目的 回顾分析慢性阻塞性肺疾病急性加重期并或不并肺部结核感染在感染及营养方面指标的差异性,明确结核感染对AECOPD的影响。方法 选取2013年7月—2015年6月因急性发作入住我院的COPD患者105例,根据GOLD 2011对COPD的诊断标准及卫生部2008年制定的肺结核诊断标准将其分为无结核组、稳定期组、好转期组及进展期四组。分别在入院时测定患者白细胞计数、中性粒细胞比率、总淋巴细胞计数、淋巴细胞比值、红细胞沉降率、血红蛋白浓度、血清白蛋白及C反应蛋白及体重指数。结果 各组感染指标比较,WBC、CRP两指标差异不显著(P>0.05),而无结核组相较于其他三组,NEUT%更高(F=4.004,P=0.010)、LY%及ESR更低(F/P分别为3.668/0.015和20.197/0.000);各组营养指标比较,合并有肺结核的三组,其Hb、ALB及BMI均比无结核组低,达到统计学差异(P<0.05),而TLC在各组间无差异(F=0.858,P=0.466)。结论 合并有结核感染的AECOPD患者更容易出血贫血(Hb降低)、低蛋白血症(ALB降低)、低体重(BMI降低)、中性粒细胞含量偏低(NEUT%降低)而血沉(ESR)、淋巴细胞比率(LY%)升高的情况,对出现此类情况的AECOPD患者应进行结核感染相关检查。

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。

目的 探讨血糖控制情况对胰岛素抵抗型糖尿病合并肺结核的临床治疗转归的影响。方法 选取我站收治的胰岛素抵抗型糖尿病合并肺结核的患者180例,随机分成对照组和观察组两组,每组各90例,对照组给予常规监测晨起空腹血糖和餐后2 h血糖,观察组给予监测血糖谱(包括三餐前、三餐后2 h、凌晨3点和晨起空腹血糖);观察组与对照组中患者均利用2HRSZ(E)／10HR(E)方案来进行治疗;记录两组患者治疗前后空腹血糖、餐后2 h血糖、痰菌阴转情况、X线胸片病灶情况和空洞变化情况,对比分析两组的临床治疗效果。结果 观察组的痰菌阴转、X线胸片病灶、空洞变化等均比对照组的效果好,且两组差异有统计学意义(P＜0.05);观察组的总体有效率87.8%(79/90)高于对照组的71.1%(64/90),两组差异有统计学意义(χ²=7.655,P=0.006)。结论 控制血糖能有效提高胰岛素抵抗型糖尿病合并肺结核的临床治疗效果,在临床上值得推广应用。

目的 探讨莫西沙星结合抗结核药物治疗糖尿病合并肺结核患者的临床疗效分析。方法 将本组126例糖尿病合并肺结核患者分为对照组(n=63)和观察组(n=63);对照组给予降血糖治疗及抗结核药物降糖治疗,观察组在对照组治疗基础上服用莫西沙星;两组治疗均以3个月为一个疗程,2个疗程后统计疗效。结果 观察组总有效率(93.65%)高于对照组(76.19%),差异有统计学意义(P<0.05);观察组痰菌检测转阴率(94.59%)高于对照组(79.49%),差异有统计学意义(P<0.05);治疗过程中观察组与对照组出现不良反应情况相比较差异无统计学意义(P＞0.05)。结论 莫西沙星结合抗结核药物治疗糖尿病合并肺结核疗效显著,具有较强的杀菌作用。

Objective To investigate the clinical efficacy of moxifloxacin combining with antituberculosis drug in the treatment of diabetic patients with pulmonary tuberculosis. Methods A group of 126 patients of diabetes complicated with pulmonary tuberculosis were divided into control group (n=63) and observation group (n=63); the control group was given by hypoglycemic therapy and therapy of antituberculosis drug only, and the observation group was also given by moxifloxacin; two groups were treated for 3 months as a course.The clinical efficacy was evaluated after 2 courses. Results The total effective rate of observation group (93.65%) was significantly higher than that of the control group (80.95%), and the difference was statistically significant (P<0.05); the negative sputum rate of observation group (94.59%) was higher than that of the control group (79.49%), and the difference was statistically significant (P<0.05); there was no statistically significant difference between the observation group and the control group in adverse effects. Conclusion The curative effect of moxifloxacin combining with antituberculosis drug in the treatment of diabetes mellitus complicated with pulmonary tuberculosis was good, with strong bactericidal effect.

目的 了解青海省北京/W系结核分枝杆菌分布特征。方法 收集青海地区结核分支杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌。结果 共收集237株结核分枝杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌220株,占92.8%,非北京/W结核分枝杆菌,共17株,占7.2%。北京/W系结核分枝杆菌在青海地区性别与民族分布差异没有统计学意义(P＞0.05)。结论 北京/W结核分枝杆菌为青海地区流行菌株,在人群易于发生感染和传播。

Objective To ascertain the epidemiological characteristics of Beijing/W lineage Mycobacterium tuberculosis in Qinghai Province. Methods M. tuberculosis clinical isolates were collected and identified with an RD105 deletion test.Statistical analysis was performed by using the test. Results Totally, 237 clinical isolates of M. tuberculosis were collected in which 220 strains (92.8%) belonged to the Beijing/W lineage of M. tuberculosis while 17strains (7.2%) belonged to the non-Beijing/W lineage of M. tuberculosis according to the RD105 deletion test. There were no significant differences in the distribution of Beijing/W lineage of M. tuberculosis in the gender and nationality (P＞0.05). Conclusion Beijing/W lineage of M. tuberculosis were prevalent in Qinghai province and prone to having infection and transmission in the crowd.

       目的   分析结核专科医院医学生特征及管理配合度影响因素，为进一步提升医学生管理配合提供参考。方法   选择在院511名医学生进行基本情况采集及问卷调查，以问卷打卡次数及打卡时间评估医学生的管理配合度，并进一步分析其影响因素。结果   进修生、研究生及实习生的性别构成比较差异无统计学意义（P＞0.05），而年龄、专业及学历比较差异有统计学意义（P＜0.05）。医学生的学历与管理配合度无关，而不同年龄、性别、类别、专业医学生的管理配合度比较差异有统计学意义（P＜0.05）。结论   针对结核病专科医院医学生的类别、专业、年龄等不同特征，调整专科医院教学管理方法并实行相应的管理措施，对加强专科教学医院的医学生管理工作具有一定的价值。

       Objective  To analyze the characteristics and the influencing factors of management cooperation of medical students in tuberculosis specialized hospital，providing  reference for further improving the cooperation of medical  students in management．Methods  Five hundred and eleven medical students were selected in the specialized hospital for basic information collection and questionnaire survey，the management cooperation of medical students were evaluated from the frequency and time of questionnaire check-in，and the influencing factors were further analyzed．Results  According to the classification as continuing education students，graduate students and interns，there was no statistical difference in gender，but there were  differences in age，major，and education degree（P＜0.05）．Age，gender，type，and major of the students were all  related to management cooperation（P＜0.05），while the education degree was not related to it． Conclusions  According to the different characteristics of medical students in tuberculosis specialized hospitals，such as their categories，majors and ages，adjusting the teaching management methods in specialized hospitals and implementing management measures have certain reference value for strengthening the management of medical students in specialized teaching hospitals．

      目的   探讨分析超声引导下胸膜活检（USPB）联合胸腔积液检验对于临床确诊结核性胸膜炎的应用价值。方法   选取2021年6月—2023年6月广州市胸科医院收治的96例临床诊断为结核性胸膜炎（渗出性胸膜炎）的患者为研究对象，分别使用胸腔积液检验（包含胸腔积液腺苷脱氨酶及细菌培养）、USPB、两者联合三种方法诊断，计算其准确率、特异度及灵敏度并进行分析。结果   胸腔积液诊断准确率73.96%、灵敏度72.84%，USPB诊断准确率为85.42%、灵敏度82.71%，两者联合诊断准确率为88.54%，灵敏度90.12%，较胸腔积液检验单独诊断准确率及灵敏度明显升高（P＜0.05），胸腔积液、USPB、两者联合诊断特异度差异（P＞0.05）无统计学意义。结论  USPB联合胸腔积液检验对结核性胸膜炎的确诊具有较高临床价值。

       Objective  To investigate the value of ultrasound-guided pleural biopsy（USPB）combined with  pleural effusion test in the diagnosis of tuberculous pleurisy．Methods  A total of 96 patients with tuberculous pleurisy（exudative pleurisy）admitted to the Guangzhou Chest Hospital from June 2021 to June 2023 were selected．The accuracy，specificity，and sensitivity of pleural effusion test（including adenosine deaminase and bacterial culture），USPB，and their combination were calculated and analyzed．Results  The diagnostic accuracy of pleural effusion was 73.96% and the sensitivity was 72.84%．The diagnostic accuracy of USPB was 85.42% and the sensitivity was 82.71%．The diagnostic accuracy 88.54% and sensitivity 90.12% of USPB combined with pleural effusion test were significantly higher than that of pleural effusion alone（P＜0.05），but there was no significant difference in the diagnostic specificity of pleural effusion，USPB and combination of them（P＞0.05）．Conclusions  USPB combined with pleural effusion test has high clinical value in the diagnosis of tuberculous pleurisy．