固定剂量复合剂治疗肺结核患者依从性调查与分析

Objective To survey and analyse the treatment compliance of fixed-dose combination （FDC）,so as to provide evidences for expending use FDC nationwide. Methods Nine hundred and sixty-six primary smear positive pulmonary tuberculosis cases registered in 17 counties TB institutions from 4 provinces were randomly divid- ed into experiment and control groups. Compared compliance difference with uniform questionnaires, and analysed compliance changes with time throughout the treatment. Results Nine hundred and sixty-one cases were surveyed at the beginning, 899（93.5% ）preferred receiving treatment. There was significant difference on the percentage who prefer had drugs per day between experiment（86.8% ）and control group（42.1% ）（ P 〈 0.01 ）.At the end of intensive phase, 261（28.3 % ）cases perceived difficulty with the treatment ;213 （23.1% ）cases thought that were the doctors who lead to the insist of treatment.At the end of treatment,only 138 cases（15.5% ）thought that were the doctom who lead to the insist of treatment. Conclusion The compliance of FDC was better than control group. It might increase the compliance when decreasing the number of tablets and should expend used on TB control. The ef- fect of TB doctors decreased through the treatment. More intention should be paid in intense phase.     

脾结核的临床特征

目的 探讨脾结核的临床特点、诊断和治疗。方法 回顾性分析经临床、手术及病理证实的11例脾结核的临床特征。结果 11例患者中，男7例，女4例，平均年龄29岁。6例术后证实，5例经内科保守治疗后证实。多数患者表现为发热、消瘦、血沉增快、贫血、脾肿大，B超发现脾脏肿大11例，其中8例脾内多发占位，3例为孤立性占位；7例行CT检查，6例发现脾脏多发性大小不等的结节状低密度灶，1例为单发类圆形低密度影，边缘不清，增强扫描病灶内部无强化；6例患者伴后腹膜、脾门区等淋巴结肿大，5例患者伴其它脏器结核。结论 不明原因发热、消瘦、血沉增快、贫血、脾肿大为脾结核的主要临床表现，腹部B超和腹部CT能对脾结核作出较准确的判断，脾结核患者经正规治疗可治愈。     

Tuberculosis in children: a 13-year follow up of 1714 patients in a Belgian home care centre

From May 1970 to September 1983, 1714 children with different forms of primary tuberculosis were referred to the paediatric home care centre (Enfants soignés au Foyer, E.S.F.) of the Brussels University Hospital St.-Pierre. They were subdivided in five groups: asymptomatic (33%), symptomatic (28%), dubious tuberculous infections (35%), high-risk contacts (3%) and unestablished diagnosis (1%). They were aged from 10 days to 19 years, and 82% of them were migrants of low socio-economic level. Fifty percent of the symptomatic infections, mainly pulmonary, appeared in children under 3 years of age. An adult source of contamination was identified in 33% of the case (48% of the symptomatic children). Diagnosis was based on tuberculin screening with a 2IU intradermal test. Gastric aspirates yieldedMycobacterium tuberculosis in 15% of our patients, 11% of them showing resistance to one or more tuberculostatic drugs. Treatment was given to 1359 patients with excellent results. Therapy was shortened during the last 2 years of the study from 12 to 6 months for the asymptomatic patients and from 12 to 9 months for the symptomatic infections. Few complications were observed. Tuberculosis remains a serious cause of morbidity particularly in migrant children. Correct diagnosis and treatment of the disease is very important.     

Some investigations into the nature and cause of massive fibrosis (MF) in the lungs of South African gold, coal, and asbestos mine workers

Samples from fibrotic lung lesions greater than 1 cm in diameter macroscopically (by definition, massive fibrosis; MF) were taken from the lungs of 9 randomly selected post-mortem cases of mine workers all showing a background of a pneumoconiosis. These samples were studied histologically, biochemically, and by X-ray diffraction and electron microscopy. As controls for the biochemical and X-ray diffraction investigations, nonfibrosed lung tissue was taken from the same specimens. The findings suggest that the higher quartz content may be the primary cause responsible for the MF formation in this series of cases, while other factors such as tuberculosis may play a part according to some relevant literature on MF. Although an area of MF appears macroscopically to be a solid lesion, on microscopy this is not the case and the lesion is composed of dense and sparse collagen bundles and cellular elements.     

协同刺激分子CD28在结核杆菌抗原体外激活人外周血γδT细胞中的作用

目的 :为了探讨CD2 8协同刺激分子在结核杆菌 (Mtb)低分子多肽抗原体外激活人外周血γδ T细胞中的作用。方法 :采用激发型抗CD2 8单抗模拟第二信号 ,Mtb低分子多肽抗原作为刺激原 ,对纯化的人外周血T细胞进行体外刺激和培养 ;用流式细胞仪检测γδ T细胞上CD2 8分子的表达、γδ T细胞的增殖效应及活化的γδ T细胞上CD6 9分子的表达。结果 :人外周血γδ T细胞中有 5 0 %左右表达CD2 8分子 ;抗CD2 8单抗协同Mtb抗原可刺激γδ T细胞的活化和增殖 ;但抗CD2 8单抗或Mtb抗原单独刺激则无作用。活化的γδ T细胞表面表达CD6 9分子。结论 :Mtb抗原在选择性活化人外周血γδ T细胞时需要第二信号的参与 ;CD2 8在Mtb抗原激活γδ T细胞时可提供协同刺激信号 ;CD6 9可作为γδ T细胞的早期活化标志。     

对某高校肺结核患者的心理分析与疏导

目的 探讨肺结核患者的心理特征及相应的心理疏导方法.方法 采用追踪访问方法,对56例确诊肺结核患者进行交谈、观察,分析出不同的心理状态及相应的疏导方法.结果 肺结核患者有焦虑紧张心理21例,占37.5 %,为各种心理问题的首位;其次为抑郁孤独心理18例,占32.1 %;其他患者不同程度地存在着怨恨发泄、意志脆弱、轻视疾病心理和乐观心理.对患者采取有针对性的心理疏导措施,保证了短程督导化疗方案的有效落实,全部临床治愈.结论 肺结核患者的心理疏导对促进患者的治愈有重要意义.     

支气管结核48例临床分析

目的：探索支气管结核的临床特征及诊断方法。方法：分析48例1995-2001年支气管结核临床表现，影像学及纤支镜检查结果。结果：48例患者中青年女性明显高于其他组占66.7%(32/48)，咳嗽42例（87.5％），咯血10例（20.8％），胸痛13例（27%），气促28例（58.3%），发热12例（25%），乏力盗汗19例（39.5%）。胸片及CT示：肺内浸润渗出性病灶32例（66.7），空调6例（12.5%），肺不张20例（41.7%），阻塞性肺炎18例（37.5%），肺门及纵隔淋巴结肿大9例（18%），痰涂片结核菌阳性率为37.5%，纤支镜刷检结核菌阳性率为45.8%，组织活检中57.5%证实为结核。结论：当有支气管结核临床表现时，应行胸部X线、CT检查，有条件者行张支镜检查，纤支镜检查是诊断支气管结核最重要的方法。     

Primary aortoduodenal fistula caused by duodenal tuberculosis without an abdominal aortic aneurysm: Report of a case

A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature.     

血清结核抗体检测对儿童结核的诊断价值

为探讨用ELISA法(酶联免疫吸附试验)检测血清抗PPD(结核菌素纯蛋白衍生物)IgG抗体对儿童结核的诊断意义,对42例儿童结核、30例儿童肺炎及16例健康对照者进行了检测,阳性率分别为92.85％、6.66％、6.25％。结核病例经六个月正规化疗后,阳性率明显降低,说明此项检测可做为一项诊断儿童结核及评价疗效的指标。     

Pulmonary tuberculosis in patients treated with inhaled beclomethasone

Inhaled beclomethasone dipropionate (BDP) has been used with few side effects in the treatment of bronchial asthma for 2 decades. Until now the manifestation of tuberculosis (TB) in patients on inhaled BDP has not been reported. Eight patients with allergic asthma, of a total of 548 asthmatics (1.46%) seen over a 2-year period, developed active TB following the use of inhaled BDP. All were sputum-positive for acid-fast bacilli (AFB) on smear and/or culture, all responded well to a combination of anti-TB drugs, and none showed evidence of immunological or pituitary-adrenal suppression. Two patients agreed to a repeat administration of BDP; both developed TB again within 2 weeks and are again on anti-TB treatment.