宝安区结核病控制策略的初步分析

目的:评价宝安区实施结核病控制(DOTS)策略的效果.方法:利用宝安区结核病控制有关资料进行分析.结果:宝安区在组织机构建设、流动人口管理、专项经费落实、人员培训等方面取得了积极的成果.特有的宝安结核病控制提高了防治的社会效益和经济效益,为降低宝安区结核病的疫情发挥了重要的作用.结论:通过国家重大专项,全面实施新的DOTS策略必将有力地推动了宝安区的结核病防治工作,从而为在全国范围内推广提供基础和依据.     

北京市延庆县非结核病防治机构网络直报肺结核患者就诊及追踪分析

目的:分析2006-2010年北京市延庆县非结核病防治机构网络直报肺结核患者就诊及追踪情况,为进一步推进结核病防控工作提供依据。方法:对2006-2010年延庆县非结核病防治机构网络直报信息管理系统数据进行回顾性描述性分析。结果:2006-2010年延庆县非结核病防治机构网络直报患者主动就诊到位率为90.18%,追踪到位率为67.35%。在主动就诊到位的450例病人中,106人(23.56%)诊断为非结核,被诊断为初治痰涂片阳性、复治痰涂片阳性和初治痰涂片阴性患者分别占主动就诊到位病人的56.67%、1.78%和18.00%。结论:非结防机构是肺结核患者接受治疗的主要场所,在肺结核患者的发现中起着重要的作用。应针对非结核病防治机构网络直报工作中存在的问题采取相应的措施,以提高主动就诊率和追踪到位率。     

赣州市结核病防治规划实施情况分析

目的详细了解赣州市结核病防治规划实施情况,为今后结核病防治工作提供依据。方法由赣州市疾病预防控制中心执行卫生部统一制定下发的《全国结核病防治规划(2001-2010年)终期评估方案》和《终期评估调查表》,进行单位自查与市级组织检查验收。通过验收的《终期评估调查表》全部录入计算机,进行资料分析。结果《规划》期间全市投入用于结核病防治的各种费用总计4 517.04万元。登记活动性肺结核63 427例,其中涂阳患者33 339例(初阳27 621例、复阳5 718例),涂阴27 408例,完成初治涂阳任务指标平均达到99.64%,治愈率平均达到91.11%。结论经实施《全国结核病防治规划(2001-2010年)》,赣州市结核病的防控措施无论是软件还是硬件都得以完善,并且病人及时得到发现与有效治疗。     

耐药结核病及其防治

目前结核病呈现出高发病、高感染、高耐药、高死亡的特点。耐药结核病则是结核病防治工作的重点和难点。为有效控制其发展,本文分析了其产生和流行的医源性和社会性原因,并从7个方面阐述了耐药结核病的防治措施。即广泛普及结核病防治的知识;加强对流动人口的管理和监测;提高对耐药结核病的诊治水平;开展中西医结合和其他辅助治疗;预防社区和医院感染;完善结核病的耐药监测;积极开展抗结核新药、新手段和新方法的研究。     

土右旗2013年结核病流行病学抽样调查分析

目的:评估2001-2010年全区结核病防治规划实施以来的效果,指导和促进我区今后的防治工作,为科学决策提供有力依据。方法:2013年,对我旗振华社区人群开展结核病流行病学抽样调查,并对其流行病学特点和临床表现进行分析。结果:共计调查了1291人,其中X线胸片检查1288人,以痰代检3人,X线胸片异常12人,痰涂片检查及痰培养15人。确诊活动性肺结核9例,其中:痰涂片阴性15例;痰培养阳性4例;新发现患者9例,活动性肺结核患病率为697.13/10万,菌阳肺结核患病率为309.84/10万。结论:加强健康教育,有效提高群众防病意识是防控结核病的关键,加强自身免疫力、及时发现治疗患者是控制结核病流行的有效措施。     

结核病仍是传染病头号杀手

3月24日是第9个“世界防治结核病日”。有关专家呼吁:结核病这个上个世纪曾经猖獗一时的“老”传染病仍然是传染病头号杀手,其防治形势不容乐观。解放军三0九医院全军结核病中心主任王巍告诉记者,今年结核病日的活动主题是“控制结核病,让每一次呼吸更健康”,其目的就是要强调结核病防治的重要性和紧迫性。2000年全国结核病流行病学抽样调查报告显示,我国目前有结核病人500多万,传染性结核病人150万,每年约有13万人死于结核病。结核病死亡在传染病和寄生虫病中仍居第1位。贫困、人口增多、耐药结核病人增多、流动人口的增多以及艾滋病流行,…     

miRNA在肺结核中的作用研究进展

肺结核(tuberculosis,TB)是由结核分枝杆菌(mycobacterium tuberculosis,MTB)引起的传染性疾病,对全球人类健康构成严重威胁。结核病作为一种传染性死亡病因,死亡率仅次于人类免疫缺陷病毒,据统计2016年全球结核病死亡人数达180万。中国是世界上第二大肺结核疫情国,随着医疗费用和其他社会经济负担的不断增加,有关肺结核作用机制的研究迫在眉睫。近年来越来越多的研究发现,miRNA通过各种机制在肺结核的发生发展中发挥着重要作用。本文主要对近年来miRNA在肺结核中的机制的研究进展进行简单综述。     

54 例儿童结核病诊治及误诊分析

近年来, 由于流动人口增加以及基层预防接种和诊治工作尚存在薄弱环节, 儿童结核病发病率有增长趋势。为分析儿童结核病的临床诊断、治疗及误诊特点, 对我院2006 年3 月― 2008 年7 月住院治疗的54 例儿童结核病病例从年龄、性别、实验室及影像学检查、临床表现、诊断、治疗、误诊等方面进行综合分析。结果显示, 儿童结核年龄≤5 岁者所占比例最高( 64. 8% ) ; 临床分布以肺结核合并肺外结核者最多( 44. 5% ) , 其次为单纯肺结核( 37. 0% ) 和肺外结核( 18. 5% ) 。本研究中患儿在外院误诊率为55. 6% ; 影像学主要表现为肺部弥漫性结节影、斑片状模糊影, 胸膜增厚或伴胸腔积液, 纵隔及( 或) 肺门淋巴结肿大, 腹腔淋巴结肿大, 颅脑断层扫描( CT) 或磁共振成像( MRI) 异常等。结果提示, 年龄≤5 岁是儿童结核病的好发年龄; 结核菌素试验联合影像学诊断可明显提高儿童结核病临床确诊率, 减少误诊、漏诊; 积极正规的抗结核治疗对绝大多数儿童结核病患者有效。     

纳米材料在结核病诊疗中的应用

结核病是由结核分枝杆菌引起的慢性感染性疾病,经过呼吸道感染后侵犯机体器官,严重威胁全球公共卫生。传统结核诊疗手段存在诊断效率低、易误诊漏诊、易产生耐药、治疗效果和患者依从性差等瓶颈问题,亟需开发快速、准确的结核即时诊断（POC）方法和安全、高效的结核治疗方案,切实解决结核防治难题。本文总结了纳米材料在结核病诊疗领域的研究进展及应用前景,旨在为开发新一代安全、快速、有效的结核病诊疗方法提供参考。     

结核杆菌与结核病

结核病为人畜共患的慢性传染病,引起结核病的病原体是分支杆菌属中的结核杆菌,对人、畜、禽威胁最大的是人型、牛型和禽型结核杆菌。感染的途径主要通过呼吸道和消化道,临床上以肺结核最为多见,肺外结核较少。     

肺结核患者治愈后复发危险因素分析及耐药状况调查

目的:研究肺结核患者治愈后复发危险因素以及耐药状况。方法:回顾性分析我院于2015年5月～2017年12月期间收治的1000例肺结核患者的临床资料。对所有患者均进行为期2年的随访观察,统计复发情况。将所有患者按照治愈后复发与否分成复发组58例以及无复发组942例,比较两组患者基线资料情况,包括年龄、性别、耐药、吸烟、职业类型、居住情况以及空洞,并对影响肺结核患者治愈后复发的因素作多因素Logistic回归分析,对所有治愈后复发患者的耐药情况进行检验,分析其耐单药、耐2药、耐3药、耐4药人数的占比情况。结果:1000例肺结核患者治愈后复发58例,复发率为5.80%。肺结核患者治愈后是否复发与性别、年龄、吸烟无关(P0.05),复发组耐药、体力型工作、流动人口、空洞患者的比例高于未复发组(P0.05)。经多因素Logistic回归分析可得:耐药、体力型工作、流动人口、空洞均是肺结核患者治愈后复发的独立危险因素。58例患者中发生耐药例数27例,耐药率为46.55%;其中耐单药、耐2药、耐3药、耐4药人数分别为8、10、7、2例,相应占比为13.79%、17.24%、12.07%、3.45%。结论:肺结核患者治愈后复发的风险较高,尤其应注意耐药、体力型工作、流动人口、空洞的患者,以降低疾病复发,且肺结核复发患者的耐药情况不容乐观。     

Influence of BCG vaccine strain on the immune response and protection against tuberculosis

The Bacille Calmette–Guérin (BCG) vaccine has been used for more than 80 years to protect against tuberculosis. Worldwide, over 90% of children are immunized with BCG, making it the most commonly administered vaccine, with more than 120 million doses used each year. Although new tuberculosis vaccines are under investigation, BCG will remain the cornerstone of the strategy to fight the worsening tuberculosis pandemic for the foreseeable future. The recent delineation of genetic differences between BCG vaccine strains has renewed interest in the influence of the vaccine strain on the protective efficacy against tuberculosis. This review critically examines the data from animal and human studies comparing BCG vaccine strains. Although there is good evidence to support the notion that the induced immune response and protection afforded against tuberculosis differs between BCG vaccine strains, currently, there are insufficient data to favour or recommend one particular strain. Identifying BCG strains with superior protection would have a dramatic effect on tuberculosis control at a population level: a small increment in protection provided by BCG immunization will prevent large numbers of cases of severe tuberculosis and deaths, particularly in children.     

复治肺结核患者结核分枝杆菌L型培养结果分析

目的：了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法：选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果：复治组的L型阳性率为43．6％,初治组的L型阳性率为15．7％,复治组显著高于初治组（P〈0．01）;菌阳复治组的L型阳性率50％,菌阴复治组的L型阳性率39．4％,菌阳组明显高于菌阴组（P〈0．05）;L型菌阳性患者的耐药率显著高于L型菌阴性组（P〈0．05）。结论：结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

Lack of association between polymorphisms in the P2X7 gene and tuberculosis in a Chinese Han population

Several studies have suggested that genetic factors may affect the susceptibility of a population to tuberculosis, and it has been found that P2X7 is linked to an increased risk for tuberculosis in some West African, Southeast Asian, North American, and North European populations. To explore the potential role of P2X7 in the susceptibility to tuberculosis among members of the Chinese Han population, we evaluated the association of the 1513A→C and −762T→C polymorphisms in P2X7 with the risk for tuberculosis. PCR amplification of genomic DNA was followed by restriction fragment length polymorphism analysis, and allele-specific PCR was used. We found no significant differences in the genotypic and allelic frequencies of 1513A→C polymorphisms in 96 patients with tuberculosis compared with 384 control subjects [ P =0.856 and 0.316, respectively; odds ratio (OR) for the C allele=0.976; 95% confidence interval (CI)=0.755–1.262]. Similarly, no significant association was found between the −762T→C polymorphism and tuberculosis ( P =0.102 and 0.095 for the patients and controls, respectively; OR for the C allele=0.924; 95% CI=0.847–1.010). Thus, our analysis of P2X7 showed that the 1513A→C and −762T→C polymorphisms did not appear to be associated with the susceptibility of the Chinese Han population to tuberculosis.     

MTB-PCDB: Mycobacterium tuberculosis proteome comparison database

The Mycobacterium tuberculosis Proteome Comparison Database (MTB-PCDB) is an online database providing integrated access to proteome sequence comparison data for five strains of Mycobacterium tuberculosis (H37Rv, H37Ra, CDC 1551, F11 and KZN 1435) sequenced completely so far. MTB-PCDB currently hosts 40252 protein sequence comparison data obtained through inter-strain proteome comparison of five different strains of MTB. 2373 proteins were found to be identical in all 5 strains using MTB H(37)Rv as reference strain. To enable wide use of this data, MTB-PCDB provides a set of tools for searching, browsing, analyzing and downloading the data. By bringing together, M. tuberculosis proteome comparison among virulent & avirulent strains and also drug susceptible & drug resistance strains MTB-PCDB provides a unique discovery platform for comparative proteomics among these strains which may give insights into the discovery & development of TB drugs, vaccines and biomarkers. AVAILABILITY: The database is available for free at http://www.bicjbtdrc-mgims.in/MTB-PCDB/     

阳和汤联合西药抗结核药物治疗骨结核的临床效果观察

目的:观察阳和汤加减联合西药抗结核治疗骨结核的临床效果。方法:收集我院2013年5月至2014年7月确诊的骨结核患者64例进行前瞻性研究分析,采用完全随机分组法分为观察组(阳和汤加减联合西药抗结核治疗组)32例和对照组(单纯西药抗结核治疗组)32例,并对所有患者进行随访,观察对比两组治疗效果。结果:观察组中有2名患者于治疗过程中查肝肾功异常,自动退出治疗,其余患者均完成治疗。在分别经过阳和汤加减联合西药抗结核治疗以及单纯西药抗结核治疗后,两组患者各项指标均较本组治疗前有显著好转,体温、血沉、C反应蛋白水平均下降,且差异有统计学意义(P0.05)。与对照组相比,观察组各项指标好转更显著,差异亦有统计学意义(P0.05)。两组患者均无明显不良反应;观察组治疗好转率93.3%显著高于对照组68.6%,且差异有统计学意义(P0.05);观察组患者发热消失、血沉恢复正常、脓肿吸收以及骨质密度恢复时间明显早于对照组,且差异均有统计学意义(P0.05);观察组患者平均住院时间(26.43±5.78天)明显短于对照组(38.17±8.91天),且差异有统计学意义(P0.05)。结论:阳和汤加减联合西药治疗骨结核较常规单纯西药治疗有较大优势,可有效提高患者好转率,缓解临床症状,缩短住院时间,值得临床上广泛推荐应用,以提高患者预后水平及生活质量。     

Identification of promising plasma immune biomarkers to differentiate active pulmonary tuberculosis

Although much research has been done related to biomarker discovery for tuberculosis infection, a set of biomarkers that can discriminate between active and latent TB diseases remains elusive. In the current study we correlate clinical aspects of TB disease with changes in the immune response as determined by biomarkers detected in plasma. Our study measured 18 molecules in human plasma in 17 patients with active disease (APTB), 14 individuals with latent tuberculosis infection (LTBI) and 16 uninfected controls (CTRL). We found that active tuberculosis patients have increased plasma levels of IL-6, IP-10, TNF-α, sCD163 and sCD14. Statistical analysis of these biomarkers indicated that simultaneous measurement of sCD14 and IL-6 was able to diagnose active tuberculosis infection with 83% accuracy. We also demonstrated that TNF-α and sCD163 were correlated with tuberculosis severity. We showed that the simultaneous detection of both plasma sCD14 and IL-6 is a promising diagnostic approach to identify APTB, and further, measurement of TNF-α and sCD163 can identify the most severe cases of tuberculosis.     

细胞因子和microRNA与结核分枝杆菌感染的研究进展

细胞因子是由免疫细胞和某些非免疫细胞经刺激而合成、分泌的一类具有广泛生物学活性的小分子蛋白质,其作为细胞间信号传递分子,主要参与调节免疫应答、免疫细胞分化发育、组织修复、介导炎症反应、刺激造血功能等。micro RNA(mi RNA)是存在于真核细胞内的一种非编码小RNA,可以调控基因转录后的表达,同时还可作为不同生理和病理状态的分子标记。许多研究表明,细胞因子相关基因的多态性与结核感染、肺结核发病易感性密切相关,而mi RNA在肺部疾病的正负调节功能与肺部疾病感染的发生、发展、转化与治疗有关。我们简要叙述了细胞因子、mi RNA与结核分枝杆菌感染三者之间的关联,以期有利于及时筛查潜伏结核感染和肺结核患者,降低结核感染率和发病率。     

The IL-17F sequence variant is associated with susceptibility to tuberculosis

The interleukin (IL)-17 gene plays a key role in host defence against infections from microbes, including Mycobacterium tuberculosis. Genetic factors contribute to host defence. However, whether genetic variation in IL-17 is associated with altered susceptibility to tuberculosis is unknown. A total of 596 pulmonary tuberculosis (PTB) patients, 176 extra-pulmonary tuberculosis (EPTB) patients, and 622 control patients from a Chinese Han population were recruited. Two single-nucleotide polymorphisms (SNPs) in IL-17F (rs1889570 and rs763780) and one SNP in IL-17A (rs2275913) were genotyped using the SNaPshot technique. Of the three SNPs in the IL-17 gene tested, there was an increased frequency of the rs1889570 G allele and the rs763780 C allele in the PTB patients and an increased frequency of the rs763780 C allele in the EPTB patients compared with the control patients. There were also significant differences in the distribution of the rs763780 genotype between the PTB and EPTB patients and the controls. The patients who had the CT/TT genotype of the rs763780 SNP were more susceptible to tuberculosis, compared to the CC genotype. There was no significant difference observed between the IL-17 SNPs when the PTB and EPTB patients were compared. Genetic variation in IL-17F is associated with altered susceptibility to tuberculosis and may provide valuable information in the development of tuberculosis.