Diabetes and tuberculosis:An emerging dual threat to healthcare

Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.

Epidemiological characteristics of 369 tuberculosis patients with multidrug resistance inHainan Island: A cross-sectional study

Objective:To investigate the epidemic characteristics of multidrug resistant tuberculosis in Hainan,China,to provide basic information and theories for the prevention and control of multidrug resistant tuberculosis.Methods:A retrospective descriptive epidemiological study was conducted.Data of multidrug resistant tuberculosis in Hainan Island from January 1,2014 to December 31,2019 were collected for statistical analysis.The counting data were described by frequency(percentage),and the measurement data were described by mean±standard deviation.Chi square test was used to compare the differences between different groups.If P<0.05,the difference was statistically significant.Results:From 2014 to 2019,the multidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treated tuberculosis,and 44.2%(306/693)in retreatedmultidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treatedtuberculosis,and 44.2%(306/693)in retreated tuberculosis.The multidrug resistant rate of newly-treated tuberculosis decreased by 0.05%per year,while that of retreated tuberculosis increased by 0.03%per year.multidrug resistant tuberculosis was mainly distributed in the city of Haikou(83 cases),Danzhou(44 cases),Wenchang(42 cases),Wanning(37 cases)and Dongfang(32 cases),accounting for 64.5%of all multidrug resistant tuberculosis.Among 369 multidrug resistant tuberculosis,81.0%were male.The proportion of newly-treated cases was 17.1%(63/369),while the proportion of retreated cases was 82.9%(306/369),which was significantly higher than that of newly-treated cases.The multidrug resistant rate of tuberculosis in different years was different.Conclusion:The drug resistance rate of tuberculosis in Hainan Island is higher than the national average level,which needs attention.The epidemiological characteristics of multidrug resistant tuberculosis with different treatment history were different.

In Vitro Anti-tuberculosis Activity of Total Crude Extract of Echinops Amplexicaulis against Multi-drug Resistant Mycobacterium Tuberculosis

Background： TB （Tuberculosis） is the second leading killer infectious disease after HIV （human immunodeficiency virus）. Its incidence is worsened by development of multi-drag resistant and extensive drug resistant TB stxains. Available treatment regimens are expensive, toxic and lengtjy resulting to problems of non-adherence and inadequate response. Medicinal plants on the other hand may offer hope for developing alternative medicine for treatment of TB. This study evaluated the anti-tuberculosis activity of Echinops amplexicaulis. Materials and methods： Total crude extracts ofE. amplexicaulis were tested for activity against a wild strain resistant to Rifampicin and Isoniazid （MDR）, a fully susceptible laboratory strain （H37Rv） and Mycobacwrium boris （BCG strain） using disk diffusion method. MIC （minimum inhibitory concentration） was determined using Middlebrook 7H9 broil1. The strains were sub-cultured on Middlebrook 7H10 medium and MBC （minimum bactericidal concentration） determined. Susceptibility was evaluated by measuring zones of inhibition; MIC was obtained as the lowest concentration with no significant growth as shown by clog formation ofMTB （Mycobacwria tuberculosis） cells on the walls of the macro broth tube and MBC was obtained as the lowest concentration that inhibited growth of MTB colonies on Middlebrook 7H10 medium. Results： The extract showed a significant effect at a concentration of 50 mg/mL against all the three test strains F （2, 18） = 437.7, p = 0.00. It exhibited a MIC of 0.0488 mg/mL against MDR-TB and M. boris. Its MBC was the same at 0.0977 mg/mL against both MDR TB and M. boris. The MIC was much lower （0.0122 mg/mL） for the H37Rv strain. Terpenoids, alkaloids and tannins were present in large amount in the extract while saponins were present in small amounts. Flavonoids were not detected in the extract. Conclusion： E. amplexicaulis has the potential to be developed into new anti-TB drug and outcome of tile study supports the folkloric claims of anti-tuberculosis activity of tile plant.

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

Objective To investigate the prevalence of primary drug-resistant tuberculosis（TB） and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis（MDR-TB）. Methods A total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. Results Among 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75（80.6%） isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65（69.9%） isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine（31.2%） primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531 L rpoB mutation. Conclusion This study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

The History of Tuberculosis: Past, Present, and Future

Tuberculosis (TB), transmitted by the bacteria Mycobacterium tuberculosis has been a global epidemic for years. The evidence for infection with TB is centuries old. It can have an indolent course, and may remain inactive for years in individuals with the possibility of reactivation at any time, causing widespread systemic symptoms. The treatment and management of TB has become more effective over the years. It is estimated that more than one-third of the world population, especially in poor and developing countries are harboring this bacterium with varying manifestations of the disease from no symptoms to life-threatening infections. This manuscript describes the history of the disease and the discoveries. It also includes the recent advances and challenges facing the world and how governments and organizations are working together to control this disease.

Tuberculosis treatment-new approach to an old problem

Chronic mycobacterium infections are major causes of disease burden of 20%in a tropical country like India. The inflammatory cascade following these bacterial infections often leads to tissue damage and perpetuates necrosis, fibrosis and the disease process.Pulmonary tuberculosis,multi-drug resistant tuberculosis not only affects individuals but society at large.Current remedial measures using various technology platforms singularly did not produce effective and appreciable reduction in global disease burden.On the contrary,the conventional chemotherapeutic chemical moieties have demonstrated variable pharmacogenomic expression,increased drug resistance,non compliance of strict prolonged drug regimens with debilitating side effects and contraindications. Furthermore,secreted inflammatory cytokines results in chronic infection,immune deviation,and immunopathology in the lungs.Hence,identification of immune escape mechanisms leading to chronic mycobacterial infections is crucial for development of new treatments.The review would dwell into the basic pathogenic mechanism and the newer approaches that may need to be considered for developing novel therapeutic strategies.

某院97例痰阳复治肺结核患者的复治原因与对抗结核药物的耐药情况分析

目的:分析医院痰阳复治肺结核患者的复治原因与对抗结核药物的耐药情况,为临床该类患者的救治提供参考。方法:选取2019年1月—2021年12月昆明市第三人民医院结核科收治的97例痰阳复治肺结核患者作为研究对象,分析患者的复治原因和对常用抗结核药物的耐药特点。结果:97例痰阳复治肺结核患者对异烟肼和利福平的耐药率最高(其耐药率分别为67.01%和75.26%),而对卷曲霉素和阿米卡星的耐药率最低(其耐药率分别为12.37%和11.34%);97例痰阳复治肺结核患者中有78例存在耐药情况,其中耐药类型主要为耐多药结核病(44例,占56.41%),其次为广泛耐药结核病(18例,占23.08%)和单耐药结核病(13例,占16.67%);97例痰阳复治肺结核患者复治的原因主要为复发(63例,占64.95%),而其耐药类型主要为耐多药结核病(36例,占57.14%)。结论:医院痰阳复治肺结核患者的复治原因主要为复发,其耐药类型主要为耐多药结核病,说明当前肺结核患者的耐药形势较为严峻,临床应当进一步加强对患者的管理,督促患者规范治疗,以减少其复发。

临潼区2017-2019年耐药结核病调查分析

目的调查和分析临潼区耐药结核病流行特征和患者的筛查、治疗及管理现状,为加强耐药结核病防治提供依据。方法统计2017—2019年临潼区肺结核患者病原学阳性检出率、耐药检出率、总体耐药率和初、复治患者耐药率;分析耐药肺结核患者基本特征、不同耐药类型患者的排列顺位及其初、复治分布。结果1041例肺结核患者中,总体耐药率为6.82%;复治耐药率为26.53%,高于初治耐药率的5.85%(P<0.01)。71例耐药肺结核患者中,男性、20~39岁、农民发病人数较多。不同耐药类型中,耐多药患者占比52.11%;利福平(RFP)耐药患者占比78.87%;37例耐多药患者中,初治32例,占比为86.49%。结论临潼区耐药结核病以20~39岁、男性、农民、初治、耐多药患者为主,传播引起的初治耐药是导致临潼区耐药结核病疫情的主要原因。临床上加大对耐药结核病患者的筛查、治疗和管理,不断完善防治体系是控制耐药结核病流行的关键。

2018~2022年黔东南地区结核病耐药特征及相关影响因素分析

目的探讨2018~2022年黔东南地区结核病耐药特征及相关影响因素。方法选择2018年1月~2022年8月就诊于本院的400例结核病患者为研究对象,鉴定患者的菌株并行药敏试验,分析结核病耐药特征和相关影响因素。结果2018~2022年黔东南地区结核病总耐药率为20.75%,呈上升趋势,而多耐药、耐多药率分别为4.00%、3.00%;初治、复治者总耐药率分别为19.51%、35.48%;结核病对异烟肼、利福平、链霉素、乙胺丁醇的耐药率分别为11.00%、5.75%、15.75%和4.75%,各药物的总耐药率呈上升趋势;初治者的耐药率普遍低于复治者;多因素Logistic回归分析显示:年龄≥60岁、复治、男性、居住地农村、吸烟史、合并糖尿病、治疗依从性差、治疗管理不规范、合并COPD是结核病耐药的高危因素(P<0.05)。结论2018~2022年黔东南地区结核病耐药率呈上升趋势,复治者耐药率较高,且结核病耐药发生与年龄、性别、治疗史、居住地、吸烟史、合并COPD、治疗管理不规范、治疗依从性密切相关。

首次复治涂阳肺结核患者耐药情况分析

目的分析首次复治涂阳肺结核患者耐药特点，为临床制定合理的化疗方案及结核病的防治提供依据。方法搜集2014年1月至2015年12月河北省胸科医院收治的首次复治涂阳肺结核患者237例[标准治疗复发组（63例），标准治疗失败组（26例），不规律治疗组（148例）]，收集上述3组患者的晨痰或支气管肺泡灌洗液行BACTECMGIT 960快速培养，然后对链霉素（Sm）、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、对氨基水杨酸异烟肼（Pa）、左氧氟沙星（Lfx）、利福布汀（Rfb）、阿米卡星（Am）8种药物进行药物敏感性试验（简称“药敏试验”），并对其结果进行分析。结果在237例首次复治涂阳肺结核患者中，有107例患者对8种检测药物耐药，任一耐药率为45．1％（107／237），对一线抗结核药物（Sm、INH、RFP、EMB、Rfb）耐药率为41．8％（99／237），对二线抗结核药物（Pa、Lfx、Am）耐药率为24．1％（57／237）；耐多药率为22．4％（53／237），广泛耐药率为1．3％（3／237）。8种检测药物耐药率顺位依次为：RFP（31．2％，74／237）、Sm（30．8％，73／237）、INH（26．6％，63／237）、Rfb（24．1％，57／237）、Pa（15．2％，36／237）、Lfx（11．8％，28／237）、EMB（10．5％，25／237）、Am（6．8％，16／237）。标准治疗失败组任一耐药率[73．1％（19／26）]明显高于标准治疗复发组[50．8％（32／63）]和不规律治疗组[37．8％（56／148）]，差异有统计学意义（χ2=12．19，P〈0．05）。结论我院收治的首次复治涂阳肺结核患者对任一抗结核药物耐药率高，特别是对一线抗结核药物耐药率高，耐多药肺结核所占比率较高，不同复治类型耐药率不同。

复治肺结核耐药性与用药史关系研究

目的了解复治肺结核患者的用药史和耐药情况,为评价复治肺结核标准化疗方案适用性提供依据。方法采用WHO/IUATLD《结核病耐药监测指南》要求的整群抽样方法,在浙江省随机抽取30个监测县,药敏试验采用比例法,详细询问复治涂阳肺结核患者用药史并填写临床资料调查表,对药敏结果和用药史进行相关分析。结果复治肺结核病人耐药率和耐多药率分别为52.9%和29.7%,对4种抗结核药物的耐药率顺位由高到低依次为:H(38.1%)、R(34.8%)、S(29.7%)、E(13.5%);其中复治标准化疗方案治疗失败的患者耐药率和耐多药率最高,分别为77.3%和52.3%,首次复治患者的耐药率和耐多药率分别为45.1%和23.2%;耐药率和耐多药率均随用药时间和种类的增加呈升高趋势。结论不同用药史的肺结核病例耐药率差异悬殊,现行标准复治化疗方案对部分患者可能无效,提示复治病人化疗方案应多元化。

复治肺结核继发肺部感染病原菌分布及耐药性分析

目的了解复治肺结核患者继发肺部感染的病原菌分布及耐药情况,为抗菌药物的选择提供依据。方法对83例复治肺结核继发肺部感染患者的痰液行痰培养及药物敏感性试验,分析病原菌的分布情况及耐药情况。结果共培养出病原菌161株,其中细菌124株,真菌37株;革兰阳性球菌51株,对阿米卡星、庆大霉素、妥布霉素、青霉素G、苯唑西林、四环素的耐药率均高于85.50%,对利奈唑胺、替考拉宁的耐药率低于15.00%,对亚胺培南、万古霉素的耐药率为0.00%;革兰阴性杆菌73株,对头孢唑林、氨苄西林、氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢噻肟、环丙沙星、左氧氟沙星、氨曲南的耐药率均高于81.50%,除鲍曼不动杆菌外,对多黏菌素、美洛培南、亚胺培南的耐药率均低于18.00%;37株真菌均为念珠菌,对两性霉素B的耐药率为0.00%。结论革兰阴性杆菌是肺结核患者继发肺部感染时的主要病原菌,革兰阳性球菌和革兰阴性杆菌对常用抗生素的耐药性均较高。

复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

目的分析耐异烟肼、耐利福平和敏感的复治肺结核患者的治疗结局,探讨耐异烟肼患者的预后。方法采取回顾性调查的方法,选择2009年7月至2019年7月首都医科大学附属北京胸科医院联合国内20余家结核病防治机构共同合作纳入的资料完整并有治疗转归结果的922例复治菌阳肺结核患者,排除219例耐多药及广泛耐药肺结核患者,排除非利福平和非异烟肼耐药的100例患者,共入选复治菌阳肺结核患者603例。复治肺结核敏感患者的治疗方案采用复治标准化方案,耐异烟肼或耐利福平治疗方案采用个体化方案,对其中药物敏感的485例患者(简称"敏感组")、耐异烟肼(包含异烟肼单耐药和多耐药)的73例患者(简称"耐异烟肼组")和耐利福平(包含利福平单耐药和多耐药)的45例患者(简称"耐利福平组")的治疗转归进行对比分析。结果在治疗2个月末时,耐异烟肼组痰涂片阴转率(63.6%,42/66)和痰培养阴转率(63.6%,35/55)均分别低于耐利福平组[84.6%(33/39)和70.6%(24/34)]和敏感组[84.2%(388/461)和80.0%(343/429)],差异均有统计学意义(χ^(2)=16.567,P<0.001;χ^(2)=8.500,P=0.014);在治疗6个月末时,耐异烟肼组痰涂片阴转率(79.7%,47/59)和痰培养阴转率(76.5%,39/51)均分别低于耐利福平组[89.2%(33/37)和93.5%(29/31)]和敏感组[91.5%(398/435)和90.8%(367/404)],差异均有统计学意义(χ^(2)=8.127,P=0.017;χ^(2)=10.533,P=0.005)。耐异烟肼组治愈率(53.4%,39/73)低于耐利福平组(60.0%,27/45)和敏感组(69.5%,337/485),差异有统计学意义(χ^(2)=8.407,P=0.015);耐异烟肼组治疗成功率(64.4%,47/73)低于耐利福平组(75.6%,34/45)和敏感组(82.1%,398/485),差异有统计学意义(χ^(2)=12.587,P=0.002)。结论复治肺结核患者中,耐异烟肼患者痰菌阴转率和治疗成功率均低于耐利福平患者和敏感患者;应重视每一种药品的耐药情况,特别是临床应用时间较长的药品。

首次复治及二次复治菌阳肺结核耐药情况分析

目的评价首次复治及二次复治菌阳肺结核的耐药情况。方法采用前瞻性多中心研究,对首次及2次复治菌阳肺结核患者行痰罗氏结核分枝杆菌培养、药敏试验,对两组耐药类型、一线及二线抗结核药物耐药情况进行分析。结果二次复治患者抗结核药物总耐药率(67.9%)明显高于首次复治患者(40.5%),差异有统计学意义(P<0.05);二次复治患者单耐药率、耐多药率、耐左氧氟沙星(Lfx)率分别为25.6%、26.9%、14.3%,明显高于首次复治患者的耐药率(15.1%、16.6%、7.1%),差异有统计学意义(P均<0.05)。二次复治患者对异烟肼及利福平的耐药率分别为46.2%、39.7%,均显著高于首次复治病例(28.8%、19.2%),P均<0.05。结论二次复治肺结核患者耐药率较首次复治病例明显增加,耐多药肺结核发生率及对利福平、异烟肼的耐药率均明显提高,因此应重视首次复治肺结核患者的规范化治疗,减少复治次数,对复治患者应及时进行药敏试验,以指导临床用药。

初次复治肺结核患者出现耐药的原因分析

目的对初次复治肺结核患者的复发与治疗资料进行整理,分析初次复治肺结核出现肺结核的原因,并对患者产生原发性耐药、获得性耐药的发生原因、临床处置以及治疗对策。方法选取242例复治肺结核患者,对所选患者进行肺结核复治的原因分析,并对患者出现的耐药类型,耐药情况进行分析,总结患者出现原发性耐药或获得性耐药的原因以及对策,并对患者的治疗进行分析,总结经验。结果不同年龄段不同耐药性患者的单耐药率、多耐药率、耐多药率、广泛耐药率、利福平耐药率差异无统计学意义(P>0.05),青年组患者的获得性耐药发生率高于中年组和老年组患者,可见不同年龄段肺结核患者的耐药率相似但差异无统计学意义(P>0.05),治疗不良反应发生率6.74%,患者用药时间0~4个月时的耐药性值明显低于用药5~8个月的患者以及用药9~12个月的患者,患者中出现并发症患者的任一药物耐药率为40.14%,未出现并发症的患者任一药物耐药率为43.00%。结论继发性耐药是我国初次复治肺结核患者耐药的主要类型,用药时间越长,耐药率越高,在临床治疗过程中,应提高治疗效果,减少耐药的发生,同时对结核病的传染源进行有效控制,减少原发耐药的发生。

首次复治耐多药肺结核采用短程与标准化疗方案的疗效分析

为探讨首次复治耐多药肺结核（MDR-PTB）患者行短程与标准化治疗的疗效并进行对比分析，作者收集了2009年3月至2014年3月广州市胸科医院门诊部诊治的既往有结核病病史、无基础疾病及严重并发症、曾仅给予常规一线抗结核药物治疗超过1个月、经实验室检测确诊的首次复治菌阳肺结核患者236例。将患者依就诊时间先后分为A、B组，各118例，两组患者分别进行耐多药筛查，共36例患者确诊为MDR-PTB，其中A组患者（21例）给予复治短程化疗方案[（2～3）H—R-Z-E-S／6H—R-E，简称“短程组”]，B组患者（15例）给予耐多药结核病标准复治方案[6Am-Z-Lfx-PAS（Cs）-Pto／18Z-Lfx-PAS（Cs）-Pto，简称“标准组”]。分析两组患者治疗后的近远期临床疗效（包括痰菌阴转率、病灶吸收、药物不良反应及治疗转归）。两组间计数资料的比较采用Fisher确切概率法检验。结果显示，短程组治疗9个月末时的痰菌阴转率（85．7％，18／21）较标准组（46．2％，6／13）明显提高（P=0．017），但在疗程结束时短程组和标准组的痰菌阴转率[85．7％（18／21）和84．6％（11／13）]、病灶显著吸收率[47．6％（10／21）和23．1％（3／13）]、空洞闭合率[25．0％（3／12）和18．2％（2／11）]、治疗成功率[76．2％（16／21）和53．8％（7／13）]、失败率[23．8％（5／21）和46．2％（6／13）]差异均无统计学意义（P值分别为0．373、0．109、0．360、0．122、0．122）。两组患者治疗过程中均未发生严重药物不良反应而暂停治疗，标准组中有1例出现药物性肝损伤经保肝治疗后缓解，5例出现尿酸升高因无关节疼痛症状未予处理；短程组中有4例出现尿酸升高，仅1例因关节疼痛给予对症治疗后好转，2例患者出现胃肠道反应经调整服药次数后缓解。提示复治短程化疗方案治疗首次复治MDR-PTB的临床近期疗效优于耐多药结核病标准化疗方案，但远期疗效差异无统计学意义。基于前者具有疗程短、药品便宜且易获得、严重药物不良反应无增加等特点，建议对于首次复治MDR-PTB患者首选复治短程化疗方案。

初治与复治耐多药肺结核患者的CT表现分析

目的探讨初治与复治耐多药肺结核患者的CT表现。方法搜集2016年1月至2019年1月重庆市公共卫生医疗救治中心经药物敏感性试验确诊的186例耐多药肺结核患者,其中初治患者80例,作为初治组;复治患者106例,作为复治组。对比两组患者病变范围、病灶形态(树芽征、腺泡结节、斑片状影、大片状影、条索状影、钙化影)、空洞数量及形态、空洞壁、支气管扩张等CT表现,对CT表现等计数资料进行统计学分析,采用χ^2检验,以P<0.05为差异有统计学意义。结果复治组肺毁损者占20.8%(22/106)、病灶范围≥3叶者占90.6%(96/106)、病灶位于中叶及舌段者占85.8%(91/106),以及出现索条状影者占54.7%(58/106)、钙化灶者占27.4%(29/106)、支气管扩张者占77.4%(82/106),与初治组比较[分别为6.2%(5/80)、71.2%(57/80)、72.5%(58/80)、23.8%(19/80)、10.0%(8/80)、31.2%(25/80)],差异均有统计学意义(χ^2值分别为7.730、11.656、5.098、18.021、8.621、39.670,P值均<0.05)。复治组发生胸廓塌陷者占21.7%(23/106)、纵隔移位者占35.8%(38/106)、胸膜增厚者占78.3%(83/106),与初治组比较[分别为5.0%(4/80)、7.5%(6/80)、53.8%(43/80)],差异均有统计学意义(χ^2值分别为8.943、20.288、12.576,P值均<0.05)。复治组患者空洞发生率为83.0%(88/106)、空洞≥3个者占59.4%(63/106)、厚壁空洞者占70.8%(75/106)、薄壁空洞者占40.6%(43/106)、虫蚀样空洞者占40.6%(43/106)、空洞呈簇聚集者占40.6%(43/106)、空洞内壁不光滑者占20.8%(22/106),与初治组比较[分别为56.2%(45/80)、23.8%(19/80)、51.2%(41/80)、12.5%(10/80)、16.2%(13/80)、16.2%(13/80)、7.5%(6/80)],差异有统计学意义(χ^2值分别为16.034、23.551、7.390、17.626、12.810、12.810、6.264,P值均<0.05)。结论复治耐多药肺结核患者病变范围,肺毁损、多发空洞且呈簇聚集、干酪性肺炎伴虫蚀样空洞及静脉曲张型支气管扩张等CT表现与初治组比较更严重。

88例老年复治肺结核的耐药分析

目的探讨老年复治肺结核患者的耐药特点。方法通过对2007年6月～2010年6月在我院治疗的88例老年(≥60岁)复治痰菌阳性的肺结核患者做耐药分析和研究。另外随机抽取80例年青组(<60岁)的复治菌阳的患者作为对照组,对比两者间耐药例数。结果 老年患者对一线药物的耐药顺序:异烟肼(INH)>链霉素(SM)>利福平(RFP)>乙胺丁醇(EMB)。在二线药物中耐药率相对低的有莫西沙星,阿米卡星和克拉霉素。在二线药物的耐药顺序为:力克肺疾>利福布汀>Th1321>左氧氟沙星>莫西沙星,阿米卡星>克拉霉素。复治肺结核患者中,老年组与年青组的耐药率之间有显著性差异(p<0.01)。老年复治肺结核患者的耐药例数为41例,耐药率达46.6%。结论正确认识老年复治肺结核患者的耐药特点,广泛开展耐药检验分析,对治疗老年肺结核患者具有重要的临床价值。

喹诺酮类药治疗复治耐多药肺结核的成本-效果分析

目的:在环丙沙星、氧氟沙星、左氧氟沙星、司帕沙星中寻找治疗复治耐多药肺结核病的最佳方案。方法:利用已有的文献资料,采用成本-效果分析方法进行评价;同时对可能的影响因素(价格)进行考察,并作敏感性分析。结果:在痰菌转阴率比较中,左氧氟沙星与司帕沙星效果相近,优于环丙沙星和氧氟沙星(P<0.05);空洞关闭率、X线病灶有效率、不良反应发生率等指标各组间比较无统计学意义(P>0．05)。各组间的医疗费用差异有统计学意义。结论:左氧氟沙星为最佳治疗方案。敏感性分析与成本-效果分析的结果一致。

复治肺结核合并重症肺炎患者的耐药性分析及相关干预对策

目的探讨复治肺结核合并重症肺炎患者的耐药性及相关干预对策。方法选取76例复治肺结核并发重症肺炎患者,均接受痰液细菌培养、药敏试验检测,对病原菌分布、耐药性结果进行分析。结果痰液细菌培养共培养出147株病原菌,其中34株为真菌,47株为革兰阳性杆菌,66株为革兰阴性杆菌。真菌对酮康唑、氟康唑的耐药性最强,而对两性霉素B无显著耐药性。革兰阳性杆菌对青霉素C、四环素、庆大霉素、氨苄西林、阿米卡星、妥布霉素、苯唑西林存在强耐药性(>80%),对替考拉宁及利奈唑胺的耐药性表现较低。革兰阴性杆菌对头孢唑林、氨苄西林、阿莫西林/克拉维酸、头孢噻肟、氨苄西林/舒巴坦、氨曲南、左氧氟沙星、环丙沙星存在高耐药性(≥80.0%),对美洛培南、及亚胺培南、多黏菌素的耐药性表现较低。结论复治肺结核并发重症肺炎的主要病原菌为革兰阴性杆菌,而革兰阳性杆菌、革兰阴性杆菌对临床常用抗生素存在较高的耐药性。