Objective:To understand the epidemiological characteristics of tuberculosis at Yuexiu District, Guangzhou and to provide scientific basis for the development of regional tuberculosis control strategies and measures.Methods:The online reported data of tuberculosis patients at Yuexiu District, Guangzhou from 2018 to 2022 were derived from "Tuberculosis Management Information System" of "China Information System for Disease Control and Prevention". Based on the demographic data of the seventh national population census in 2020, the reported incidence rates of tuberculosis by gender, age, and sub-district in the five years and the annual percentage of the reported cases in different months in each year were descriptively analyzed. Their five-year change trends were also analyzed.Results:A total of 2 504 cases of pulmonary tuberculosis, including 1 426 pathogenic positive cases and 1 078 pathogenic negative cases and 2 337 cases of initial treatment and 167 cases of re-treatment, were reported in the whole district during the five years. The reported incidence of pulmonary tuberculosis was 48.22/100 000. From 2018 to 2022, the reported incidence rates of pulmonary tuberculosis were 51.89/100 000, 49.39/100 000, 47.27/100 000, 49.58/100 000, and 42.94/100 000, respectively; those of the males were 2.07, 1.84, 2.03, 1.74, and 1.91 times those of the females. The 5-year average reported incidence rates of the 0-, ≥15-, ≥25-, ≥35-, ≥45-, ≥55-, ≥65-, and ≥75- years old groups were 1.55/100 000, 44.31/100 000, 47.16/100 000, 30.98/100 000, 46.57/100 000, 75.05/100 000, 79.22/100 000, 98.28/100 000, and 48.22/100 000, respectively; the change trends of these rates in the 8 age groups in the five years were roughly the same as that of the 5-year average reported incidence rate. In terms of case reporting time, the percentages of the number of cases reported in each month to that of a year ranged from 5.12% to 11.50% in the five years. It was the most common feature of each year that the numbers of the reported cases in February and October were relatively small, and the number of the reported cases in September was the biggest. The general incidence rates of pulmonary tuberculosis of different sub-districts ranged from 30.14/100 000 to 64.05/100 000 in the five years. The top five sub-districts were Zhuguang Street (64.05/100 000), Renmin Street (62.48/100 000), Kuangquan Street (60.13/100 000), Guangta Street (59.70/100 000), and Beijing Street (58.67/100 000); while the top five sub-districts whose incidence rates were from high to low were Liuhua Street, Guangta Street, Beijing Street, Renmin Street, and Dadong Street.Conclusions:The incidence of tuberculosis at Yuexiu District, Guangzhou in the five years was lower than that in Guangzhou, but the decrease was small. Therefore, tuberculosis control should be vigorously strengthened.

Objective:To understand the latest epidemiological status of tuberculosis in floating population at Yuexiu District and to provide scientific basis for continuous improvement and optimization of measures of tuberculosis prevention and control for floating population.Methods:Basing on the data of Tuberculosis Management Information System, a subsystem of China Disease Prevention and Control Information System, the online data of the patients with pulmonary tuberculosis at Yuexiu District floating between districts, cities, and provinces from 2018 to 2022 were collected and collated. The epidemiological status in the 3 floating populations with different gender, age, case finding model, treatment delay, pathogenic test results, and treatment classification were descriptively analyzed.Results:In the five years, 1 267 cases of pulmonary tuberculosis at Yuexiu District were reported, including 829 males (65.43%) and 438 females (34.57%). Among them, 80.58% (1 021/1 267) patients went directly to the tuberculosis prevention and treatment institution for medical treatment. In the patients, 713 cases (56.27%) were pathogenic positive, and 554 cases (43.73%) pathogenic positive. There were 1 188 first treated cases (93.76%) and 79 re-treated cases (6.24%). The median of the reported incidence rates of pulmonary tuberculosis in the floating population was 71.1/100 000 in 2020. The rates of delay in seeing a doctor and diagnosis delay were 75.30% (854/1 267) and 77.19% (978/1 267), respectively. The percentages of the patients <18 years old, ≥18-45 years old, ≥45-60 years old, and ≥60 years old were 3.28% (2/61), 50.82% (31/61), 22.95% (14/61), and 22.95% (14/61), respectively.Conclusions:The incidence of tuberculosis and rates of delay in seeing a doctor and diagnosis delay in the floating population at Yuexiu are all at a high level. Therefore, it is urgent to strengthen tuberculosis control in floating population.

Objective:To analyze the characteristics of diagnosis and treatment delay of patients with tuberculosis in recent years at Yuexiu, and to provide the basic basis for the formulation of control strategies for the early detection of tuberculosis cases and the optimization and improvement of the implementation measures.Methods:The online reporting data of tuberculosis patients at Yuexiu District, Guangzhou from 2018 to 2022 were derived from the Tuberculosis Management Information System of China Information System for Disease Control and Prevention. Whether the intervals between the first diagnosis date and present symptom date and between the present diagnosis date and the present first diagnosis date were over 14 days were referred to as delay in seeing a doctor and diagnosis delay, respectively. The data of these two kinds of delay were statistically analyzed by day, week, month, and year. And the delays between male and female, between the juvenile group (< 18), the youth group (≥18-45), the middle-aged group (≥45-60), and the elderly group (≥60), and between the delay of each street were compared. χ2 test and rank sum test were applied. Results:In the 2 504 cases of pulmonary tuberculosis, the rates of delay in seeing a doctor and diagnosis delay were 41.5% (1 028/2 504) and 30.71% (769/2 504), respectively. The ranges and medians of the two kinds of delays were 1-7 664 days and 27 days and 1-1 100 days and 14 days, respectively; the percentages of delay for one month, one year, and over one year were 52.72% (542/1 028), 43.29% (445/1 028), and 3.99% (41/1 028) and 77.76% (598/769), 21.59% (166/769), and 0.65% (5/769), respectively. The delay in seeing a doctor and diagnosis delay occurred in 662 cases (40.89%) and 482 cases (29.96%) among the 1 619 male patients, respectively, while 366 cases (41.36%) and 287 cases (32.43%) experienced the delays among the 885 female patients, respectively, with no statistical differences between the males and the females (all P?0.05). The rates of delay in seeing a doctor and diagnosis delay in the juvenile group, the youth group, the middle-aged group, and the elderly group were 36.36% (16/44), 38.31% (321/838), 41.81% (268/641), and 43.12% (423/981) and 31.82% (14/44), 33.77% (283/838), 28.55% (183/641), and 29.46% (289/981), respectively, with no statistical differences (all P?0.05). In the 18 sub-districts of Yuexiu District, the ranges of the rates of delay in seeing a doctor and diagnosis delay were 32.91%-50.79% and 21.52%-34.73%, respectively, with statistical differences ( U=96.0 and 41.5; both P<0.05). Conclusions:There are high proportions of delay in seeing a doctor and diagnosis delay among patients with pulmonary tuberculosis at Yuexiu District. How to shorten delay in seeing a doctor by strengthening the active case finding and to reduce diagnosis delay by improving clinical diagnosis and treatment is an urgent problem to be solved.

目的 探讨社区采用不同方式发现肺结核患者的临床特征.方法 对2019年1月1日-2019年12月31日在广州市越秀区登记肺结核患者临床特征进行分析.根据就诊方式分为主动发现组和被动发现组.结果 主动发现组301例(47.55％),被动发现组332例(52.45％).主动发现组患者年龄22.5～53.0岁,中位数34.0岁;被动发现组患者年龄28.0～57.0岁,中位数44.0岁,主动发现组患者平均年龄低于被动发现组年龄,差异有统计学意义(U=39 754,P=0.000).病原学痰涂片抗酸杆菌阳性率方面,主动发现组患者(19.46％)低于被动发现组(43.60％),差异有统计学意义(x2=41.721,P=0.000).影像学上,肺部病灶范围≥3个肺野,主动发现组98例(32.56％)低于被动发现组168例(50.61％),两组患者病灶范围差异有统计学意义(x2=22.467,P=0.000).主动发现组肺部有空洞者(21.60％)低于被动发现组(34.04％),差异有统计学意义(x2=12.090,P=0.001);在既往治疗史上,肺结核复治主动发现组7例(2.33％)低于被动发现组25例(7.53％),两组患者肺结核患者登记差异有统计学意义(x2=8.909,P=0.003).结论 主动发现肺结核患者痰涂片阳性率低,病灶范围较小,病情较轻.采用主动发现方式,可对肺结核患者早期诊断和早期治疗,有助于提高肺结核的治愈率.

目的 分析无症状肺结核病人的临床特点,为肺结核发现方式采取策略提供依据.方法 633例确诊为肺结核的病人,分为结核症状组和无症状组,对这两组病例的特征,包括年龄、性别、职业、病灶范围、病灶是否含有空洞、确诊时间、诊断类别、治疗转归等因素进行比较,分析其特点及差异.结果 症状组有356例,占56.2％,无症状组有277例,占43.8％.症状组与无症状组在年龄≥60岁、职业为家政家务待业、病灶范围≥2个肺野、病灶含有空洞、确诊时间≥14天、诊断为初治病例、涂片阳性、确诊病例与临床诊断病例等方面比较两者差异有统计学意义(P<0.05),而在性别、治疗转归方面比较,差异无统计学意义(P>0.05).结论 在结核病疫情还相当严峻的今天,对无症状病人亦应高度警惕肺结核病,应采取在高危人群中筛查结核的主动发现病人的策略.

目的:调查2018—2021年广州市越秀区学校肺结核患者密切接触者的筛查情况，为开展学校结核病防控工作提供依据。方法:按照《关于印发学校结核病防控工作规范（2017版）的通知》的要求，对学校密切接触者进行结核可疑症状、结核菌素试验和/或胸部X线等检查。结果:2018—2021年广州市越秀区学校共发现学生肺结核患者161例（2018年42例，2019年50例，2020年38例，2021年31例）。大学生73例（45.34%），中专及高中学生74例（45.96%），初中生8例（4.97%），托幼机构6例（3.73%）。其中男性患者83例（51.55%），女性患者78例（48.45%）。发现的161例学生肺结核患者中，病原学阳性患者48例（29.81%），病原学阴性患者113例（70.17%）。通过对161例确诊患者进行流行病学调查，共筛查密切接触者7 698例，其中7 667例密切接触者结核菌素皮肤试验（PPD试验）结果中，强阳性326例；有6 193例进行胸片筛查，胸片表现为异常者38例，在7 698例密接者中共发现活动性肺结核患者8例。结论:通过对学校肺结核患者密切接触者的筛查，可及早发现结核患者并杜绝传染源，从而防止学校结核疫情的发生。

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.

目的:分析广州市越秀区1032例肺结核患者耐药情况.方法:收集2011年1月1日至2015年12月31日结核病信息管理专报系统中可疑耐多药患者病案信息及普通病案信息,共1032例.对其进行酸性改良罗氏培养基培养分枝杆菌,鉴定菌种,最终采用BACTECMGIT960system快速药敏实验,对异烟肼(H)、利福平(R)、链霉素(SM)、乙胺丁醇(E)进行药敏实验.分析患者耐药情况.结果:1032名涂阳患者培养阳性690例,培阴342例,涂阳陪阴率为33.14％.涂阳培阳690例肺结核患者中:耐多药患者101例,广泛耐药患者86例,耐H不耐R98例,耐R不耐H 22例,不耐药383例,总耐药率为44.49％.结论:广州市越秀区肺结核患者耐药率较高,应进一步加强监测与管理工作.

目的 了解广州市肺结核患者在门诊确诊前及治疗过程的直接医疗费用及构成,为完善结核病医疗保障政策,控制医疗费用,减轻患者医疗负担提供循证依据.方法 采用前瞻性追踪研究方法,对2015年1月至2018年12月在广州市各区结核病防治机构的门诊中确诊及治疗的肺结核患者进行追踪研究.通过文献研究及专家咨询法设计《广州市肺结核疾病负担研究调查表》,包括《基本情况调查表》、《医疗费用调查表》、《治疗情况调查表》三部分,由患者本人在各区结核病防治机构的门诊完成现场问卷调查,由各区结核病防治机构的医务人员开展追踪管理并根据患者诊治情况填写《医疗费用调查表》及《治疗情况调查表》,了解肺结核患者的社会经济情况、确诊前及治疗过程的各项直接医疗费用.用两独立样本Wilcoxon秩和检验方法比较不同类型肺结核患者门诊直接医疗费用及构成的差异.结果(1)共纳入肺结核患者950例,年龄(43.28±15.13)岁.男性占64.6％(614/950),女性占35.4％(336/950).初治病原学阳性肺结核患者占41.8％(397/950),初治病原学阴性肺结核患者占58.2％(553/950),复治病原学阳性肺结核患者占8.0％(76/950).(2)经追踪研究,肺结核治愈患者占96.8％(920/950),死亡占0.3％(3/950),失败占1.4％(13/950),失访占1.5％(14/950).(3)920例治愈肺结核患者的门诊直接医疗总费用为(5546.16±2758.72)元,其中检查费占49.06％,药费占47.70％.确诊前费用为(809.20±352.59)元,占总费用15.58％;治疗期间门诊费用为(4385.82±1787.97)元,占总费用84.42％.支付方式中自费占61.01％,医保支付占27.83％,政府减免费用占10.38％.(4)无论是门诊确诊前还是治疗期间直接医疗费用,均有复治者高于初治者,病原学阳性者高于病原学阴性者(P<0.05),本地户籍者与外地户籍者差异均无统计学意义(P>0.05).结论 广州市肺结核患者确诊前直接医疗费用较低,治疗期间直接医疗费用较高,医保及政府减免费用比例较低,建议结合患者实际治疗情况扩大政府减免项目范围,降低结核病患者医疗负担,遏制结核病危害.

Objective:To promote pulmonary tuberculosis prevention and control in schools analyzing the characteristics of tuberculosis in the college entrance examination students in Guangzhou from 2019 to 2020.Methods:The clinical symptoms, pulmonary lesions, etiology, drug resistance, and treatment outcomes of pulmonary tuberculosis in the college entrance examination students in Guangzhou from 2019 to 2020 were analyzed.Results:The detection rate of tuberculosis was 50.53/100 000 (40 cases) in the 79 168 students in 2019, and was 90.58/100 000 (51 cases) in the 56 305 students in 2020; most cases had no clinical symptoms; the average diagnosis time was 9.3 days. Among the 91 cases, 2 had simple tuberculous pleuritic and 89 secondary pulmonary tuberculosis. Among the 89 cases of secondary pulmonary tuberculosis, 71 cases (79.8%) got lung lesions less than two lung fields, and 10 cases (11.2%) had cavity. Of the 91 cases, 41 (45.1%) were pathologically positive. No MDR patients were found. All the cases were cured after treatment or completed treatment.Conclusions:In recent two years, the detection rate of pulmonary tuberculosis in college entrance examination students in Guangzhou is relatively high, with scores of positive cases. In the future, we need to strengthen the prevention and control of tuberculosis in schools.

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.

Objective:To continuously improve measures and level of tuberculosis diagnosis, treatment, and prevention by analyzing the current status of sputum smear staining for acid-fast bacteria in the process of the implementation of the tuberculosis prevention and control plan and by exploring the possible factors affecting test quality.Methods:The registration data of Yuexiu District between 2006 and 2015 and of Haizhu District between 2018 and 2019 from the Registration Book for Newly Diagnosed Patients of the Guangzhou Tuberculosis Control Project were retrospectively analyzed.Results:5 989 cases were diagnosed as pulmonary tuberculosis from the 11 742 registered cases with suspected tuberculosis; of which, 1 970 patients, accounting for 33.16%, were positive in sputum smear staining for acid-fast bacteria. Among the patients with pulmonary tuberculosis, 1 481 (24.73%) were positive in all the samples, 284 (4.74%) in 2, and 205 (3.42%) in 1, and 4 019(67.11%) were negative in all the 3. According to the time interval between patient consultation and test report, the csaes were divided into group A of at least two sputums processed at a convenient time with an interval of zero day and group B possibly including morning sputum, night sputum, and sputums at a convenient time with an interval ≥ 1 d. Among the 2 147 cases whose data of time interval were available, there were 406 cases in group A, accounting for 18.91%, and 1 741 cases in group B. Among the 2 147 cases, 1 149 patients were with pulmonary tuberculosis, including 185 cases in group A and 964 cases in group B, and 509 patients were positive in sputum smear staining for acid-fast bacteria. 70 case (37.83%) were positive in all the 3 samples, 14 (7.56%) in 2, and 17(9.19%) in 1, and 84(45.41%) were negative in all the 3 samples in group A; and 303 (31.43%), 53(5.50%), 52(5.39%), and 556(57.60%) in group B; the positive rate was significantly lower in group B than in group A ( χ2= 9.4718, P<0.05). Conclusion:In the process of the implementation of clinical diagnosis, treatment, prevention and control of tuberculosis, the works addressing the norms of processing "sputums at a convenient time" , "night sputum" and "morning sputum" and urging patients to perform well must be strengthened for improving the positive rate of sputum smear staining for acid-fast bacteria.

目的 分析肺结核患者抗痨药物所致不良反应发生特征及其危险因素,为结核病防控提供依据.方法 将2016年5月1日-2017年4月31日期间在广州市胸科医院使用标准化疗方案的初治涂阳或培阳肺结核患者作为研究对象,设计统一调查表,通过查阅病案资料及面对面问卷调查方式,收集其治疗期间不良反应发生情况及患者相关信息.采用单因素及多因素分析各研究因素对于不良反应发生结局的影响.结果 共纳入研究261例,发生不良反应者189例,不良反应发生率为72.41％.不良反应类型主要为骨关节损害,发生率为55.94％(146/261),其次为肝功能损害和胃肠道反应,发生率分别为41.00％(107/261)和38.70％(101/261).单因素分析显示,年龄、体质指数(BMI)、月收入、是否有肝病史、有无合并症及是否饮酒等因素的不良反应发生率的差异有统计学意义(P＜0.05).多因素分析显示,年龄＞60岁(OR=3.19,95％CI:2.11～5.39)、低BMI(＜18.5 kg/m2)(OR=1.40,95％CI:1.01～3.70)、肝病史(OR=1.89,95％CI: 1.01～6.59)在回归方程中差异有统计学意义(P＜0.05).结论 由抗结核药物引起的不良反应发生率较高,年老、营养不良、有肝病史可增加抗痨药物不良反应发生风险,临床诊疗过程中应加强危险因素早期识别,强化辅助治疗.

目的 通过对2013-2017年广州市越秀区本地户籍肺结核流行特征的分析,提出针对性的疫情控制方法,达到提高疫情控制效果的目的. 方法 在“国家结核病管理信息系统”,下载首管理单位为越秀区、登记时间为2013年1月1日-2017年12月31日、本地户籍的新登记肺结核患者的病案信息,将信息表转换成FoxPro 6.0数据库进行统计,分析本地居民肺结核登记发病率、复发比例、病型分布、人群分布、发现方式、患者延误、HIV检出率、非结核菌检出率及耐药检出率等变化情况. 结果 肺结核登记发病率从2013年的85.84/10万下降到2017年的58.73/10万,5年间下降了31.57％,差异有统计学意义(x2=141.47,P＜0.001).复发比例分布在8％～12％之间,不同年份的复发比例差异有统计学意义(x2=13.75,P=0.008).病型以浸润型肺结核为主,占97.14％,其次是结核性胸膜炎,占2.36％,不同年份的病型构成比差异无统计学意义(x2=11.12,P=0.195).男∶女性别比1.98:1;65岁及以上病人占比最高,为23.50％,25岁以下占比最小,为10.81％,但不同年份的年龄段构成比差异有统计学意义(x2=47.15,P=0.001),其中55岁以上构成比有所提高;无业、离退休占比分别为45.61％和29.29％,不同年份的职业构成比差异有统计学意义(x2=59.94,P＜0.001),其中商业服务和离退人员构成比例有所提高.患者因症就诊被发现占63.72％,综合医院转诊发现占26.36％,各年因症就诊和转诊为主的发现方式没有改变,不同年份的发现方式构成比差异有统计学意义(x2=130.27,P＜0.001),其中因症就诊比例有所提高,转诊比例有所下降.总涂阳病人就诊延误率46.45％明显高于总涂阴患者的37.86％,差异有统计学意义(x2=31.76,P＜0.001);总涂阳病人确诊延误率17.32％明显低于涂阴病人确诊延误率40.30％,差异有统计学意义(x2=263.26,P＜0.001).HIV检出阳性率0.61％.非结核分枝杆菌总体检出率12.45％,各年间差异未见统计学意义(x2=7.75.P=0.101).总耐药率为18.74％,耐多药率8.46％,不同年份耐多药检出率差异未见统计学意义(x2=5.15.P=0.272). 结论 2013-2017年,广州市越秀区结核病疫情呈不断好转趋势,但仍应重点加强对男性、无业、离退休人群的防控工作,积极开展新登记肺结核患者的菌型鉴定工作,提高HIV和耐药结核病的筛查率.

Objective To explore the correlation of Ziehl-Neelsen stain examination of sputum smear with cough time and chest X-ray radiographic features in patients with pulmonary tuberculosis,and to comprehend the risk factors of tuberculosis transmission.Methods The data from Guangzhou Tuberculosis Control Project New Cases Registration Book,including cough time,chest X-ray radiography,and Ziehl-Neelsen stain examination of sputum smear of new cases with pulmonary tuberculosis in the first outpatient department of our hospital from 2006 to 2015,were applied to analyzed the correlation of Ziehl-Neelsen stain examination of sputum smear with cough time and chest X-ray radiographic features by x2 test.In the analysis,the cases were classified into five groups according to 4+、3+、2+、1+、-of Ziehl-Neelsen stain examination of sputum smear;according to the cough time,they were grouped into three kinds of duration——none,less than two weeks(＜ 2 weeks),and at least two weeks(≥ 2 weeks);the chest X-ray radiographic features included the presence and absence of cavity as well as the distribution of lesions in six lung fields (from one to six).Results 5 235 cases with pulmonary tuberculosis were enrolled;and the number of the five case groups from 4+ to-were 304,213,305,973,and 3,440,respectively.The analysis results were as follows.The overall percentages of the three kinds of duration were different or incompletely the same (x2=284.170,P =0.000) in the five case groups;the Cramer's V coefficient (for short "V") and corrected contingency coefficient(for short "r'") were 0.16 and 0.28,and there was a positive correlation between the positive level of sputum smear examination and cough duration.The overall percentages of those with or without cavity were different (x2=868.661,P=0.000);V and r'were 0.41 and 0.53,and the positive level of sputum smear examination was closely related to the cavity.The overall percentages of the numbers of lung fields involved were different or incompletely the same (x2=524.543,P =0.000);V and r'were 0.18 and 0.37,and there was a positive correlation between the positive level of sputum smear examination and the number of lung fields involved.Conclusions The positive level of sputum smear examination relates to cough duration,cavity,and the number of lung fields involved;and the correlation degree is from weak to strong according to this order.

目的 了解结核专科门诊发现初治肺结核患者并发肺部其他感染现状,探讨肺结核并发肺部其他感染患者的临床特点.方法 回顾性分析2015年1月至2016年6月在广州市结核病防治所一分所就诊的、临床资料完整的初治菌阳肺结核患者506例,根据患者就诊时是否并发肺部其他感染,分为肺结核并发肺部其他感染组(简称“并发感染组”;共计200例)及肺结核未并发其他感染组(简称“对照组”;共计306例).506例患者中有98例为老年患者.应用SPSS 19.0软件进行统计学分析,计数资料采用x2检验,以P＜0.05为差异有统计学意义.结果 (1)并发感染组200例,占39.53％;在并发感染组中,老年患者比例(24.50％,49/200)明显高于对照组(16.01％,49/306)(x2=6.583,P=0.037),两组比较差异有统计学意义;(2)在并发感染组中,伴有咳嗽或咳痰症状者占83.00％(166/200),与对照组的76.47％(234/306)相似,两组比较差异无统计学意义(x2=3.510,P=0.319);(3)并发感染组肺部累及病灶＞3个肺野者占49.00％(98/200),明显高于对照组的31.70％(97/306),两组比较差异有统计学意义(x2=6.965,P=0.008);(4)并发感染组患者中,肺结核并发空洞者占42.50％ (85/200),明显高于对照组的26.80％(82/306),两组比较差异有统计学意义(x2=13.487,P=0.000).结论 结核专科门诊发现初治菌阳肺结核并发肺部其他感染患者中,老年患者并发肺部其他感染的比例较高,并发感染组患者肺部病灶累及范围较广泛,常伴有空洞形成.

为探讨首次复治耐多药肺结核(MDR-PTB)患者行短程与标准化治疗的疗效并进行对比分析,作者收集了2009年3月至2014年3月广州市胸科医院门诊部诊治的既往有结核病病史、无基础疾病及严重并发症、曾仅给予常规一线抗结核药物治疗超过1个月、经实验室检测确诊的首次复治菌阳肺结核患者236例.将患者依就诊时间先后分为A、B组,各118例,两组患者分别进行耐多药筛查,共36例患者确诊为MDR-PTB,其中A组患者(21例)给予复治短程化疗方案[(2～3) H-R-Z-E-S/6 H-R-E,简称“短程组”],B组患者(15例)给予耐多药结核病标准复治方案[6Am-Z-Lfx-PAS(Cs)-Pto/18Z-Lfx-PAS(Cs)-Pto,简称“标准组”].分析两组患者治疗后的近远期临床疗效(包括痰菌阴转率、病灶吸收、药物不良反应及治疗转归).两组间计数资料的比较采用Fisher确切概率法检验.结果显示,短程组治疗9个月末时的痰菌阴转率(85.7％,18/21)较标准组(46.2％,6/13)明显提高(P=0.017),但在疗程结束时短程组和标准组的痰菌阴转率[85.7％(18/21)和84.6％(11/13)]、病灶显著吸收率[47.6％(10/21)和23.1％ (3/13)]、空洞闭合率[25.0％(3/12)和18.2％(2/11)]、治疗成功率[76.2％(16/21)和53.8％(7/13)]、失败率[23.8％(5/21)和46.2％(6/13)]差异均无统计学意义(P值分别为0.373、0.109、0.360、0.122、0.122).两组患者治疗过程中均未发生严重药物不良反应而暂停治疗,标准组中有1例出现药物性肝损伤经保肝治疗后缓解,5例出现尿酸升高因无关节疼痛症状未予处理;短程组中有4例出现尿酸升高,仅1例因关节疼痛给予对症治疗后好转,2例患者出现胃肠道反应经调整服药次数后缓解.提示复治短程化疗方案治疗首次复治MDR-PTB的临床近期疗效优于耐多药结核病标准化疗方案,但远期疗效差异无统计学意义.基于前者具有疗程短、药品便宜且易获得、严重药物不良反应无增加等特点,建议对于首次复治MDR-PTB患者首选复治短程化疗方案.

目的 比较高频超声与MRI对膝骨性关节炎的诊断价值.方法 58例接受关节镜手术的膝骨性关节炎患者,评价术前高频超声、MRI对膝骨性关节炎的诊断价值.结果 高频超声检查显示滑膜增厚、关节腔积液、软骨破坏、半月板病变和肌腱韧带损伤的诊断符合率分别为94.7％、96.4％、75.0％、57.1％、46.2％,而MRI的诊断符合率分别为96.5％、98.2％、90.0％、92.8％、84.6％,差异均无统计学意义P＞0.05).结论 高频超声对膝骨性关节炎患者滑膜增厚、关节腔积液、软骨破坏的诊断价值类似于MRI.

目的 观察抗结核治疗对非结核分枝杆菌(Nontuberculous Mycobacteria,NTM)肺病的疗效.方法 对收治的NTM肺病患者80例,70例给予抗结核治疗,10例给予一般对症治疗,治疗后比较两者的疗效,同时把抗结核治疗的70例患者,根据分离的菌种分为快生长NTM组和慢生长NTM组,比较两组的疗效.结果 治疗后抗结核治疗组与对症治疗组痰涂阴转率分别为83.3％和60.0％,痰培阴转率分别为53.0％和40.0％,临床症状有改善病例分别占57.6％和70.0％,胸片病灶有吸收或不变病例分别占81.8％和70.0％,这几方面的疗效比较差异无统计学意义(P＞0.05).快生长NTM组和慢生长NTM组痰涂阴转率分别为85.7％和71.4％,痰培阴转率分别为59.2％和38.1％,胸片病灶有吸收或不变病例分别占63.3％和52.4％,这几方面的疗效比较差异无统计学意义(P＞0.05),临床症状有改善病例分别占87.8％和66.7％,差异有统计学意义(P＜0.05).结论 抗结核治疗对NTM肺病患者疗效尚可,且对快生长NTM肺病的临床症状改善优于慢生长NTM肺病,但一般对症治疗对临床症状不明显的NTM肺病患者亦可取得满意疗效.

目的 比较咳嗽咳痰长于2 w与短于2 w肺结核可疑症状者肺结核发生率,为更准确定义肺结核可疑症状提供科学依据.方法 对2010-2015年来医院第一门诊部就诊的2 487例咳嗽咳痰长于2 w(A组)与1 151例短于2周(B组)的肺结核可疑症状者的临床诊断资料进行回顾性分析,分别按少年(<15岁)、青年(15~44岁)、中年(45~64岁)、老年(≥65岁)年龄别和春(3~5月)、夏(6~8月)、秋(9~11月)、冬(12月、1~2)就诊时间段应用x2检验,比较A、B两组间肺结核发生率的差异.结果 A、B组患者肺结核的发生率分别为60.96%(1 516/2 487)、61.34%(706/1 151),其中:A、B组中少年、青年、中年、老年患者肺结核的发生率分别为36.36% (4/11)、70.48%(542/769)、61.47% (654/1 064)、49.14%(316/643)和0(0/3)、66.58%(267/401)、62.55%(304/486)、51.72%(135/261);A、B组患者在春、夏、秋、冬季节肺结核的发生率分别为61.95%(451/728)、62.81%(353/562)、58.31%(249/427)、55.92%(463/828)和64.78%(195/301)、60.84%(160/263)、55.69%(137/246)、59.28%(214/361).经x2检验比较,各年龄段以及不同季节中A、B 两组患者肺结核的发生率均无显著性差异.结论 目前肺结核可疑症状定义中的"咳嗽、咳痰≥2 w"可适宜缩短,以利用肺结核病例的及时发现和尽早治疗.