含环丙沙星及卷曲霉素方案治疗耐多药肺结核近期疗效分析

目的观察和评价含环丙沙星（CPFX）和卷曲霉素（CPM）联合化疗方案在耐多药肺结核（MDR—PTB）治疗中的效果。方法将186例MDR—PTB患者随机分为治疗组92例和对照组94例。化疗方案：治疗组以CPFX和CPM为主，联合利福喷汀、异烟肼对氨基水杨酸钠、吡嗪酰胺；对照组用链霉素、乙胺丁醇，联用药物同治疗组，疗程均为21个月。结果共有170例患者完成化疗疗程，治疗组86例，痰菌阴转率为83％，对照组84例，痰菌阴转率为58％，痰菌阴转率治疗组与对照组比较差异有统计学意义（P〈0．01）；治疗组病灶显著吸收率为50％，空洞闭合率为64％，治疗组与对照组比较差异有统计学意义（P〈0．01或〈0．05）；治疗组的药物不良反应率为32％，对照组为34％，两组比较差异无统计学意义（P〉0．05）。结论含CPFX和CPM的方案治疗MDR—PTB，有助于痰菌阴转和病变吸收好转，药物不良反应低，值得在临床上推广应用。     

252株耐药结核菌分析

目的：分析宝安区结核病耐药情况.方法：2003年门诊就诊的结核病例,用罗氏培养基进行痰菌培养,选择培养阳性进行药敏试验.结果：初始耐药率顺位依次为：链霉素（67.5%）、异烟肼（50.4%）、乙胺醇（32.9%）、利褐平（25.0%）.对1种2种3种和4种药物初始耐药率分别为48.0%、29.4%、3.6%、9.9%,获得耐药率为4.0%、3.2%、0%、2.0%,常住人口耐药率为21.4%,暂住人口为78.6%.在46例耐多药病列中,常住人口耐多药率为26.1%,暂住人口为73.9%,暂住人口明显多过常住人口.耐药率男女之间没有显著差别.宝安区暂住人口40岁以下的成年人是结控工作的主要对象.结论：初始耐药病例是宝安区主要耐药病例,是结核病防治的新问题.     

耐多药结核分枝杆菌三种基因的快速检测

目的 :探讨耐多药结核分枝杆菌耐药基因突变与耐药性的关系。方法 :采用 PCR和 PCR- DS技术对 5 7例耐多药结核临床分离株进行 kat G、rpo B和 emb B基因检测和序列分析。结果 :耐 INH(kat G)、RFP(rpo B)、EMB(emb B)基因突变率分别为 6 3.8%、90 .7%、37.1% ,其中同时耐 INH(kat G)和 RFP(rpo B)基因突变率为 5 4 .1% ,同时耐三种药的基因突变率为 6 5 .6 %。结论 :PCR- DS法对耐两种或两种以上药物的结核检出率较高 ,与传统药敏试验互相弥补 ,对临床用药有指导意义。     

脊柱结核的影像学诊断及临床病理分析

研究脊柱结核的影像学诊断价值,并探讨各型脊柱结核的临床病理特点.对156例经临床及病理证实且影像学资料完整的脊柱结核进行回顾性分析,比较其X线(或CR)、CT及MRI的影像学特点及符合率.结果显示①X线(或CR)、CT及MRI对脊柱结核诊断符合率分别为90.5%、96.2%及99.5%.②X线(或CR)、CT及MRI对椎体骨质破坏、椎间隙狭窄的敏感性分别为74.5%、89.9%及96.87%.③对椎旁软组织肿块和腰大肌脓肿、附件破坏及骨性椎管受累的显示,CT优于X线(和CR)片;对早期病变的显示及脊髓受累情况,MRI优于X线(或CR)及CT,有显著差异性(P＜0.01).④对死骨及钙化的显示CT优于X线(或CR)及MRI.认为X线(或CR)检查为诊断脊柱结核的基本方法,但对早期病变的显示有限度;CT显示早期微小的骨质破坏、死骨、脓肿、钙化及脓肿对椎管脊髓压迫明显优于X线;MRI可清晰显示硬膜外脓肿及脊柱后突畸形对脊髓的压迫和脊髓变性情况,尤其是对早期病变的诊断,有较高的敏感性和特异性,但对死骨及钙化不敏感.     

五酯胶囊预防抗结核药对肝功能损害疗效观察

目的观察五酯胶囊预防抗结核药物对肝功能损害的疗效。方法86例结核病患者在全程常规抗痨的同时,随机分为五酯胶囊治疗组和常规护肝对照组,6-12个月为一疗程,结束后分别统计并进行比较它们的临床症状、体征和肝功能变化情况。结果观察6-12个月,显示两组有显著性差异(P<0.05)。结论在全程常规抗痨的同时口服五酯胶囊,能有效地预防抗结核药物对肝功能的损害,无反弹现象,未见不良反应,具有较高的临床价值。     

On the 99mTc‐labeling of isoniazid with different 99mTc cores

Recent advances in the chemistry of radiolabeling with ^99mTc such as use of the ^99mTc tricarbonyl and ^99mTc–HYNIC cores have revived interest in ^99mTc‐labeling of small biomolecules and further investigation as potential radiopharmaceuticals. Isoniazid, a drug commonly used for treatment of tuberculosis, has been chosen for the present study. Three distinct strategies were utilized to radiolabel isoniazid with ^99mTc. In the direct labeling protocol, the hydrazino amide functional group of isoniazid was used for ^99mTc‐labeling in the HYNIC sense using tricine and EDDA as co‐ligands. The other strategies of ^99mTc‐labeling involved the derivatization of isoniazid to its N, N‐diacetic acid derivative, which in turn was either used as a tridentate ligand for labeling with the [^99mTc(CO)₃(H₂O)₃]⁺ synthon or directly labeled by the conventional route wherein ^99mTc is in the +3 oxidation state. The complexes prepared in >95% yields were characterized by paper chromatography, thin layer chromatography and HPLC. Comparison of the three approaches showed that maximum specific activity and stability was obtained in the ^99mTc–isoniazid derivative synthesized via the tricarbonyl method. However, in vitro cell‐binding studies indicated that none of the ^99mTc–isoniazid complexes prepared had any appreciable uptake in Mycobacterium tuberculosis. Copyright © 2005 John Wiley & Sons, Ltd.     

老年结核病患者对中国结核病控制的影响

目的 分析在现代结核病控制策略(DOTS策略)下老年结核病患者对中国结核病控制的影响。方法 根据2000年全国结核病流行病学抽样调查中老年结核病的患病特征,对照分析在实施DOTS策略地区和非DOTS策略地区老年结核病患者的发现、治疗和管理现状。结果 ≥65岁年龄组肺结核涂阳患病率为440/10万,是各年龄组平均涂阳患病率的3.6倍;≥65岁老年人涂阳病例数占全人口涂阳病例数的28.6％;在已实施DOTS策略的13个省和未实施DOTS策略的15个省中,老年涂阳病例数分别占各年龄组涂阳病例数的28.8％和28.9％;1992～2000年在实施DOTS策略的13省新涂阳病例登记数中,≥65岁老年结核病患者占11.4％。结论 老年结核病患者涂阳患病率高,不论在实施DOTS策略地区或非DOTS策略地区,所有涂阳病例中老年涂阳病例构成比例大,而新涂阳病例登记比例却最低。老年结核病患病率高、发现率低是结核病控制工作中值得关注的问题。     

寡核苷酸表达谱揭示异烟肼耐药对结核分支杆菌致病性的影响

目的研究结核分支杆菌异烟肼耐药菌株与H37Rv异烟肼敏感菌株感染巨噬细胞后差异表达的基因. 方法利用高密度cDNA芯片检测巨噬细胞U937感染结核分支杆菌异烟肼耐药菌株与H37Rv后的基因表达谱的差异. 结果两者诱导巨噬细胞的差异表达基因有53条,异烟肼耐药菌株比敏感菌株诱导多种趋化因子和细胞免疫增强的细胞因子表达上调和免疫抑制细胞因子IL-10等表达下调. 结论异烟肼耐药对细菌毒力有明显的影响,异烟肼耐药菌株的致病力下降,异烟肼耐药菌株容易被宿主免疫系统清除;结果为耐多药结核病控制提供依据;骨桥接素和巨噬细胞趋化因子等,在抗异烟肼耐药结核分支杆菌感染免疫中的作用值得深入研究.     

2013～2018年安徽省老年肺结核疫情特征分析

目的分析2013～2018年安徽省老年肺结核疫情特征,为制定老年肺结核防治策略提供参考依据。方法采用描述性流行病学研究方法,分析2013～2018年安徽省老年肺结核患者疫情特征。结果 2013～2018年,安徽省活动性肺结核年平均登记率老年人高于全人群(χ~2=55. 061,P <0. 001);涂阳肺结核年平均登记率老年人高于全人群(χ~2=21. 840,P <0. 001),老年复治涂阳占全省复治涂阳的42. 42%(3 379/7 965);老年肺结核男女性别比为3. 32∶1;安徽省所辖16个市以亳州、铜陵、池州老年肺结核年平均登记率最高。结论安徽省老年肺结核疫情高于全人群,男性高于女性,亳州、铜陵、池州老年肺结核疫情重,需加强重点人群和重点地区的结核病防治工作。     

Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

IntroductionIsoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited.MethodsWe evaluated the IPT cascade among CLHIV aged <15 years and newly enrolled in HIV care in eight HIV clinics in western Kenya. Medical record data were abstracted from September 2015 through July 2019. We assessed the proportion of CLHIV completing TB symptom screening, IPT eligibility assessment, IPT initiation and completion. TB incidence rate was calculated stratified by IPT initiation and completion status. Risk factors for IPT non‐initiation and non‐completion were assessed using Poisson regression with generalized linear models.ResultsOverall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97–99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1–3) were ineligible due to active TB and 828 (98%; 95% CI 97–99) were eligible. Five hundred and fifty‐nine (68%; 95% CI 64–71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5–10.2). Overall, 434 (78%; 95% CI 74–81) IPT initiators completed. Attending high‐volume HIV clinics (aRR = 2.82; 95% CI 1.20–6.62) was independently associated with IPT non‐initiation. IPT non‐initiation had a trend of being higher among those enrolled in the period 2017–2019 versus 2015–2016 (aRR = 1.91; 0.98–3.73) and those who were HIV virally non‐suppressed (aRR = 1.90; 95% CI 0.98–3.71). Being enrolled in 2017–2019 versus 2015–2016 (aRR = 1.40; 1.01–1.96) was independently associated with IPT non‐completion. By 24 months after IPT screening, TB incidence was four‐fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08–17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82–23.56).ConclusionsDespite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop‐offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6‐month course to reduce TB in CLHIV.