BACKGROUND:The common diagnostic methods for tuberculosis have been showing reduced sensitivity among chronic obstructive pulmonary disease patients. This study was conducted to evaluate and analyse the diagnostic value of an interferon-γ release assay in COPD patients complicated with pulmonary tuberculosis. METHODS:A nested case-control study was conducted on 123 COPD patients hospitalized at the Fifth Hospital of Shijiazhuang, Hebei Province, from January 2019 to June 2021. Thirty-one patients with active pulmonary tuberculosis complicated with COPD composed the observation group (Group A), 31 patients with nonactive pulmonary tuberculosis complicated with COPD composed the COPD control group (Group B), and 31 patients with active pulmonary tuberculosis not complicated with COPD composed the non-COPD control group (Group C). An interferon-γ release assay, a purified protein derivative of tuberculin (PPD) test, an anti-tuberculosis antibody test, a test of Mycobacterium tuberculosis by sputum smear microscopy and a test of Mycobacterium tuberculosis by PCR method were used to test patients in each group. The positive detection rates generated from the five test methods were compared and analysed. RESULTS:In COPD patients complicated with active pulmonary tuberculosis, the differences in the percentage of patients with positive interferon-γ release between the PPD test, anti-tuberculosis antibody test, Mycobacterium tuberculosis by sputum smear microscopy and PCR test results were statistically significant. CONCLUSION:In patients with COPD complicated with active pulmonary tuberculosis, the percentage of patients who were positive according to the interferon-γ release assay was higher than that according to the sputum smear microscopy, PCR detection of Mycobacterium tuberculosis in sputum specimen, and detection of anti-tuberculosis antibodies. COPD-related complications did not affect the T-SPOT; the greater the T-SPOT value was, the greater the likelihood of active TB. For patients who are T-SPOT positive but clinically considered to have inactive tuberculosis, regular follow-ups should be performed to observe changes in the patient's condition.

Abstract Background The diagnosis of tuberculous pleurisy (TP) presents a significant challenge due to the low bacterial load in pleural effusion (PE) samples. Cell-free Mycobacterium tuberculosis DNA (cf-TB) in PE samples is considered an optimal biomarker for diagnosing TP. This study aimed to evaluate the applicability of cf-TB testing across diverse research sites with a relatively large sample size. Methods Patients suspected of TP and presenting with clinical symptoms and radiological evidence of PE were consecutively enrolled by treating physicians from 11 research sites across 6 provinces in China between April 2020 and August 2022. Following centrifugation, sediments obtained from PE were used for Xpert MTB/RIF (Xpert) and mycobacterial culture, while the supernatants were subjected to cf-TB testing. This study employed a composite reference standard to definite TP, which was characterized by any positive result for Mycobacterium tuberculosis (MTB) through either PE culture, PE Xpert, or pleural biopsy. Results A total of 1412 participants underwent screening, and 1344 (95.2%) were subsequently enrolled in this study. Data from 1241 (92.3%) participants were included, comprising 284 with definite TP, 677 with clinically diagnosed TP, and 280 without TP. The sensitivity of cf-TB testing in definite TP was 73.6% (95% CI 68.2–78.4), significantly higher than both Xpert (40.8%, 95% CI 35.3–46.7, P < 0.001) and mycobacterial culture (54.2%, 95% CI 48.4–59.9, P < 0.001). When clinically diagnosed TP was incorporated into the composite reference standard for sensitivity analysis, cf-TB testing showed a sensitivity of 46.8% (450/961, 95% CI 43.7–50.0), significantly higher than both Xpert (116/961, 12.1%, 95% CI 10.2–14.3, P < 0.001) and mycobacterial culture (154/961, 16.0%, 95% CI 13.8–18.5, P < 0.001). The specificities of cf-TB testing, Xpert, and mycobacterial culture were all 100.0%. Conclusions The performance of cf-TB testing is significantly superior to that of Xpert and mycobacterial culture methods, indicating that it can be considered as the primary diagnostic approach for improving TP detection. Trial registration The trial was registered on Chictr.org.cn (ChiCTR2000031680, https://www.chictr.org.cn/showproj.html?proj=49316 ).

Objective To explore the risk factors of pulmonary tuberculosis in patients with chronic obstructive pulmonary disease（COPD） and establish a risk prediction model. Methods COPD patients in our hospital from January 2019 to December 2021were into case group（COPD patients with pulmonary tuberculosis） and control group（COPD patients） according to whether they had pulmonary tuberculosis or not, 40 patients in the case group and 40 patients in the control group were included by 1:1 propensity score matching method, to screen independent predictors of pulmonary tuberculosis in patients with COPD and to construct a risk prediction model. Results Age ≥ 70 years（OR=1.518, 95%CI: 1.230 ～ 2.262）, smoking（OR=1.863, 95%CI: 1.461 ～ 2.741）, long-term steroid use（ ＞ 3 months）（OR=4.314, 95%CI: 3.377 ～ 17.808） and COPD course ≥ 10 years（OR=3.031, 95%CI: 2.932 ～ 8.268）were independent risk factors for COPD complicated with pulmonary tuberculosis（P ＜0.05）, the above four independent risk factors were used to construct the predictive model of COPD patients complicated with pulmonary tuberculosis. The internal and external validation showed that the area under the ROC curve was 0.797（95% CI: 0.699～0.894, P=0.000） and 0.810（95%CI: 0.673 ～ 0.913,P=0.000）, respectively; The results of Hosmer-Lemeshow goodness-of-fit test were χ2=5.127（P=0.551） and χ2=5.489（P=0.530）,respectively, indicating that the model has good performance and there is no significant difference between the predicted risk and the actual risk. Conclusion Age ≥ 70 years, smoking, long-term steroid use（ ＞ 3 months）, and COPD course ≥ 10 years were the independent risk factors of COPD patients complicated with pulmonary tuberculosis, the risk prediction model based on this model has clinical application value in the identification of COPD complicated with pulmonary tuberculosis.

This study was designed to evaluate the effect of IL-10 on drug-resistance BCG acting on the production of inducible nitric oxide synthase（iNOS） and lactic acid by macrophages in vitro, providing the theoretical basis on screening the diagnosis and treatment of drug-resistance mycobacteria. The expression of STAT1 and STAT3 in macrophages were detected by Western blotting; the content of iNOS and lactic acid was determined by colorimetry. The levels of STAT1, STAT3, iNOS and lactic acid were also analyzed after knocking down IL-10 with small interfering RNA（si-IL-10）. Data showed that under the condition of drug-sensitive BCG（S’and S groups）, STAT1 was influenced in the group S’ with si-IL-10 or not, while drug-resistance BCG had weaker ability to induce STAT1 contrast with drug-susceptibility one; and STAT3 in the R’ group was remarkably less than that in the S’ group or R group（P=0.001 8; P=0.004 1）. After si-IL-10, both of iNOS and lactic acid were ascended in the R’ group. In conclusion, the capacity of drug-resistance BCG to promote macrophage to differentiate into M2 and produce bactericidal enzymes are depended on IL-10.

目的 分析可溶性白细胞介素2 受体(sIL-2R)、可溶性髓系细胞触发受体1(sTREM-1)及白细胞介素1(IL-1)在慢性阻塞性肺疾病(COPD)合并肺结核(PTB)患者血清中的表达及临床意义.方法 选取2019 年1 月至2021 年6 月我院收治的52 例合并COPD的活动性PTB患者(A组),50 例单纯COPD患者(B组)和50 例不合并COPD的活动性PTB患者(C组).比较三组血清中sIL-2R、sTREM-1、IL-1 及细胞免疫指标差异,分析各指标之间的相关性.根据观察期内(治疗 2 个月后)A组治疗情况分为好转租和恶化组,比较两组sIL-2R、sTREM-1、IL-1 水平,分析sIL-2R、sTREM-1、IL-1 对COPD合并PTB患者预后的预测价值.结果 三组血清sIL-2R、sTREM-1、IL-1、CD8+比较,A组>C组>B组,CD4+、CD4+/CD8+比较,A组

目的 分析与抗结核药物相关的不良反应并探讨相应的防治措施.方法 选取某院2015年1月至2017年12月间收治的1 000例肺结核病患者为研究对象,所有患者采用标准化疗方案治疗,观察相关不良反应的发生情况,为其制定相应的防治措施.结果 所入选的1 000例患者共有166例发生了不良反应,总发生率为16.60％.不良反应发生率由高到低依次为肝功能损害(23.83％)、过敏反应(16.17％)、消化系统异常(15.74％)、神经系统异常(13.62％)、泌尿系统异常(6.81％)、血液系统异常(5.96％)、骨关节损害(5.53％)、运动系统异常(4.68％)、眼科系统异常(4.26％)、其他(3.40％).引起药物不良反应的药物依次为异烟肼、乙胺丁醇、利福平、吡嗪酰胺、链霉素.结论 合理应用抗结核药物是控制结核病病情的一种重要措施,然而在使用抗结核药物治疗期间易发生肝功能损害、过敏反应、消化系统异常等不良反应,应针对各种不良反应制定有效的护理措施.

目的 分析肺结核感染患者中血清转铁蛋白(TRF)、免疫抑制酸性蛋白(IAP)及细胞外高迁移率族蛋白B1(HMGB1)的表达及意义.方法 选取2017年6月至2019年6月本院收治的142例肺结核患者作为观察组,其中肺结核病灶进展期46例、吸收好转期53例、稳定期43例,选取同期于本院体检的100例健康者作为对照组.对比不同对象TRF、IAP及HMGB1水平,采用Logistic回归分析影响肺结核患者临床转归的相关因素.结果 观察组TRF、IAP及HMGB1水平均高于对照组,差异具有统计学意义(P<0.05).进展期患者TRF、IAP及HMGB1水平均高于吸收好转期及稳定期患者,吸收好转期患者TRF、IAP及HMGB1水平高于稳定期患者,差异均具有统计学意义(P<0.05).142例肺结核患者治疗无效者41例,有效者101例,治疗有效率为71.13％.机械通气、复发、APACHEⅡ评分、TRF、IAP、HGMB1水平与肺结核患者预后呈正相关(P<0.05),规范化治疗与肺结核患者预后呈负相关(P<0.05).复发(有)、规范化治疗(否)、APACHEⅡ评分(≥25分)、TRF(异常)、IAP(异常)及HMGB1(异常)水平是影响肺结核患者预后的独立危险因素(P<0.05).结论 TRF、IAP及HMGB1水平在肺结核患者中显著升高,三者与患者预后转归关系密切,可作为病情监测及预后评估的有效指标.

Objective:To investigate the clinical data of asymptomatic patients with 2019 novel Coronavirus (2019-nCoV) infection in Shijiazhuang and provide scientific evidence for prevention and treatment of Coronavirus Disease 2019(COVID-19).Methods:Retrospective study was conducted to analyze the clinical features and laboratory data of 9 asymptomatic 2019-nCoV infected patients, admitted to the Fifth Hospital of Shijiazhuang from January 21, 2020 to February 21, 2020.Results:Asymptomatic infection was found in all age groups, including 5 males and 4 females. On the first day of admission, the detection result of leukocytes, lymphocytes and neutrophils in asymptomatic patients were at normal levels. On the third day after admission, the results increased and continued to stabilize on the twelfth day. The levels of alanine aminotransferase and lactate dehydrogenase were at normal levels during hospitalization, without transient increase or decrease. The level of C-reactive protein reached the highest level on the third day after admission, but it was always in the normal range. D-dimer level was relatively stable during hospitalization. The absolute value of T cell subsets showed that the levels of CD 3+ , CD 4+ , CD 8+ T cells in asymptomatic infection patients were higher than those determined before admission. The average duration of pharyngeal nucleic acid positive detection in asymptomatic patients was 11.88 days. The average cycle threshold of ORF1ab gene and N gene was 36.94 and 35.43 respectively. Conclusions:The inflammatory reaction in patients with asymptomatic 2019-nCoV infection was mild, and the immune function was relatively good.

We quantified the serum levels of 34 cytokines/chemokines in 30 patients with SARS-CoV-2 infection. Elevated levels of IP-10 and IL-7 were detected in the acute and convalescent stages of the infection and were highly associated with disease severity.

目的 分析石家庄地区新型冠状病毒肺炎(COVID-19)患者的临床特征及影像学特点.方法 以2020年1月21日—2月10日石家庄市第五医院收治的21例COVID-19患者为研究对象,回顾性分析患者的人口学特征、临床资料、实验室指标及肺部影像学特征.根据年龄分为2组:<45岁组(n=13),≥45岁组(n=8),比较2组上述指标的差异.结果 21例COVID-19患者中男14例,女7例;有7组家庭聚集性发病(共19例).临床体征:发热15例(71.4％),咳嗽9例(42.9％),无任何临床症状5例(23.8％).实验室检查:T淋巴细胞亚群CD3+计数降低8例(38.1％),CD4+计数降低12例(57.1％),CD8+计数降低6例(28.6％),白细胞计数降低2例(9.5％),中性粒细胞(N)计数降低2例(9.5％),淋巴细胞(L)计数降低5例(23.8％),C反应蛋白(CPR)升高10例(47.6％).年龄≥45岁组及<45岁组患者CD3+计数、CD4+计数、CD8+计数、白细胞计数、N及L计数及其降低比例、CRP水平及CRP升高比例比较,差异均无统计学意义(P>0.05).21例患者中,3例胸部CT检查未见异常;入院前首次影像学检查为胸部X线者11例,胸部CT者10例,其中胸部X线检查假阴性6例(漏诊率54.5％),而胸部CT检查均呈阳性.结论 石家庄地区COVID-19感染以家族聚集性为主,T淋巴细胞亚群降低较为明显,早期胸部X线检查极易漏诊.

目的 研究心理干预对耐多药结核病患者治疗效果的影响.方法 选取本院2013年5月～2017年4月期间收治的103例耐多药结核病患者为研究对象,将其随机分成对照组和实验组,其中对照组51例患者,实验组52例患者.对照组施行常规护理,实验组在对照组的基础上施行心理干预护理,治疗后,对两组患者的治疗成功率和患者对护理工作的满意度进行分析.结果 实验组患者治疗成功率为65.38％,显著高于对照组的50.98％;实验组患者对护理工作满意率为96.15％,显著高于对照组的84.31％,两组数据差异显著,具有统计学意义(P＜0.05).结论 心理干预能够显著提高耐多药结核病患者的治疗依从性,从而提高治疗成功率,并且显著提高患者对护理工作的满意度,值得临床推广应用.

目的 分析心理干预对耐多药结核病患者治疗依从性的影响.方法 随机将本院收治的耐多药结核病患者103例分成两组,给予A组51例实施常规干预,给予B组52例在其基础上加用心理干预,对比两组耐多药结核病患者的护理效果.结果 两组护理后的治疗依从性、护理满意度及心理状态评分存在显著差异(P＜0.05),有统计学意义.结论 针对耐多药结核病患者实施心理干预的效果显著,能提高患者的治疗依从性,促进患者预后.

Objective To observe and analyze retrospectively the clinical characteristics,diseased region,the incidence rate of different subtypes of tracheobronchial tuberculosis in order to increase the realization of clinical doctors for the disease.Methods The data about 478 patients with active tuberculosis complicated by tracheobronchial tuberculosis who were admitted and treated in our hospital from June 2013 to May 2016 were retrospectively analyzed to statistically analyze the clinical characteristics,diseased region and the incidence rate of different subtypes of tracheobronchial tuberculosis.Results The statistical analysis showed that sex ratio of tracheobronchial tuberculosis was 1:1.93,with average age being (36.22 ± 14.24) years.The inflammatory infiltration type accounted for 54.81％,and mixed subtype (more than two subtypes) accounted for 40.59％.The proportion of tuberculosis involving bronchus lobaris superior sinister was 42.47％,and the one involving bronchus lobaris superior dexter was 39.12％.Conclusion The female patients with tracheobronchial tuberculosis are more than male patients,moreover,majority of patients are young adults.The inflammatory infiltration type is more common,with multiple pattern changes overlap.The tracheobronchial tuberculosis is often involved in multiple bronchus,and the most invasion region is two upper lobe bronchus,next one is bronchus lobaris inferior sinister.

我国结核性胸腔积液的发病率近年来呈现明显的上升趋势，并且患者但往往就诊较晚，导致胸腔积液包裹或被分割成多个小房，导致常规治疗效果不理想。近年来研究［1，2］显示尿激酶、内科胸腔镜治疗结核性渗出性胸膜炎多房分隔均达到一定的疗效，但是2种治疗方案单独应用，同样存在治疗效果欠佳的局限性，为此本研究采用胸腔镜联合尿激酶对结核性胸膜炎多房分隔的患者进行治疗，现报告如下。

Tuberculosis (TB) is caused by infection of Mycobacterium tuberculosis. Host genetic variability is an important determinant of the risk of developing TB in humans. Although the association between MBL2 polymorphisms and TB has been studied in various populations, the results are controversial. In this study four functional single-nucleotide polymorphisms (SNPs, H/L, X/Y, P/Q and A/B) across the MBL2 gene were genotyped by direct DNA sequencing of PCR products in a case-control population of Chinese Han origin, consisting of 1,020 patients with pulmonary TB and 1,020 controls. We found that individuals carrying variant allele at A/B (namely BB or AB genotypes) was associated with increased susceptibility to TB (odds ratios [OR] = 1.57, 95% confidence interval [CI] 1.30–1.91, P = 1.3 × 10−6). Additionally, LYPB haplotype showed a significant association with increased risk of TB (OR = 1.54, 95% CI 1.27–1.87, P = 4.2 × 10−6; global haplotype association P = 3.5 × 10−5). Furthermore, individuals bearing low- or medium- MBL expression haplotype pairs had an increased risk of TB (OR = 1.56, 95% CI 1.29–1.90, P = 1.4 × 10−6). Thus, the reduced expression of functional MBL secondary to having MBL2 variants may partially mediate the increased susceptibility to TB risk.

目的：探讨男护生在传染病医院临床实习中个性化带教干预研究。方法将2010年7月至2014年7月在传染病医院实习的32名学生随机分为对照组及试验组，每组16例。对照组按照常规护理模式带教，即岗前集中培训1周后，进入临床实习，采取“一对一”护理模式带教。试验组则在对照组的基础上，针对其个人特点进行职业生涯规划培训、择业观及离职意向和心理辅导等个性化带教干预，实习结束按照护理部制定的护理质量考核部分标准比较2组的护理质量完成情况。结果经个性化带教干预后与对照组比较试验组男护生的护理质量结果明显优于对照组（ P ＜0.05）。结论男护生在传染病医院临床护理带教中，个性化带教干预模式有助于增强护生自信心及学习积极性，提高临床带教质量。

目的 探讨常规抗结核药物联合经支气管镜冷冻治疗支气管结核(EBTB)的临床疗效,分析治疗前后患者免疫功能的变化.方法 选取2013-2015年于石家庄市第五医院确诊为EBTB患者50例为研究对象.患者常规给予2HRZE (S) /10HRE抗结核方案治疗;支气管镜下清理支气管分泌物,在病变部位给予异烟肼0.3g局部注射,冷冻探头冷冻病灶,冷冻时间约60s/次,自行解融1 min,每个病灶反复3～5次.1周后复查支气管镜,清理冷冻坏死组织.根据患者耐受情况及病变严重程度,可多次进行冷冻治疗.记录治疗期间不良反应发生情况,治疗2个月后评价临床疗效,并于治疗前及治疗2个月后检测血清T淋巴细胞亚群和免疫球蛋白水平.结果 患者接受冷冻治疗3～11次,平均(4.0±2.5)次.治疗2个月后,显效41例(82.0％),有效8例(16.0％),无效1例(2.0％),总有效率为98.0％ (49/50).5例患者出现咳嗽,3例患者出现轻微出血,未出现其他严重不良反应及并发症.治疗后CD3T细胞比例、CD4+T细胞比例、CD4+T细胞及CD8+T细胞比值高于治疗前,CD8+T细胞比例低于治疗前(P＜0.05).治疗前后免疫球蛋白IgA、IgG、IgM水平比较,差异均无统计学意义(P＞0.05).结论 常规抗结核药物联合经支气管镜冷冻治疗EBTB可取得良好效果,可改善患者T淋巴细胞亚群紊乱.

我国是世界上结核病负担最重的22个国家之一,结核病病例数在世界排名第二,具有高患病率、高耐药率、高死亡率、高感染率、低递降率的特点.在许多结核病控制较好的地区原发性耐药患者已占全部耐药患者的多数[1].考虑到目前初始耐药的病人已占一定的比例,重度肺结核病人病情严重,为提高其治疗效果,本文探讨了莫西沙星联合其他抗结核药物治疗重度初治涂阳肺结核患者,与常规治疗对照分析,结果如下

<正>1病例患者,男49岁,体质量55kg。因"间断咳嗽、咳痰、胸闷"3月余来院就诊。主诉:⑴咳嗽、咳痰、胸闷;⑵乏力、食欲减退、盗汗;⑶15年前曾患结核性胸膜炎;⑷无药物过敏史与心脏病、高血压、糖尿病、肝炎病史。查体:右肺呼吸音粗,未闻及干湿性罗音;胸X线片检查:右肺上中野及左肺上下野