. For that reason, new therapeutic strategies that can be implemented in the clinical setting are urgently needed. The design of new compounds active against mycobacteria must take into account that tuberculosis is mainly an intracellular infection of the alveolar macrophage and therefore must maintain activity within the host cells. An alternative therapeutic approach will be described in this review, focusing on the activation of the phagocytic cell and the subsequent killing of the internalized bacteria. This approach explores the combined use of antibiotics and phenothiazines, or Ca(2+) and K(+) flux inhibitors, in the infected macrophage. Targeting the infected macrophage and not the internalized bacteria could overcome the problem of bacterial multi-drug resistance. This will potentially eliminate the appearance of new multi-drug resistant tuberculosis (MDR-TB) cases and subsequently prevent the emergence of extensively-drug resistant tuberculosis (XDR-TB). Patents resulting from this novel and innovative approach could be extremely valuable if they can be implemented in the clinical setting. Other patents will also be discussed such as the treatment of TB using immunomodulator compounds (for example: betaglycans).     

Revised guidelines for the diagnosis and control of tuberculosis: impact on management in the elderly

Despite major progress in the development of new strategies for diagnosing and treating tuberculosis, the disease still remains a major challenge for healthcare workers throughout the world. A number of causes are responsible for this threat but, unfortunately, many of these cannot be resolved easily because of cultural and social factors. Furthermore, not all countries throughout the world have enough financial resources to support educational and therapeutic programmes. The major challenges with tuberculosis are 2-fold: (i) to deal with the growing epidemic around the world (and especially in 'low-income' [developing] countries), and; (ii) to ensure correct use of antituberculosis medications in order to protect these drugs for future use. In 'high-income' countries, a major decline in the incidence of tuberculosis has been observed. Nevertheless, tuberculosis remains an important challenge in some risk groups, particularly the elderly patient, in these countries. The clinical and radiological presentations are often nonspecific, leading to delayed diagnosis and appropriate treatment, which often results in a large proportion of cases being discovered at autopsy only. Considering tuberculosis in the differential diagnosis remains the cornerstone of a fast and accurate diagnosis of this condition. Management of active tuberculosis in the elderly does not differ fundamentally from that in younger patients with respect to outcomes or adverse effects of treatment. However, empirical treatment perhaps may be considered more readily in the elderly patient. Elderly persons infected with tuberculosis at the beginning of the 20th century constitute a large reservoir of latent tuberculosis infection. Furthermore, these individuals are at increased risk of reactivation of this remote infection as their immunological status declines with aging. Compared with the past, modern guidelines are less reluctant to recommend use of tuberculin skin testing, treatment of latent tuberculosis infection in elderly persons, and prevention of transmission of tuberculosis in nursing homes.     

艾滋病结核病双重感染治疗管理分析

目的：探讨艾滋病、结核病双重感染患者的临床治疗管理效果。方法选取本院2010年1月~2013年1月收治的艾滋病、结核病双重感染患者72例,均给予抗HIV治疗与抗结核治疗,通过1年随访观察患者的治疗效果。结果72例患者治疗后结核感染治疗有效共68例,总有效率为94.4%;2例患者未坚持抗HIV治疗,该治疗的依从性为97.2%。结核杆菌呈阴性与结核杆菌呈阳性患者治疗前后的CD4 T淋巴细胞计数差异均具有统计学意义（P〈0.05）。治疗结束后,4例患者发生过敏性皮疹,9例患者发生肝功能损害,纠正治疗后均获好转。结论对艾滋病与结核病双重感染的患者建立有效的治疗管理,能够保证早期诊治的正确开展,指导抗结核治疗与抗HIV治疗的联合应用,最终增加患者治疗依从性,提高临床施治效果,改善其生活质量,延长患者的生存时间。     

艾滋病和结核病双重感染的临床分析

目的：探讨艾滋病、结核病双重感染患者的临床特点与治疗方法。方法选取本院2011年11月~2013年10月收治的艾滋病合并结核病患者68例作为研究对象，回顾性分析样本的临床资料，总结临床特点与治疗方式。结果68例患者临床表现为咳痰、发热、咳嗽、气短、消瘦、贫血等，其中，以咳痰为最主要的表现症状；胸部X线检测的表现不明显，多存在弥漫性侵润和粟粒性阴影；临床开展的治疗方式较为复杂，治疗后死亡率为13.2%。结论艾滋病与结核病双重感染患者的临床表现不明显，开展相关检查对结核病的诊断效果也缺乏特异性，治疗方法趋于复杂，主要是通过抗结核治疗后再进一步行抗病毒治疗，起到延长患者生存时间的效果。     

对比艾滋病与肺结核合并重症肺炎行机械通气患者的病原分布及耐药性分析

目的:探讨艾滋病合并重症肺炎的病原分布特点及耐药性,为临床治疗艾滋病合并重症肺炎提供依据。方法:应用回顾性分析方法,选择2012年1月-2014年1月期间在我院住院的重症肺炎患者156例,按感染HIV或肺结核将患者分为A、B 2组,每组各78例,A组为艾滋病合并重症肺炎患者,B组为肺结核合并重症肺炎患者,检测156例重症肺炎并行有创机械通气患者的致病菌及对抗菌药物的耐药率。结果:分离出196株病原菌,其中痰标本分离出140株,占71.4%株,其余分别分离自血液、胸腔积液、肺穿刺组织学标本。A组134株病原菌中:真菌感染54株,革兰阴性杆菌34株(其中14株为ESBL表型阳性菌, 4株ESBL表型阳性菌为泛耐药菌株),革兰阳性菌15株(2株MRSA, 2株MRSE), 结核分支杆菌16株,巨细胞病毒14株,46例病例为2种以上病原感染;B组62株病原菌中:革兰阴性菌25株(其中4株为ESBL表型阳性菌,2株ESBL表型阳性菌为泛耐药菌株)、结核分枝杆菌20株、真菌11株、革兰阳性菌6株(1株MRSA),16例为2种以上病原感染。结论:艾滋病合并重症肺炎感染病原菌以革兰阴性杆菌为主,常合并2种或上2种多种病原菌感染,与肺结核合并重症肺炎患者比较,耐药现象明显。药敏试验结果可以为临床用药提供一定参考。