Sample survey of drug-resistant tuberculosis in Henan, China, 1996

BACKGROUND: There is little reliable data on the global drug resistance to tuberculosis (TB) as most of the existing data is based upon biased samples, is not standardized or was obtained using poor techniques. For this reason, the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) developed a global project on anti-TB drug resistance surveillance (DRS) in 1994. China joined this project in 1995 and the province of Henan was selected as the first site for collection of representative samples to survey the prevalence of drug-resistant TB. METHODOLOGY: Standard drug susceptibility testing by the proportion method against streptomycin (S), isoniazid (H), rifampicin (R), and ethambutol (E) was performed with Mycobacterium tuberculosis isolated from 916 new cases and 456 previously treated cases. Treatment outcome of these patients has been evaluated according to the regimens and drug susceptibility patterns. RESULTS: Drug resistance among new cases to any drug was found to be 43.0% and any resistance: S, 32.5%; H, 31.0%; R, 20.7%; and E, 10.3%. Drug resistance among previously treated cases to any drug was 68.2% and any resistance: S, 52.2%; H, 49.3%; R, 48.3%; and E, 20.4%. The cure rate for new cases was 43.3% and 29.4% for previously treated cases. The poor cure rate resulted mainly from a high defaulter rate. CONCLUSION: Drug-resistant TB was found to be highly prevalent in Henan and the cure rate remained poor. The results strongly indicated that Henan should take immediate action to improve the cure rate of patients through expansion of the introduction of the directly observed treatment short-course strategy.     

Colonic tuberculosis

Tubercle bacillus was discovered in 1882 by Robert Koch. With the introduction of chemotherapy for tuberculosis in the 1940s the incidence of this entity decreased. The incidence of the tuberculosis of the colon began to increase at the 1980s with the rise in numbers of patients considered as high risk for this entity, such as HIV-infected individuals, patients with chronic renal disease, and immunosuppressed patients with prolonged steroid therapy. We report on two patients with history of chronic abdominal pain and weight loss with a palpable mass in the right lower quadrant. In one patient chest radiography revealed a miliary reticulonodular pattern. In both, abdominal CT scan showed retroperitoneal lymphadenopathy and colonic wall thickness. Colonoscopic examination showed ulcerative lesions and ileocecal valve disruption. Microscopic examination of intestinal content showed evidenced M. tuberculosis. Tuberculosis of the colon should be suspected in patients suffering from chronic abdominal pain and weight loss.     

某高校大学生结核菌素试验结果分析

目的:了解高校大学生结核菌素的试验结果,为制定结核病的预防措施提供依据。方法:对某高校688名大学生结核菌素(PPD)试验进行调查,并进行流行病学特征分析。结果:被调查的大学生PPD试验的阳性率为30.81%,强阳性率为6.10%;男生的阳性率(30.63%)低于女生(42.39%)(χ2=10.175,P=0.001);城镇生源大学生PPD试验阳性率(41.75%)高于乡村生源大学生(33.25%)(χ2=5.240,P=0.022);PPD试验的阳性率随大学生年龄增长而呈上升趋势(χ2趋势=19.891,P=0.000)。结论:高校大学生是结核病控制的重点人群,PPD试验是结核病的必要辅助诊断方法,根据PPD试验结果采取不同措施,可有效地控制结核病在高校中的传播和流行。     

传统结核杆菌细菌培养法的现状分析

传统结核杆菌细菌培养法,培养生长繁殖速度过于缓慢,初次培养需4~8周,次代培养仍需2~4周,培养时间长,难以得到理想的检出速度,这是传统结核杆菌细菌培养在技术上一直不能攻克的最主要的难题,引致结核病的病原诊断慢、治疗周期长;结核病误诊、漏诊、耐药菌增多;结核病无病原依据、诊治不规范、流行呈上升趋势等三大问题非常严峻。揭示只有探索到结核杆菌快速细菌培养法,推动结核杆菌快速细菌培养普及到基层医院,这样困扰三大问题就会迎刃而解。     

TBQ注射剂抗结核的实验研究

目的:研究TBQ注射剂的抗结核作用。方法:在体外抑菌实验基础上,通过三种不同的给药方案,观察TBQ注射剂对结核病模型小鼠ST50及脏器结核病变面积的影响。结果:TBQ注射剂能在一定程度上降低结核病模型小鼠的脏器结核病变面积,延长其ST50。结论:TBQ注射剂在体内外均具有一定的抗痨抑菌作用,进一步深入研究可望将TBQ开发成为新型抗结核中药制剂。     

耐多药支气管结核微波介入治疗的疗效观察

目的观察微波介入治疗耐多药支气管结核的有效性和安全性。方法86例耐多药支气管结核住院患者随机分成治疗组、对照组。治疗组应用微波介入治疗;对照组予局部药物注入治疗。结果治疗组21个月后痰菌阴转率达到90.7%,肺不张治愈率均达到96.9%,胸片病灶有效率86.0%,电子支气管镜复查病变支气管总有效率86.0%,明显高于对照组;呼吸困难指数由治疗前1.98±0·69降低到0.70±0.61(P<0.01);FEV1由治疗前(1.85±0·33)L增加到(2·57±0.38)L(P<0.01),疗效较好。结论电子支气管镜微波介入治疗耐多药支气管结核是一种安全、有效的方法。     

肾结核延误诊断19例临床分析

目的 探讨肾结核发病和临床表现的新特点及诊断方法。方法 回顾性分析误诊的肾结核患者19例，外院首诊泌尿系感染11例（57．9％），肾积水5例（26．3％），泌尿系结石3例（15，8％）。出现症状至确诊时间为2个月-20a，平均2.7a。结果 11例行手术，其中6例为术前诊断不明确，手术探查明确诊断，并经病理证实。14例（73．7％）最终经病理结果证实为结核，5例（26．3％）依靠病原学诊断。结论 对肾结核的诊断，应依靠患者病史、病原学、影像学、病理活检及手术探查多种方法，综合分析，减少误诊和漏诊。     

结核性胸膜炎235例临床分析

目的 总结结核性胸膜炎的临床特点,并探讨治疗方案.方法 对235结核性胸膜炎患者的临床特征进行回顾性分析.结果 年龄分布:≤40岁占64.6%,＞60岁占22.2%,平均39.2岁.发热、胸痛、咳嗽的发生率分别为71.5%、60.9%和52.8%.单侧胸水占92.4%,双侧胸水占7.6%,左右侧发生率分别为44.3%及48.1%,中、小量胸水共占94.5%,大量胸水占5.5%.胸水ADA＞45IU者占81.3%.PPD阳性反应者占82.9%.红细胞沉降率增快者占65.1%,均值为44.9 mm/1h.结论 掌握结核性胸膜炎的临床特点,综合分析,早期诊断,合理治疗,可取得较好疗效.     

利福布汀治疗耐多药肺结核临床观察

目的评价利福布汀治疗耐多药肺结核的临床有效性和安全性。方法采用为期18个月的随机、开放、对照临床试验。试验组：3BPaVEThAk／6BPaVETh／9BPaVE；对照组：3LPaVEThAk／6L2PaVETh／9LPaVE。结果试验组在各阶段的病灶显吸率与空洞闭合率均高于平行对照组，且临床症状与体征的改善也优于对照组。其中试验组在3个月时病灶有效率达100．0％（9／9），在6个月时痰结核菌阴转率达100．0％，与对照组同期经χ^2检验比较，差异有显著性（P〈0．05）。利福布汀不良反应为抗结核药物中常见的副反应。结论利福布汀治疗耐多药肺结核的疗效优于利福喷丁，且具有较好的安全性，对治疗耐多药肺结核具有很大的潜力。     

痰热清注射液治疗肺结核并发下呼吸道感染

目的：观察痰热清注射液治疗肺结核并发下呼吸道感染的临床疗效。方法：患者64例，随机分为痰热清治疗组和头孢呋辛钠对照组，观察在抗结核治疗基础上，痰热清注射液治疗肺结核并发下呼吸道感染的临床疗效。结果：痰热清治疗组有效率93．8％，对照组有效率96．9％，两组治疗比较差异无统计学意义，但治疗组热程明显缩短。结论：痰热清治疗肺结核并发下呼吸道感染有良好的临床疗效，不良反应轻，值得临床应用。