Asthma is a chronic inflammatory disease of the airway,characterized by recurrent chest tightness,cough,wheezing and shortness of breath,airflow obstruction and airway hyperresponsiveness.There is great heterogeneity in the symptoms,inflammatory patterns,and response to treatment in asthma patients,the different asthma phenotypes were identified according to the heterogeneity.Further study on the phenotype is helpful to the accurate diagnosis and treatment of asthma,so as to improve the herapeutic effect,reduce the acute attack and improve the prognosis.Using induced sputum analysis techniques to detect airway inflammation,four different inflammatory phenotypes could be identified.This article reviews the clinical characteristics,lung function characteristics and treatment progress in asthma patients with different airway inflammation phenotypes.
At the end of 2019,the coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)spread rapidly and became pandemic worldwide.Due to rapid mutation and strong infectivity of the virus strains,COVID-19 has brought heavy medical and economic burden to countries around the world.COVID-19 may infected multiple systems of the body.In addition to typical respiratory symptoms,patients with COVID-19 may be combined with myocardial injury.With the further studies,there is a better understanding of COVID-19-related myocardial injury currently.The current researches that involved COVID-19-related myocardial injury were summarized to deepen clinicians'understanding.
Objective:To analyze the chest CT imaging manifestations of patients with pulmonary tuberculosis complicated with pulmonary embolism,and to improve clinicians'understanding of the imaging of this disease.Methods:A total of 101 patients diagnosed with pulmonary tuberculosis combined with pulmonary embolism in the Kunming Third People's Hospital from January 2017 to December 2022 were retrospectively selected as the observation group(all patients admitted during this period),and 101 patients diagnosed with simple pulmonary tuberculosis were selected as the control group from 39 495 patients by random numbers generated by Excel.The general data and chest CT imaging data were collected,and the distribution,morphology,lesion type and location were summarized and analyzed.Results:The median age of the observation group(65.00(51.00,71.50)years)was higher than that of the control group(39.00(27.00,55.00)years)(Z=-7.562,P＜0.001).Proportion of retreatment patients(57.4％,58/101)in the observation group was statistically higher than that(32.7％,33/101)in the control group(x2=12.499,P＜0.001).In the observation group,43 cases(42.6％,43/101)had emboli located in the lower right lung lobe.The distribution of lesions in the observation group were 53 cases(52.5％,53/101)in the right upper lobe,26 cases(25.7％,26/101)in the right middle lobe,49 cases(48.5％,49/101)in the right lower lobe,50 cases(49.5％,50/101)in the left upper lobe,43 cases(42.6％,43/101)in the left lower lobe,while for the control group were 50 cases(49.5％,50/101),19 cases(18.8％,19/101),39 cases(38.6％,39/101),43 cases(42.6％,43/101),37 cases(36.6％,37/101),the differences were not statistically significant(x2=0.339,P=0.560;x2=1.616,P=0.204;x2=2.702,P=0.100;x2=1.410,P=0.235;x2=1.020,P=0.312);In the observation group,70 cases(69.3％,70/101)had lesions accumulated in three or more than three lobes,56 cases(55.4％,56/101)showed patchy shadow,12 cases(11.9％,12/101)showed consolidation shadow,37 cases(36.6％,37/101)showed destroyed lungs,they were all higher than that in the control group(36 cases(35.6％,36/101),39 cases(38.6％,39/101),2 cases(2.0％,2/101)and 4 cases(4.0％,4/101)),and the differences were all statistically significant(x2=31.439,P＜0.001;x2=6.012.P=0.014;x2=8.176,P=0.004;x2=33.325,P＜0.001);In the observation group,there were 29 cases(28.7％,29/101)complicated with emphysema,30 cases(29.7％,30/101)with pericardial effusion,43 cases(42.6％,43/101)with bilateral pleural effusion,37 cases(36.6％,37/101)with right heart enlargement,17 cases(16.8％,17/101)with atelectasis,and 33 cases(32.7％,33/101)with pulmonary artery thickness,which were all statistically higher than that of the control group(5 cases(5.0％,5/101),4 cases(4.0％,4/101),8 cases(7.9％,8/101),4 cases(4.0％,4/101),6 cases(5.9％,6/101),3 cases(3.0％,3/101);x2=20.688,P＜0.001;x2=24.243,P＜0.001;x2=33.635,P＜0.001;x2=49.155,P＜0.001;x2=6.488,P=0.011;x2=33.223,P＜0.001).The working characteristic curves showed that when D-dimer＞1.290 μg/ml,pulmonary tuberculosis patients were more likely to develop pulmonary embolism.Conclusion:In older patients with retreated pulmonary tuberculosis whose CT show patchy shadow,consolidation shadow or damaged lungs,accompanied by emphysema,pericardial effusion,bilateral pleural effusion,right heart enlargement,atelectasis,pulmonary artery thickening and D-dimer＞1.290 pg/ml,it is necessary to be alert to the occurrence of pulmonary embolism.Doctors should consider clinical symptoms and other laboratory examinations of patients to make early diagnosis and treatment.
Objective:To analyze the resistance of multidrug-resistant tuberculosis(MDR-TB)patients to fluoroquinolones(FQs)and its influencing factors in Chongqing.Methods:A simple random sampling method was used in 165 MDR-TB patients from 39 districts(counties)in Chongqing from January 2020 to December 2022(study subjects),and basic information of the study subjects was collected.All the 165 strains of multidrug-resistant Mycobacterium tuberculosis(MDR-MTB)isolated from the study subjects were confirmed through strain identification and proportional drug sensitivity testing.Using the micro broth dilution method,the drug sensitivities of clinical isolates to ofloxacin(Ofx),levofloxacin(Lfx),and moxifloxacin(Mfx)were tested,and the drug resistance of the strains to FQs and related influencing factors were analyzed.Results:The total resistance rate of 165 MDR-MTB isolates to FQs was 37.6％(62/165),and the resistance rates to Ofx,Lfx,and Mfx were 37.6％(62/165),37.0％(61/165),and 29.7％(49/165),respectively.Multivariate logistic regression analysis showed that no history of FQs medication was a protective factor for FQs resistance(OR(95％CI)=0.348(0.169-0.717)).Conclusion:The FQs resistance rate of MDR-TB patients in Chongqing is relatively high,and patients with a history of FQs medication have a higher risk of FQs resistance.
Objective:To explore the use and influencing factors of mobile WeChat tuberculosis management system(referred to as"micro-surveillance")after its comprehensive promotion in Huizhou.Methods:The retrospective research method was used to collect the data of tuberculosis patients registered in Huizhou micro-surveillance promotion area from January to December 2021,including the medical record data of people using micro-surveillance at different times,in different regions and with different characteristics,and analyzed the use of micro-surveillance in tuberculosis patients.Logistic regression model was used to analyze the influencing factors of micro-surveillance in tuberculosis patients.Results:In 2021,a total of 1714 tuberculosis patients were registered in Huizhou micro-surveillance promotion area,764 patients were included in micro-surveillance management,and the use rate of micro-surveillance was 44.57％.The results of multivariate logistic regression analysis showed that those from Huidong County(OR=1.532,95％CI:1.154-2.035),Longmen County(OR=1.654,95％CI:1.165-2.347),Zhongkai District(OR=3.157,95％CI:1.263-7.896),and were employed as farmers(OR=1.541,95％CI:1.198-1.982),patients with symptomatic visits(OR=1.308,95％CI:1.016-1.684)had a higher usage rate of micro-surveillance.Conclusion:Micro-surveillance had a certain degree of scalability in Huizhou City,especially suitable for promotion among patients from Huidong County,Longmen County,Zhongkai District,farmers,and symptomatic patients.
Chronic obstructive pulmonary disease(COPD)is a heterogeneous pulmonary condition and a common chronic respiratory disease with high morbidity and mortality.Bronchiectasis is a recurring pyogenic infection caused by various causes,resulting in repeated damage and/or obstruction of the small and medium bronchus,the destruction of the bronchial wall structure,bronchial abnormalities and persistent dilation.Bronchodilatation-chronic obstructive pulmonary disease overlap syndrome(BCOS)is a combination of bronchiectasis and COPD in the same patient.BCOS is a common clinical syndrome,but there are few studies on the clinical characteristics and prognosis of BCOS.Through a large number of literature retrieval and analysis,this review comprehensively expounds the latest mechanism research,clinical characteristics research,and related risk and prognosis research progress of COPD complicated with bronchiectasis,aiming at a clearer understanding of this syndrome and providing new ideas for clinical prevention and treatment of BCOS.
Objective:To analyze clinical characteristics and prognosis of pulmonary diseases caused by Mycobacterium kansassi(M.kansassi)and Mycobacterium intracellular(M.intracellular),and to improve awareness of pulmonary disease caused by slow-growing mycobacteria.Methods:Medical records of 87 patients with M.kansassi pulmonary diseases and 285 patients with M.intracellular pulmonary diseases diagnosed in Shenzhen Third People's Hospital from January 2017 to January 2021 were retrospectively reviewed.Demographic information,clinical manifestations,treatment,and sputum negative conversion between the two groups were compared and analyzed.Results:Patients with pulmonary disease caused by M.kansasii were predominantly male(18-45 years old,81.6％(71/87))and young adults(44.8％(39/87)),while patients with pulmonary disease caused by M.intracellulare were predominantly female(46-65 years old,67.4％(192/285))and middle-aged(50.9％(145/285)).The differences in the distribution of gender and age between the two groups were statistically significant(x2=64.863,22.243,respectively,both P＜0.001).M.kansasii tuberculosis patients complicated with bronchiectasis were significantly less than those M.intracellulare tuberculosis(5.7％(5/87)vs.33.7％(96/285),x2=26.301,P＜0.001).and the number of M.kansasii tuberculosis patients receiving treatment was significantly higher than that of M.intracellulare tuberculosis patients(75.9％(66/87)vs.42.5％(121/285),x2=29.754,P＜0.001).The main drugs for M.kansasii tuberculosis patients were ethambutol(87.9％(58/66)),rifampicin(86.4％(57/66))and isoniazid(57.6％(38/66)),while the main drugs for M.intracellulare tuberculosis patients were rifampicin(83.5％(101/121)),ethambutol(77.7％(94/121))and macrolides(70.2％(85/121)).The sputum culture conversion rate of M.kansasii tuberculosis patients who received treatment was significantly higher than that of M.intracellulare tuberculosis patients receiving treatment(87.9％(58/66)vs.59.5％(72/121),x2=16.816,P＜0.001).The difference of adverse drug reactions of the two groups was was not significantly(24.2％(16/66)vs.31.4％(38/121),x2=1.067,P=0.302),and all the adverse drug reactions were mild.Conclusion:M.kansasii tuberculosis patients are more common in males and young adults,with rare complications such as bronchiectasis and underlying diseases,more likely to receive treatment,have shorter treatment duration,and have good treatment effect;while M.intracellulare tuberculosis patients are more common in females and middle-aged and elderly,and have poor treatment effect,it is necessary to explore new treatment strategy for patients with M.intracellular pulmonary disease.
Objective:To evaluate the application effect of diversified missionary nursing on multidrug-resistant pulmonary tuberculosis(MDR-PTB)patients.Methods:A total of 115 MDR-PTB patients admitted to the Tuberculosis Department of Shanghai Pulmonary Hospital from March 2019 to March 2022 were selected as the study subjects.They were divided into an observation group(58 cases)and a control group(57 cases)using a random number table method.The control group received routine nursing intervention,while the observation group received diversified missionary nursing except for routine nursing.Intervention for the patients in two began after admission and last for one month.The depression and anxiety emotions of the study subjects were evaluated using the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA);the treatment compliance was evaluated based on their performance and compliance with medical practices;the nursing satisfaction was evaluated using a self-made satisfaction survey questionnaire;the quality of life was evaluated using the Quality of Life Assessment Scale(SF-36);and the self-care ability was evaluated by using the Self Care Ability Assessment Scale(ESCA).Results:After intervention,the HAMD and HAMA scores of the observation group were 18.13±1.48 and 22.46±3.12,respectively,significantly lower than those of the control group(21.63±1.33 and 27.07±3.08)(t values were 13.331 and 7.973,both P＜0.001).The treatment compliance rate and nursing satisfaction rate of the observation group were 94.8％(55/58)and 96.6％(56/58),which were significantly higher than those of the control group(77.2％(44/57)and 82.5％(47/57),respectively),and the differences were statistically significant(x2 values were 7.464 and 6.112,P values were 0.006 and 0.013).After intervention,the quality of life,self-concept,sense of responsibility,nursing skills,and health knowledge scores of the observation group were 81.45±8.60,26.69±3.74,20.25±3.21,38.87±5.22,and 52.47±7.30,respectively,which were significantly higher than those of the control group(70.52±7.92,20.47±3.86,17.41±3.10,31.96±5.24,and 46.22± 6.84,respectively),the differences were statistically significant(t values were 4.086,8.776,4.825,7.084,4.736,all P values＜0.001).Conclusion:Diversified missionary nursing can improve the treatment compliance and life quality of MDR-PTB patients,enhance the nursing satisfaction and the self-care ability.
Tuberculosis caused by Mycobacterium tuberculosis(MTB),remains an important chronic inflammatory respiratory infectious disease.The pathogenesis of MTB depends on its ability to regulate the host metabolism.The host macrophage metabolic plasticity plays a key role in the progress of tuberculosis.The host release of IL-1 during MTB infection is critical for host defence and is subject to the host metabolic status.We reviewed the secretion of IL-1 during MTB infection and its effect on host resistance,the regulation of IL-1 by host macrophage metabolic reprogramming,and the crosstalk between IL-1 and other cytokines.This can deepen our understanding of host resistance to infection and the role of IL-1.
结核病是严重危害人民群众健康的重大传染病,我国政府一直以来高度重视结核病防治工作.近年来,我国各地区、各结核病相关部门认真贯彻党中央、国务院决策部署,坚持以人民健康为中心,坚持预防为主、防治结合、依法防治、科学防治,落实结核病各项防控措施,防治工作取得了显著进展[1].
The discovery of artemisinin-based antimalarial drugs is a milestone in the history of global antimalarial drug development.It is a major accomplishment achieved by the multi-departmental and multidisciplinary cooperation and mutual cooperation under the organization of scientific research programs,and is a successful example of inheriting and carrying forward the treasure house of traditional medicine in China.Learning the measures of successful experience in artemisinin research and development and drawing experience is important for improving the status quo of tuberculosis preventive treatment,promoting and improving the current tuberculosis prevention and control measures in China,and will play a beneficial role in promoting the goal of ending tuberculosis epidemic as scheduled.
Objective:To evaluate the implementation effect of WeChat application based tuberculosis management system(referred to as"micro-supervision")in Huizhou.Methods:A prospective study was conducted,1714 newly registered drug-susceptible pulmonary tuberculosis patients who met the inclusion criteria in Huizhou City from January to December 2021 were allocated to micro-supervision management group(764 cases)and the conventional supervision management group(950 cases),according to the patient's voluntary principle.According to the table of random sampling numbers,500 cases were randomly selected from the observation group(micro-supervision group)and the control group(conventional supervision group),respectively.The status of receiving medical staff visits,promotion and education,treatment adherence(missed medication and follow-up examination),treatment success,and occurrence of drug resistance were observed for the two groups.Results:The rate of medical staff visits(92.60％(463/500)),promotion(97.80％(489/500)),and the successful treatment rate(97.40％(487/500))among observation group were higher than those of the control group(84.20％(421/500),85.80％(429/500)and 85.20％(426/500)),and the differences were statistically significant(x2=17.202,47.824,46.846,Ps=0.000).The dropout rate(2.60％(13/500)),missed medication rate(15.81％(77/487)),and drug resistance rate(0.40％(2/500))were all significantly lower than the control group(14.80％(74/500),30.98％(132/426)and 3.00％(15/500)),and the differences were statistically significant(x2=46.846,P=0.000;x2=29.644,P=0.000;x2=10.113,P=0.001).The sputum examination rate(97.59％(486/498),97.12％(473/487),90.96％(443/487))at the end of the 2nd,5th,and 6th,and X-ray examination rate(93.02％(453/487))at the end of the 6th months of treatment in the observation group were higher than those in the control group(84.88％(421/496),86.08％(371/431),78.40％(334/426),80.98％(345/426)),the differences were statistically significant(x2=50.275,37.646,28.283,29.883;Ps=0.000).Conclusion:The micro-supervision management model can effectively improve patient treatment adherence,successful treatment rate,and reduce the occurance of drug resistance,so it is worth promoting and applying.
A 83-year-old,male,pulmonary tuberculosis patient complicated with pulmonary embolism treated in the First Department of Tuberculosis,Shanghai Pulmonary Hospital Affiliated to Tongji University on January 5,2022 was retrospectively analyzed.A professional nursing team was set up for this patient who were seriously ill with infiltrative pulmonary tuberculosis,pulmonary embolism,severe pulmonary infection,atrial fibrillation and deep vein thrombosis of lower extremity.With the help of various nursing records,assessment and monitoring sheets,the patient's condition was closely monitored,risk events were reported and monitored,and standardized communication modes were implemented.The relevant examinations were improved,and the patients also gain definite diagnosis,ECG monitoring and oxygen inhalation,furthermore,the implementation of safety protection measures was also strengthened,to avoid the occurrence of safety incidents such as falling bed and catheter accidents.Strict drug treatment was managed,and daily drug input plan was formulated,to ensure the drug input accurate,safe and timely.Active anti-infection,anti-tuberculosis,anti-coagulation,diuresis were given to reduce cardiac load,nutritional support and other treatment,as well as careful care were given,and the treatment was summarized.After 23 d hospitalization and careful nursing,the patient's symptoms improved and the condition was stable,therefore,he was discharged.
Objective:To analyze the infection situation and influencing factors of latent tuberculosis infection(LTBI)among high school sophomores.Methods:Sophomore high school students with no previous history of tuberculosis in schools of Hechuan District,Chongqing in 2022 were selected to take purified protein derivative of tuberculin(PPD)test to understand the LTBI situation among them.A simple random sampling was conducted to select LTBI students and students with negative PPD test results to receive a questionnaire survey,including questions about demographic characteristics,contact history and knowledge of tuberculosis,etc.One thousand pieces of questionnaire were distributed and 993 valid questionnaire were collected,with an effective rate of 99.3％.Univariable and multivariable logistic regression were done to analyze the influencing factors of LTBI in sophomore students.Results:Among 8873 high school sophomores,there were 1521 cases of LTBI,with an infection rate of 17.14％.Multivariable logistic analysis showed that the risk factors of LTBI among high school sophomores were female students(OR=1.451,95％CI:1.025-2.055),students having a history of close contact with tuberculosis patients(OR=8.523,95％CI:3.609-20.127),while students'mother having college or above education level(OR=0.401,95％CI:0.235-0.683),participation in physical exercise(OR=0.579,95％CI:0.387-0.866),having good knowledge of core message of tuberculosis prevention and control(OR=0.079,95％CI:0.054-0.115)were protective factors.Conclusion:The LTBI rate among sophomore high school students in Hechuan District,Chongqing is relatively high.LTBI acquisition are affected by gender,history of close contact with tuberculosis patients,mother's education level,physical exercise,and awareness of core tuberculosis message.Targeted health education and preventive medication can be carried out.
Objective:To evaluate the effect of focused nursing care on treatment compliance and prognosis of drug-resistant pulmonary tuberculosis patients.Methods:A total of 100 drug-resistant pulmonary tuberculosis patients who were treated in Shenyang 10th People's Hospital from December 2021 to November 2022 were selected as the research subjects.According to the admission time,they were divided into a control group(50 cases)and an observation group(50 cases)using a random number table method.The control group adopted routine nursing mode,while the observation group adopted cluster nursing in addition to the routine nursing mode.The scores of treatment compliance,physical recovery,and psychological recovery between the two groups were compared.Results:The treatment compliance,physical recovery,and psychological recovery scores of the observation group were 41.89±2.35,51.56±4.56,and 55.53±5.75,respectively,and were 15.19±3.26,34.62±3.17,and 32.35±5.42,respectively,in the control group.The scores of all indicators in the observation group were significantly higher than those in the control group,and the differences were statistically significant(t values were 13.271,15.231,and 12.241,respectively,all P＜0.05).The nursing satisfaction rate in the observation group was 96.0％(48/50),which was significantly higher than that in the control group(60.0％(30/50)),and the difference was statistically significant(x2=13.785,P＜0.05).Conclusion:During the treatment of drug-resistant pulmonary tuberculosis patients,adopting focused nursing care can effectively improve the treatment compliance,improve the quality of life,and enhance the confidence.
目的:探讨合并糖尿病的药物敏感性肺结核(DSPTB-DM)患者在抗结核治疗2个月末的痰菌阴转情况及影响痰菌阴转的危险因素.方法:采用回顾性研究方法,选取2021年5月至2022年7月于深圳市第三人民医院治疗及"药物敏感性肺结核合并糖尿病的优化抗结核方案的随机对照临床试验"前瞻性队列中的DSPTB-DM患者作为研究对象,共70例.所有研究对象按照研究方案设定,均使用H-R-Z-E(H:异烟肼;R:利福平;Z:吡嗪酰胺;E:乙胺丁醇)进行2个月强化期治疗,在强化治疗2个月末留取痰液行抗酸杆菌涂片镜检及分枝杆菌培养,并分为痰菌阴转组及为未阴转组.收集研究对象临床资料,包括年龄、性别、体质量指数、营养筛查评分(NRS-2002)、DM与PTB诊断先后顺序、痰抗酸杆菌涂片镜检结果、胸部影像学检查结果、空腹血糖及糖化血红蛋白情况,以及外周血实验室检测指标等.采用logisitic回归分析影响DSPTB-DM患者治疗强化期痰菌延迟阴转的危险因素.结果:70例研究对象经2个月强化期治疗,痰菌未阴转20例(28.6％;未阴转组),阴转50例(71.4％;阴转组).抗结核治疗初始时,DM与PTB同时间诊断者共19例,其中,转阴组有8例,占42.1％;阴转组中同时诊断者占16.0％(8/50),明显低于未转阴组(55.0％,11/20),差异有统计学意义(x2=9.104,P=0.003).未阴转组肺部有空洞者占85.0％(17/20),明显高于转阴组(48.0％,24/50),差异有统计学意义(x2=6.607,P=0.010).多因素分析结果显示,DM 与 PTB 同时诊断(OR=11.003,95％CI:2.548～61.956)、肺部有空洞(OR=7.711,95％CI:1.837～45.099)均是DSPTB-DM患者抗结核治疗2个月末痰菌延迟阴转的独立危险因素.结论:DSPTB-DM患者抗结核治疗强化期痰菌阴转率低,在治疗初始时需注意DM与PTB共病存在延迟诊断、肺部影像存在空洞的患者可能出现强化期末痰菌延迟转阴.
肺纤维化并发肺气肿(combined pulmonary fibrosis and emphysema,CPFE)是一种未被充分认识的综合征,其特征是呼吸道症状进行性恶化,影像学上表现为上叶以肺气肿为主、下叶以纤维化为主,肺功能表现为肺容量相对保留以及气体弥散能力下降,常见的合并症是肺动脉高压和肺癌,预后不佳.进一步认识CPFE疾病对临床医生的诊治工作有一定的帮助,作者总结近年来CPFE的研究进展,包括流行病学、发病机制和危险因素、临床表现、肺功能、影像学表现、诊断、治疗、合并症及预后.
目的:通过实习医师反馈以及相关量表,评估在糖尿病与结核病共病教学中混合教学模式在实习医师实习期间对相关专业知识掌握的作用.方法:选取2021年3月至2022年3月在解放军总医院第八医学中心内分泌科轮转的64名临床医学本科实习医师为研究对象.采用随机数字表法分为观察组与对照组,观察组(传统教学模式+基于案例的学习模式+基于问题的学习模式相结合)32名和对照组(传统教学模式)32名.入科当天进行入科糖尿病基础知识理论考核.课程结束3 d内所有实习医师完成对糖尿病与结核病共病知识的理论考试测评.给两组实习医师发放匿名测评问卷(主要内容为学生对相应知识掌握水平的自我评价和对教学模式的满意度).共发放问卷64份,回收64份,回收率为100.0％.结果:课程结束后,观察组的糖尿病与结核病共病理论知识考核成绩得分为(89.25±4.68)分,明显高于对照组[(73.53±4.41)分],差异有统计学意义(t=13.816,P＜0.001).测评问卷的结果显示:观察组在学习糖尿病与结核病共病的知识掌握水平的自我评价得分为(8.05± 0.65)分,优于对照组的(6.54±0.58)分,差异具有统计学意义(t=9.816,P＜0.001).观察组对教学满意度得分为(8.61±0.40)分,高于对照组的(6.55±0.42)分,差异有统计学意义(t=19.897,P＜0.001).结论:多种教学模式相结合在内分泌科中以糖尿病与结核病共病为范例的教学活动中取得更好的效果,有利于激发实习医师的学习兴趣,提高实习医师的学习效率,形成科学的诊疗思路.
目的:调查老年住院肺结核患者躯体功能情况及影响因素.方法:便利选取2021年6-12月于成都市公共卫生临床医疗中心结核科住院的429例老年肺结核患者(年龄范围为60～95岁)作为研究对象,收集研究对象的年龄、性别、婚姻状况、居住地、文化程度、吸烟史、饮酒史、体质量指数、耐药情况、治疗分类、痰菌检查情况等信息.采用日常生活活动能力量表[Barthel指数(Barthel index,BI)]、Berg平衡量表(berg balance scale,BBS)、Morse跌倒评估量表(Morse fall seale,MFS)评估研究对象躯体功能.结果:研究对象BI得分为(81.97± 17.62)分,BBS得分为(49.82±11.09)分,MFS得分为(41.90±12.79)分.年龄＞80岁的老年肺结核患者BBS、BI、MFS得分分别为(40.32±14.56)、(72.76±17.66)、(51.58±12.63)分,而 60～70 岁的老年肺结核患者 BBS、BI、MFS得分分别为(51.80±9.78)、(84.92±15.69)、(40.06±12.22)分;多元回归分析显示,年龄越大的老年肺结核患者日常生活活动能力越差(标准回归系数为-0.183,t=-3.797,P＜0.001)、平衡和步态能力越差(标准化回归系数为-0.245,t=-5.220,P＜0.001)、跌倒风险越大(标准化回归系数为0.187,t=3.802,P＜0.001).体质量指数＜18.5的老年肺结核患者BBS、BI、MFS得分分别为(45.07±14.03)、(75.82±17.82)、(46.12±12.83)分,而体质量指数为24.0～28.0的老年肺结核患者BBS、BI、MFS得分分别为(53.13±6.86)、(89.29±12.44)、(37.46±11.74)分;多元回归分析显示,体质量指数越低的老年肺结核患者日常生活活动能力越差(标准化回归系数为0.146,t=3.086,P=0.002)、平衡和步态能力越差(标准化回归系数为0.133,t=2.806,P=0.005)、跌倒风险越大(标准化回归系数为-0.119,t=-2.477,P=0.014).合并症数量为5～6个的老年肺结核患者BBS、BI、MFS得分分别为(48.18±11.64)、(82.27±20.78)、(38.64±15.35)分,而合并症数量为1～2个的老年肺结核患者BBS、BI、MFS得分分别为(51.55±8.86)、(84.76±14.39)、(41.37±12.35)分;多元回归分析显示,合并症数量越多的老年肺结核患者日常生活活动能力越差(标准化回归系数为-0.139,t=-2.967,P=0.003)、平衡和步态能力越差(标准化回归系数为-0.162,t=-3.494,P=0.001).痰菌阳性的老年肺结核患者BBS得分为(48.75± 11.37)分,明显低于痰菌阴性者[(50.64±10.90)分],差异有统计学意义(t=1.722,P=0.046).结论:老年肺结核患者年龄越大、体质量指数越低、合并症数量越多及痰菌阳性越容易导致其躯体功能下降,在诊疗过程中应结合躯体功能下降的相关影响因素,对患者进行全面评估及早期干预.
目的:应用机器学习算法随机森林建立吉林省老年流动人口肺结核发病风险模型并分析发病风险因素,为制定结核病重点人群防治策略提供参考.方法:采用1∶1匹配设计的病例对照研究,选择2021年吉林省登记的年龄≥60岁的流动人口肺结核患者(281例)为病例组,281例性别匹配的非本地户籍健康人群为对照组,随机抽取70％(393例/名)和30％(169例/名)的数据作为训练集和测试集,使用R Software Version 4.2.1软件建立随机森林算法的发病风险模型.结果:发病风险因素前5位分别为有结核病患者接触史、工作经常变动、个人防护差、吸烟、较少摄入肉蛋奶,其基尼平均减少值分别为44.344、29.007、21.859、19.703、15.242;随机森林模型最优树数量为281,袋外数据误差率为6.44％;ROC曲线下面积为0.967;使用Caret包10折交叉验证随机森林算法,正确率为93.5％,Kappa值为0.870.结论:有结核病患者接触史的老年流动人口被感染的风险最大,常态化的结核病防控要重视隔离具有传染性的肺结核患者,加强个人防护和营养摄入.
