Objective:To understand the clinical manifestations and etiological diagnosis characteristics of AIDS patients complicated with tuberculosis, and to explore the method to improve the diagnosis rate of HIV/AIDS patients with tuberculosis.Methods:There were 116 HIV/AIDS patients co-infected with tuberculosis enrolled as the observation group in People's Hospital of Xiangxi Autonomous Prefecture from October 2012 to December 2019, and 59 cases with simple tuberculosis in the same period were enrolled as the control group. The clinical symptoms, extrapulmonary tuberculosis, pulmonary tuberculosis imaging characteristics, PPD tuberculin response, sample mezzanine cup assay acid-fast staining results, tuberculosis infection T cellular immunospot detection (T-SPOT.TB) results, Mycobacterium tuberculosis rpoB gene detection (XPERT) results were collected and compared between the two groups. The positive rates of PPD and respiratory tract sample mezzanine cup acid-fast staining (sputum and bronchial lavage fluid) were further analyzed in the observation group with different CD4 +T cell counts. Results:The main clinical manifestations in the observation group were repeated high fever (82.76%) and weight loss (75.00%) , and the incidence of extrapulmonary tuberculosis (56.89%) was significantly higher than that in the control group ( χ2=10.911, P<0.05) . In the observation group, lung lesions were in 2 and ≥3 lung fields (30.17% and 46.55%) , and millet-like changes were common (21.55%) , which were all significantly higher than those in the control group ( χ2=7.160, 7.310 and 4.709, P<0.05) . The positive rates of routine PPD test, respiratory tract sample mezzanine cup acid stain and the initial T-SPOT.TB in the observation group were 14.66% , 34.48% and 46.67%, which were all significantly lower than 40.68%, 52.54% and 82.35% in the control group ( χ2=14.763, 5.290 and 10.471, P<0.05) . The positive rates of T-SPOT.TB (after review) and XPERT were high in both groups, and there was no significant difference between them ( χ2=1.857 and 0.405, P>0.05) . The positive rate of sample mezzanine cup acid-fast staining from extrapulmonary tissue and puncture fluid in the observation group was 100.00%, which was higher than 66.67% in the control group ( χ2=12.291, P<0.05) . In the observation group, the lower the CD4 +T cell count the lower the positive rates of PPD and sample mezzanine cup acid-fast staining in respiratory tract samples. Conclusions:The clinical manifestations of HIV/AIDS patients co-infected with tuberculosis are atypical, and the positive rate of routine immunological examination is low. The XPERT testing of sputum and extrapulmonary specimens, the modified T-SPOT.TB test of blood, and sample mezzanine cup acid-fast staining of extrapulmonary tissue and puncture fluid are helpful to improve the diagnosis of AIDS patients complicated with tuberculosis.

Objectives: Plasma Exchange (PE) in the treatment of severe autoimmune hepatitis and the clinical outcome of the clinical data were retrospectively analyzed. The clinical efficacy and safety of single plasma exchange (PE) in the treatment of autoimmune hepatitis were also evaluated. Method: The PE group of 22 patients was given conventional treatment of combined treatment of patients with simple PE while 21 cases of the control group were treated with comprehensive treatment. The efficacy of PE group and control group were compared within 2 weeks. Results : The clinical symptoms of 22 patients in PE group were significantly improved ( p < 0.05); in total bilirubin (TBIL), (AST), (INR), (ALT) where the PE group (17/22) 77.27%, and control group (10/21) 47.62%. The difference was statistically significant ( p < 0.05). Conclusion: Pure plasma exchange (PE) is an effective method for the treatment of severe autoimmune hepatitis (AIH).

目的：结合临床资料回顾性分析单纯血浆置换术（plasma exchange ，PE）在治疗重症自身免疫性肝炎的临床转归，评价单纯血浆置换（PE）术在治疗自身免疫性肝炎的疗效和安全性。方法：PE组22例患者给予常规内科综合治疗基础上联合单纯血浆置换（PE）术治疗，对照组21例患者给予内科综合治疗，比较 PE 组和对照组治疗2周的疗效、最终治愈好转率、各项生化指标等，并观察单纯血浆置换（PE）术的不良反应。结果：PE 组22例患者治2周临床症状均显著改善，总胆红素（TBIL）、转氨酶（ALT 、AST）、INR 下降（P ＜0．05），而对照组各项指标也有改善，但不明显（P ＞0．05）；PE 组治愈好转率（17/22）77．27％，对照组为（10/21）47．62％。单纯血浆置换（PE）术治疗后可能皮疹、颜面、口唇、四肢麻木或抽搐、过敏性休克等。结论：单纯血浆置换（PE）术是治疗重症自身免疫性肝炎（AIH）的有效手段。

获得性免疫缺陷综合征(AIDS)是由人类免疫缺陷病毒(HIV)引起的以侵犯辅助性T淋巴细胞为主、造成细胞免疫功能缺损为基本特征的传染病.AIDS患者常因发生各种机会性感染而就诊,其中以口腔念珠菌病最常见,有报道其患病率为20.6％～56.0％[1].本研究拟探讨氟康唑与碳酸氢钠溶液局部治疗AIDS合并口腔念珠菌病的治疗效果,现报道如下.

目的探讨难治性肺结核继发肺部霉菌病的诱因及临床特点.方法根据临床表现、治疗情况及转归对自1999年以来收治的难治性肺结核继发肺部霉菌病36例进行回顾性分析.结果难治性肺结核在病程中继发肺部真菌病后,临床症状及肺部病灶进展,导致病情恶化,病死率高(15/36).经积极抗结核同时,酌情静脉小剂量抗霉菌治疗及免疫调节等综合治疗,21例患者肺部霉菌病及时控制,为抗结核化疗争取了时间.结论继发肺部霉菌病已经成为难治性肺结核的重要死因或诱因.难治性肺结核在抗结核疗程中应该尽可能避免广谱抗菌药长程使用.临床工作中在已经给予合理的化疗的难治性肺结核患者出现病情反复、病灶扩散时应想到继发肺部霉菌病的可能,应申请深部痰液真菌培养等进一步确诊.及时诊断和治疗仍能逆转病情,挽救患者生命.

近年来多媒体技术对当今教学的冲击力和影响力非常大,其总体效果是肯定的.但是,不同教员、不同教研室、不同学校,在教学器材的配备和教学手段的使用等方面的差异非常明显,以及不同专业在使用多媒体时的效果都有不同,临床医学专业与基础专业有差别,传染病学专业与其他临床医学专业比较又有其自身的特点.与传统的板书、挂图、实物及幻灯相比较,多媒体教学有其名显的优势.

Objective To compare the effect and adverse reactions of various Chinese-made α-interferons in treatment of chronic hepatitis B.Methods One hundred and fifty patients met with the inclusion criteria of chronic hepatitis B were divided into three groups: patients in group A received IFN-α2a(An Fulong),patients in group B received IFN-α2b(An Dafen) and patients in group C were given with IFN-α1b(Sinogen).The efficacy and adverse reactions were observed and compared between pre-treatment and 3,6 and 12 months after treatment.Results After 12 months of treatment,serum levels of ALT,AST and TBIL in patients of these three groups were all returned to normal and the difference between pre-treatment and after α-interferon treatment was significant.The seroinversion rates of HBeAg in patients of groups A,B and C all reached 48.0%,and seroinversion rates of HBsAg in these 3 groups were 16.0%,8.0% and 6.0% respectively,while HBV DNA negative inversion rates in these 3 groups were 52.0%,52.0% and 48.0% respectively.The incidence of fever,weight loss and transient decrease in amount of platelets in patients of group B were significantly higher than those of patients in groups A and C(P0.05 or P0.01),while the incidence of insomnia and depression in patients of group B was much less than those of patients in group A and group C(P0.05,P0.05).Conclusion The efficacy of various domestic made α-interferons in treatment of patients with chronic hepatitis B was very similar,but the efficacy of An Fulong is particularly ideal.

Objective To study the clinical efficacy of anisodamine as adjuvant therapy of chronic severe hepatitis B. Methods One hundred and fifty cases of chronic severe hepatitis B were randomly divided into control group (75cases) and treated group (75cases). The control group were given lamivudine 100 mg/d and conventional treatment. Meanwhile some patients accepted 1-3 times of the treatment of Plasma Exchange. Besides the treatment in control group,the treated group had anisodamine (20 mg every day by intravenous drip or injection 2 times every day). The mortality rate and the changes of serum (such as TBIL,ALT,etc)of two groups before treatment and two weeks,4 weeks,8 weeks after treatment were compared. Results The mortality rate of treatment group decreased significantly(18/75),compared with control group(30/75)(x2=4.41,P＜0.05). The liver function of survival cases in both two groups (57 cases of treatment group,45cases of control group)was restored gradually. But the serum indicators of liver function of the treatment group decreased more rapidly that those in control group at 2 weeks,4 weeks and 8 weeks after treatment(P＜0.01). Conclusion Anisodamine can restore the liver function and reduce mortality in the treatment of chronic severe hepatitis B.

Objective To observe the bicyclic alcohol with adefovir dipivoxil treatment of chronic hepatitis B with a single treatment of chronic hepatitis B with adefovir dipivoxil clinical response,biochemical response,virological response were compared.Methods A random sampling and divided into treatment group and observation group and control group was given capsules of adefovir dipivoxil(Jiangsu Chia Tai Pharmaceutical Co.,Ltd.was fine) 10 mg,oral,1 day course of treatment 48 wk;treatment group were given adefovir dipivoxil capsules and bicyclol-100 Sino(Beijing Concord pharmaceutical companies) ,in which capsules adefovir dipivoxil 10 mg,oral,1 day course of treatment 48 wk;100 zaino-bicyclol 50mg,Orally,three times a day course of treatment 48 wk,HBV-DNA detection,using fluorescent quantitative PCR.HBeAg hepatitis B five radio-immunoassay.Results The symptoms and signs improve the situation,two groups had no statistical significance difference.In both groups after 48 weeks of treatment significantly improved liver function than the control group,hepatitis B markers HBeAg and HBV DNA negative conversion of the number of groups have more significant.Conclusion The treatment group in the biochemical response,virological response and the control group,significant differences.

目的:探讨自发性腹膜炎的临床特点,为临床治疗提供参考.方法:对2008年4月～2010年7月我院收治的38例肝硬化并自发性腹膜炎患者临床资料进行回顾性分析.结果:38例患者中发热者20例,腹部仍有疼痛者16例,腹胀者18例,腹部有压痛者15例,腹肌紧张者7例,有移动性浊音者21例.38例患者中有21例腹水细菌培养结果阳性,且以大肠埃希菌者最为常见.38例患者中治愈18例、好转15例、无效5例,其中中毒性休克者死亡者1例,发生上消化道大出血死亡者1例.结论:对自发性腹膜炎患者应尽早进行腹水检查及细菌培养,并根据检查结果进行早期诊断和及早治疗.

Objective Seven cases diagnosed as HIV infection combined with histoplasmosis in our hospital from 2006 to 2007 were studied retrospectively,the clinical manifestations were compared and the reasons for misdiagnosis were analysed.Methods Six indexes were compared respectively:general information,clinical symptoms,supplementary examination,misdiagnosed diseases,diagnosis methods and the process of diagnosis.Results(1) Clinical manifestations of 7 cases diversified and all had been misdiagnosed:3 cases misdiagnosed as tuberculosis,1 case as typhoid,2 cases as blood disorders and lymphoma in 1 case.Misdiagnosis lasted:the shortest for 1 month and the longest for 12 months,with an average of 5 months.(2) Treatment:oral anti-fungal drugs is relatively effective,while anti-HIV virus medication was not carried out due to misdiagnosis.(3) Five of 7 cases died finally and 2 cases discharged from hospital but failed to follow up.Conclusions(1) Patients with HIV infection and histoplasmosis are vulnerable to be misdiagnosed and the fatality rate is very high.Capsulatum infection in immunocompromised may develop into disseminated histoplasmosis,involving the monocyte-macrophage system such as bone marrow,liver,spleen,lymph nodes and so on.During the progress,its clinical manifestations and laboratory tests showed the diversity,X-ray and CT inspection are similar to tuberculosis or swollen lymph nodes,so it need to be identified from tuberculosis or lymphoma.The infection symptoms with blood cells reduced were often misdiagnosed as blood diseases,also with poor treatment.(2) Analysis of misdiagnosis reasons:① doctors are satisfied with common and frequently-occurring diseases diagnosis.② clinical manifestations of the diseases at early time are diverse which lack the specificity and easy to draw conclusions from a part.③ reception doctors neglect detailed inquiry of medical history and perfect medical examination.

[目的]分析近年来湘西地区部分人类免疫缺陷病毒(HIV)/炙滋病(AIDS)患者流行病学及临床特征.[方法]收集34例HIV/AIDS患者临床资料,并从流行情况,临床表现及辅助检查指标等方面作回顾性分析.[结果]患者中男性25例(73.5%),农民17例(50%);已知感染途径者以性传播为主(29.4%);发热消瘦及皮肤、口腔感染为主要临床特征.接受正规治疗者较少.[结论]湘西地区HIV/AIDS患者逐年增加,且临床表现复杂,首诊科室弥散,易致误诊.应增强防范意识,加大预防及治疗力度.

Objective To investigate main points and superiority of abdominal puncture inserted central venous catheter daily drainage for the treatment of refractory ascites.Methods Patients with cirrhosis Child-Pugh grade class B or C and refractory ascites(some with signs of hepatic coma stage or suffered from gastrointestinal bleeding and liver cancer) were observed by continuous peritoneal catheter for daily ascites drainage.And combined with comprehensive therapy support(such as application of drugs to strengthen liver function,infusion of plasma or human serum albumin intravenously,active application of diuretic,vasoactive drugs and antibiotics).Changes before and after treatment for the same patient were compared.Results Blood biochemical examination for 3 to 5 days and serum protein for 7 to 10 days were relatively stable,while abdominal circumference were reduced significantly and urination were increased.General situation such as the spirit,loss of appetite,abdominal distension were improved.Abdominal ultrasound examination revealed ascites decreased significantly.Fewer adverse reactions and no complications occurred.Conclusions Patients with central venous catheters intraperitoneal implantation enjoyed no obvious discomfort and puncturation reduction;daily drainage could decrease the abdominal pressure with uniform continuity and gradient to avoid sudden drop and jump in abdominal pressure,also with little rebound and complications.Daily drainage work quickly,with distension degree,the spirit,loss of appetite will be significantly improved within five days and ascites disappeared in an average of 10 to 15 days,which may shorten patients' hospitalization;catheter placement can be reset if ascites repeat,with little surgical trauma and easy tolerance for patients.As for its simple and convenient operation,small chances of infection,no significant adverse reactions,effective improvement in patients' life quality and medical staff's workload reduction,continuous peritoneal catheter for daily ascites drainage could be widely promoted in community and grass-roots level hospitals.

目的研究山莨菪碱对慢性肝炎血清肝纤维化相关指标的影响。方法将75例慢性肝炎患者随机分为两组。治疗组37例,对照组38例,均给予水飞蓟素、肝泰乐、甘草酸二胺等药物常规保肝治疗。治疗组加用山莨菪碱,20～40 mg/d,分2次静脉注射或静脉滴注。2个月后,对比两组治疗前、后的血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、胆碱酯酶(CHE)和血清肝纤维化指标的变化。结果治疗后两组肝功能均恢复良好,但治疗组血清肝纤雏化指标下降显著,两组对比差异有统计学意义(P<0.01)。结论山莨菪碱治疗慢性肝炎具有明显降低血清肝纤维化指标的作用,反映了山莨菪碱对肝纤维化发生的抑制作用。

[目的]分析近年来湘西地区部分人类免疫缺陷病毒（HIV）／艾滋病（AIDS）患者流行病学及临床特征。[方法]收集34例HIV／AIDs患者临床资料，并从流行情况、临床表现及辅助检查指标等方面作回顾性分析。[结果]患者中男性25例（73．5％），农民17例（50％）；已知感染途径者以性传播为主（29．4％）；发热消瘦及皮肤、口腔感染为主要临床特征。接受正规治疗者较少。[结论]湘西地区HIV／AIDs患者逐年增加，且临床表现复杂，首诊科室弥散，易致误诊。应增强防范意识，加大预防及治疗力度。

目的:分析2007年2月～2009年2月33例成人麻疹,进一步探讨其临床特点。方法:采用流行病学方法对33例患者进行分析,结果:发病时间以3～5月份为主(57%),成人高发年龄段15～29岁(63.4%),成人呼吸道及消化道症状明显,肌痛骨痛多见(57%)。结论:注意并发症的防治,成人肝损害应与病毒性肝炎进行鉴别;高危人群应加强免疫,建议对流动人口加强监管与复种,退热剂的使用要慎重。

近年来,由于结核病疫情的回升和耐药结核病的流行,咽喉结核的发病亦有所增加.为探讨咽喉结核的治疗,我们自2003年以来采用沐舒坦(活性成分为盐酸氨溴索,勃林格殷桥翰生产,批号:725998)联合异烟肼注射液(天津药业集团新郑股份有限公司生产,批号:0707022)氧气雾化吸入辅助治疗,取得良好的疗效,报道如下.

To observe the clinical effect of intrapleural injection of urokinase(UK)and draining with indwelling central venous catheter in patients with tuberculous exudative pleurids.Methods:52 cases of patients with large amounts of pleural effusion by tuberculos exudative pleuritis were randomly divided into treated group(n=27)and control group(n=25).The control group was given conventional drug treatment and the traditional simple thoracic cavity puncture pumping fluids(three times every week);to oral prednisone 15～30mg.d—1 in the patients with acute systemic intoxication,reduced 5～10mg every week,treated for 4-6 weeks.Based on conventional drug treatment,in the treated group,the central venous catheterization was put into thoracic cavity to drain the pleural effusion,then 100,000U～200,000U urokinase was injected into thoracic cavity,draining pleural effusion again after 24 hours,after that,draining again and again until the pleural effusion was exhausted,and then pulling out the central venous catheter.Results:The average hospitalization time:the treated group was(12.3±6.6)days,but the control group was(20.4±7.9)days.The average hospitalization total costs:the treated group was(2219.5±1161.3)Yuan;but the control group was(2721.9±1711.4)Yuan.After three months,the pleural thickness in treated group was(1.00+0.23)mm,but the control group's was(2.1±0.31)mm;there were no complications occurred in the treated group,but 5 cases of complication,in the control group There were significant difference between the two groups(p＜0.05 or p＜0.01).Conclusion:Intrapleural injection of urokinase(UK) and draining with the indwelling central venous catheter in patients with tuberculous exudative pleurifis could shorten hospitalization time and reduce hospitalization cost.It could also prevent the pleural thickening and adhesion,which is effective, simple and less side effects.