Xpert结核分枝杆菌/利福平试验对结核病及耐多药结核病诊断价值的Meta分析

目的 评估Xpert结核分枝杆菌/利福平（MTB/RIF）试验对结核病的诊断价值.方法 检索PubMed、Medline、中国知网、万方数据库等,收集Xpert MTB/RIF试验对结核病诊断价值的文献,检索起止时间均为建库至2012年6月.2名研究者独立进行资料提取和文献质量评估.采用Meta-Disc 1.4软件进行Meta分析.结果 共纳入26篇文献,其中2篇文献涉及儿童病例,包含了13 270例来自临床患者的检测标本.Meta分析结果显示,Xpert MTB/RIF试验诊断结核病的汇总敏感度为87%（95%CI：86%～88%）、特异度为97%（95%CI：97%～97%）.按照结核病的类型和患者年龄进行亚组分析,Xpert MTB/RIF试验诊断肺结核的敏感度高于肺外结核病,90%（95%CI：89%～91%） vs 76%（95%CI：72%～79%）;诊断涂阴菌阳性和涂阳菌阳性结核病的敏感度分别为74%（95%CI：71%～76%）和99%（95%CI：98%～99%）;对儿童肺结核的诊断敏感度比成人肺结核低,74%（95%CI：65%～83%） vs 90%（95%CI：89%～92%）.Xpert MTB/RIF试验诊断耐多药结核病的敏感度为96%（95%CI：94%～97%）,特异度为98%（95%CI：98%～99%）.结论 Xpert MTB/RIF试验诊断结核病的价值较高,尤其是成人结核病及耐多药结核病.Xpert MTB/RIF试验在儿童结核病中的诊断价值由于纳入文献较少,尚待进一步研究.     

儿童库欣病研究进展

儿童库欣病与成人病因相同,因垂体ACTH腺瘤或分泌ACTH细胞增生分泌过多ACTH,导致肾上腺皮质增生和高皮质醇状态,产生皮质醇增多症临床表现。儿童库欣病具有与成人不同的临床特征,诊断流程更为复杂,且早期诊断和治疗对于儿童患者获得较好的预后极为重要。     

北京儿童医院2002至2010年结核病住院患儿临床流行病学研究

目的分析结核病住院患儿的临床流行病学特征,为结核病的防治提供帮助。方法回顾性收集2002年1月至2010年12月北京儿童医院（我院）0～17岁的结核病住院患儿,采集性别、年龄、临床表现、结核病接触史、卡介苗接种史和治疗等资料。根据卡介苗接种情况,将结核病患儿分为卡介苗接种组、卡介苗未接种组和卡介苗接种史不详组。并对结核病的类型、接触史和疗效进行评价。采用Logistic回归分析与儿童结核病疗效相关的危险因素。结果研究期间我院共收治结核病住院患儿1212例,其中男性766例（63.2%）,女性446例;年龄2月龄至17岁,中位年龄5.5岁。农村患儿938例（77.4%）,城市患儿274例。①肺结核占45.5%（552例）,肺外结核和血行播散性结核病分别占23.5%（285例）和15.8%（191例）。在肺外结核中,结核性脑膜炎为主要类型,占57.2%（163/285例）。②0～3岁509例（42.0%）、～6岁158例（13.0%）、～12岁370例（30.5%）、～17岁175例（14.4%）。重症结核病主要见于1岁以下儿童,随着年龄增长,其所占比例逐渐减少。③卡介苗接种组重症结核病比例（26.9%,180/670例）低于卡介苗未接种组（34.4%,170/494例）,P=0.004。④有结核病密切接触史患儿中重症结核病比例（43.7%,159/364例）高于无结核病密切接触史者（34.6%,280/809例）,P=0.003。⑤好转或治愈989例（81.6%）,未愈或死亡223例。女性患儿治疗成功率（77.8%,347例）低于男性（83.8%,642例）,P=0.015;肺结核治疗成功率最高（84.2%,465/552例）,血行播散性结核病治疗成功率最低（73.8%,141/191例）,P=0.006。结论儿童结核病主要见于4岁以下患儿,与成人结核病相比,儿童更易发生肺外及重症结核病,且重症结核病及女性患儿抗结核治疗效果较差;卡介苗对重症结核病具有一定的免疫保护作用。     

儿童重症结核病相关危险因素分析

目的调查分析与儿童重症结核病相关的危险因素。方法回顾性研究2002年1月至2010年12月北京儿童医院住院病人中诊断为结核病的0-17岁儿童结核病病例,并对可能影响儿童患重症结核病的危险因素进行单因素及多因素的logistic回归分析。结果年龄、卡介苗接种、结核病接触史及PPD试验4项研究因素P值小于0.05,OR值及95%可信区间分别为：0.716（0.650-0.789）,0.606（0.468-0.784）,1.483（1.131-1.945）和0.417（0.317-0.549）。结论小于1岁、未接种卡介苗、有结核病密切接触史及PPD试验结果阴性是儿童重症结核病的独立危险因素。     

ELISPOT检测技术在儿童结核病诊断中的应用

为了评价ELISPOT试验在儿童结核病诊断中的应用价值,采用以结核分枝杆菌特异性蛋白ESAT-6和CFP-10(culture filtrate protein-10)为抗原的ELISPOT试验技术,检测了42例非结核性肺疾病患儿和27例活动性结核病患儿体内特异性T淋巴细胞分泌的γ-干扰素水平,评价其在儿童活动性结核病和潜伏结核感染中的敏感性和特异性,并将结果与结核菌素皮试结果(PPD)进行比较;同时分析了该试验的各影响因素.结果显示,ELISPOT试验的敏感性为88.9%,特异性(97.6%)高于PPD(81%,P﹤0.05);与PPD试验结果结合分析,其诊断阳性率为96.3%.此外,ELISPOT试验结果与性别、年龄、BCG接种史、结核病接触史、机体免疫状态、PPD直径和感染部位等影响因素之间的相关性进行了初步探讨.实验结果提示ELISPOT试验适宜作为儿童PPD试验初筛后结核病诊断的重要辅助工具.     

抗原诱发的γ干扰素测定在结核诊断中的应用

目的 探讨结核分枝杆菌特异性抗原早期分泌抗原靶6000(ESAT-6)体外诱发的γ干扰素反应在结核感染和结核病诊断中的价值.方法 外周全血中加入ESAT-6抗原,诱导产生γ干扰素,以酶联免疫吸附法测定γ干扰素浓度,以增加的百分率为ESAT-6抗原诱发的γ干扰素反应值.进行下列研究:对比结核密切接触者(60例)、痰培养证实的结核患者(46例)以及健康人(55例);追踪调查儿童(68例)、青少年(52例)、老年(45例);治疗过程中动态观察20例结核患者;比较HIV(+)TB(+)者(78例)和HIV(+)TB(-)者(60例).结果 结核密切接触者与痰培养证实的结核患者ESAT-6反应具有很高的敏感性;儿童与青少年ESAT-6反应与临床诊断和预后具有很高的一致性;65%的结核患者在治疗过程中ESAT-6反应呈下降趋势;ESAT-6反应在HIV(+)TB(+)的诊断中敏感度为87.2%.结论 体外ESAT-6诱发的γ干扰素测定对活动性结核病尤其是儿童和青少年结核病的诊断有一定意义,也可用于鉴别HIV阳性者合并结核.     

PCR检测结核杆菌DNA的临床应用

聚合酶链反应(PCR)自1989年引入结核病诊断以来,已成为结核病细菌学诊断中关注的焦点.为结核病的早期诊断、治疗、预防开拓了新领域,因此我们采用聚合酶链反应技术检测结核菌特异性DNA片段,现报告如下.     

儿童常见淋巴造血系统肿瘤的诊断和鉴别诊断和鉴别诊断

儿童的多数恶性肿瘤,包括实体瘤与非实体瘤,在病理学上大多表现为一致性小细胞(母细胞)组成的肉瘤,以往称为"小蓝细胞肉瘤",其病理诊断有时十分困难.近年来由于免疫组织化学、流式细胞术和基因重排、染色体易位检测技术的发展,儿童的小细胞肉瘤的诊断与鉴别诊断有了巨大的进展,同时带来治疗上的进步.目前多数儿童的淋巴瘤/白血病是可以治愈的.可以说儿童淋巴瘤/白血病,尤其是实体瘤的诊断与治疗领先于成人肿瘤.     

儿童常见淋巴造血系统肿瘤的诊断和鉴别诊断

儿童的多数恶性肿瘤，包括实体瘤与非实体瘤，在病理学上大多表现为一致性小细胞（母细胞）组成的肉瘤，以往称为“小蓝细胞肉瘤”，其病理诊断有时十分困难。近年来由于免疫组织化学、流式细胞术和基因重排、染色体易位检测技术的发展，儿童的小细胞肉瘤的诊断与鉴别诊断有了巨大的进展，同时带来治疗上的进步。目前多数儿童的淋巴瘤／白血病是可以治愈的。可以说儿童淋巴瘤／白血病，尤其是实体瘤的诊断与治疗领先于成人肿瘤。     

成人失神癫痫临床及脑电图分析

目的：探讨成人失神癫痫临床及脑电图特征,为治疗和评估预后提供依据.方法：对2005年10月至2009年10月在我院接受检查和治疗的18例成人失神癫痫进行回顾性分析,总结其临床表现和脑电图特征.结果：符合成人失神癫痫诊断的患者18例,其中在成人期发病6例（起病年龄18-35岁） 儿童青少年失神癫痫未治疗、非正规治疗或延续治疗至成人期的12例.结论：成人失神癫痫临床发作隐蔽,多以亚临床发作为主,特征性脑电图表现对其具有诊断意义,正确诊断对于合理用药及客观判断其预后具有重要意义.     

Tuberculosis in children—is PCR the diagnostic solution?

Polymerase chain reaction (PCR) has been recently incorporated as a diagnostic tool for the diagnosis of tuberculosis. The benefit of rapid results and greater sensitivity compared with traditional microbiological methods makes PCR a suitable technique in childhood tuberculosis, especially when diagnosis is difficult or when urgent diagnosis is needed. However, the possibility of false-positive results must be considered, especially if the clinical and epidemiologic context of the child make the diagnosis of tuberculosis improbable. The commercial 'Amplicor PCR test' lacks good sensitivity and specificity and it would be necessary to develop other commercial easy-to-use PCR kits that provides better yield.     

Analysis of the diagnostic criteria used in childhood tuberculosis in a Cote d'Ivoire hospital

Based on a retrospective study the authors analyzed the diagnostic criteria used in pediatric department in Yopougon CHU (teaching hospital), from January 1996 to December 2002. Fifty children, aged of 1 month to 15 years, have been studied. The tuberculosis contact was found in 18%. The diagnosis of tuberculosis was accurate in 32% and it was based on presumptive arguments in 68%. The pulmonary examination and pulmonary radiographs seem to be good criteria for the tuberculosis diagnosis. The pulmonary examination found an abnormality in 96%, and the radiographs found a pathological picture in 85% of cases. The skin test was positive in 42%. The Ziehl-Neelsen coloration was used to look for the acid-fast bacilli and it was positive in 41%. But the two last examinations were not reliable in the case of HIV infection. The skin test which is very important for the diagnosis of tuberculosis is often negative among HIV infected children because of their anergy. On the other hand, the Ziehl-Neelsen coloration is based on the recognition of the acid-fast bacillus, which is not specific of the Mycobacterium tuberculosis. In our area the prevalence of HIV/AIDS is high, the atypical pneumonia with Mycobacterium were also frequent and may reveal a wrong positive diagnosis for the tuberculosis diagnosis, as they are also acid-fast bacillus.     

Potential role of blood microRNAs as non-invasive biomarkers for early detection of asymptomatic coronary atherosclerosis in obese children with metabolic syndrome

The pandemic of the childhood obesity represent a major public health problem all over the world. This leads to detection of many health conditions that were previously considered an adulthood diseases. The rise in the prevalence of the obesity and overweight among children means that the world will face an explosion in the prevalence of the metabolic syndrome (MS), which increases the risk of atherosclerotic disease and death in adulthood. The atherosclerotic process has proved to develop silently for decades during childhood and adolescence before the cardiovascular complications such as myocardial infarction and stroke occur. This means that obese children especially with MS could have heart attacks and suffer from heart disease in an age when they should be very healthy, but most of these data either derived from autopsy findings or studies that confirmed the presence of peripheral atherosclerosis. Very early detection of coronary atherosclerosis in obese children with metabolic syndrome through a non invasive method will be of great importance, allowing for early therapeutic intervention. The discovery of microRNAs (miRNAs) is considered a major scientific breakthrough in the last years; recent studies have suggested a potentially important role of miRNAs in the control of diversity aspects of cardiac functions in health and disease including coronary atherosclerosis. Moreover, circulating miRNAs profiles recently used as a non-invasive biomarker for diagnosis of multiple cardiovascular diseases. The identification of distinct circulating miRNA profiles may impact the development of specific miRNAs as biomarkers in pediatric cardiovascular diseases. Therefore, we postulate that some of these circulating miRNAs may be a potential biomarker for early non-invasive diagnosis of coronary atherosclerosis in very early asymptomatic stage in obese children with metabolic syndrome, giving an excellent chance to fight against the first killer in the adult population in childhood period.     

Potential role of blood microRNAs as non-invasive biomarkers for early detection of asymptomatic coronary atherosclerosis in obese children with metabolic syndrome

The pandemic of the childhood obesity represent a major public health problem all over the world. This leads to detection of many health conditions that were previously considered an adulthood diseases. The rise in the prevalence of the obesity and overweight among children means that the world will face an explosion in the prevalence of the metabolic syndrome (MS), which increases the risk of atherosclerotic disease and death in adulthood. The atherosclerotic process has proved to develop silently for decades during childhood and adolescence before the cardiovascular complications such as myocardial infarction and stroke occur. This means that obese children especially with MS could have heart attacks and suffer from heart disease in an age when they should be very healthy, but most of these data either derived from autopsy findings or studies that confirmed the presence of peripheral atherosclerosis. Very early detection of coronary atherosclerosis in obese children with metabolic syndrome through a non invasive method will be of great importance, allowing for early therapeutic intervention. The discovery of microRNAs (miRNAs) is considered a major scientific breakthrough in the last years; recent studies have suggested a potentially important role of miRNAs in the control of diversity aspects of cardiac functions in health and disease including coronary atherosclerosis. Moreover, circulating miRNAs profiles recently used as a non-invasive biomarker for diagnosis of multiple cardiovascular diseases. The identification of distinct circulating miRNA profiles may impact the development of specific miRNAs as biomarkers in pediatric cardiovascular diseases. Therefore, we postulate that some of these circulating miRNAs may be a potential biomarker for early non-invasive diagnosis of coronary atherosclerosis in very early asymptomatic stage in obese children with metabolic syndrome, giving an excellent chance to fight against the first killer in the adult population in childhood period.     

Antibody Responses to Mycobacterial Antigens in Children with Tuberculosis: Challenges and Potential Diagnostic Value

The identification of easily detectable biomarkers for active tuberculosis (TB) is a global health priority. Such biomarkers would be of particular value in childhood TB, which poses greater diagnostic challenges than adult TB. Serum antibodies can be detected by simple formats that provide extremely rapid results. However, attempts to develop accurate serodiagnostic tests for TB have been unsuccessful. Whereas antibody responses to mycobacterial antigens in adult TB have been studied extensively and reviewed, the same cannot be said for serologic data in pediatric populations. Here we appraise studies on serological responses in childhood TB and discuss findings and limitations in the context of the developing immune system, the age range, and the spectrum of TB manifestations. We found that the antibody responses to mycobacterial antigens in childhood TB can vary widely, with sensitivities and specificities ranging from 14% to 85% and from 86% to 100%, respectively. We conclude that the limitations in serodiagnostic studies of childhood TB are manifold, thereby restricting the interpretation of currently available data. Concerns about the methodology used in published studies suggest that conclusions about the eventual value of serodiagnosis cannot be made at this time. However, the available data suggest a potential adjunctive value for serology in the diagnosis of childhood TB. Despite the difficulties noted in this field, there is optimism that the application of novel antigens and the integration of those factors which contribute to the serological responses in childhood TB can lead to useful future diagnostics.     

Childhood tuberculosis: an ancient disease in the youngest generation in the 21st century from epidemiological point of view

Childhood tuberculosis (TB) has distinct epidemiological and clinical features. TB burden in children worldwide and in Croatia, the risk of infection and disease, as well as disease characteristics, sources of infection in children, diagnostic difficulties, impact of HIV on pediatric tuberculosis, limits of BCG-vaccine and program implications are discussed in this paper. Children younger than 15 years account for 15%-20% of global TB burden, which is often associated with severe TB-related morbidity and mortality. Childhood TB is rarely sputum-smear positive on microscopy. That is probably the reason for the lower priority traditionally given to children by TB control programs compared to that of adult disease. Young children are at a high risk of rapid progression from infection to disease, reflecting recent transmission rather than secondary reactivation. Therefore, the pediatric burden potentially provides a useful measure of current transmission within a community and it is a good indicator of the efficacy of TB control achieved in a particular community. Strict contact tracing and use of preventive chemotherapy is important to reduce TB-related suffering of children. Untreated latent TB infection in children provides the seed of the epidemic for the next generation. Evidence of an adult TB index case is a clue for diagnosis of childhood TB in low-endemic countries. Prognosis of early detected and properly treated TB is excellent. Consequently, new diagnostic methods and treatment options are an imperative. Among HIV-coinfected children, the optimal timing for highly active antiretroviral therapy initiation and drug combinations that have minimal interactions with anti-TB drugs need to be further explored. The most effective vaccine, suitable even for HIV-infected children, remains the need for successful prevention at the global level. The Stop TB Strategy, which builds on the previous Directly Observed Treatment Short-Course Strategy (DOTS) developed by the World Health Organization, has a critical role in reducing the worldwide burden of the disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. In addition to reducing the burden of adult TB, attention to childhood nutrition and improvement of socioeconomic conditions of communities is likely to have an impact on TB transmission to children.     

Cytodiagnosis of tuberculosis of the skull by fine needle aspiration cytology: a case report

Close to one-third of the world's population is believed to be infected with tuberculosis, with the vast majority being in the developing world. However, even in the developed world, the incidence of this disease has been steadily increasing. Tuberculosis is very common in the Indian subcontinent, but at the same time tuberculous infection of the skull is rare and very few cases have been reported. We report a child who presented with a swelling of the frontal bone of the skull. Fine needle aspiration yielded the cytological diagnosis of tuberculosis on the basis of a necrotising granulomatous process with acid-fast bacilli detected on Ziehl Neelsen stain. This procedure obviated the need for an operative procedure and the patient responded to anti-tuberculous therapy. As the incidence of tuberculous infection is on the increase, both in the developed and in the developing world, the importance of diagnosis by newer non-invasive techniques like fine needle aspiration cytology cannot be overemphasized. To the best of our knowledge, this is the first report of its kind in the world literature.     

The nodular form of hepatic tuberculosis: a review with five additional new cases

BACKGROUND: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare. A greater awareness of this rare clinical entity may prevent needless surgical intervention. AIMS: To help characterise this distinctly rare presentation of tuberculosis, five new cases are presented, together with a review of the world literature. The clinical, laboratory, radiological, and pathological features of these patients are described. METHODS: Polymerase chain reaction (PCR) assay of the liver tissue was carried out in all cases to confirm an aetiological diagnosis of Mycobacterium tuberculosis infection. RESULTS: All five patients (44-71 years old; two women, three men) underwent surgery, and had a preoperative diagnosis of malignant hepatic neoplasm and a postoperative histological diagnosis of chronic granulomatous inflammation, suggestive of tuberculosis. None of them had a known previous history of tuberculosis. All of them were positive for M tuberculosis by PCR analysis of the liver tissue. CONCLUSIONS: This report illustrates the difficulty in reaching a correct preoperative diagnosis. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver, especially when it coexists with other malignancies. A high index of suspicion is required for diagnosis, which can be made only by histological and bacteriological studies, and PCR analysis.     

Tuberculosis: socio-medical aspects

Tuberculosis is an ubiquitous infection. The epidemiological situation is now critical. 2.5 million people die every year in the world due to different types of tuberculosis. In Russia, tuberculosis morbidity and mortality are also on the increase. Clinical manifestations of the disease became grave while the treatment less efficient. The key element in tuberculosis pathogenesis is interaction between bacteria, T-lymphocytes and macrophages with cytokines participation this resulting in elimination of the bacteria and formation of hypersensitivity. One of the main control mechanisms may be macrophage apoptosis in the center of the granulomas following with caseous necrosis. Methods of molecular biology open new perspectives in diagnosis, understanding of pathogenesis and tuberculosis treatment.     

Tuberculous meningo-encephalitis in pediatrics. Considerations on 71 cases (1968-1993)

The tuberculous meningitis is an uncommon but severe complication of the tuberculosis mainly in childhood. Neurological sequelae are frequent and high mortality rate, till now, occurs. We reviewed the medical records of 71 cases and we evaluated the most frequent symptoms before the admission and signs and symptoms on the admission according to prognosis. An early diagnosis and specific anti-tuberculous treatment are essential in order to prevent permanent neurological sequelae and fatal outcome