目的:研究不典型肺结核诊断中结核感染T细胞斑点试验(TSPOT.TB)的敏感性与特异性.方法:应用TSPOT.TB和TST两种检测方式对本院100例疑似肺结核患者进行诊断,比较两种检测方式差异性.结果:不典型肺结核组阳性检出率明显高于肺结核组,组内对比TSPOT.TB在不典型肺结核,TSPOT.TB敏感性(94.21)、特异性(94.50)、阳性预测值(PPV) (74.20)、阴性预测值(NPV)(94.17)、阳性似然比(LR+)(6.14)均明显高于TST,而LR-(0.13)明显低于TST,差异有统计学意义(P＜0.05).结论:TSPOT.TB相比TST具有更高的临床应用价值,其具有快速、敏感等多种优势,在不典型肺结核诊断中占有重要地位.

Although the association of tuberculosis (TB) and the development of lung carcinoma (LC) has been acknowledged, the underlying mechanism remains not clarified. Since sustained and repeated local inflammation and tissue remodeling have been suggested to be responsible for the high incidence of developing CL from TB, we hypothesize that macrophages may play a critical role in the process. To prove it, we induced TB in mice by injection of virulent Mycobacterium tuberculosis (MTB). Then the mice were allotted into two groups. One group received weekly tail vein injection of 20 μg saporin-conjugated antibody against the pan-macrophage surface marker CD11b to eliminate macrophages, while the other group received injection of control IgG in the same frequency. Six months later, the development of LC was determined by histology. We found that the occurrence of LC in TB mice that received macrophage depletion was significantly lower than those in control TB mice without macrophage intervention. These data suggest that macrophages may promote the progression of TB into LC.

Objective To detect antigen-specific INF-γsecreting cells in CSF by ELISPOT assay to deter-mine its clinical value for TBMdiagnosis.Methods The study selected 1 04 patients with tuberculous meningitis and 40 people without tuberculous meningitis to detect their INF-γsecreting cells in CSF and blood by ELISPOT assay. Then the results were compared with AFB staining,Mtb culture,quantitative PCR,and Mtb antibodies.Results The sensitivity of CSF-ELISPOT assay was 92.3%,the specificity was 94.1%,which were higher than other assays (P<0.05).The CSF-ELISPOT assay was better than other assay in the diagnosis of TBM (Kappa=0.856,P<0.001 ).Conclusion The CSF-ELISPOT assay,with high sensitivity and specificity,will be a rapid diagnostic method for TBM.

ObjectiveTo investigate the mycobacterium tuberculosis bacterium distribution of drug-resistant tuberculosis patients, and analyze its drug resistance feature.Method568 cases of pulmonary tuberculosis patients’ lesion specimen were collected from June 2012 to June 2014, and used bacterial culture, identiifcation and drug sensitization experiments, the distribution of mycobacterium tuberculosis bacteria and drug resistance were analyzed.ResultThere were 198 cases of human type mycobacterium tuberculosis, 4 cases of mycobacterium bovis, 12 cases of NTM in 214 cases of culture-positive pulmonary tuberculosis. The difference of percentage among three types of mycobacterium tuberculosis was signiifcantly (P<0.05). There were 58 cases of drug-resistant strains of mycobacterium tuberculosis, 1 case of drug resistance of cattle mycobacterium tuberculosis, 1 case of drug resistance NTM, the difference was signiifcant (P<0.05); 12 cases of multi drug resistance in human mycobacterium tuberculosis, and there were no multi drug resistance in mycobacterium bovis and NTM, the difference was signiifcant (P<0.05); drug sensitization experiments showed that the highest rates of drug resistance was SM, the lowest was PAS, the difference was signiifcantly (P<0.05); Logistic regression analysis showed that there was significant association between treatment duration and resistance rates (P<0.05).ConclusionTB drug resistance is more serious and should strengthen monitoring of drug resistance, and based on susceptibility testing to select reasonable and effective chemotherapy.

Objective To evaluate the diagnostic value of IGRA in patients with tuberculous pleural. Meth-ods 116 patients with suspected tuberculosis pleurisy were selected in this study, and their whole blood and pleural effusion were given T-SPOT. TB detection. PBMCs isolated from whole blood and pleural effusion were co-cultured with mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10, then the spots were counted which formed by specific T cells. Results 91 patients were diagnosed with active TB infection, and the other 25 patients were diag-nosed with non-TB infection. For diagnosing TBP, the sensitivity and specificity of PBMCs from whole blood were 79. 1% and 64. 0% respectively. The relative proportions with cells from pleural effusion were 90. 1% and 88. 0% re-spectively. The positive rate of T-SPOT. TB was significantly higher in the ATB group than in the non-TB group ( P<0. 001). The results of T-SPOT. TB combined whole blood PBMCs with pleural effusion cells had a positive predictive value of 100% (72/72) and a negative predictive value of 94. 1% (16/17). Conclusion T-SPOT. TB assay with pleural effusion cells can be used in the diagnosis of TBP, and the diagnostic value will be even greater while combi-ning with the IGRA results from whole blood and pleural fluid cells.

我们应用水飞蓟宾(卵磷脂复合物胶囊)对抗结核药物所致的肝功能损害进行预防性治疗,现报道如下. 一、资料与方法 1.临床资料:对2006-2008年本院收治的92例肺结核患者在使用抗结核药物的同时使用水飞蓟宾,入选病例诊断均符合2001年中华医学会结核病学分会制定的 [1]。

<正>材料与方法观察对象以正在接受抗结核药物治疗的肺结核患者为观察对象,入选病例符合1999年结核病分类标准:包括原发型肺结核、血行播散型肺结核、继发型肺结核、结核性胸膜炎。2006～

1 临床资料患者,男,65岁,因发热伴干咳近2个月于2004年12月22日入院,体温39℃以上,全身皮肤反复出现红色斑丘疹,院外多种抗生素(菌必治1周、盐酸左氧氟沙星2周、泰能2周)治疗无效.

OBJECTIVE To observe the relationship between the genetic polymorphism of P450-2E1 and the risk for antituberculosis drug-induced hepatotoxicity in a Chinese population. METHODS Blood samples and clinical data were collected from 85 patients with antituberculosis drug-induced hepatotoxicity and 100 tuberculosis patients without hepatotoxicity as the control. DNA was extracted from the blood samples, and the frequencies of P450-2E1 RsaI genotypes were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The relationship between the polymorphisms of P450-2E1 RsaI and the antituberculosis drug-induced hepatotoxicity was analyzed. Predisposing factors for antituberculosis drug-induced hepatitis, such as gender, age, and polymorphism of P450-2E1 RsaI were evaluated by using logistic regression analysis. RESULTS The frequencies of the 3 gene types P450-2E1 RsaI c1/c1, c1/c2, and c2/c2 were 75% (64/85), 20% (17/85) and 5% (4/85) respectively in patients with antituberculosis drug-induced hepatotoxicity, and 61% (61/100), 30% (30/100), and 9% (9/100) respectively in the controls. A statistical difference was found between the cases and the controls (chi(2) = 4.284, P < 0.05, OR = 2.016, 95%CI = 1.058 - 3.842). Logistic regression analysis showed that the polymorphism of P450-2E1 RsaI remained a significant independent risk factor for antituberculosis drug-induced hepatotoxicity after adjustment for age, gender and body mass index. CONCLUSION Polymorphisms of P450-2E1 were found to be significantly associated with the risk of antituberculosis drug-induced hepatotoxicity, and the c1/c1 genotype was one of the risk factors.

Objective: To investigate and analyze the clinical effect of diabetes combined with pulmonary tuberculosis with continuous sub- cutaneous insulin infusion (CSII). Methods: 51 cases of diabetes combined with pulmonary tuberculosis were randomly divided CSII group and the MSII group,CSII group was treated with CSII,MSII group was treated with subcutaneous injection therapy treatment. at the same time,two groups were given anti-TB treatment. Observation of sputum conversion and absorption of lesions,blood glucose in patients with standard time,the amount of insulin, the incidence of low blood sugar,insulin suspended after blood sugar control to maintain a good time. Results: At the 1-month and 3 months after,the sputum conversion rate and absorption of lesions significantly increased in the CSII group,and compared with the MSII group the difference was significant ( P < 0. 05 ). CSII group and MSII group compared to standard blood sugar a short time, use less insulin,in- sulin-out after a good blood sugar control to maintain the long hours,low incidence of hypoglycemia ( P < 0. 05 ). Conclusion: CSII treatment of diabetes combined with pulmonary tuberculosis can better control the disease and promote negative sputum.

1 临床资料 患者,男,65岁,因发热伴干咳近2个月于2004年12月22日入院,体温39℃以上,全身皮肤反复出现红色斑丘疹,院外多种抗生素(菌必治1周、盐酸左氧氟沙星2周、泰能2周)治疗无效.

患者,男,28岁,既往有乙型病毒性肝炎(小三阳)、糖尿病病史.发热、纳差2月余,加重伴黄疸2周入院.山东省济南市第一人民医院B超及腹部CT均发现肝脏体积增大,肝实质内弥漫分布大小不等结节影.查血常规正常,血细菌学培养阴性.使用头孢类及喹诺酮类抗生素治疗体温不降,逐渐出现皮肤黏膜、巩膜黄染.后因血结核抗体阳性诊断为肝、脾结核,未使用抗结核药物治疗转我院.

现将妊娠合并胃癌及多系统继发性肿瘤误诊1例分析如下. 1 病历摘要 女,29岁.妊娠3个月时右肩胛区出现肿物且逐渐增大.整个孕期体重无增加,伴腹胀,进食后恶心、呕吐,乏力,右肩关节酸痛及腰部酸痛,呕吐较频繁及剧烈,常呕少量咖啡色胃内容物及排黑便,多次就诊于当地县级医院妇产科,考虑妊娠反应,未行特殊检查,予对症治疗效果差.