目的:研究不典型肺结核诊断中结核感染T细胞斑点试验(TSPOT.TB)的敏感性与特异性.方法:应用TSPOT.TB和TST两种检测方式对本院100例疑似肺结核患者进行诊断,比较两种检测方式差异性.结果:不典型肺结核组阳性检出率明显高于肺结核组,组内对比TSPOT.TB在不典型肺结核,TSPOT.TB敏感性(94.21)、特异性(94.50)、阳性预测值(PPV) (74.20)、阴性预测值(NPV)(94.17)、阳性似然比(LR+)(6.14)均明显高于TST,而LR-(0.13)明显低于TST,差异有统计学意义(P＜0.05).结论:TSPOT.TB相比TST具有更高的临床应用价值,其具有快速、敏感等多种优势,在不典型肺结核诊断中占有重要地位.

目的 分析驻闽部队群体性成人甲型H3N2流感的发病特点,并观察奥司他韦治疗的疗效和不良反应.方法 对2014年夏季驻闽部队作训期间有流感症状并初筛显示为甲/乙型流感阳性的官兵进行问卷调查,并采用咽拭子病毒核酸检测(RT-PCR)进行诊断.予奥司他韦75 mg,po,bid,疗程2～5d.观察患者症状、体征、实验室指标的改变,评估治疗效果,记录不良反应发生情况.结果 2014年6月24日至7月21日共纳入85例,均确诊为甲型H3N2流感.患者年龄(22.2±4.6)岁,主要临床表现为发热、咳嗽、咳痰、全身酸痛、咽痛、乏力、头痛等流感样症状.实验室检查表现为淋巴细胞计数减少、C反应蛋白升高.经奥司他韦治疗后,均治愈,患者体温降至正常时间为(2.0±0.4)d.32例(38％)患者发生不良反应,发生率排前3位的为白细胞减少、粒细胞减少、窦性心律不齐.结论 本次部队群体性甲型H3N2流感属季节性流感,传染性强,传播速度快,病情相对轻.奥司他韦疗效好,不良反应发生率高于以往报道,最主要表现为白细胞和粒细胞减少.

ObjectiveTo investigate the mycobacterium tuberculosis bacterium distribution of drug-resistant tuberculosis patients, and analyze its drug resistance feature.Method568 cases of pulmonary tuberculosis patients’ lesion specimen were collected from June 2012 to June 2014, and used bacterial culture, identiifcation and drug sensitization experiments, the distribution of mycobacterium tuberculosis bacteria and drug resistance were analyzed.ResultThere were 198 cases of human type mycobacterium tuberculosis, 4 cases of mycobacterium bovis, 12 cases of NTM in 214 cases of culture-positive pulmonary tuberculosis. The difference of percentage among three types of mycobacterium tuberculosis was signiifcantly (P<0.05). There were 58 cases of drug-resistant strains of mycobacterium tuberculosis, 1 case of drug resistance of cattle mycobacterium tuberculosis, 1 case of drug resistance NTM, the difference was signiifcant (P<0.05); 12 cases of multi drug resistance in human mycobacterium tuberculosis, and there were no multi drug resistance in mycobacterium bovis and NTM, the difference was signiifcant (P<0.05); drug sensitization experiments showed that the highest rates of drug resistance was SM, the lowest was PAS, the difference was signiifcantly (P<0.05); Logistic regression analysis showed that there was significant association between treatment duration and resistance rates (P<0.05).ConclusionTB drug resistance is more serious and should strengthen monitoring of drug resistance, and based on susceptibility testing to select reasonable and effective chemotherapy.

Objective To evaluate the effectiveness, the influence on cellular immune function and the side-effect of bacillus of Calmette-Guerin polysaccharide nucleic acid(BCG-PSN)combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis. Methods A total of 60 pulmonary tuberculosis patients were divided into treatment group(30 patients)and control group(30 patients)by random digits table. All patients accepted the same standard antituberculous chemotherapy, meanwhile patients in treatment group were injected with BCG-PSN. Observed and compared the clinical symptom,the size of the focas nidus,the change of toxic response and immunity. Results The symptoms were significantly relieved in both groups after treatment(P＜0.05), but it was significantly better in treatment group(P＜0.05), the effective rate and control rate in treatment group[36.7%(11/30),96.7%(29/30)]were significantly higher than those in control group[23.3%(7/30), 86.7%(26/30)](P ＜ 0.05). After treatment,the levels of CD3,CD4 and IL-2 were higher, and the level of CD8 was lower, but the treatment group improved significantly better than control group(P ＜ 0.05). The rate of leukopenia was lower in treatment group than that in control group[10.0%(3/30)vs. 33.3%(10/30),P ＜0.05]. As to the safety,no other toxicities were observed in the treatment group. Conclusions BCG-PSN combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis contributes to relieve the symptom, reduce size of the nidus, decrease leukopenia incidence and enhance the cell immunity. It is safe.

<正>患者,男,22岁,皮鞋厂工人。因反复头痛、呕吐、午后低热2月余于2009年11月21日收住我院。入院前20 d患者于院外住院,多次行脑脊液抗酸杆菌涂片阳性,诊断为结核性脑膜炎,行抗结核、激素治疗3 d后,患者曾一度体温正常、头痛明显减轻,入院前1周患者再次低热、头痛加重,伴恶心

目的 观察并总结糖尿病合并肺结核的临床特点,分析控制血糖对其疗效的影响.方法 收集2007年1月～2010年12月在我科确诊为糖尿病合并肺结核的72例患者的临床资料,与同期收治的76例单纯肺结核患者的临床资料进行比较.结果 糖尿病合并肺结核病组空洞形成率高,痰菌阳性率高,单纯肺结核患者肺结核疗效(病灶吸收率、空洞闭合率、痰菌阴转率)高于糖尿病合并肺结核患者(P<0.05);血糖控制良好组高于血糖控制较差组(P<0.05).结论 糖尿病合并肺结核患者严格控制血糖明显影响抗痨效果.

我们应用水飞蓟宾(卵磷脂复合物胶囊)对抗结核药物所致的肝功能损害进行预防性治疗,现报道如下. 一、资料与方法 1.临床资料:对2006-2008年本院收治的92例肺结核患者在使用抗结核药物的同时使用水飞蓟宾,入选病例诊断均符合2001年中华医学会结核病学分会制定的 [1]。

<正>材料与方法观察对象以正在接受抗结核药物治疗的肺结核患者为观察对象,入选病例符合1999年结核病分类标准:包括原发型肺结核、血行播散型肺结核、继发型肺结核、结核性胸膜炎。2006～

我们采用中西医结合方法治疗难治性肺结核24例,取得较满意疗效,现报告如下. 1 临床资料 共40例,均为难治性肺结核住院患者.治疗组24例中,男14例,女10例;年龄35～78岁,平均55岁.对照组16例,男11例,女5例;年龄40～74岁,平均57岁.化疗2年以上仍排菌者9例,初治病人规律化疗满疗程后有排菌者7例,病史4年以上未接受全程化疗而迁延不愈者24例.治疗组咳嗽、胸闷气喘者18例,咯血、胸痛6例;对照组咳嗽咳痰、胸闷气喘者11例,咯血、胸痛5例.全部患者均经临床诊断、影像学及实验室检查证实,肺结核均属难治性.