目的 探索两种常用免疫学指标—结核菌素试验(purified protein derivative skin test, PPD皮试)与结核分枝杆菌γ-干扰素释放试验(tuberculosis-interferon gamma release assay,TB-IGRA)对结核病的辅助诊断价值。方法 收集2017年1月—2021年1月于我中心门诊部就诊的疑似结核病患者资料,共171例,所有病例均行PPD皮试和外周血TB-IGRA。将病例分为结核病组(TB组)和非结核病组(非TB组)。TB组共98例,非TB组共73例。比较两组病例PPD皮试、TB-IGRA对结核病诊断的准确度、敏感度、特异度。结果 TB-IGRA对结核病诊断的准确度、敏感度和特异度分别为94.2%、93.9%和90.4%,PPD皮试对结核病诊断的准确度、敏感度和特异度分别为77.2%、84.7%和76.7%。TB-IGRA的准确度和特异度与PPD皮试比较差异有统计学意义(分别为χ²=20.034,P<0.05和χ²=5.176,P<0.05);TB-IGRA的敏感度高于PPD皮试,但两者比较差异无统计学意义(χ²=0.948,P>0.05)。2组间TB-IGRA结果、PPD皮试结果比较差异均具有统计学意义(分别为χ²=132.77,P<0.01和χ²=47.963 5,P<0.01)。结论 TB-IGRA和PPD皮试均具有良好的结核病辅助诊断价值;TB-IGRA的引进大大提高了诊断试验的准确度和特异度,但仍需要进一步探索其诊断标准以更好地为临床使用。

Objective To explore the auxiliary diagnosis value of two commonly used immunological indicators for tuberculosis, purified protein derivative skin test (PPD test) and tuberculosis-interferon gamma release assay (TB-IGRA). Methods A total of 171 cases of suspected tuberculosis patients who were treated in the outpatient department of our center from January 2017 to January 2021 were collected. All cases underwent PPD test and peripheral blood TB-IGRA. The cases were divided into tuberculosis groups (TB group) and non-tuberculosis group (non-TB group). There were 98 cases in the TB group and 73 cases in the non-TB group. The accuracy, sensitivity, and specificity of PPD test and TB-IGRA for tuberculosis diagnosis were compared between the two groups. Results The accuracy, sensitivity, and specificity of TB-IGRA for tuberculosis diagnosis were 94.2%, 93.9% and 90.4% respectively, which of PPD test for tuberculosis diagnosis were 77.2%, 84.7% and 76.7% respectively. The accuracy and specificity of TB-IGRA were statistically different from those of PPD test (χ²=20.034,P<0.05 and χ²=5.176,P<0.05, respectively). The sensitivity of TB-IGRA was higher than that of PPD test, but the difference was not statistically significant (χ²=0.948,P>0.05). The differences of TB-IGRA and PPD test results between the two groups were statistically significant (χ²=132.77,P<0.01 and χ²=47.9635,P<0.01). Conclusion Both TB-IGRA and PPD test had good auxiliary diagnostic value for tuberculosis; the introduction of TB-IGRA had greatly improved the accuracy and specificity of the diagnostic test, but it is still necessary to further explore its diagnostic criteria to better serve the clinical use.

目的 探讨结核病相关重症患者的诊治特点,提高此类疾病的诊治水平。方法 回顾性分析2020年7月—8月我科收住的4例临床表现类似的结核病相关重症患者的临床资料。结果 4例患者均诊断为活动性结核病或结核潜伏感染,均为合并1个或多个器官功能衰竭的重症患者,均表现为发热、血小板减少、肝肾损伤,经予以个体化的积极抢救治疗,均获得满意疗效。结论 结核病相关重症患者往往病情复杂危重,可能临床特点相似,但实际病因不同,因而治疗重点各异,需临床医生认真剖析病情,找到关键病因,以尽量挽救患者生命。

Objective To explore the characteristics of diagnosis and treatment of severe tuberculosis-related patients and improve diagnosis and treatment of such diseases. Methods Retrospectively analyzed the clinical data of 4 severe tuberculosis-related patients with similar clinical symptoms admitted to our department from July to August, 2020. Results All 4 patients were diagnosed as active tuberculosis or latent tuberculosis infection, with one or several organs failure, fever, thrombocytopenia, liver and renal injury. They were given individualized positive rescue treatment, and achieved satisfying outcomes. Conclusions Severe tuberculosis-related patients often have complex and critical conditions, and may have similar clinical characteristics, but the actual causes are different, so the treatment focuses are different. Clinicians need to carefully analyze the condition, find out the key causes, and try to save the lives of patients.

目的 了解广州市海珠区在校学生结核病核心知识知晓率现状、对结核病态度及相关行为,为进一步加强学校结核病健康教育工作提供依据。方法 采用分层整群随机抽样的方法随机选取海珠区内6所学校268名学生进行问卷调查,采用描述性分析、卡方检验。结果 学生结核病知识总知晓率为76.4%,女生结核病知识知晓率比男生高,高中生比大学生和初中生高,市内学生比市外学生知晓率高;户籍是市内的学生更愿意去了解结核病,女生比男生高,市内比市外的学生更加愿意成为志愿者;对于出现结核病疑似症状,大学生更为主动地寻求医生帮助,女学生在自己得了肺结核后会更加主动提醒周围人去检查。结论 学生对结核病的总知晓率仍偏低,以后的结核病健康教育应进一步针对学生的不同特征采取更合适的方式进行宣传,提高学生对结核病的知晓率,促使其形成正确的态度和行为。

Objective To understand the status of the awareness rate of tuberculosis knowledge,attitude and behavior among students in Haizhu district, Guangzhou, and to provide evidence for further strengthening the work of tuberculosis health education in schools. Methods Applying stratified random sampling method to choose 268 students from 6 schools for questionnaire investigation and used descriptive statistical analysis method, Chi-square test to assess related indicators. Results The awareness rate of TB knowledge was 76.4%, female students' was higher than male students', high school students' was the highest, Guangzhou household registers was higher than that no householder in Guangzhou; the students of householder in Guangzhou were more willing to learn about TB, female students' and the students of householder in Guangzhou were more willing to become a volunteer; College students were more active to seek medical help, female students after they had pulmonary tuberculosis would more active to remind the people around to have a check. Conclusion The level of knowledge about tuberculosis among students in the district was still lower than the standard. The health education of tuberculosis knowledge should further make publicity according to the different features of the students, to improve the students the awareness of TB and to promote the formation of correct confidence and behavior

目的 探讨拉米夫定治疗对乙肝活动的肺结核病人抗结核治疗中的临床价值。方法 通过回顾性分析159例初治肺结核乙肝表面抗原(HBsAg)阳性、HBV-DNA定量阳性病人,所有病例在抗结核前查肝功能均正常,分为两组,治疗组:在抗结核及护肝治疗过程中,加用拉米夫定抗乙肝病毒治疗;对照组:没用任何抗乙肝病毒药物;分别在抗结核治疗前、治疗2周、4周及8周复查肝功能,对比两组间肝损发生率,及肝损发生时间及严重程度。抗结核治疗4周后复查HBV-DNA定量,对比两组间HBV-DNA定量下降例数。结果 治疗组的肝损发生率仅20.5%,对照组病人抗结核治疗后肝损的发生率为53.1%,两者间差异有统计学意义。治疗组肝损出现时间多为大于4周,而且多数是轻度肝损。治疗组出现肝损中断抗结核治疗的病例数低于对照组。抗乙肝病毒治疗后复查HBV-DNA定量降低例数高于对照组。结论 拉米夫定抗乙肝病毒治疗,能抑制乙肝病毒复制,降低乙肝合并肺结核病人的肝损发生率并减轻肝损严重程度,提高病人对抗结核药物的耐受性。