Tuberculosis antigen A60 serodiagnosis in tuberculous infection: Application in extrapulmonary and smear-negative pulmonary tuberculosis

Abstract An ELISA diagnostic test for tuberculosis antigen A60 (TBA60) IgG/IgM was used in a tertiary referral hospital in Taiwan. From June 1992 to December 1993, serum samples obtained from 907 patients were analyzed for TBA60 IgG and IgM titres. The final diagnosis of these patients was confirmed by microbiological study and clinical follow up for 18–24 months. Among 147 patients with active pulmonary tuberculosis, IgG was positive in 112 (76.2%), IgM was positive in 14 (9.52%). Among 90 patients with active extrapulmonary tuberculosis, IgG was positive in 53 (58.9%), IgM was positive in 9 (10%). Among 153 patients with inactive tuberculosis, IgG was positive in 28 (18.3%), IgM was positive in 1 (0.6%). Among 517 patients with nontuberculous disease, IgG was positive in 50 (9.7%), IgM was positive in 3 (0.6%). In this study population with 26% (237/907) active tuberculous infection rate, the TBA60 ELISA IgG had a diagnostic sensitivity of 69.6% and a specificity of 92.1%. These results indicate a positive predictive value of 67.9% and a negative predictive value of 89.2%. The sensitivity of IgM was 10.5% and specificity, 99.4%. The serum IgG titre had good correlation with the extent of pulmonary disease. Patients with smear-positive pulmonary TB had a higher percentage of IgG seropositivity (83.9%) than those with smear-negative pulmonary TB (70.6%) and extrapulmonary TB (58.9%). In 50 cases with active tuberculosis, follow- up examinations were carried out one month after treatment. In 18 cases with initially negative IgG and IgM titres, 13 showed elevation of serum IgG titres into positive level, one had positive seroconversion of IgM which was the only serological marker indicating active infection. Therefore, 77.8% (14/18) gained diagnostic benefit from follow-up serological examination. It was concluded that TBA60 IgG and IgM ELISA is a useful test when diagnosing tuberculosis. This test also assists in the clinical judgement of tuberculosis when used as an adjunct to symptoms and sputum smear, and for monitoring therapeutic response at the commencement of treatment.     

Isolation and characterisation of in vivo released 41 kDa mycobacterial antigen in pulmonary and bone and joint tuberculosis and its identification with H37Ra in vitro released antigen.

OBJECTIVE: To isolate and characterise in vivo released 41 kDa mycobacterial antigen in pulmonary and bone and joint tuberculosis (TB) and its identification with in vitro released ES-41 kDa antigen. DESIGN: Circulating antigen was isolated from confirmed pulmonary tuberculosis serum (PTS) and bone and joint tuberculosis serum (BJS) by trichloroacetic acid precipitation and further fractionation by fast-protein liquid chromatography (FPLC). RESULTS: Fractionation of PTS and BJS by gel filtration column gave six protein fractions each. PTS-G3 and BJS-G3 showed maximum antigenic activity with ELISA. Further fractionation of PTS-G3 and BJS-G3 on cation exchange FPLC gave four different fractions each, of which BJS-G3B was seroreactive similarly to in vitro released 41 kDa antigen (ES-41) isolated from culture medium, whereas PTS-G3C was slightly less seroreactive. BJS-G3B could inhibit binding of in vitro released ES-41 to affinity purified antibodies in inhibition ELISA at lower concentrations than PTS-G3C (2 vs. 20 ng/ml), showing the identical nature of the antigens. Biochemical characterisation showed that circulating antigen PTS-G3C, BJS-G3B and in vitro released ES-41 antigen were lipoproteins in nature. CONCLUSION: This study helped to demonstrate the presence of 41 kDa antigen in the serum of pulmonary and bone and joint TB patients and its identification with H37Ra in vitro released 41 kDa antigen.     

Isolation and characterization of a 31 kDa mycobacterial antigen from tuberculous sera and its identification with in vitro released culture filtrate antigen of mtb H37Ra bacilli

Antigens released in vivo are of considerable interest in the immunodiagnosis of infectious diseases. Circulating antigen was isolated from bacteriologically confirmed tuberculous sera by ammonium sulphate precipitation. The protein fraction between 36%, and 75%, ammonium sulphate was reactive with tuberculosis (TB) sera showing the presence of circulating tubercular antigen (CTA). Fractionation of CTA on ultrogel AcA 34 gel filtration column gave 3 protein fractions CTA1, CTA2 and CTA3. CTA2 showed maximum antigenic activity by sandwich enzyme-linked immunosorbent assay (ELISA). SDS-PAGE fractionation and seroreactivity studies showed the presence of highly reactive tubercular antigen in CTA2-7 protein fraction by sandwich ELISA. Further fractionation of CTA2-7 on cation exchange fast-protein liquid chromatography (FPLC) gave 4 antigenic fractions, of which CTA2-7D was seroreactive similar to 31 kDa antigen (ESAS-7F) isolated from in vitro culture medium. Furthermore, CTA2-7D could inhibit binding of in vitro released ESAS-7F to affinity purified antibodies in inhibition ELISA. CTA2-7D antigen may be used as a target antigen in confirming active tubercular infection. Biochemical characterization showed circulating antigen CTA2-7D to be a lipoglycoprotein is released in vivo. ESAS-7F as a glycoprotein is released in vitro culture.     

Purification and characterization of a 31 kDa mycobacterial excretory-secretory antigenic protein with a diagnostic potential in pulmonary tuberculosis

Proteins secreted into the culture medium by Mycobacterium tuberculosis are shown to be a source of antigens of immunodiagnostic importance. In our earlier study, we had reported a 31-37 kDa seroreactive gel-eluted antigenic fraction (ESAS-7), isolated from culture filtrate proteins of Mycobacterium tuberculosis H37Ra. In this report, we describe further purification of excretory-secretory ESAS-7 antigen fraction by fast protein liquid chromatography (FPLC) on Resource 'S' cation-exchange column and isolation of a more active and purified protein antigen fraction ESAS-7F. ESAS-7F antigen was characterized as a 31 kDa molecular weight glycoprotein containing a metallo-serine protease activity. N-terminal sequence analysis showed the first five amino acids as NTGQS (Asp-Thr-Gly-Glu-Ser). The present study helped in the isolation of a well characterized 31 kDa mycobacterial glycoprotein antigen with protease activity and diagnostic potential in detection of tuberculosis infection.     

Diagnosis of tuberculous lymphadenitis in Butajira,rural Ethiopia

Tuberculous lymphadenitis (TBLN) is a diagnostic challenge in sub-Saharan Africa, where there is a high rate of human immunodeficiency virus (HIV) infection. This study aimed to find ways to improve the diagnosis in Butajira, rural Ethiopia, where TBLN constitutes 40% of the total tuberculosis (TB) diagnosis. Among 147 clinically suspected cases, 107 (72.8%) were confirmed as TBLN by fine-needle aspiration (FNA) cytology and acid-fast bacillus (AFB) smear examination. Of the remaining 40 cases, denoted non-tuberculous lymphadenitis (NTBLN) after this smear examination, 37 (92.5%) showed a cytological pattern with neutrophil aggregates. The clinical manifestations were similar and cervical lymph nodes were the most affected in these 2 groups. 24 of the 107 TBLN cases (22.4%) and 9 (22.5%) of the other cases were seropositive for HIV infection (p > 0.5). FNA cytology combined with AFB smear examination is a good alternative to histology in rural Ethiopia where the expertise in taking biopsies is very limited. Polymerase chain reaction for Mycobacterium tuberculosis complex DNA was positive in 15 of 23 cases tested with NTBLN cytology, showing that an additional independent criterion for the presence of M. tuberculosis is needed for diagnosis in lymphadenitis cases of this kind. These findings could help to strengthen the diagnostic algorithm suggested by the National TB Control Program.     

结核抗体lgG/lgM检测在肺结核和肺外结核中的诊断价值

目的 探讨异种血清抗体检测技术在结核病诊断中的应用价值。方法 采用IgG/IgM抗体试剂盒分别检测102例结核病患者(包括73例肺结核和29例肺外结核)、223例其他肺部疾病患者和100例对照者结核感染情况,以临床诊断为标准评价该方法的敏感度和特异性,同时分别与痰菌培养及痰涂片平行检验的结果作比较,统计学分析采用χ²检验。结果 结核抗体IgG/IgM检测结核病患者的敏感度为74.51%、特异度为91.64%。结核抗体IgG/IgM检测肺结核和肺外结核的敏感度分别为82.19%、55.17%,肺内和肺外结核的敏感度差异有统计学意义(P＜0.05),结核抗体lgG/IgM检测结核患者阳性检出率明显高于痰培养法和痰涂片法(P<0.05)。102例结核病患者年龄段分组分析,少年组和老年组检出率分别为58.33%、36%,远低于青年组和中年组的96.15%和89.74%。不同年龄组间进行卡方比较分析显示,P＜0.05,差异有统计学意义。425例标本中,共发现8例非结核分枝杆菌,其中6例胞内分枝杆菌, 2例脓肿分枝杆菌,lgG/lgM抗体检测均为阴性。结论 IgG/IgM血清抗体检测肺内、外结核具有快速方便、经济和较高的敏感度,适合用于临床结核筛查。     

肺结核住院患者并发肺外结核状况及其与性别和年龄相关性的多中心研究

目的 探讨住院肺结核患者并发肺外结核的发生情况及其与性别、年龄的关系。方法 采用观察性研究方法,由参加过统一培训的调查员从医院信息管理系统(HIS系统)收集2011年1月1日至2017年12月31日我国15省21家医疗机构360187例住院肺结核患者的性别、年龄,以及结核病灶累及部位等信息,比较分析肺结核患者并发肺外结核的发生情况及其与性别、年龄的关系。 结果 360187例肺结核患者中,男238910例(66.33%),女121277(33.67%),年龄中位数(四分位数) [M(Q₁,Q₃)]为47(28,62)岁;42987例(11.93%)并发肺外结核,并发率依次为结核性脑膜炎[2.72%(9809例)]、颈部淋巴结结核[1.93%(6966例)]、结核性腹膜炎[1.59%(5733例)]、结核性心包炎[0.94% (3399例)]、肠结核[0.94%(3380例)]等。男性肺结核患者并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、结核性心包炎、结核性多浆膜炎、腰椎结核、胸椎结核、胸壁结核的并发率分别为2.44%(5829例)、1.44%(3429例)、1.41%(3376例)、0.90%(2138例)、0.75%(1791例)、0.67%(1604例)、0.64%(1522例)、0.60%(1438例),均明显低于女性[分别为3.28% (3980例)、2.92% (3537例)、1.94% (2357例)、1.04% (1261例)、0.90% (1093例)、0.79% (960例)、0.76% (924例)、0.66% (805例)](χ ²=215.235,930.541,144.480,18.061,23.272,16.442,18.585,4.976;P值均<0.05)。不同年龄组(1~岁组至≥65岁组)肺结核患者并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、肠结核、结核性心包炎、结核性多浆膜炎、腰椎结核、胸椎结核、胸壁结核、咽喉结核的并发率差异均有统计学意义(χ ²=3870.549,2939.502,1830.620,673.372,115.428,319.078,52.512,19.308,439.177,136.619;P值均<0.05)。除胸椎结核的并发率未呈现出随年龄变化的趋势($\chi^{2}_{趋势}$=0.814, P=0.367),结核性心包炎呈现出随年龄增长而增高的趋势 ($\chi^{2}_{趋势}$=62.087,P<0.001)外,其他肺外结核的发生率均呈现出随年龄增长而降低的趋势 (P值均<0.001)。多因素logistic回归分析结果显示,肺结核并发肺外结核患者的风险女性高于男性[OR(95%CI)=1.325(1.297~1.353)];其他各年龄组风险均高于≥65岁年龄组[1~岁组、15~岁组、25~岁组、35~岁组、45~岁组、55~岁组的OR(95%CI)值分别为:4.995(4.655~5.360)、2.481(2.397~2.568)、2.053(1.982~2.126)、1.683(1.619~1.749)、1.276(1.228~1.326)、1.109(1.067~1.153)];在控制了性别的影响后,肺结核并发肺外结核患者的风险随年龄的增长而降低[OR(95%CI)=0.817(0.812~0.821)]。结论 肺结核患者可并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、结核性心包炎和肠结核等多种肺外结核;且并发肺外结核的风险女性高于男性,并呈现出随年龄的增长而降低的趋势。     

结核感染T细胞斑点试验在不同患者群中的检测结果分析

目的 探讨影响结核感染T细胞斑点试验(T-SPOT.TB)检测结果的因素。方法收集2014年5月至2015年4月同济大学附属上海市肺科医院共1537例住院患者的临床资料。以《临床诊疗指南:结核病分册》的标准将患者分为临床诊断结核病组(1159例)和临床诊断非结核病组(378例);再经病原学诊断及随访排除不能做出最终诊断的39例患者后,将患者分为结核病组(1103例;包括经分枝杆菌培养及菌种鉴定确诊的229例和最终临床诊断的874例)和非结核病组(395例;包括既往有结核病史或肺部存在陈旧性病灶者94例,无病史者301例);1103例结核病组患者中,肺结核557例,结核性胸膜炎107例,淋巴结结核16例,骨关节结核51例,脑结核7例,多组织器官结核363例,其他肺外结核2例;395例非结核病组患者中,经分枝杆菌培养及菌种鉴定确诊的非结核分枝杆菌(NTM)感染患者93例。回顾性分析临床诊断结核病组和结核病组患者T-SPOT.TB检测结果的敏感度、特异度,结核病组与非结核病组患者T-SPOT.TB检测反应强度,不同结核病类型T-SPOT.TB检测阳性率,以及NTM感染患者与结核病患者的年龄差异。结果 (1)临床诊断结核病组T-SPOT.TB检测的敏感度为81.97% (950/1159)、特异度为53.44%(202/378);结核病组T-SPOT.TB检测的敏感度为83.77%(924/1103)、特异度为54.43%(215/395);结核病组中抗酸染色阳性患者T-SPOT.TB检测阳性率为90.73%(235/259);培养阳性患者T-SPOT.TB检测阳性率为92.58%(212/229)。(2)非结核病组有结核病史或肺部显示陈旧性结核病灶的患者与无病史者T-SPOT.TB检测的阳性率分别为69.15%(65/94)和38.21%(115/301),两组间差异有统计学意义(χ ²=27.65,P=0.000)。(3)结核病组与非结核病组T-SPOT.TB检测结果以斑点计数表示反应强度,结核病组对A、B抗原刺激出现阳性反应(斑点数≥1)的患者中,明显阳性及超强阳性(斑点数≥11)的比率分别为69.81%(652/934)和69.67%(627/900),明显高于非结核病组[分别为46.83%(96/205)和46.63%(83/178)];经曼-惠特尼秩和检验,差异有统计学意义(Z值分别为-14.20、-14.63,P值均<0.01)。(4)1103例结核病组患者中,T-SPOT.TB检测阳性率以淋巴结结核(87.50%,14/16)为最高,随后依次为多组织器官结核(87.33%,317/363)、肺结核(86.54%,482/557)、结核性胸膜炎(74.77%,80/107),脑结核(57.14%,4/7)和骨关节结核(50.98%,26/51)相对较低。(5)T-SPOT.TB检测阳性的NTM感染患者的平均年龄[(53.61±18.43)岁]较T-SPOT.TB检测阳性的确诊结核病患者[(44.98±18.88)岁]高,差异有统计学意义(t=-2.63,P=0.009)。结论 T-SPOT.TB检测结果受结核病诊断依据、痰菌量、既往结核病史或肺部陈旧性结核病灶、NTM感染、结核病灶存在的部位等多种因素的影响;T-SPOT.TB检测用于指导结核病诊断时,需综合考虑各项因素。     

上海市肺外结核的流行病学分析

目的 了解上海市肺外结核的流行病学特征，探讨对其进行监测的意义。方法 根据１９９６￣１９９９年上海市１０个市区所有肺外结核新登记病例资料，分析肺外结核的年龄、性别、患病部位的分布及流行趋势和死亡情况。结果 上海市１９９６￣１９９９年肺外结核新登记率为４．６３／１０万￣５．７８／１０万，肺外结核占全结核的９．７％￣１１．９％，肺外结核死亡占全结核死亡的１４．１％￣１７．６％。肺外结核中以周围淋巴结核     

综合医院以不明原因发热为表现的结核病100例临床分析

目的 探讨以不明原因发热(FUO)为表现的结核病的临床特征.方法 回顾性分析100例北京协和医院确诊的以FUO为表现的结核病患者的临床资料.结果 (1)结核累及部位:单纯肺结核39例,单纯肺外结核28例,肺结核合并肺外结核33例.(2)临床表现:由于累及部位的不同,伴随症状各异.实验室检查多为ESR增快和C反应蛋白升高以及不同程度的消耗表现即贫血和低白蛋白血症.(3)诊断方法:抗酸杆菌阳性的34例,组织病理符合结核病的8例,临床诊断并经抗结核治疗有效的49例,诊断性抗结核治疗有效的9例.从发病至确诊的时间为3～77周,中位确诊时间14周.(4)治疗反应:73例随访的患者中仅有2例(2.7%)死亡,其余均好转或治愈.正规抗结核治疗4周以内显效率为77.5%.37例(52.1%)出现药物不良反应,经调整治疗方案和对症处理后均好转.结论 以FUO为表现的结核病诊断比较困难,应对该病临床表现进行综合分析,认真阅读胸部影像学资料,尽可能寻找病原学和病理学的证据,必要时可给予诊断性抗结核治疗.     

Unusual presentation of renal tuberculosis

Urogenital tuberculosis (TB) is a common late manifestation of an earlier symptomatic or asymptomatic pulmonary TB infection. A latency period ranging from 5 to 40 years between the time of the initial infection and the expression of urogenital TB frequently occurs. As one of the most common sites of involvement of extrapulmonary TB, urogenital TB accounts for 15% to 20% of the infections. We present a patient who had culture-negative active tubercular kidney disease due to silent tuberculous infection. Our case demonstrates the limitations of noninvasive testing in establishing the diagnosis of renal tuberculosis.     

结核性脑膜炎100例临床分析

目的探讨成人结核性脑膜炎的临床特点、脑脊液改变、影像学特点、诊治方法及其转归。方法回顾性分析1982年1月至2003年12月间在北京协和医院确诊或临床诊断为结核性脑膜炎的100例住院患者的临床资料。结果100例结核性脑膜炎患者中,男性49例,女性51例;年龄（31±11）岁。70％为慢性病程（11．1±9．2）周。13例确诊病例,脑脊液结核杆菌培养阳性,或开颅脑活检病理证实为结核性肉芽肿或粟粒样结核;87例为临床诊断病例。临床表现以发热（97％）,头痛（92％）、意识障碍（71％）和脑膜刺激征多见（77％）,44例伴颅神经损害,以动眼神经和外展神经受损为主。35例X线胸片有活动性肺结核表现,肺外活动性结核12例,陈旧性肺结核18例。腰穿示颅内压增高者占86％,脑脊液呈非化脓性改变,白细胞增高以淋巴细胞为主,蛋白质明显增高,葡萄糖显著下降。52例患者头颅影像学有异常发现,脑室扩张、交通性脑积水和脑梗死最常见。全部病例均接受抗结核治疗,9例行侧脑室外引流术。81例患者病情好转,4例因合并开放性肺结核转结核病院治疗,8例自动出院,死亡7例。结论慢性脑膜炎若伴发肺结核或肺外结核者应高度疑诊结核性,鉴别诊断和诊断性抗结核治疗有效有助诊断。脑脊液涂片和（或）培养抗酸杆菌／结核分枝杆菌阳性,以及脑活检为诊断的金标准。早期诊断、早期治疗是改善本病预后的关键。     

Detection of free and immune-complexed serine protease and its antibody in TB patients with and without HIV co-infection.

OBJECTIVE: To understand the usefulness of detecting tuberculous IgG antibodies against mycobacterial excretory-secretory 31 kDa serine protease antigen (SEVA TB ES-31) and circulating free and circulating immune-complexed (CIC) serine protease in TB patients with and without HIV infection. DESIGN: Serum was collected from 144 individuals: patients with TB, with TB-HIV co-infection and HIV infection only, and ill and healthy controls. SEVA TB ES-31 antigen, a serine protease isolated from Mycobacterium tuberculosis H37Ra culture fluid, was used in indirect penicillinase ELISA to detect tuberculous antibodies. Similarly, affinity purified anti-ES-31 antibody was used in sandwich ELISA to detect circulating free and CIC serine protease. RESULTS: There was less sensitivity for tuberculous antibody in HIV-infected TB patients (46%) than in those with TB alone (87%) using mycobacterial serine protease. However, the sensitivity of detection of TB in the presence of HIV increased to 87% by concomitant detection of circulating free and CIC serine protease antigen. CONCLUSION: Detection of free and CIC tuberculous serine protease antigen along with antibody is more useful for detecting TB in the presence of HIV co-infection.     

基于CT分型方法的儿童肺结核临床特征分析

目的 分析儿童肺结核CT特征的临床特点。方法 回顾性分析首都医科大学附属北京儿童医院2006年7月至2014年12月经临床诊断并确诊为肺结核的734例患儿的临床资料(包括年龄、性别、临床表现,疫苗接种史、接触史及实验室检查等),基于CT分型对其CT特征、临床特点进行分析。结果 734例患儿中159例(21.7%)为经病原学检测确诊;CT分型中原发性肺结核和气管、支气管结核最多见(365例,50.4%),并发2种及以上类型者次之(199例,27.3%);3岁以下婴幼儿以原发性肺结核和气管、支气管结核多见(189例,26.1%), 7~14岁青春期儿童以结核性胸膜炎多见(94例,13.0%);并发肺外结核患者以结核性脑膜炎(109例,34.5%)及肺外播散累及2个及以上器官或组织者(103例,32.6%)最多见。192例(26.2%)患儿并发其他疾病或患有基础疾病。结论 不同年龄阶段患儿的肺结核CT分型不同,且常并发肺外结核;儿童肺结核CT表现有其自身特点及年龄分布特点。     

Primary sternal tuberculosis osteomyelitis: A case report and discussion

As immigration to the United States from countries endemic for tuberculosis (TB) increases, the incidence of pulmonary and extrapulmonary TB disease may increase. Primary tuberculous sternal osteomyelitis is one form of extrapulmonary TB that is exceedingly rare throughout the world, and falls under the differential diagnosis for chest wall masses. Management involves standard antituberculous therapy with antibiotics similar to treating other forms of extrapulmonary TB, as well as consideration of surgical intervention depending on the extent of osteomyelitis. A typical case of primary sternal TB osteomyelitis is reported, and the epidemiology, differential diagnosis, clinical manifestations and management are reviewed.     

Tuberculosis and sudden death: a case report and review

Although deaths from tuberculosis (TB) are increasing, TB-related sudden death (TBRSD) is rarely reported in the literature. We present a case report of fatal pulmonary TB with extrapulmonary extension in a patient infected with the human immunodeficiency virus (HIV) and a review of published reports of TBRSD in MEDLINE (1966 to October 2000). Forty-six cases of TBRSD were reported. The most common cause of TBRSD was tuberculous bronchopneumonia in 30 (64%) patients, followed by hemoptysis in 14 (30%) patients. Tuberculous myocarditis and isolated TB of the adrenal glands are seldom causes of TBRSD. The early detection of TB, use of directly observed therapy, and individualization of treatment can be helpful in decreasing the incidence of TBRSD.     

TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test. .

SETTING: Cecilia Makiwane Hospital, Mdantsane, Eastern Cape, Republic of South Africa. OBJECTIVE: To assess the role of the semi-automated Roche COBAS AMPLICOR(TM)Mycobacterium tuberculosis PCR test in the diagnosis of tuberculous meningitis (TBM). DESIGN: Eighty-three specimens of cerebrospinal fluid (CSF) were collected prospectively from 69 patients with suspected TBM. The COBAS AMPLICOR TB PCR test was compared with the manual AMPLICOR(TM)TB PCR test, clinical and cerebrospinal fluid (CSF) findings, direct ZN smear and radiometric TB culture. RESULTS: CSF from 7/40 (17.5%) patients treated for TBM were positive by TB COBAS AMPLICOR(TM). The sensitivity of the test was not significantly different (p=0.375) from the manual TB AMPLICOR(TM)PCR test. The comparative sensitivities of the TB COBAS AMPLICOR(TM)PCR and the manual AMPLICOR PCR for detecting cases of definite and probable TBM from CSF collected within 9 days of commencing antituberculosis treatment were 40% and 60% respectively. All 29 patients not treated for TBM were negative by COBAS AMPLICOR(TM), giving a specificity of 100%. CONCLUSION: The COBAS AMPLICOR(TM)TB PCR test is a rapid and highly specific diagnostic test for TBM. However, there was a non-significant trend favouring slightly greater sensitivity using the manual AMPLICOR(TM)TB PCR test.     

194例结核性胸膜炎合并肺结核病的临床

目的 探讨结核性胸膜炎合并肺结核病的临床及其防治方法。方法 对194例结核性胸膜炎合并肺结核病进行回顾分析。结果 结核性胸膜炎患中合并肺结核病的发生率为23．2％(45／195)；肺内病灶和胸膜炎在同一侧的占53．3％。结论 结核性胸膜炎与肺结核病关系密切，加强初感染结核病早期诊断和治疗，可减少结核性胸膜炎的发病率。     

骨髓结核的诊断和治疗

目的探讨骨髓结核的诊断和治疗。方法对１９９０～１９９７年２４１０例行骨髓活组织检查（活检）病例中诊断为骨髓结核的１１例的临床及病理资料作回顾性分析。结果高热、乏力、消瘦、贫血１１例，腹胀、腹痛４例，腹水３例，肝脾肿大５例。１１例均无骨关节的局部症状与体征。痰涂片抗酸杆菌均阴性，肝功能受损９例，检查的６例血沉均升高，为３０～１６８ｍｍ／１ｈ。胸片示血行播散型肺结核４例，７例胸片未见结核病变。病理检查１１例发现结核性肉芽肿，６例发现干酪样坏死，３例肉芽肿组织抗酸染色查到抗酸杆菌。１０例除有骨髓结核外，尚伴有一种或多种其他部位的结核病变。８例经联合抗结核化疗好转出院，３例死亡。结论骨髓结核是血行播散型结核在骨髓的病变，临床表现缺乏特异性。对长期高热待诊的病例，应考虑血行播散型结核的可能，除了寻找常见的肺部病变外，必要时可考虑行骨髓活检。骨髓结核一经诊断，应立即行联合抗结核化疗     

系统性红斑狼疮伴结核分枝杆菌感染42例临床分析

目的 探讨系统性红斑狼疮(SEE)患者伴结核分枝杆菌感染的临床特点.方法 回顾性分析452例SLE患者在应用糖皮质激素和免疫抑制剂治疗过程中出现结核分枝杆菌感染的临床资料.结果 452例SLE患者中42例(9.29%)在住院期间被确诊为活动性结核,单纯浸润犁肺结核11例(26.19%);肺外结核31例(73.81%),其中有10例(23.81%)未找到结核感染病灶,8例(19.05%)血行播散型肺结核,6例(14.29%)结核性脑膜炎,2例(4.76%)胸腔结核,2例(4.76%)腹腔结核,1例(2.38%)淋巴结核,1例(2.38%)骨结核,1例(2.38%)肾结核.42例结核感染患者有狼疮肾炎38例,血清白蛋白低40例,有结核病史10例,白细胞低14例,血糖升高14例.抗结核治疗起效时间一般在1周以上,最长可达4周.死亡2例,均为血行播散型结核.结论 应用糖皮质激素及免疫抑制剂治疗SLE的过程中,结核分枝杆菌感染的发病率明显升高,以重症结核和肺外结核为多.既往有结核病史、狼疮肾炎等SLE患者,町能易感染结核分枝杆菌.