初治涂阳肺结核病人短程化疗方案（含链霉素或含乙胺丁醇）的对比研究

目的 探讨２Ｅ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３（简称含ＥＭＢ方案）和２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３方案（简称含ＳＭ方案）在结核病控制中的利弊。方法 以河北省石家庄市为研究现场，通过回顾、现况和前瞻性研究。结果 含ＳＭ方案与含ＥＭＢ方案在疗效、复发率和全程督导上无差异；含ＥＭＢ方案适用性高于含ＳＭ方案：ＳＭ的副作用显高于ＥＭＢ；链霉素皮试阳性率为４.5%；使用ＳＭ费用高于使用ＥＭＢ８４％；基层消毒合格率为４２.9%，ＳＭ注射不安全；患更愿意接受含ＥＭＢ方案。结论 含ＥＭＢ方案比含ＳＭ方案更适宜于在结核病控制规划中推行。     

初治涂阳肺结核病人短程化疗方案（含链霉素或含乙胺丁醇）的对？…

目的 探讨２Ｅ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３（简称含ＥＭＢ方案）和２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３方案（简称含ＳＭ方案）在结核病控制中的利弊。方法 以河北省石家庄市为研究现场，通过回顾、现况和前瞻性研究。结果①含ＳＭ方案与含ＥＭＢ方案在疗效、复发率和全程督导上无差异；②含ＥＭＢ方案适用于高于含ＳＭ方案；③ＳＭ的副作用显著高于ＥＭＢ；④链霉素皮试阳性率为４．５％；⑤ＳＭ费用高于ＥＭＢ８４％；⑥基层消毒合格     

全程督导短程间歇化疗方案治疗涂阳肺结核近远期效果观察

目的观察全程督导短程间歇化疗方案治疗涂阳肺结核的疗效。方法对１２５例初治和２４９例复治涂阳肺结核患者，分别采用２Ｈ３Ｒ３Ｚ３Ｓ３（Ｅ３）／４Ｈ３Ｒ３（异烟肼：Ｈ，利福平：Ｒ，吡嗪酰胺：Ｅ，链霉素：Ｓ，乙胺丁醇：Ｅ）和２Ｈ３Ｒ３Ｚ３Ｓ３Ｅ３／６Ｈ３Ｒ３Ｅ３化疗方案，实施全程督导化疗、管理。结果总完成治疗率为９９．７％；初、复治患者满疗程痰菌转阴率分别为９６．７％和８４．８％；经３年随访，细菌学复发率初治患者为１．８％，复治患者为１０．２％。结论全程督导短程间歇化疗方案对控制结核病具有简便、经济和高效的实用价值。     

乌体林斯治疗菌阳肺结核的临床观察

目的 观察和评价化疗并用乌体林斯治疗菌阳肺结核的疗效。方法 将１９１例初、复治菌阳肺结核患者随机分为Ａ、Ｂ、Ｃ、Ｄ组，Ａ、Ｃ组（各５０例）分别采用２Ｈ３Ｒ３Ｚ３Ｓ３／４Ｈ３Ｒ３和２Ｈ３Ｒ３Ｚ３Ｅ３Ｓ３／６Ｈ３Ｒ３Ｅ３加乌体林斯方案治疗；Ｂ组（４６例）、Ｄ组（４５例）单纯用２Ｈ３Ｒ３Ｚ３Ｓ３／４Ｈ３Ｒ３和２Ｈ３Ｒ３Ｚ３Ｅ３Ｓ３／６Ｈ３Ｒ３Ｅ３方案治疗。观察治疗后肺部病灶吸收，痰菌阴转情况。结果 ２月     

五个月短程化疗及六个月全程间歇方案治疗菌阳肺结核的临床对照研究

目的考核利福喷丁（Ｌ）的疗效；缩短疗程或全程间歇以减少用药次数；观察全程应用吡嗪酰胺（Ｚ）对疗效及毒副反应的影响。方法以利福平（Ｒ）为对照，采用５个月疗程方案（Ⅰ组２ＳＨＲＺ／３Ｒ２Ｈ２Ｚ２，Ⅱ组２ＳＨＲＺ／３Ｌ１Ｈ２Ｚ２）、６个月全间歇方案（Ⅲ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｚ２，Ⅳ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｅ２），观察Ｚ的全程应用结果，巩固期以乙胺丁醇（Ｅ）为对照。３６６例初治菌阳肺结核随机分入以上４组。结果（１）３３９例完成疗程者中３２９例治疗成功，满疗程时痰菌阴转率Ⅰ～Ⅳ组分别为９７０％、９４１％、１０００％、９７２％。Ｘ线病灶有效率依序为９６０％、９７６％、１０００％和９４４％。５个月组与６个月组空洞关闭率分别为７７％及７６％。各组相互比较均无显著性差异（Ｐ＞０．０５），未见严重副作用。（２）３０５例完成３年随访，Ⅰ、Ⅱ、Ⅲ、Ⅳ组细菌学加Ｘ线复发分别为２、３、６和３例。结论本研究结果进一步证明Ｌ是长效、高效、安全、便于督导的新药；巩固期用Ｚ无必要；现有基本药物合理联用有可能缩短疗程为５个月，值得进一步研究。     

2H3R3Z3S3（E3）／4H3R3方案治疗对乙肝病毒标志物阳性患者肝功能？…

目的 探讨２Ｈ３Ｒ３Ｚ３Ｓ３（Ｅ３）／４Ｈ３Ｒ３方案治疗对合并乙型肝炎病毒标习物ＨＢｓＡｇ（＋）、ＨＢｅ－Ａｂ（＋）、ＨＢｃＡｂ（＋）肺结核患者肝功能的影响。方法 回顾性分析１９９４年１２月至１９９８年１２月采用患者肝功能的情况。以同期采用同样方案治疗的乙肝标志物五项阴性肺结核患者为对照。结果 乙肝阳性组肝损率（１５．６％）高于乙肝阴性组（１２．０％）。两组经统计学处理无显著性差异。（Ｐ〉０．０５     

NIDDM患者ApoE基因型与大,微血管病变关系的研究

目的 研究ＮＩＤＤＭ患者ＡｐｏＥ基因型与大，微血管病变的关系。方法 采用ＡＲＭＳ技术检测２００例ＮＩＤＤＭ患者漱口水ＤＮＡ ＡｐｏＥ基因型，结果 （１）∈４／３∈４／４组ＣＡＤ发生率为７０．８％，显著高于∈３／３组４８．４％，和∈２／２∈３／２组４３．５；ＣＶＤ及ＰＶＤ亦存在这种趋势；∈４／３∈４／４组任何证据大血管病变发生率为７５％，显著高于∈３／３组５１．６％和∈２／２∈３／２组４７．８％。     

武汉地区Ⅱ型糖尿病患者冠心病与载脂蛋白E基因型的关系

应用聚合酶链反应（ＰＣＲ）技术，对随机选择的１２５例ＮＩＤＤＭ患者和５０例非ＤＭ患者进行ＡｐｏＥ基因型检测，以研究ＮＩＤＤＭ患者ＣＨＤ与ＡｐｏＥ基因型间的关系。结果表明，ＮＩＤＤＭ患者心肌梗塞和缺血性心电图改变在Ａｐｏε４／４和ε４／３型组中发生率分别为２１％和４１％，但不同基因型组间差异无显著性。心绞痛在Ａｐｏε４／４和ε４／３型组中为５２％，显著高于ε３／３型组（３１％，Ｐ＜０．０５）。Ａｐｏε４／４和ε４／３型ＮＩＤＤＭ患者，任何证据的ＣＨＤ发生率为７２％，显著高于ε３／３型组（３７％）及ε２／２、ε３／２型组（３３％，Ｐ＜０．０１）。ＮＩＤＤＭ患者中ＣＨＤ组Ａｐｏε３／３和ε４／３基因型频率分别为５２％和３４％，分别低于（ε３／３）、高于（ε４／３）非ＣＨＤ组（７１％，Ｐ＜０．０５；１０％，Ｐ＜０．０１）；ＣＨＤ组ε４等位基因频率为２１％，明显高于非ＣＨＤ组（７％，Ｐ＜０．０１）。提示Ａｐｏε４／４和ε４／３为ＮＩＤＤＭ患者ＣＨＤ的重要危险指标。     

二甲基硫脲对心肌细胞抗过氧化氢损伤的实验研究

为探讨二甲基硫脲（ＤＭＴＵ）保护心肌细胞抗过氧化氢（Ｈ２Ｏ２）损伤。３２瓶培养乳鼠心肌细胞随机分４组，每组８瓶：（１）对照组；（２）Ｈ２Ｏ２（５ｍｍｏｌ）组；（３）ＤＭＴＵ（２０ｍｍｏｌ）组；（４）Ｈ２Ｏ２（５ｍｍｏｌ）＋ＤＭＴＵ（２０ｍｍｏｌ）组。在３７℃、５％ＣＯ２的ＭＥＭ培养４小时。结果发现：（１）与对照组比，Ｈ２Ｏ２组乳酸脱氢酶（ＬＤＨ，Ｕ／１００ｍｌ）释放多（２８２．３８±４７．２８比７７．２５±１８．２５，Ｐ＜０．０１）、ＴＢＡ反应物（ＴＢＡＲＳ，ｎｍｏｌ／ｍｇＰｒ．）产生多（２．２５±０．５３比０．７９±０．３６，Ｐ＜０．０１）；（２）与Ｈ２Ｏ２组比，Ｈ２Ｏ２＋ＤＭ－ＴＵ组ＬＤＨ释放少（９９．２５±４１．８８比２８２．３８±４７．２８，Ｐ＜０．０１）；ＴＢＡＲＳ产生少（０．５９±０．１８比２．２５±０．５３，Ｐ＜０．０１）；此外，我们还发现ＤＭＴＵ组超氧化物歧化酶（ＳＯＤ，μｇ／ｍｇＰｒ．）比对照组高（８．４９±３．６５比１．９２±１．４０，Ｐ＜０．０１）。ＤＭＴＵ能保护心肌细胞抗Ｈ２Ｏ２损伤，机制与灭活羟自由基（·ＯＨ）、保护ＳＯＤ活性有关     

白介素—2联用短化治疗50例伴发乙肝初治涂阳肺结核疗效观察

目的 提高伴发乙肝初治涂阳肺结核治疗疗效,减少副作用产生。方法 采用ＩＬ－２联用２ＳＨＲＺ／４Ｈ３Ｒ３方案治疗５０例伴发乙肝初治涂阳肺结核,并以同期用２ＳＨＲＺ／４Ｈ３Ｒ３和一般护肝药治疗２３例作为对照。结果 治疗６月末ＩＬ－２组痰菌阴转率、ＨＢｅＡｇ和ＨＢＶ－ＤＮＡ的转阴率分别为９６．０％、７０．４％和７１．４％,明显高于对照组的６５．３％、８．３％和１４．３％（Ｐ〈０．０１）,并且前者肝功损害     

Comparison of intermittent ethambutol with rifampicin-based regimens in HIV-infected adults with PTB, Kampala.

BACKGROUND: The human immunodeficiency virus (HIV) is a key factor responsible for the high rates of tuberculosis (TB) in sub-Saharan Africa. Treatment of TB with rifampicin (R, RMP) containing short-course regimens is highly effective in HIV-infected adults. We conducted a study to compare the efficacy and safety of intermittent ethambutol (E, EMB) with two RMP-containing regimens to treat pulmonary TB in HIV-infected patients. SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. DESIGN: This was a prospective cohort compared to two non-randomised control groups. The study group and the two control arms were treated with 2 months of isoniazid (H), RMP, pyrazinamide (Z) and EMB followed by 6 E3H3 for the study group and 4HR or 6HR for controls. RESULTS: Between April 1993 and March 2000, 136 patients were enrolled in the 2EHRZ/E3H3 arm, 147 in the 2EHRZ/4HR arm and 266 in the 2EHRZ/6HR arm. The relapse rate was 18.2 per 100 person-years observation (PYO) for the study regimen compared to 9.7/100 PYO (P = 0.0063) and 4.8/100 PYO (P = 0.0001) in patients treated with 2 EHRZ/4HR or 2EHRZ/6HR, respectively. CONCLUSION: The 2EHRZ/6E3H3 regimen is safe and effective but has a significant risk of relapse.     

结核病控制项目中初治涂阳重症肺结核的认定和方案选择

目的 对结核病控制项目中重症肺结核进行不同方案的治愈率和复发率的比较分析.方法对Ⅰ组3 HREZ/6HRE、Ⅱ组3H2R2E2Z2/6H2R2E2、Ⅲ组2HREZ/4HR和Ⅳ组2H2R2E2Z2/4H2R2方案进行组间分层分析比较.评价痰菌阴转率、治愈率、复发率和不良反应.结果(1)强化期痰菌阴转和疗程结束痰菌阴转情况:Ⅰ组和Ⅱ组痰菌阴转优于Ⅲ组和Ⅳ组;(2)强化期结束和疗程结束X线吸收情况:Ⅰ组和Ⅱ组X线吸收优于Ⅲ组和Ⅳ组;(3)3年内细菌学复发Ⅰ组和Ⅲ组、Ⅳ组存在显著性差异;(4)不良反应各组无差异.结论 结控项目中重症肺结核9个月方案疗效明显优于6个月方案.     

肺结核病人全程间歇短程化疗方案远期疗效分析

１９９１年９月～１９９４年１２月间我省对不住院初治涂阳肺结核病人进行了短程化疗实施性研究工作，应用２Ｒ３Ｈ３Ｚ３Ｅ３／４Ｒ３Ｈ３全程间歇短程化疗方案，采取全程督导治疗管理措施，共选例３８１例，初期观察结果报告效果是令人满意的，病人痰菌阴转率达到９７．９％。我们对满疗程３７３例临床治愈病人进行了２年随访观察，细菌学复发和Ｘ线复发率分别为１．４％和１．１％，总复发率为２．５％。本结果证实，采用全程间歇６个月短程化疗方案是合理有效的，只要措施得力，疗效是无可置疑的，并便于基层全程监督化疗使用。     

Ethambutol compared to rifampin in original treatment of pulmonary tuberculosis

Two hundred and eighteen patients with pulmonary tuberculosis were randomly allocated to three regimens: (1) isoniazid (INH)-rifampin (RIF), (2) INH-RIF-ethambutol (EMB), and (3) INH-EMB. The dose of INH was 300 mg, RIF 600 mg, and EMB 25 mg/kg/day for four months. All patients then continued treatment with INH 300 mg-EMB 15 mg/kg/day for 20 months. Almost all sputum cultures had become negative after ten weeks of treatment, with no significant difference in the efficacy of the 3 regimens. There was no significant difference between the regimens or between the moderately and far-advanced cases in time of sputum conversion. In the very far-advanced cases (total cavitation 6 cm or more), however, conversion was slower in the INH-EMB regimen than in the RIF regimens. Forty-three patients were observed up to one year after completion of treatment without relapse. The principal toxic reaction was hepatitis; 5 patients who received RIF (3.4%) and 3 patients who received INH (1.3%) were removed because of this complication. The hepatitis was specifically attributed to INH or RIF by subsequent rechallenge. Ethambutol induced no serious reaction. There was a significant difference in favor of EMB over RIF with respect to adverse reactions requiring cessation of therapy. The INH-EMB regimen employed with a daily dose of EMB at 25 mg/kg for the first 4 months (instead of the more conventional 15 mg/kg daily dose) was an effective combination in achieving sputum conversion. INH-EMB was the best tolerated regimen and provided adequate treatment for advanced tuberculosis. But the study did not prove its adequacy compared with RIF containing regimens as regards posttreatment relapse.     

Is oral intermittent initial phase anti-tuberculosis treatment associated with higher mortality in high HIV-prevalent areas in sub-Saharan Africa?

The Malawi Tuberculosis Programme has evaluated an oral ambulatory treatment regimen (2R3H3Z3E3/6HE) in five districts, and observed a mortality rate of 23% in 2671 new patients with smear-positive pulmonary tuberculosis (PTB). Three studies were performed comparing treatment outcomes between patients treated with 2R3H3Z3E3/6HE and 2SRHZ/6HE using historical data in the same districts and concurrent data in different districts. Using historical comparisons, mortality was significantly higher with 2R3H3Z3E3/6HE than 2SRHZ/6HE. Using concurrent comparisons, mortality was similar, although there was a higher death rate in the first month with the intermittent regimen. The intermittent regimen may be inferior to the established regimen.     

湖北省结核分支杆菌耐药性监测研究

目的 建立以世界卫生组织（WHO）和国际防痨和肺病联合会（IUATLD）指南为基础的结核病耐药监测系统，掌握湖北省初始和获得性耐药水平，评价现行结核病控制策略效果。方法 采用整群抽样方法，在全省随机抽取30个县（市，区）为监测点，各监测点连续选30个新发涂阳肺结核病例，期间的其他涂阳病例同时纳入，并对全部培养阳性菌株进行菌型鉴定及SM，INH，RFP，EMB4种抗结核药物的药敏试验（比例法）。结果 共入选1136例，其中培养阳性1097例，培养阳性率为96．6％，污染率为0．4％。总耐药率为23．3％，其中初始耐药率为17．5％，获得性耐药率为44．5％，初始耐多药率（含H＋R）为2．1％。获得性耐多药率为21．8％。结论 初步建立了抗结核药物耐药性监测实验室方法和质量控制机制，首次获得可信的全省耐药水平资料。提示推行合理化疗和贯彻全程督导治疗原则对减少耐药的至关重要性和定期连续观测及深入研究的必要性。     

Shortest possible acceptable effective chemotherapy in ambulatory patients with pulmonary tuberculosis. Part II. Results during the 24 months after the end of chemotherapy

Efficacy of two 4.5-month regimens (3 RSZH / S2H2Z2 and 3 RSZH /RH) and one 3-month regimen (3 RSZH ) in the management of pulmonary tuberculosis is reported (see table 1 for definition of regimen abbreviations). Even when the patients were ambulatory and outpatient attendance was required for supervised drug administration, drug compliance was high (87%). Bacillary sterilization was achieved in 99% of the patients at 3 months. During first year follow-up after cessation of chemotherapy, 6% of the patients receiving the 3 RSZH regimen, 7% of the patients receiving the 3 RSZH / S2H2Z2 regimen, and 2% of the patients receiving the 3 RSZH / R2H2 regimen experienced relapse. During second year follow-up, relapse was observed in only 1 patient receiving the 3 RSZH / S2H2Z2 regimen. The patients who relapsed usually had drug-susceptible strains at the time of relapse. Regression of pulmonary lesions continued even after the cessation of chemotherapy.     

Five year results of a 3-month and two 5-month regimens for the treatment of sputum-positive pulmonary tuberculosis in south India

A controlled study of three short-course regimens was undertaken in South Indian patients with newly diagnosed, sputum-positive pulmonary tuberculosis. The patients were allocated at random to one of three regimens: a) Rifampicin, streptomycin, isoniazid and pyrazinamide daily for 3 months (R3); b) the same regimen as above but followed by streptomycin, isoniazid and pyrazinamide twice-weekly for a further period of 2 months (R5); c) the same as R5 but without rifampicin (Z5). A bacteriological relapse requiring treatment occurred by 5 years in 16.8% of 113 R3, 5.2% of 97 R5, and 20.0% of 115 Z5 patients with organisms sensitive to streptomycin and isoniazid initially. The differences in the relapse rates between the R3 and R5 regimens and the R5 and Z5 regimens were statistically significant (p less than 0.01 for both). Considering patients with organisms initially resistant to streptomycin or isoniazid or both, 7 of 52 patients (4 R3, 2 R5, 1 Z5) had a bacteriological relapse requiring retreatment.     

两种间歇短程化疗方案对初治涂阳肺结核近远期疗效观察

本文报道杭州市１９８５～１９８９年市区２２９例初治涂阳肺结核病人，在不住院全程监督或全程管理下，采用２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３（ＤＬ１）和２ＳＨＲＺ／４Ｈ２Ｒ２（ＤＬ１）两种间歇短程化疗（短化）方案治疗。疗程结束痰菌阴转率分别为９７．７％及９９．０％，３年随访复发率为２．４％及３．０％。两方案疗效差异无显著性。认为①６个月间歇短化服药７８～９４次，节省了费用，减少了管理次数值得推广。②原发ＲＦＰ耐药者疗效差，宜改变方案。③全程管理化疗如认真按规范实施，可取得与全程监督管理相似的效果。     

惠州市最新肺结核耐药监测结果及趋势分析

目的分析惠州市最新肺结核耐药监测结果及趋势,为进一步完善本地区肺结核防控对策提供依据。方法 2013年1月—2014年5月,对惠州市各县区涂阳培阳患者进行抽样调查,本研究共监测6个试点,共纳入肺结核患者638例。对患者进行痰菌分离培养,采用比例法进行一线药及二线药耐药性检测。结果本次抽样菌株总耐药率为45.1%,其中初治总耐药率为33.1%、复治总耐药率为60.8%。初治涂阳患者单一耐药率〔12.9%(82/638)〕低于复合耐药率〔32.3%(206/638)〕,总耐多药率低于复治涂阳患者(P0.05)。初、复治涂阳患者异烟肼(INH,H)+利福平(RFP,R)耐药率均为最高。单一任意耐药顺序为:H(194)R(131)链霉素(SM,S)(131)氧氟沙星(OFX)(84)乙胺丁醇(EMB,E)(33)左氧氟沙星(LOF)(32)卡那霉素(KM)(31)对氨基水杨酸(PAS)(15)卷曲霉素(CM)(14)丁胺卡那(AM)(10)丙硫异烟胺(TH1321)(8)。结论惠州市肺结核耐药情况复杂多样,耐多药肺结核有上升趋势,面临耐多药、广泛耐药肺结核的挑战,应重点关注H、R、S这3种一线抗结核药物的合理使用,以减少耐药菌株的产生和传播,降低耐药肺结核发生率。