结核病是全球各种传染病中造成死亡的"头号杀手",我国每年因结核病而丧生者为其他各类传染病死亡总和的2倍[1].近年来,吸毒者中肺结核患病率普遍增高[2],且吸毒肺结核患者抗结核治疗效果较差[3],故研究吸毒肺结核患者的治疗难点对结核病的防治意义重大.

Objective To research the drug fever caused by the antituberculotic medicament in the during short-course intermittent chemotherapies. Methods 34 cases were analyzed directly observed treatment retrospectively. Results All of the drug fever was occurred within the first two months, the rifampicin was the most cause, and the isoniaxid was the secondly. Conclusion In the course of the chemotherapy, especially the patients with fever occurring in the first two months, the drug fever should be considered.

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。

目的探讨初治涂阳肺结核患者强化期每天用药与隔天用药的疗效差别,为完善结核病的控制策略和方法提供一定的临床依据。方法对262例初治涂阳肺结核患者每天用药与隔天用药疗效差别结果的临床资料进行回顾分析。结果强化期每天用药2个月末痰菌阴转率82．2％,3个月末阴转率94．4％,全程每天用药治愈率为95．5％;而强化期隔天用药2,3个月末阴转率分别为66．9％和88．9％,全程隔天用药治愈率为83．7％;2个月末及治愈(完成疗程)时痰菌阴转率两组差异有显著性(P=0．008,P=0．005)。结论每天用药的疗效优于隔天用药,尤其是治愈(完成疗程)时,初治涂阳肺结核患者应争取全程每天用药,至少应强化期每天用药。

<正>随着世界人口的老年化,老年肺结核有增加趋势。近年来,我国老年肺结核亦有增加趋势。因此,我们要重视老年肺结核。根据世界卫生组织划分：60～74岁称为年轻老年人,75～89岁称为老年人,90岁以上称长寿老年人。本资料报道我院近几年收治老年肺结核患者212例,其中60～74岁134例,75～88岁78例,分析比较,探讨其临床特点。

目的探讨母牛分支杆菌菌苗(M.Vaccae)应用于老年复治涂阳肺结核患者的临床疗效及对免疫功能的影响.方法老年复治涂阳肺结核患者106例,随机分入微卡治疗组及对照组(各53例),化疗方案均为3HRZE/6HR,治疗组加用M.Vaccae治疗,分别观察治疗前后症状与体征、胸部X线变化、痰菌、免疫功能状态及不良反应等.结果治疗后两组在症状体征、肝肾功能、体液免疫等指标的对照中无明显差异(P>0.05),两组CD3、CD4水平均有明显升高(P<0.05),但两组对照无明显差异(P>0.05);在病变吸收、空洞缩小、痰菌阴转、NK细胞上升、PPD阳转等方面,治疗组明显高于对照组(P<0.05);治疗组无明确因M.Vaccae导致的副作用.结论 M.Vaccae可加快老年复治涂阳肺结核患者病变吸收、空洞缩小、痰菌转阴的速度,调节细胞免疫功能,无明显不良反应.

目的探讨广东省结核病控制项目初治涂阳肺结核治疗2月末痰涂不阴转病人的临床特点,为提高化疗效果提供参考资料.方法对项目实施初期所收治的初治涂阳肺结核治疗2月末痰涂不阴转的78病人的临床资料进行分析.结果①年龄≥60岁15例(19.2%);②合并糖尿病16例(20.5%);③平均就诊延误122天;④病灶占3个肺野以上55例(70.5%),有空洞43例(55.1%),空洞≥2厘米28例;⑤耐药16例(20.5%),其中耐多药4例;⑥治愈与完成疗程55例(70.5%).结论就诊延误时间长,结核病病情重是初治涂阳肺结核化疗2月末痰菌不阴转的主要原因,结核病防治工作需加强健康教育.

Objective To study on the reasons of the smear positive result at the end of 2th months of treatment of new smear positive pulmonary tuberculosis patients of Tuberculosis Control Project in Guangzhou,and to provide the reference evidences for improvement of treatment. Methods 231 new smear positive pulmonary tuberculosis patients in the initial stage of the project,were divided into smear negative groups and smear positive groups according to the results of sputum test at the end of 2th months of treatment,and the clinical data of the two groups had been analysed retrospectively. Results By univariate analysis,patient delay,focus scope≥2 pulmonary field,with cavities in lungs,with diabetes,sputum smear≥2+ were significantly different between the negative and the positive groups(P<0.001,Logistic regression analysis showed that factors significantly contributed to the smear positive at the end of 2nd months of treatment were patient delay,with cavities in lungs,with diabetes. Conclusion The health education need to be enhanced on tuberculosis control,and it is important to pay great attention to the patients with cavities in lungs,or with the diabetes.

目的探讨广州市初治涂阳肺结核治疗2个月末痰涂不阴转的原因,为提高化疗效果提供参考资料.方法对项目实施初期收治的初治涂阳肺结核病例231例,根据治疗2个月末痰涂片结果分为阴转组与未阴转组,回顾分析比较2组的临床资料.结果单因素分析显示阴转组与未阴转组之间就诊延误、病灶范围≥2个肺野、肺部含有空洞、合并有糖尿病、痰涂片≥2+等变量有显著性差异(P＜0.01);以治疗2个月末痰涂片不阴转作为因变量进行Logistic回归分析,结果显示影响因素是就诊延误、肺部含有空洞、合并有糖尿病等.结论结核病防治工作需加强健康教育,重视对肺部含有空洞的病人的治疗、特别是重视合并有糖尿病病人的治疗.

目的探讨老年重症肺结核并多脏器功能衰竭的临床特征.方法分析老年重症肺结核并多脏器功能衰竭的临床表现.结果老年重症肺结核并多脏器功能衰竭病例男性多于女性、年龄大、病程长、并发症多,免疫功能低下容易引起呼吸道感染是诱发多脏器功能衰竭的主要原因.受累脏器数目越多,病死率越高,病死率为58.9%.2个受损脏器与4个受损脏器无显著性差异,P＞0.05,2个受损脏器与5个受损脏器有显著性差异,P＜0.05.结论掌握老年重症肺结核并多脏器功能衰竭的临床特征,重视预防及早期发现,治疗中亦密切配合和综合治疗.抗结核治疗中注意肝肾功能,并积极预防和治疗呼吸道感染,减少诱发因素,防止多脏器功能衰竭发生,降低病死率.

目的探讨初始耐药肺结核督导化疗的效果.方法对196例初治涂阳肺结核,其中初始耐药肺结核86例(耐药组),同期的初治非耐药肺结核110例(敏感组),两组临床特征具有可比性(P＞0.05),按世界银行结控项目指引实行督导化疗,评价疗效,并进行2年随访.结果初始耐药组第2,3,5,6个月的痰菌阴转率分别是62.8%,81.4%,89.5%,94.2%;敏感组分别是76.4%,85.5%,94.5%,94.4%,耐药组第2个月痰菌阴转率低于敏感组(P＜0.05);其余月份的痰阴转率相似(P＞0.05);疗程结束后耐药组空洞闭合率57.1%,缩小35.7%,无改变7.2%;敏感组空洞闭合率59.4%,缩小31.3%,无改变9.4%,空洞闭合率差异无显著性(P＞0.05);2年随访耐药组复发率12.3%;敏感组3.8%(P＜0.05).结论初治肺结核实行督导化疗,初始耐药与非耐药肺结核具有相似的近期效果,但初始耐药肺结核的痰菌阴转速度较慢和具有较高的复发率.

目的研究吸毒肺结核患者的临床特点.方法比较了吸毒和非吸毒肺结核患者的结核病分布类型、临床症状、痰菌情况及X线胸片检查.结果吸毒组中患者临床症状(咳嗽、咳痰、胸痛、呼吸困难、咯血、盗汗、乏力、消瘦、发热),病灶范围,空洞及痰菌阳性较对照组明显增高(P<0.01),而吸毒组中各类型肺结核与对照组无差异(P>0.05).结论社会应高度重视对吸毒肺结核患者的防治工作.

目的:探讨菌阳肺结核患者化疗前后其血清结核抗体与痰菌转归及预后的关系.方法:化疗前及化疗期,每月检测血清特异性结核抗体PPD-IgG(ELISA法),同时做细菌学检查(涂片+培养).停药后继续追踪两年.结果:74例中,结核抗体(Anti+TB)呈持续强阳性反应者2例(复治),化疗无效.余72例,结核抗体与结核菌之间显示出五组关系,①抗体与痰菌同时转阴,占5.56%(4/72);②痰菌转阴,抗体仍阳性,占44.44%(32/72);③化疗后抗体才转阳,占16.67%(12/72);④抗体持续阴性,占26.39%(19/72);⑤抗体先于痰菌转阴,占5.56%(4/72).痰菌转阴时间:第一、五组最长;初治者第四组时间最短,平均1.46个月;复治比初治转阴时间长;复发病例仅见于二、三组.结论:①抗体早转阴者,痰结核菌转阴时间晚;②抗体比痰菌晚阴者,有结核复发可能;③抗体阴性:初治者,抗结核疗效好,复治者则反之;④抗体持续强阳性者,痰菌难以转阴.

To study the content and correlation of trace element of infants aged 2～4 months,the content of Zn,Fe,Cu,Ca,Mn and Pb in hair of the infants was determined and the relativity was analysed with SPSS.The results show that the content of Zn,Fe,Cu,Ca,Mn of infants is deficiency. The deficiency of Zn,Cu,Ca,Mn is significant difference in sex. It is related to Fe with Zn,Cu with Ca,Mn with Zn,no related to Pb with others.It concluded mothers should pay attention to food and environment.

目的了解目前结核病死亡的原因,为制定合理的防治措施提供依据.

目的探讨吸烟对抗结核药物性肝损的影响.方法对比吸烟者和非吸烟者肺结核患者抗结核治疗中出现的药物性肝损率.结果吸烟组肝损出现率较对照组升高,两者存在显著性差异(P<0.05).结论提示吸烟可致肺结核患者抗结核药物性肝损出现率升高.

咯血是肺结核病的常见急症之一,特别是老年人,如果处理不及时,常导致窒息死亡.本文报道我院近20年来收治的肺结核咯血病例,其中60岁以上的老年人肺结核咯血380例,并与20～59岁的中青年肺结核咯血300例作比较,以探讨其临床特点.

Objective To probe into the influence of drug taking on the seriousness of pulmonary tuberculosis.Methods To compare the chest X-ray,sputum examination and clinical symtoms before and after treatments between drug taking group and non-drug taking group.Results There were significantly increased the severity of clinical symtoms,the sputum positive rate,rate of cavitation and the scope of pathological changes were significantly increased comparing with control groups before treatment.The improvement of clinical symtoms,the sputum negative convertion rate,scope of pathological improvement,cavity reduce rate were signigicantly decreased after treatment.The differece between the two groups was significant.Conclusion Drug taking may aggravate the severity of pulmonary tuberculosis.