结核蛋白芯片对肺结核诊断的临床价值

目的　探讨结核蛋白芯片、痰涂片抗酸染色及结核菌素(PPD)皮试单独和联合检测对肺结核患者临床诊断的意义。方法 对45例肺结核和30例非结核性肺疾病患者,同时进行结核蛋白芯片、痰抗酸杆菌直接涂片、PPD皮试,观察单项和联合指标对诊断肺结核的敏感性与特异性。结果 结核蛋白芯片、PPD及痰涂片的敏感性分别为66.7%、44.4%、22.2%,特异性分别为93.3%、84.6%、100%。结核蛋白芯片联合PPD对肺结核的阳性检出率为86.7%,结核蛋白芯片联合PPD及痰涂片的阳性检出率提高到88.9%,与单项检测的最高阳性检出率相比差异有显著性意义(P<0.05)。三种方法联合检测的特异性为80%,与PPD或结核蛋白芯片单项检测相比无显著性差异(P>0.05)。结论 结核蛋白芯片是诊断结核病较有效方法,具有快速方便等优点,蛋白芯片联合PPD、痰涂片抗酸染色,能显著提高肺结核的阳性检出率,但特异性并没有明显下降。     

抗结核抗体检测方法及临床意义

目的 探讨抗结核抗体检测技术在临床诊断中的应用价值.方法 对1823例确诊肺结核患者、580例非结核病的其他呼吸系统疾病患者及500名健康体检者进行抗酸染色法、酶联免疫吸附试验(ELISA)法、金标法及蛋白芯片法检测,并进行相关统计分析.结果 ELISA法、金标法及蛋白芯片法对肺结核患者的检出敏感性分别为59.1%、62.7%和71.2%,均显著高于抗酸染色(18.4%).蛋白芯片法对抗酸染色阴性肺结核患者的抗结核抗体检出率为67.9%.结论 3种结核抗体检测技术均可用于肺结核的快速辅助诊断.相对于ELISA法及金标法而言,蛋白芯片法敏感性和特异性更高,对痰菌阴性肺结核患者的辅助诊断更具积极意义.     

痰结核分枝杆菌DNA检测诊断肺结核的临床意义

目的评估痰结核分枝杆菌DNA检测诊断肺结核的可行性及临床意义。方法回顾性分析2016年5月—12月在我科住院的经痰结核分枝杆菌培养确诊的136例肺结核患者的临床资料,比较痰涂片找抗酸杆菌和痰结核分枝杆菌DNA检测2种方法的检出率。结果 136例确诊的肺结核患者中,痰涂片阳性的有64例(47.06%),痰结核分枝杆菌DNA检测阳性的88例(64.71%),痰结核分枝杆菌DNA检测阳性率明显高于痰涂片找抗酸杆菌(P0.05)。72例痰涂片阴性患者中痰结核分枝杆菌DNA检测阳性29例,占痰涂片阴性肺结核患者比例的40.28%。结论痰结核分枝杆菌DNA检测优于痰涂片找抗酸杆菌,能够辅助涂阳肺结核的诊断,并提高涂阴肺结核的诊断水平,是一种快速、敏感的病原学诊断方法。     

4种方法联合检测在菌阴肺结核临床诊断价值的研究

目的　探讨痰聚合酶链反应——微孔板杂交技术(PCR ELISA)、抗脂阿拉伯甘露糖(LAM-IgG)抗体、结核菌素(PPD)1TU皮试以及血清可溶性白细胞介素2受体(sIL-2R)水平,4种方法联合检测对初治菌阴肺结核患者临床诊断的意义。方法 以上述4种方法检测初治菌阳肺结核57例,初治菌阴肺结核58例,非结核肺疾病41例,健康对照36例。分别进行单项与联合检测,观察初治菌阴肺结核的特异性与敏感性。结果 PCR-ELISA、LAM-IgG、TB-PPD及sIL-2R单项检测对菌阴肺结核的阳性检出率依次分别为 43.1%,37.9%,31.0%,50.0%。联合检测对菌阴肺结核的阳性检出率2联、3联及4联依次分别为 56.9%,70.7%,84.5%,与单项检测的最高阳性检出率相比由50.0%提高到84.5%;联合检测的特异性分别为92.2%,88.3%和84.4%。结论 通过4种方法联合检测能显著提高菌阴肺结核的阳性检出率,同时也保持了相对高的特异性。联合检测对于菌阴肺结核的诊断,具有实用意义。     

血T-SPOT.TB联合肺泡灌洗液TbDNA检测对诊断肺结核的应用价值

目的分析血T-SPOT.TB联合肺泡灌洗液(BALF)Tb DNA检测对肺结核诊断的价值。方法选择2013.3~11月86例疑似肺结核患者,经确诊后分为肺结核组46例、肺炎组40例,均行T-SPOT.TB、BALF-Tb DNA、BALF涂片、痰涂片、PPD、结核抗体检测,对各检测结果进行对比,并行T-SPOT.TB与BALFTb DNA联合检测与单用检测、涂片法、PPD、结核抗体对比分析。结果血T-SPOT.TB、BALF-Tb DNA敏感性分别为84.8%、80.4%,特异性分别为80.0%、77.5%,两者联合检测敏感性为100.0%,阳性预测值为97.1%,阴性预测值为100.0%,与单用检测对比,差异有统计学意义(P0.05),与涂片法、PPD、结核抗体对比,存在显著差异(P0.01)。结论血T-SPOT.TB与BALF-Tb DNA联合检测提高了肺结核的诊断阳性率,弥补对方不足,减少肺结核的漏诊、误诊,是一个有前途的检测方法。     

结核菌特异性IFN-γ Elispot检测结核感染情况分析

目的通过结核菌特异性IFN-γElispot检测技术,了解痰涂阳性肺结核患者密切接触者中结核潜伏感染情况。方法应用Elispot技术对1052例痰涂阳性肺结核患者的密切接触者进行外周血结核菌特异性IFN-γ水平检测,同时进行PPD皮试。结果在密切接触者的家庭成员和同事中Elispot的阳性率分别是29.4%和22.1%,PPD强阳性结果是30.5%和8.9%;两者阳性率有统计学意义。其中14例确诊为肺结核患者,发病率为1.3%。结论 Elispot诊断结核感染的特异性高于PPD,用Elispot筛查结核密切接触者,有利于早期发现结核病人。     

快速免疫色谱实验诊断可疑肺结核病人的评价

目的评价基于结核分支杆菌38KDa等五种抗原的快速免疫色谱实验(澳大利亚ICT TB)对可疑肺结核的临床诊断价值?方法以初诊可疑肺结核患者125例为受试对象,同时做痰涂片?培养,血清ICT TB以及胸片检查?结果总的敏感性为45%?特异性为100%?结论此试验不能完全代替痰涂片抗酸染色检查,但二者联合使用,可使敏感性提高到63.6%.     

四种方法诊断涂阴肺结核的临床应用价值探讨

痰涂片查到抗酸杆菌是确诊肺结核病的重要依据。但是我国有50%～70%的活动性肺结核病例痰涂片检查抗酸杆菌阴性,而这些患者可能也是传染源或发展为新的传染源^[1]。由于痰涂片阴性肺结核大多仅以临床症状及X线胸片作诊断,其特异性不高,存在过诊、漏诊等现象。本实验应用噬菌体扩增法（PhaB）及痰培养法检测痰涂片阴性（涂阴）肺结核患者痰标本中结核分枝杆菌,并结合血清结核抗体（LAM-IgG）检测和PPD皮肤试验,探讨其应用于临床诊断的可行性和适用性,报告如下。     

4种方法联合检测在菌阴肺结核临床诊断价值的研究

目的 探讨痰聚合酶链反应——微孔板杂交技术(PCR-ELISA)、抗脂阿拉伯甘露糖(LAM—IgG)抗体、结核菌素(PPD))1Tu皮试以及血清可溶性白细胞介素2受体(sIL-2R)水平，4种方法联合检测对初治菌阴肺结核患者临床诊断的意义。方法 以上述4种方法检测初治菌阳肺结核57例，初治菌阴肺结核58例，非结核肺疾病41例，健康对照36例。分别进行单项与联合检测，观察初治菌阴肺结核的特异性与敏感性。结果 PCR-ELISA、LAM—IgG、TB-PPD及sIL-2R单项检测对菌阴肺结核的阳性检出率依次分别为43．1％，37．9％，31．0％，50．0％。联合检测对菌阴肺结核的阳性检出率2联、3联及4联依次分别为56．9％，70．7％，84．5％，与单项检测的最高阳性检出率相比由50．0％提高到84．5％；联合检测的特异性分别为92．2％，88．3％和84．4％。结论 通过4种方法联合检测能显著提高菌阴肺结核的阳性检出率，同时也保持了相对高的特异性。联合检测对于菌阴肺结核的诊断，具有实用意义。     

结核分枝杆菌TB—SA抗体检测在结核病诊断中价值的研究

目的研究结核分枝杆菌TB—SA抗体检测在结核病诊断中的价值。方法对1232例结核病、非结核病的其他呼吸系统疾患患者及健康志愿者同日寸进行抗酸杆菌涂片、培养、PPD皮试及结核分枝杆菌TB—SA抗体检测。结果①结核分枝杆菌TB—SA抗体检测菌阳肺结核的敏感性为75．1％；菌阴肺结核的敏感性为68．9％；肺外结核病的敏感性为71．2％；诊断结核病的总体敏感性为72．0％，特异性为82．1％。②TB—SA血清抗体检测OD405值并不与PPD值成线性关系，结核分枝杆菌TB—SA抗体检测对结核病人的诊断不受患者卡介苗反应的影响。结论结核分枝杆菌TB—SA抗体检测诊断结核病有较好的敏感性和特异性，是结核病诊断和鉴别诊断的可靠手段。     

Lingual tuberculosis revealing disseminated tuberculosis

INTRODUCTION: Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS: We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION: Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.     

Hypertrophic tuberculosis of vulva--a rare presentation of tuberculosis

The authors report a rare case of hypertrophic vulval tuberculosis of primary origin in a 26-year-old female patient. The diagnosis was mainly based on histopathological examination. Good outcome was obtained with antitubercular chemotherapy supplemented with surgical reduction for aesthetic concern.     

结核分枝杆菌肝素结合血凝黏附素与结核病

结核分枝杆菌肝素结合血凝黏附素是一种表面蛋白,有3个功能结构域,其C末端在翻译后进行甲基化修饰,与其免疫特性相关.可结合硫酸化糖,可通过补体C3介导与巨噬细胞的结合,与上皮细胞结合在肺外结核发病中有重要作用.通过对其细胞免疫及体液免疫作用的研究发现,其在诊断中有较好的作用,在免疫预防及免疫治疗中有广阔的应用前景.     

Present-day treatment of tuberculosis and latent tuberculosis infection

The major objectives of tuberculosis (TB) control are to reduce morbidity and mortality via an early and appropriate treatment of the disease, to prevent carriers of the Mycobacterium tuberculosis bacillus from transmitting it to others, and to prevent latent tuberculosis infection (LTB) sufferers from progressing to the disease. To achieve these objectives, it is imperative to start an appropriate, effective antituberculosis treatment as early as possible, as well as identify contacts of the infected TB patient and others at risk of LTB progressing to TB, in order to establish an appropriate treatment for them. Here we review the bases for treating TB and LTB infections, including those produced by strains resistant to anti-TB drugs.     

Hepatic tuberculosis in absence of disseminated abdominal tuberculosis

Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.