Objective:To explore the transmission of tuberculosis caused by treatment delay, cavitation, lesion range, bacterial load, and other factors in school contacts with pathogen positive cases of pulmonary tuberculosis.Methods:The clinical diagnosis and treatment data of 79 patients with pathogen-positive pulmonary tuberculosis from the universities and middle schools at Yuexiu District, Guangzhou, including 45 males and 24 females who were 12-25 years old and hereinafter referred to as "clue cases", were retrospectively analyzed. And the results of tuberculin skin test (TST) of their 4 934 contacts at their campuses or schoolyard, including 1 867 males and 3 067 females who were 12-65 years old, were analyzed.Results:The clue cases came from 33 universities and middle schools. Thirteen patients with tuberculosis were found in the close contacts of 12 clue cases at 8 universities and middle schools, hereinafter referred to as "contact cases"; 7 clue cases and 2 contact cases presented treatment delay of 7-81 days and 16-76 days, respectively. There were no statistical differences in delay of seeking medical attention, diagnosis delay, cavitation, lesion range, and pathogenic testing (including smears and cultures) between the healthy and sick cases of the contacts. The positive rate and strong positive rate of TST were 68.36% (1 934/2 829) and 21.81% (617/2 829) in the clue cases' close contacts, and were 47.84% (1 007/2 105) and 3.42% (72/2 105) in the clue cases' non-close contacts ( P＜0.001). Conclusion:It is essential that screening of close contacts should be strengthened in school tuberculosis control for the early detection of tuberculosis cases.

Objective:To explore the clinical application values of tuberculin skin test (TST) and interferon-γ release assays (IGRAs) in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.Methods:The data of IGRAs (T-SPOT.TB method) and TST test results of 603 patients with pulmonary tuberculosis [343 males and 260 females; the age of the bacteria positive group was (52±20) years old, and that of the bacteria negative group was (48±20) years old] and 242 patients with pulmonary diseases other than tuberculous [116 males and 126 females, with the age of (40±16) years old] who came to our hospital from January 2018 to December 2019 were collected. And the clinical significance of IGRAs, TST alone, and their 8 combined test models results were analyzed with the diagnostic test evaluation method.Results:In the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous, the sensitivities of TST and IGRAs were 96.85% (584/603) and 88.89% (536/603), and the specificity were 7.85% (19/242) and 83.06% (201/242), respectively. In terms of positive test results, among 13 test models, which included 5 independent tests [TST (1+) above, TST (2+) above, TST (3+) above, TST (4+), and IGRAs (+)], 4 types of parallel tests [TST (1+) above/IGRAs (+), TST (2+) above/IGRAs (+), TST (3+) above/IGRAs (+), and TST (4+)/IGRAs (+)],and 4 types of serial tests [TST (1+) above + IGRAs (+), TST (2+) above + IGRAs (+), TST (3+) above + IGRAs (+), and TST (4+) + IGRAs (+)], IGRAs (+) test model presented the best diagnostic performance, and its diagnostic sensitivity, specificity, accuracy, odds ratio ( OR), positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 88.89% (536/603), 83.06% (201/242), 87.22% (737/845), 39.22, 92.89% (536/577), 75.00% (201/268), 5.25, and 0.13, respectively. Conclusion:As a latent tuberculosis infection test, IGRAs have good auxiliary diagnostic values in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.

目的 探讨计划免疫在儿童传染病预防控制中的应用效果.方法 采取抽样调查方法,选取2015年5月至2016年5月郑州大学第二附属医院0～6岁1008例儿童作为研究对象.根据是否接受计划免疫接种将其分为观察组(681例)和对照组(327例),比较两组儿童传染病发生率、儿童监护人对计划免疫接种相关知识知晓率情况.结果 对照组儿童传染病发生率[37.00％(121/327)]高于观察组[11.89％(81/681)],差异有统计学意义(P<0.05);对照组儿童监护人对计划免疫接种相关知识知晓率均低于观察组,差异均有统计学意义(P<0.05).结论 计划免疫可有效预防儿童传染病的发生,并提高儿童监护人对计划免疫及传染病的认知度,进而降低儿童传染病发生率,提高儿童生存质量.

Objective To investigate the screening and treatment for mycobacterium tuberculosis (Mtb)/human immunodeficiency virus(HIV)co-infection in the Guangzhou. Methods 13697 cases of tuberculosis and 9093 cases of HIV-infected or AIDS were collected and analyzed by two-way screening in six administrative regions of Guangzhou between 2013 and 2014. Prognosis of the patients treated for Mtb/HIV co-infection was also followed. Results Among patients with pulmonary tuberculosis registered from 2013 to 2014 ,the HIV antibody test rate was 18.77%(2571/13926),and 0.19%(5/2571) was positive. The detection rate of reachable patients with HIV/AIDS screened for tuberculosis was 1.87%(170/9093). Of those,past-registered patients with HIV/AIDS were statistically different from newly-registered ones on the tuberculosis positive rate(χ2=9.333,P<0.01);the two-way detection rate of Mtb/HIV co-infection was statistically varied between HIV/AIDS patients and tuberculosis patients (χ2=38.055,P<0.01). The cure rate for initial and retreated smear-positive pulmonary tuberculosis of the Mtb/HIV co-infected patients were 69.23%and 42.86%,respectively;the total treatment success rate and total mortality rate were 72.05% and 8.70%,respectively. Conclusions Two-way screening of Mtb/HIV infection is the main way to discover the co-infection of Mtb/HIV. The anti tuberculosis organization and the anti epidemic organization should strengthen their cooperation to improve the success rate of treatment for the Mtb/HIV co-infected patients.

Objective To investigate the clinical features and therapeutic method of elderly pulmonary tuberculosis patients. Methods The clinical characteristics in 187 elderly patients with pulmonary tuberculosis who were over the age of 65 and treated in our hospital from the first day of January,2009 to December 31,2011 were analyzed clinically,including clinical symptoms,chest radiograph,phlegm examines,the drug resistance,complications and co-existing disease,curative effect and prognosis,adverse drug reaction and other aspects. Results We found more atypical clinical symptoms,drug resistance,complications,long course,poor curative effect,adverse drug reactions and poor compliance in elderly pulmonary tuberculosis cases. Conclusion We should pay more attention to elderly pulmonary tuberculosis,strengthen research of the elderly pulmonary tuberculosis,and improve early diagnosis and treatment effect.Only in this way can we restrain the prevalence of tuberculosis effectively.

Objective To evaluate the application of detecting secretory protein MPB64 for the identification of Mycobacterium tuberculosis complex.Methods For clinical isolated strains,0.1 ml of either liquid medium obtained from BacT/ALERT 3D system or bacterial sodium suspension from colonies cultured by L(o)wenstein-Jensen solid medium with 1 Mcfarland standard at room temperature for about two hours was made as samples.Secretory protein MPB64 was detected by immunochromatographic method with colloidal gold labeled anti-MPB64 monoclonal antibody,then the results were compared with the strain identification.For reference strains,both liquid culture medium and bacterial sodium suspension were detected.Results Totally,23 reference strains and 267 clinical isolated strains of mycobacteria were detected.① For the reference strains,Mycobacterium tuberculosis,Mycobacterium bovis and Mycobacterium microti were positive in two kind of samples,and other 20 non tuberculous Mycobacterium were negative.The accuracy of identification was 100 ％.②Among 111 clinical isolated strains from BacT/ALERT 3D system,55 strains were Mycobacterium,in which MPB64 of 51 strains was positive,and 56 strains were non'tuberculous Mycobacterium,in which MPB64 of 54 strains was negative.The accuracy of identification was 94.59 ％.③ Among 156 clinical isolated strains from L(o)wenstein-Jensen solid medium,121 strains were Mycobacterium tuberculosis,in which MPB64 of 115 strains was positive,and 35 strains were non tuberculous Mycobacterium,in which MPB64 was all negative.The accuracy of identification was 96.15 ％.④For all samples,the sensitivity,specificity and accuracy in the identification of Mycobacterium tuberculosis complex by detecting secretory protein MPB64 were 94.41％,98.20％ and 95.86％,respectively.Conclusions Identifying Mycobacterium tuberculosis complex by detecting secretory protein MPB64 was a accurate,fast and simple method.Furthermore,it could be widely used in clinic because of no special instrument.

目的 探讨应用MPB64单克隆抗体检测液体培养基中结核分枝杆菌的临床应用价值.方法 应用抗酸染色涂片阳性样本进行分枝杆菌培养前处理,接种于BacT/A1ert 3D全自动分枝杆菌培养系统培养基中.在培养监测的同时,每天定时测定培养液中的结核分枝杆菌分泌蛋白MPB64,比较它们可指示有结核分枝杆菌生长在时间上的差异.结果 在12例涂片阳性样本中,仪器系统对12例样本都指示培养阳性结果,其中10例样本MPB64检测阳性;对12例样本进行分枝杆菌菌鉴定,培养指示阳性、MPB64指示阴性的2例样本为非结核分枝杆菌,培养与MPB64均指示阳性的10例样本为结核分枝杆菌;仪器系统指示培养阳性的平均时间为11.5天,MPB64检测指示有结核分枝杆菌生长的平均时间为6.5天.结论 应用MPB64单克隆抗体检测液体培养基中结核分枝杆菌分泌蛋白MPB64来指示有无结核分枝杆菌生长具有操作简便、报告结果快速的特点,值得更进一步研究。

目的观察和评价化疗联用母牛分支杆菌菌苗(vaccae)在菌阳肺结核治疗的临床疗效。方法采用随机对照分组法将300例患者分为母牛分支杆菌治疗观察组、对照组。每组初、复治涂阳各60例,耐多药30例。结果观察组痰菌阴转、病变吸收方面明显优于对照组,初治涂阳患者疗效末痰菌阴转率:观察组100%,对照组91.7%。两组结果无显著差异性(P>0.05)。复治涂阳组疗程末痰菌阴转率95%,对照组75%。两组结果有显著性差异(P<0.01)。耐多药患者疗程末痰菌阴转率观察组56.7%,对照组26.7%,两组结果有显著性差异(P<0.01)。初、复治菌阳二月末,耐多药三月末观察组及对照组均有显著差异(0.01<P<0.05)。耐多药结核患者血清T淋巴细胞亚群测定显示,在疗程末,CD4明显升高,CD8下降,经统计学处理,差异有显著性(P<0.01)。结论母牛分支菌菌苗在菌阳肺结核治疗中,能协同增加化疗疗效。有助于痰菌阴性、病灶吸收好转、空洞缩小,可作为菌阳肺结核的免疫治疗和化疗的辅助治疗。

目的通过对抗结核治疗中57例类赫氏反应的发病机制、临床表现和治疗转归进行探讨,提高对类赫氏反应的认识.方法观察1990～2002年7 207例肺结核患者中57例发生类赫氏反应病例.结果类赫氏反应发生率0.79%,平均年龄32±0.2岁,多于抗结核治疗1～3月内发生,呈病灶暂时性或一过性恶化表现.结论类赫氏反应多发于初治年青患者,发生率低.其转归是良性的,只需坚持原方案治疗并对症处理则很快消失,无须更改治疗方案.

目的: 探讨长期应用肾上腺皮质激素后的患者并发肺结核的发生、发病特点及治疗.方法: 收集我院1990年至2000年诊治的应用肾上腺皮质激素并发肺结核病例51例进行回顾性临床分析.结果: 51例肺结核患者中,男性31例,女性20例;39例继发型肺结核,9例血行播散型肺结核,5例结核性胸膜炎;其中32例痰菌阳性.经积极抗结核治疗,疗程结束时痰菌阴转率94%.结论:长期应用肾上腺皮质激素后的患者并发肺结核以继发型和血行播散型多见,痰菌阳性率高,预后较差.