目的 探讨非免疫受损马尔尼菲篮状菌病患者的临床特征.方法 收集2019年3月-2021年12月期间在某医院收治的18例非免疫受损马尔尼菲篮状菌病患者的临床资料,回顾性分析患者的临床表现、影像学及实验室检查结果、治疗经过及疾病转归等临床资料.结果 18例患者中男性16例,女性2例,中位年龄为56岁,中老年患者为主,占72.22％;临床表现为咳嗽(83.3％)、发热(38.9％),病灶主要位于肺部(83.3％)及淋巴结(50.0％),单一器官发病占50％;患者血白细胞升高达61.1％,血CD4+T淋巴细胞值正常者占88.9％;影像学缺乏特征性,易误诊为肺结核;合并分枝杆菌病率44.4％、细菌性肺炎率27.8％,死亡率为16.7％.结论 本组非免疫受损马尔尼菲篮状菌病患者起病隐匿、临床表现及影像学缺乏明显特征,与分枝杆菌肺病相似,容易出现误诊、漏诊而延误治疗.

目的:探讨戒烟门诊干预后戒烟者的戒烟效果和影响因素,提出戒烟干预改进措施.方法:采用前瞻性干预研究设计,对2021年1月至2022年1月在广州市胸科医院戒烟门诊咨询的吸烟者采用强化戒烟干预,明确提出戒烟建议,然后顺序进行1周、1个月、3个月、6个月的规范化随访.把未戒烟者和戒烟＜7 d者记为戒烟失败组,把戒烟≥7 d(包括戒烟7 d后复吸)者记为7 d戒烟成功组.完成6个月随访后分析吸烟者的戒烟行为、戒烟结局、复吸情况并探讨戒烟成败影响因素.结果:共79名吸烟者完成6个月随访,7 d戒烟成功者为23名,未戒烟者为15名,复吸者为41名.各随访期均有复吸发生,但大部分复吸发生在戒烟后第一周内,占48.8％(20/41).7日戒烟成功率为55.7％(44/79),比较戒烟失败组和戒烟成功组两组的基线情况,戒烟成功组的日平均吸烟量[(17.43+4.95)支]明显低于戒烟失败组[(21.43+7.43)支],差异有统计学意义(t=-2.859,P=0.005);烟草依赖评分[(5.43±1.11)分]明显低于戒烟失败组[(6.14±0.97)分],差异有统计学意义(t=-2.987,P=0.004).多因素logistic回归分析显示,日平均吸烟量≥20支是戒烟成败的独立影响因素[OR(95％CI):4.441(1.652～11.940),P=0.003].结论:吸烟者经戒烟门诊强化干预后,可取得较好的戒烟效果;日平均吸烟量是影响戒烟的主要因素.

Objective:To explore the main influencing factors of tuberculosis students analyzing visit delay and diagnosis delay of students with pulmonary tuberculosis.Methods:The relevant information including symptom onset times, initial visit times, and disease diagnosis times of the hospitalized students with pulmonary tuberculosis from 2019 to 2021 was obtained, which were abstracted from the electronic medical records of the "Hospital Statistical Medical Record System" searching the terms "discharge time", "occupation", and "international classification code of main diagnoses of diseases". The intervals between symptom onset time and initial visit time and between the interval between initial visit time and disease diagnosis time were the visit time and the diagnosis time, respectively; the times ≥ 15 days were defined as visit delay and diagnosis delay accordingly. The two kinds of delays of different groups were described, inferred, and analyzed statistically; they were grouped according to gender (male / female), student levels (primary school student / junior high schools tudent / high school student / undergraduate / postgraduate), case finding methods (seeking medical attention in tuberculosis control agency / referral from general hospital / recommendation by medical staff of primary health care institutions / physical examination), and symptom onset month (from January to February / from March to June / from July to August / from September to December). The χ2, Mann-Whitney U, and Kruskal-Wallis rank sum tests were applied. Results:There were 723 hospitalized students with pulmonary tuberculosis during the three years; their visit time was 0-92 days, and 406 cases (56.16%) had visit delay of 15-92 days (median 25 days); their diagnosis time was 1-95 days ,and 503 cases (69.57%) had diagnosis delay of 15-95 days (median 24 days). There was a statistical difference in the incidence of visit delay between the groups of case finding method ( χ2=33.288, P?0.001); there were statistical differences in the incidence of diagnosis delay between the groups of gender and symptom onset month ( χ2=10.029, P=0.002; χ2=18.187, P?0.001) by χ2 test. There were statistical differences in visit delay time betweeb the groups of student level and symptom onset month ( χ2=33.000, P?0.001; χ2=12.750, P=0.005) and was in diagnosis delay time between the groups of symptom onset month ( χ2=15.987, P=0.001) by Mann- Whitney U test (comparison between two groups) or Kruskal-Wallis rank-sum test (comparison between ≥3 groups). Conclusions:There are high incidences of visit delay and diagnosis delay in students with pulmonary tuberculosis. And the degree of delay is closely related to gender, student level, case finding methods, and symptom onset month.

目的 评价家庭支持方法对吸烟者戒烟的有效性.方法 采用前瞻性干预研究设计,选择符合纳入标准的80例戒烟门诊患者,每例患者首诊时进行标准的基线问卷评估,并在首诊后1、3、6个月进行随访,由经过培训的医师对每例患者进行面对面心理干预和戒烟方法辅导,并将其按首诊时是否有家属陪同分为对照组(43例)和家庭支持组(37例),对照组仅给予心理干预,家庭支持组在心理干预的基础上,给予家庭内戒烟支持和监督.比较两组患者治疗的7天时点戒烟率、已戒烟患者的复吸率,以及干预结束时尼古丁依赖程度的差异.结果 随访1、3、6个月时,家庭支持组的7天时点戒烟率[分别为83.3％(30/36)、68.6％(24/35)和48.6％(17/35)]均明显高于对照组[分别为58.5％(24/41)、37.5％(15/40)和17.5％(7/40)],差异均有统计学意义(x2=5.627,P=0.018;x2 =8.142,P=0.017;x2=10.174,P=0.006).随访3个月时,家庭支持组的复吸率[20.0％(6/30)]低于对照组[37.5％(9/24)],但两组间差异无统计学意义(x2=2.035,P=0.154);随访6个月时,家庭支持组的复吸率[43.3％(13/30)]明显低于对照组[70.8％(17/24)],差异有统计学意义(x2=4.084,P=0.043).干预结束时,尼古丁依赖评分为重度的患者,家庭支持组所占比例[28.6％(10/35)]明显少于对照组[52.5％ (21/40)],差异有统计学意义(x2=4.408,P=0.036).结论 在对吸烟者的戒烟干预中,运用家庭支持方法可有效提高戒烟率,降低复吸率,促进未戒烟者减少吸烟依赖程度.

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)对使用免疫抑制剂患者并发肺结核的诊断价值.方法 收集2013年7月至2015年12月广州市胸科医院收治的197例使用免疫抑制剂并发肺结核患者(简称“观察组”),及同期住院的200例未使用免疫抑制剂的肺结核患者(简称“对照组”)作为研究对象.所有患者均通过痰液或支气管灌洗液(BALF)的涂片或培养查找抗酸杆菌,对阳性菌株行菌种鉴定以排除非结核分枝杆菌,结合胸部X线摄影检查符合活动性肺结核表现,肺结核诊断均符合《肺结核诊断和治疗指南》标准.比较两组患者血T-SPOT.TB、抗酸杆菌金胺O荧光染色涂片镜检(简称“金胺O涂片镜检”)、BACTEC MGIT 960液体培养(简称“MGIT 960”),以及结核菌素纯蛋白衍生物试验(PPD试验)检测阳性率的差异.采用SPSS 19.0软件对计数资料进行x2检验,以P＜0.05为差异有统计学意义.结果 观察组与对照组患者的血T-SPOT.TB检测阳性率[分别为85.28％(168/197)、96.00％(192/200)]均明显高于金胺O涂片镜检[36.55％(72/197)、35.50％(71/200)](x2值分别为98.24、162.53,P值均=0.000),MGIT 960[53.81％(106/197),57.50％(115/200)](x2值分别为46.06、83.06,P值均=0.000),PPD试验[34.52％(68/197),63.50％(127/200)](x2值分别为105.66、65.40,P值均=0.000).观察组患者T-SPOT.TB、PPD试验检测阳性率均明显低于对照组(x2值分别为13.50、33.36,P值均=0.000).结论 在使用免疫抑制剂患者并发肺结核时采用血T-SPOT.TB技术进行检测仍具有较高的阳性率,较传统的检测方法具有更高的辅助诊断价值.

Objective To investigate the clinical efficacy of bronchoscopic MMC topical spraying for the treatment of tuberculous cicatricial stenosis of the central airway. Methods 45 patients with t tuberculous cicatricial stenosis of the central airway were randomly divided into a control group (14 patients), treatment group 1 (group1, 15 patients), or treatment group 2 (group 2, 16 patients), who received bronchial balloon dilatation alone, bronchial balloon dilatation combined with topical MMC spraying for one time, and for twice, respectively . The clinical efficacy was observed by using the MRC score and measuring airway diameter at the time points before treatment, end of treatment, and 3, 6, and 12 months after treatment, respectively. Results For the MRC scores at different time points, the MRC scores in group 2 (0.06 ± 0.25) and group 1 (0.33 ± 0.617) were significantly lower than those in the control group at 3 months after treatment (P < 0.05 for all comparisons);there were nosignificant differences at the other time points among the three groups. For the airway mean diameters at the different time points, the airway mean diameter was higher in group 2 than in the control group at 3 and 6 months after treatment (P < 0.01), and in group 1 at 3, 6, and 12 months (P < 0.05). No statistical differences were found in the other time points among three groups (P > 0.05). Conclusions Bronchial balloon dilatation combined with topical MMC spraying has certain short-term and long-term efficacy for improving dyspnea and maintaining the airway diameter after dilatation.

Objective To compare clinical value of bronchofibroscope excision and surgical resection in treatment of aspergilloma inside cavities of pulmonary tuberculosis.Methods One hundred and eighty three hospitalized cases with aspergilloma inside cavities of pulmonary tuberculosis were analyzed retrospectively on time of therapy,treatment costs,complication of therapy and efficacy.Results Of 183 cases,126 cases received excision of aspergilloma by bronchoscope and 57 cases received surgical resection.Average time of therapy were 49 days and 46 days using bronchofibroscope excision and surgical resection,respectively.Average treatment costs were 26 535 yuan and 50 296 yuan,respectively.Incidence rate of complications using surgical resection was higher than that of bronchofibroscope excision.But surgical resection was complete and low rate of relapse.Conclusion Bronchofibroscope excision can get relatively thorough,efficacy,less complication and low costs in patients with aspergilloma inside cavities of pulmonary tuberculosis.It is a better method in patients who are poor pulmonary function reserve,high surgical risk and reluctant to accept surgery.

目的:探讨肾移植术后结核病的特点及其诊断与治疗.方法:对33例肾移植术后结核病患者的临床资料进行数理分析.结果:33例中肺结核30例,肺外结核3例.多以长时间发热为首发、主要的临床表现,伴咳嗽26例,以轻度干咳为主,45%(15/33)患者于术后1年内发病.20例患者经病原学或组织病理学确诊.治疗首选一线抗结核药物,肺结核疗程6～12个月,合并肺外结核者疗程12～18个月.10例患者死亡;19例治愈,随访2年无复发;4例仍在治疗中.结论:肾移植术后结核病以肺结核为主,可合并肺外多部位结核,临床症状隐匿而不典型.对肾移植术后发热、咳嗽患者应及时行相关检查以明确诊断,治疗须兼顾抗结核与抗排斥两方面.

目的:研究传染性非典型肺炎(severe acute respiratory syndrome,SARS,非典)康复者的心身健康状况,提高对非典的认识.方法:对2003年2月～2003年6月期间感染非典、经住院治疗好转后出院的62例康复者和70名健康对照组采用症状自评量表(symptom self-check list,SCL-90)进行问卷式调查.结果:非典康复组的SCL-90评分总分为129±37,高于对照组105±13(P＜0.01).阳性项目数两组分别为8～50(中位数30)、4～24(中位数14),两组比较差异有统计学意义(P＜0.01).9个因子的平均得分非典康复者均高于对照组(均为P＜0.01),女性非典康复者的躯体化、人际关系敏感、抑郁、焦虑、恐惧等项目的因子分均高于男性非典康复者(均为P＜0.05).结论:非典康复者存在一定的心理或精神障碍,女性较男性严重,需要加强心理辅导或治疗.