利福喷丁与利福平治疗肺结核的临床对比研究

目的探究利福喷丁治疗肺结核患者的临床疗效。方法 2009年3月—2013年2月就诊于淄博市第一医院的肺结核患者122例,随机分为治疗组（61例）和对照组（61例）,所有患者均口服异烟肼片0.3 g/d,吡嗪酰胺片1.5 g/d,盐酸乙胺丁醇片0.75 g/d。治疗组在此基础上口服利福喷丁胶囊,0.6 g/次,1次/周。对照组口服利福平胶囊,0.45 g/d。两组患者均连续治疗6个月。治疗结束后,评价两组患者的临床疗效,同时观察痰涂片转阴、空洞消失及病灶吸收情况和不良反应发生情况。结果治疗组和对照组的总有效率分别为96.72%、85.25%,两组比较差异有统计学意义（P〈0.05）。治疗3、6个月治疗组患者的痰涂片转阴率、空洞消失率及病灶吸收率均明显高于对照组,两组比较差异有统计学意义（P〈0.05）。治疗3、6个月后治疗组患者的胃肠道反应、白细胞降低例数、谷氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）水平均明显低于对照组,两组比较差异有统计学意义（P〈0.05）。结论应用利福喷丁对肺结核患者进行治疗可明显增强临床疗效,且不良反应较小,建议临床推广应用。     

Association between tuberculosis infections and non-pulmonary malignancies: a nationwide population-based study

Background:

In addition to lung cancers, tuberculosis infections have been associated with increased risk of non-pulmonary malignancies in case reports. Our population-based study employed standardized incidence ratios (SIRs) to systemically survey non-pulmonary cancer risks after tuberculosis infections.

Methods:

Data of patients who had newly diagnosed tuberculosis, were aged 20 years or older, and had no prior cancer or tuberculosis were sampled from the Taiwan National Health Insurance database between 2000 and 2010. SIRs compared cancer incidence in patients with tuberculosis infections to the general population. SIRs of specific cancers were further analyzed with respect to gender and time after tuberculosis infections.

Results:

After a follow-up period of 28 866 person–years, 530 tuberculosis cases developed cancers compared with 256 cases in the general populations (2.07, 95% confidence interval (CI), 1.90–2.26). The SIR of non-pulmonary malignancies was also increased (1.71, 95% CI, 1.54–1.90). For males, SIRs were increased within 1 year after tuberculosis diagnosis for the following cancers: head and neck, esophageal, colorectal, liver, lung, melanomas, and Hodgkin''s disease. SIRs were increased for liver, biliary, lung, and bladder cancers beyond the first year after tuberculosis diagnosis. For females, SIRs were increased for leukemia, esophageal, and lung cancers within the first year, and only for leukemia beyond 1 year post diagnosis.

Conclusion:

Having found increased risks of several cancers that differ with gender and time after tuberculosis diagnosis, physicians may consider these factors in patients following tuberculosis diagnosis.     

不同督导模式在肺结核患者管理中应用的初步分析

目的 初步分析不同督导模式在肺结核患者管理中的应用效果,为转变督导方式提供依据.方法 以宝安区慢性病防治院登记管理的肺结核患者为对象,根据不同的督导服药方式分为视频督导组和常规督导组,采用(x)±s或频数和构成比进行统计描述,采用 χ2检验进行统计分析.结果 本次研究共纳入患者418例,其中视频督导组206例,常规督导...     

腺苷脱氨酶活性检测在胸腔积液诊断中的临床价值

目的探讨腺苷脱氨酶（ADA）活性测定在胸腔积液诊断和抗结核疗效观察中的应用价值。方法采用北京利德曼生物技术有限公司ADA液体试剂盒,对127例胸腔积液患者胸腔积液中ADA活性进行检测,并对44例结核性胸腔积液和83例非结核性胸腔积液进行ADA活性比较及结核性胸腔积液治疗前、后ADA活性变化比较。结果127例患者胸腔积液中ADA活性增高共43例,其中结核组41例,非结核组2例,结核性胸腔积液组ADA活性为（40．67±10．22）U／L,明显高于癌性胸腔积液组[（5．98±5．56）U／L3及炎性胸腔积液组[（6．35±4．65）U／L3,差异有统计学意义（P〈0．05）;ADA诊断结核性胸腔积液的敏感性为93．2％（41／44）,特异性为97．6％（81／83）。结核性胸腔积液患者ADA活性治疗前[（40．67±10．22）U／L3与治疗后[（9．12±6．24）U／L3比较,差异有统计学意义（P〈0．05）。结论胸腔积液ADA活性检测可以作为鉴别结核核性与非结核性胸腔积液的指标,并可作为抗结核治疗疗效观察的指标。     

3种白细胞介素与结核病免疫水平的关系

目的 研究白细胞介素-12(IL-12)、IL-18和IL-10 在结核病免疫发病机制中的作用,为设计新的疫苗和开展辅助性免疫疗法提供依据.方法 用ABC-酶联免疫吸附试验(ABC-ELISA)及双抗体夹心ELISA试剂盒检测39例结核性胸腔积液患者胸水中和血清中的IL-12、IL-18、IL-10水平.对结果进行显著性检验及相关性分析,并对治疗好转过程中的10例继发型肺结核和5例结核性胸膜炎患者的这3种细胞因子在胸水中的变化进行观测.结果 除IL-18外,其他两种细胞因子在胸水中与血清中含量差异有统计学意义;只有IL-12与IL-10之间有相关关系.治疗好转过程中,绝大多数患者有IL-12、IL-18水平增高和IL-10水平降低.结论 IL-18用作疫苗佐剂可能优于IL-12,这3种细胞因子均可用于开展免疫疗法,但不可一概而论.     

Improving TB case notification and treatment coverage through data use

BACKGROUND:This was a study on national TB data.OBJECTIVE:To assess improvement in TB case notification and treatment coverage through improved data use for action in NigeriaDESIGN:We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ² test for linear trends.RESULTS:Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (P < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (P < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (P < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020.CONCLUSION:TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.     

Isoniazid preventive therapy-related adverse events among Malawian adults on antiretroviral therapy: A cohort study

Adverse events may be a cause of observed poor completion of isoniazid preventive therapy (IPT) among people living with HIV in high tuberculosis burden areas. Data on IPT-related adverse events (AE) from sub-Saharan Africa are scarce. We report IPT-related AEs, associated clinical characteristics, and IPT discontinuations in adults who were stable on antiretroviral therapy (ART) when they initiated IPT. Cohort study nested within a randomized, controlled, clinical trial of cotrimoxazole and chloroquine prophylaxis in Malawians aged ≥ 18 years and virologically suppressed on ART. Eight hundred sixty-nine patients were followed for a median of 6 months after IPT initiation. IPT relatedness of AEs was determined retrospectively with the World Health Organization case-causality tool. Frailty survival regression modeling identified factors associated with time to first probably IPT-related AE. The overall IPT-related AE incidence rate was 1.1/person year of observation. IPT relatedness was mostly uncertain and few AEs were severe. Most common were liver and hematological toxicities. Higher age increased risk of a probably IPT-related AE (aHR = 1.02; 95% CI 1.00–1.06; P = .06) and higher weight reduced this risk (aHR = 0.98; 95% CI 0.96–1.00; P = .03). Of 869 patients, 114 (13%) discontinued IPT and 94/114 (82%) discontinuations occurred at the time of a possibly or probably IPT-related AE. We observed a high incidence of mostly mild IPT-related AEs among individuals who were stable on ART. More than 1 in 8 persons discontinued IPT. These findings inform strategies to improve implementation of IPT in adults on ART, including close monitoring of groups at higher risk of IPT-related AEs.     

Pulmonary Paragonimiasis in Native Community,Esmeraldas Province,Ecuador, 2022

Paragonimiasis is a food-borne infection caused by several species of the Paragonimus fluke. Clinical manifestations can mimic tuberculosis and contribute to diagnostic delay. We report a cluster of paragonimiasis in a community in Ecuador, where active surveillance was set up after detection of the first 2 cases.     

Prevalence of Histoplasmosis among Persons with Advanced HIV Disease,Nigeria

We sought to determine the prevalence of probable disseminated histoplasmosis among advanced HIV disease (AHD) patients in Nigeria. We conducted a cross-sectional study in 10 sites across 5 of 6 geopolitical zones in Nigeria. We identified patients with urinary samples containing CD4 cell counts <200 cells/mm³ or World Health Organization stage 3 or 4 disease who also had >2 clinical features of disseminated histoplasmosis, and we tested them for Histoplasma antigen using a Histoplasma enzyme immune assay. Of 988 participants we recruited, 76 (7.7%) were antigen-positive. The 76 Histoplasma antigen–positive participants had significantly lower (p = 0.03) CD4 counts; 9 (11.8%) were also co-infected with tuberculosis. Most antigen-positive participants (50/76; 65.8%; p = 0.015) had previously received antiretroviral treatment; 26/76 (34.2%) had not. Because histoplasmosis is often a hidden disease among AHD patients in Nigeria, Histoplasma antigen testing should be required in the AHD package of care.