Ultrasound-guided percutaneous lung needle biopsy(US-PLNB)is a pivotal diagnostic technique for subpleural pulmonary lesions,offering significant advantages such as real-time imaging,absence of ionizing radiation,and high operational flexibility.To standardize its clinical application and enhance both procedural safety and diagnostic accuracy,a multidisciplinary panel of experts was convened by eleven authoritative Chinese academic societies,including Chinese Society of Ultrasound in Medicine.Based on the latest domestic and international evidence-based medicine,this panel developed Chinese expert consensus on ultrasound-guided percutaneous lung needle biopsy(2025 edition).This consensus systematically elaborates on the indications and contraindications,preprocedural assessment and preparation,intraoperative techniques,complication prevention and management,and post-procedural care for US-PLNB.Furthermore,it puts forward 18 specific evidence-based recommendations.The primary aim of this consensus is to provide radiologists and clinicians with standardized operational guidance,promote the standardized application of US-PLNB,and ultimately improve patient care for individuals with pulmonary diseases.
The Acquired Immunodeficiency Syndrome Professional Group of the Society of Infectious Diseases of the Chinese Medical Association formulated the first edition of theChinese Guidelines for the Diagnosis and Treatment of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (referred to as the Guidelines) in 2005. The 2024 edition of the Guidelines has been compiled by updating the 2021 fifth edition, incorporating the latest research advancements in antiviral therapy, comprehensive management, opportunistic infections, concurrent tumors, and the prevention and intervention of HIV infection. The new edition also introduces a new section on "Incomplete immune reconstitution", proposes the concept of "HIV vulnerable populations" for the first time with recommendations for their diagnosis and treatment. This edition of the Guidelines covers 14 sections: epidemiology, pathogenic characteristics, laboratory tests, pathogenesis, clinical presentation and staging, diagnostic criteria, common opportunistic infections, antiretroviral therapy, immune reconstitution inflammatory syndrome, incomplete immune reconstitution, AIDS-related neoplasms, prevention of mother-to-child transmission and conception in serodiscordant couples, pre- and post-exposure prophylaxis, and whole-course management of HIV infection. This edition of the Guidelines aims to assist clinical physicians in making informed decisions in the diagnosis, treatment, and management of HIV/AIDS and will be periodically revised and updated based on domestic and international research progress.
目的:初步探索鼠衣原体质粒编码蛋白(pGP)维持鼠衣原体定植在消化道的作用，并分析具体参与鼠衣原体在消化道抵制胃酸杀伤作用的pGP种类。方法:选取6周龄雌性健康C57BL/6J小鼠进行灌胃感染不同剂量的鼠衣原体，包括质粒完整衣原体、质粒缺乏衣原体、质粒缺陷衣原体(pGP3S-CM、pGP4S-CM、pGP5S-CM、pGP6S-CM、pGP7S-CM、pGP8d-CM)。于感染后第3、7、14、21、28、35、42、49、56、63天采集直肠拭子，感染后第3、7、14、21、28天取小鼠消化道不同部位组织(胃、十二指肠、空肠、回肠、结肠、盲肠)，离心取上清液，将上清液接种于海拉细胞进行间接免疫荧光染色，荧光显微镜下计数衣原体包涵体，计算组织中鼠衣原体的感染数量。将pH值为1.0、2.0、2.5、3.0、3.5、4.0、4.5、5.0、5.5、6.0、6.5、7.0的模拟胃酸分别与质粒完整衣原体、pGP3S-CM和pGP4S-CM共同孵育10 min，计算经过不同pH值模拟胃酸杀伤后存活鼠衣原体的数量。统计学比较采用两独立样本 t检验。 结果:采用剂量分别为1×10 3衣原体包涵体形成单位(IFUs)、1×10 4 IFUs、1×10 5 IFUs、1×10 6 IFUs质粒完整衣原体灌胃小鼠后，感染第7至56天小鼠直肠拭子均可检测到质粒完整衣原体，而质粒缺乏衣原体仅在高剂量1×10 5 IFUs和1×10 6 IFUs灌胃小鼠感染后第14天、第7天的直肠拭子中分别被检测到，较质粒完整衣原体在消化道被检出时间明显延迟。采用1×10 5 IFUs质粒完整衣原体灌胃小鼠感染后第3至21天的胃、十二指肠、空肠、回肠、盲肠、结肠、直肠组织中均可检测出衣原体，第28天后局限在盲肠、结肠、直肠，而质粒缺乏衣原体以相同剂量灌胃感染后仅在第14、21、28天的盲肠、结肠、直肠中被检出。pGP3S-CM与pH值为3.0、3.5、4.0、4.5模拟胃酸共同孵育后存活的鼠衣原体数量均低于质粒完整衣原体组，差异均有统计学意义( t＝－0.79、－6.44、－6.99、－6.96，均 P<0.05)，而pGP3S-CM与pH值为5.0~7.0的模拟胃酸共同孵育后存活鼠衣原体数量与质粒完整衣原体组差异无统计学意义(均 P>0.05)。 结论:鼠衣原体质粒可以促进鼠衣原体在消化道内不同部位组织相互作用，使衣原体存活并长期定植，质粒缺乏使鼠衣原体无法在胃和小肠中定植。其中pGP3、pGP4对于鼠衣原体在消化道定植起主要影响，pGP3参与鼠衣原体耐受胃酸杀伤保证鼠衣原体定植于消化道起关键作用。
由新型冠状病毒(SARS-CoV-2)引起的新型冠状病毒感染(COVID-19)对全球公共卫生系统产生了广泛而持久的影响，但人们对COVID-19的长期影响仍然知之甚少。成年感染患者可能在康复后出现成人多系统炎症综合征(MIS-A)，它是一种罕见但严重的SARS-CoV-2感染后并发症，通常在感染后2~6周出现，主要症状为发热和肌痛，伴有肺外多器官功能障碍，炎症指标显著升高和心肌标志物异常。临床易与急性呼吸窘迫综合征、脓毒症休克等混淆而延误临床救治。现报道1例35岁健康男性，在SARS-CoV-2感染后4周发生MIS-A，以发热、心力衰竭症状最为突出，予地塞米松、丙种球蛋白及相应对症治疗后病情好转，最终治愈。
目的:分析耐碳青霉烯类肺炎克雷伯菌(CRKP)肺部感染患者的危险因素及预后，为CRKP感染防控及临床抗菌药物选择提供参考。方法:以2021年1月至2023年6月四川大学华西医院收治的CRKP肺部感染患者为研究对象，并针对患者年龄及性别使用倾向评分匹配按1∶1匹配碳青霉烯类敏感肺炎克雷伯菌(CSKP)肺部感染患者作为对照组。收集纳入患者的病历资料，进行CRKP肺部感染的危险因素及预后分析。采用logistic回归模型和Cox回归模型进行多因素分析。结果:CRKP组和CSKP组各纳入190例患者。CRKP组来源于综合重症监护病房(ICU)最多，占24.2%(46/190)。logistic回归模型分析显示，采样前住院时长[比值比( OR)＝1.050, 95%可信区间(95% CI) 1.030~1.071]、ICU入住史( OR＝4.239, 95% CI 1.970~9.122)、≥3 d碳青霉烯类抗菌药物用药史( OR＝9.821, 95% CI 5.486~17.581)为CRKP肺部感染的独立危险因素(均 P<0.001)。CRKP分离株对替加环素、多黏菌素、头孢他啶阿维巴坦均有较高的敏感率(≥94.9%)。序贯器官衰竭评估(SOFA)评分是CRKP肺部感染疗效不佳的独立危险因素( OR＝1.238, 95% CI 1.057~1.450， P＝0.008)。CRKP肺部感染患者感染后28 d的全因死亡率为39.5%(75/190)。Cox回归模型分析显示，年龄大[风险比( HR)＝1.021，95% CI 1.002~1.040， P＝0.033]、高SOFA评分( HR＝1.265，95% CI 1.158~1.382, P<0.001)是患者发生CRKP肺部感染后28 d死亡的独立危险因素。 结论:采样前住院时长、ICU入住史和≥3 d碳青霉烯类抗菌药物用药史是CRKP肺部感染的独立危险因素。CRKP感染预后差，尤其是在年龄较大和高SOFA评分的患者中。
Objective:To analyze the clinical and laboratory characteristics of mpox patients in Guangzhou City.Methods:The general conditions, symptoms and signs, and laboratory test results of mpox patients admitted to Guangzhou Eighth People′s Hospital, Guangzhou Medical University from June 8 to June 21, 2023 were collected. The clinical characteristics of human immunodeficiency virus (HIV)-infected patients and HIV-negative patients were compared.Independent sample t test, Mann-Whitney U test and Fisher exact probability method were used for statistical analysis. Results:Nineteen mpox patients were included in this study, none of them had been vaccinated with smallpox vaccine. All of them were identifed as gay men with an age of (33.2±6.4) years. And all of them had sex with men within 21 days of onset. There were eight cases with HIV infection and syphilis, respectively. All of these 19 patients had skin lesions which were the first symptom of 15 patients, and appeared during the course of the disease of four patients. Other common symptoms and signs were lymph node enlargement (17 cases), lymph node tenderness (15 cases), pharyngeal congestion (15 cases), tonsil enlargement (13 cases), fever (11 cases) and pruritus (10 cases). There were 13 cases with elevated CD8 + T lymphocytes, interleukin-10 level and procalcitonin level, respectively, 12 cases with elevated serum amyloid A level, and seven cases with elevated blood lymphocyte count. Eight patients were infected with HIV, including one acute infection and seven chronic infections (all of them had received regular antiviral therapy and had a CD4 + T lymphocyte count of 657(400, 757)/μL before onset). There were no significant differences in age ( t=1.55), incidence of complications (Fisher exact probability method), number of skin lesions ( Z=-0.21), incidence of lymph node enlargement (Fisher exact probability method), incidence of fever (Fisher exact probability method), duration of fever ( Z=-0.48), lymphocyte count ( t=-1.55), CD4 + T lymphocyte count ( Z=-0.17) and CD8 + T lymphocyte count ( Z=-1.49) between the HIV-infected patients and HIV-negative patients (all P>0.05). The number of skin lesions was 19(6, 26), and the locations of skin lesions were mainly in perineum and nearby areas (17 cases). The most frequent morphology of skin lesions at admission were papules (15 cases), eschar (15 cases) and pustules (12 cases). All patients recovered after topical medication and symptomatic treatment. Conclusions:Mpox mainly occurs in young and middle-aged men who have sex with men in Guangzhou City. Skin lesions, lymph node enlargement accompanied by tenderness, pharyngeal congestion, tonsil enlargement and fever are the most common features. Common laboratory abnormities are elevated inflammatory markers. The clinical characteristics of HIV-infected patients with normal immune function are similar to those of HIV-negative patients.
Objective:To investigate the efficacy and safety of posaconazole in the prevention of invasive pulmonary aspergillosis (IPA) in patients with liver failure treated with glucocorticoids (GC).Methods:The study was an observational study. Patients with early and middle stages of liver failure hospitalized in the Department of Infectious Diseases of Hebei Medical University Third Hospital, who received GC treatment between February 2016 and February 2022 were included. The patients were divided into trial group (with posaconazole suspension (200 mg each time, three times daily)) and control group (without posaconazole) according to whether posaconazole was used during treatment. Two groups of patients were matched of 1∶2 ratio according to age, gender and baseline model for end-stage liver disease (MELD) score. The basic information, laboratory examination results, adverse reactions of posaconazole, incidence of invasive Aspergillus infection and therapeutic effect of patients were collected. Statistical analysis was performed using the chi-square test, logistic regression analysis was used to screen risk factors for IPA, the receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the risk factors, Kaplan-Meier survival curves was used to analyze patient′s survival, and Log-rank test was used to compare the survival rates between the trial group and control group. Results:A total of 108 patients (36 in trial group and 72 in control group) were enrolled. There were no statistical differences between the two groups in terms of the etiology of liver diseases, baseline laboratory findings and risk factors for invasive Aspergillus infection (all P>0.05). There were 21 cases of IPA during hospitalization, with a total infection rate of 19.4%(21/108), including 5.6%(2/36) in the trial group and 26.4%(19/72) in the control group. The difference of IPA incidences between the two groups was statistically significant ( χ2=6.65, P=0.010). Logistic regression analysis suggested that elevated C-reactive protein, GC application more than seven days and cumulative dose of GC were independent risk factors for IPA in patients with liver failure treated with GC (odds ratio ( OR)=1.080, 15.266, 1.004, respectively, all P<0.05). The ROC curve showed that the cut-off value of C-reactive protein was 6.00 mg/L, and cumulative dose of GC was 490 mg. There were no statistical differences between the two groups in terms of adverse effects such as neutropenia, thrombocytopenia, gastrointestinal bleeding, nausea and vomiting rates (all P>0.05), and there were no patients with visual disturbances or discontinuation of medication. Cumulative deaths were 20(18.5%), and 88(81.5%) patients survived in this study. There were 11(52.4%) deaths among 21 patients with IPA and nine (10.3%) deaths among 87 patients without IPA. The difference of survival rates between patients who developed and did not develop IPA was statistically significant ( χ2=21.31, P<0.001). Conclusions:Posaconazole may be helpful in reducing the incidence of concurrent IPA morbidity in patients with liver failure treated with GC, thereby improving survival rates with few adverse effects.
随着检测技术的进步与生物信息学的发展，人类不断从健康者或非菌血症疾病患者外周血中检出细菌或细菌成分，并对其生物学功能进行了初步探究，发现循环细菌的多样性、组成及各菌相对丰度的改变均可能是特定疾病发生与进展的重要驱动力，由此开启了学术界对循环细菌的新认识和讨论。现总结有关研究证据，阐述循环细菌在健康维持或非菌血症疾病发病机制中的角色，并进一步指明该主题中亟待回答的关键科学问题，以推动靶向循环细菌干预策略的开发与临床应用。
新型冠状病毒感染流行期间出现了大量新型冠状病毒感染相关神经系统并发症病例。如何正确识别、评估和管理新型冠状病毒感染相关神经系统并发症，对接诊新型冠状病毒感染者的相关科室医师而言充满挑战。国家传染病医学中心、国家神经疾病医学中心联合复旦大学循证医学中心，基于当前的最佳循证证据，结合来自中国一线诊治新型冠状病毒感染相关神经系统并发症的经验，经全国多家医院神经科、感染科专家共同讨论，制订了《新型冠状病毒感染相关神经系统并发症的评估与管理中国专家共识(2023)》，内容包括脑病、脑血管病、脑/脊髓炎、吉兰-巴雷综合征等新型冠状病毒感染神经系统并发症人群的识别、评估项目和治疗策略，为指导临床正确地评估与管理新型冠状病毒感染神经系统并发症提供理论依据。
Objective:To explore the predictive value of inflammatory markers for convulsions in children infected with the severe acute respiratory syndrome coronavirus 2 Omicron variant.Methods:A total of 263 children infected with the Omicron variant admitted to various wards of Fujian Children′s Hospital from December 2022 to January 2023 were included in this study. Based on the presence or absence of convulsions, the children were divided into convulsions group (93 cases) and non-convulsions group (170 cases). Chi-square test and independent samples t-test were used to compare the clinical characteristics and laboratory indicators of the two groups. Binary logistic regression analysis was conducted to determine the relationship between inflammatory markers and convulsions, and receiver operator characteristic (ROC) curve was used to evaluate the efficacy of serum amyloid A (SAA) and interleukin-6 (IL-6) for predicting convulsions occurrence in children. Results:The convulsions group had proportions of 29.03%(27/93) with underlying medical conditions and 40.86%(38/93) with a history of febrile convulsions, which were both higher than the non-convulsions group′s proportions of 18.24%(31/170) and 5.29%(9/170), respectively. These differences were both statistically significant ( χ2=8.71 and 16.92, respectively, both P<0.05). In the convulsions group, levels of procalcitonin, serum ferritin, IL-6, SAA, aspartate aminotransferase, creatine kinase, creatine kinase-isoenzymes and fibrinogen were all significantly higher than those in the non-convulsions group. These differences were all statistically significant ( t=-2.00, -1.54, -2.71, -5.04, -1.30, -2.03, -1.38 and 1.57, respectively, all P<0.05). Erythrocyte sedimentation rate, C-reactive protein, lymphocyte count, blood urea nitrogen and serum creatinine in the convulsions group were all lower than those in the non-convulsions group, with statistically significant differences ( t=3.31, 2.05, 4.21, 2.37 and 1.85, respectively, all P<0.05). SAA and IL-6 were identified as independent risk factors for convulsions in children infected with Omicron variant (both P<0.01). The ROC curve analysis showed that the area under the curve of predictive value of combined SAA and IL-6 was 0.833 ( P<0.01), with a sensitivity of 0.724 and specificity of 0.843. The optimal cutoff values for SAA and IL-6 in predicting convulsions in children infected with the Omicron variant were 141.40 mg/L and 85.05 ng/L, respectively. Conclusions:The combination of SAA and IL-6 could serve as early predictive indicators for convulsions in children infected with the Omicron variant, which could provide valuable insights for timely clinical diagnosis and treatment.
Objective:To evaluate the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) with or without ribavirin in the treatment of patients diagnosed with chronic hepatitis C (CHC) and chronic kidney disease (CKD).Methods:From June 2018 to May 2022, a total of 75 patients with CHC and CKD, and treated with SOF/VEL±ribavirin at the Kunming Third People′s Hospital were enrolled in this study. The basic information of patients were collected. Assessments of renal function, liver function, virologic response rate and adverse events were conducted at baseline, four weeks and 12 weeks of treatment and 12 weeks after treatment withdrawal. Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results:Among the 75 patients, 51 cases(68.0%) were classified as CKD stage 2, 12 cases (16.0%) as CKD stage 3, four cases (5.3%) as CKD stage 4, eight cases (10.7%) as CKD stage 5. Additionally, 26 cases (34.7%) were classified as HCV type 3a, while 37 cases (49.3%) were classified as type 3b. Among the patients, 51 cases (68.0%) had cirrhosis, including 15(20.0%) compensated cirrhosis and 36(48.0%) decompensated cirrhosis. Twelve weeks after treatment withdrawal, there was a statistically significant improvement in the estimated glomerular filtration rate (eGFR) compared to baseline (81.76(60.94, 94.34) mL/(min·1.73 m 2) vs 70.99(52.86, 82.38) mL/(min·1.73 m 2), Z=8.12, P=0.040). From baseline to 12 weeks after treatment withdrawal, eGFR of patients with CKD stage 2 and stage 3 were both gradually increased, with statistical significance ( H=8.91 and 8.03, respectively, both P<0.05). For CKD stage 2 patients, eGFR increased from 78.82(70.98, 84.80) mL/(min·1.73 m 2) to 86.94 (75.91, 96.01) mL/(min·1.73 m 2), while CKD stage 3 patients had an increased from 51.24 (45.92, 53.37) mL/(min·1.73 m 2) to 64.58 (44.54, 74.34) mL/(min·1.73 m 2). Renal function was improved to CKD stage 1 in 21 patients (28.0%). Compared to baseline, CKD stage 2 patients exhibited a decrease of aspartate aminotransferase to platelet ratio index 12 weeks after treatment withdrawal, and alanine aminotransferase and aspartate aminotransferase levels were also significantly improved with statistical significance ( Z=8.03, 21.57 and 43.74, respectively, all P<0.05). The rate of sustained virological response (SVR)12 at 12 weeks after treatment withdrawal was 98.7%(74/75). Among these cases, 51 patients in CKD stage 2, 11 patients in CKD stage 3, 12 patients in CKD stage 4 and stage 5 reached SVR12. Adverse events occurred in 32 patients (42.7%), including 18 cases of mild hemolytic anemia, four cases of skin itching, three cases of rash, two cases of chest tightness, and five cases of fatigue. Conclusions:SOF/VEL with or without ribavirin for the treatment of patients with CHC and CKD has good effectiveness and safety. The renal function, liver function and liver fibrosis degree have been improved after antiviral treatment.
亚临床结核病是结核病自然史的一部分，目前主流文献对其的定义是无结核病相关症状的结核病患者。近年来，随着对结核病自然史的重新分析与对亚临床结核病群体的公共卫生意义的探索，这类患者受到越来越多的关注。本综述总结了目前对于亚临床结核病的认知及其流行病学、诊断、治疗、预后方面的研究进展，并提出了这一领域待解决的问题。
狒狒巴拉姆希阿米巴脑炎是一种极为罕见且凶险的疾病，其临床表现不具有特异性，临床上很难与结核性脑膜炎及化脓性脑膜炎相鉴别，诊断困难，预后极差，病死率高达98%。本病确诊主要依靠脑组织病理检查。现报道1例经宏基因组学二代测序技术辅助诊断的狒狒巴拉姆希阿米巴脑炎的诊治经过。
耐药结核分枝杆菌的出现对全球结核病防控构成严重威胁。贝达喹啉和德拉马尼是过去40年来专门开发用于治疗耐多药结核病的2种新药物。德拉马尼在成人耐多药结核病和广泛耐药结核病患者中取得了较好的疗效，而关于德拉马尼在青少年、人类免疫缺陷病毒感染患者和肺外结核等特殊耐药结核病人群中的研究较少，本文旨在对德拉马尼治疗耐药结核病特殊人群的有效性及安全性进行综述。
本研究报道1例合并输入性重症疟疾的新型冠状病毒感染病例，患者从加纳回国，在病程中出现脓毒血症、休克、弥散性血管内凝血等严重并发症，经青蒿琥酯序贯青蒿琥酯阿莫地喹抗疟、抗休克、抗凝、无创呼吸机辅助呼吸、短程小剂量糖皮质激素、免疫调节、中医药等治疗后，救治成功并康复出院。
细菌耐药问题给人类健康和公共卫生安全带来巨大威胁，然而，新型抗菌药物的研发速度远不及病原菌耐药产生的速度。因此，研发新型的抗菌疗法迫在眉睫。噬菌体是一种可特异性感染并杀死细菌的病毒，其杀菌机制与传统抗菌药物截然不同，且对抗菌药物耐药的细菌同样有效，不良反应少。噬菌体是治疗难治性耐药细菌感染中极具应用潜力的新策略。近年来，噬菌体治疗超级细菌感染的成功案例越来越多。中国、美国、欧洲联盟、以色列和澳大利亚等国家和地区相继批准了噬菌体治疗耐药菌感染的临床试验。但是，目前噬菌体治疗的临床循证医学证据有限，缺乏统一的技术规范和评价体系。因此，现组织噬菌体治疗过程中涉及的基础医学、临床医学、临床检验诊断学等多学科的专家，基于我国前期进行的噬菌体治疗临床试验经验，并通过文献检索和证据评价，共同起草了《噬菌体治疗中国专家建议》，以期规范噬菌体的临床应用流程，促进噬菌体在临床实践中的应用，提高我国噬菌体临床应用水平，为有效遏制耐药细菌危机，更好地维护人民生命健康奠定坚实的基础。
Objective:To understand the in vitro antimicrobial resistance and resistance phenotypes profile of Streptococcus suis strains isolated from human in Zhejiang Province. Methods:The strains of sporadic Streptococcus suis infections were isolated during 2005 to 2021 in Zhejiang Province, and were subjected to antimicrobial resistance analysis using agar dilution method. Polymerase chain reaction (PCR) technology was also used to detect 70 resistance genes including tetracyclines, macrolides and aminoglycosides. Results:The results of antimicrobial resistance analysis showed that these strains were sensitive to eleven kinds of antimicrobial agents with a sensitivity rate ≥96.8%, including cefepime, cefotaxime, ceftriaxone, chloramphenicol, daptomycin, ertapenem, levofloxacin, linezolid, meropenem, penicillin and vancomycin. These strains were mainly resistant to tetracycline, clindamycin, azithromycin and erythromycin, especially resistant to tetracycline with a rate of 93.5%(29/31). Fourteen strains (45.2%) exhibited multidrug resistant patterns. The PCR analysis of 70 drug resistance genes showed that 14(20.0%) different resistance genes were detected. The highest detection rate of resistant genes came from tetracycline, including tet ( O) gene (58.1%, 18/31), tet ( M) gene (48.4%, 15/31), tet ( 40) gene (35.5%, 11/31), followed by ermB gene (41.9%, 13/31) in the class of macrolide. Fourteen strains (45.2%) with more than three drug resistance genes were detected, of which eight strains (25.8%) detected 10 drug resistance genes. The analysis of antibiotic resistance and resistance phenotypes profile showed that tet ( M)+ ST7 accounted for 35.5%(11/31), tet( O)+ tet( 40)+ ermB+ mef( A)+ mef( A/ E)+ msrD+ Ant( 6)- Ⅰb+ aph( 3′)- Ⅲa+ aadB+ sat4+ ST7 accounted for 25.8%(8/31). Conclusions:The antimicrobial resistance and resistance phenotypes profile of sporadic Streptococcus suis strains isolated from human in Zhejiang Province are endemic, with mainly two types of characteristic genetic cloning of drug resistance genes.
慢性乙型肝炎(CHB)患者乙型肝炎表面抗原(HBsAg)自发清除率较低，在HBsAg清除较长时间后，由于体内共价闭合环状DNA(cccDNA)的存在，部分患者仍可以检测到HBsAg。能够准确反映cccDNA的指标对患者的治疗具有重要的临床意义。乙型肝炎核心相关抗原(HBcrAg)是新型血清标志物，其低水平与较高的乙型肝炎病毒特异性T细胞反应和HBsAg清除率相关，能更好地反映CHB患者体内cccDNA的转录活性。HBcrAg在乙型肝炎e抗原血清学转换、病毒学与临床复发、疾病进展方面也有较好的预测价值，监测HBcrAg可有效提高对CHB患者疾病进展情况的判断。
Objective:To explore the risk factors related to death in patients with tuberculosis complicated with sepsis in an intensive care unit, in order to provide reference for the clinical treatment of patients with tuberculosis complicated with sepsis.Methods:A retrospective case-control study was conducted to collect the general clinical data of 384 patients with tuberculosis complicated with sepsis in intensive care unit of Public Health Clinical Center of Chengdu from March 2020 to November 2022. Multivariate logistic regression model was used to analyze independent risk factors for death in patients with tuberculosis complicated with sepsis.Results:Among 384 patients with tuberculosis complicated with sepsis, the 28-day mortality rate was 43.2%(166/384). Multivariate logistic regression analysis showed that age ≥60 years old (odds ratio ( OR)=1.924, 95% confidence interval ( CI) 1.033 to 3.585, P=0.039), body mass index (BMI) <18.5 kg/m 2 ( OR=4.496, 95% CI 2.242 to 9.016, P<0.001), acute physiology and chronic health evaluation (APACHE) Ⅱ ≥20 points ( OR=2.133, 95% CI 1.093 to 4.162, P=0.026), blood urea nitrogen-to-albumin ratio>5.945 mg/g ( OR=20.886, 95% CI 10.883 to 40.084, P<0.001) and septic shock ( OR=6.137, 95% CI 2.852 to 13.209, P<0.001) were independent risk factors for death in patients with tuberculosis complicated with sepsis in intensive care unit. Conclusions:Age≥60 years old, BMI<18.5 kg/m 2, APACHE Ⅱ≥20 points, blood urea nitrogen-to-albumin ratio>5.945 mg/g and septic shock are independent risk factors for the death in patients with tuberculosis complicated with sepsis. Early attention should be paid to these patients and cluster therapy should be started as soon as possible in order to shorten the disease process, and to improve the prognosis and reduce mortality.
