Diagnosis of tuberculous uveitis by the macrogenome of intraocular fluid:A case report and review of the literature

BACKGROUND Tuberculous uveitis caused by tuberculosis infection factors is common,but tuberculous uveitis caused by Mycobacterium tuberculosis found in the intraocular fluid is rare.This report describes the use of intraocular fluid in the diagnosis of tuberculous uveitis in a patient and reviews the relevant literature.CASE SUMMARY A 24-year-old woman who was 31-wk pregnant visited Hebei Chest Hospital due to intermittent chest pain,fever,and decreased vision for 3 mo.The hydrothorax test suggested“tuberculous pleurisy”,and yellow effusion was extracted from the chest tube twice resulting in a total volume of approximately 800 mL.The patient chose to continue the pregnancy without treatment,and was hospitalized again due to high fever.Following 2 mo of anti-tuberculosis treatment,a healthy boy was delivered by cesarean section.Tuberculous uveitis was diagnosed using tuberculosis Xpert,and intraocular infection was detected by second-generation gene sequencing.Following systemic treatment,the patient gradually improved,and the corrected visual acuity of the left eye gradually increased from 0.08 to 1.0.CONCLUSION The etiology of uveitis is complex,and it is necessary to assess the patient’s general condition and apply molecular biology methods to determine the pathogenesis and guide precise treatment,to improve clinicians’awareness and standardize treatment of the disease.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Interferon-gamma release assays in tuberculous uveitis:a comprehensive review

·Tuberculous uveitis(TBU)comprises a broad clinical spectrum of ocular manifestations,making its diagnosis challenging.Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU.Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens,resultant test positivities are low in yield.Immunodiagnostic tests,including the tuberculin skin test and interferon-gamma release assays(IGRAs),can help support a clinical diagnosis of TBU.Unlike the tuberculin skin test,IGRAs are in vitro tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination.Currently,available IGRAs consist of different techniques and interpretation methods.Moreover,newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis.This narrative review collates salient practice points as a reference for general ophthalmologists,such as evidence for the utilization of IGRAs in patients with suspected TBU,and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting.

A challenging case of tuberculosis-associated uveitis after corticosteroid treatment for Vogt-Koyanagi-Harada disease

Dear Editor,I am Dr.Tian-Wei Qian,from Shanghai General Hospital,Shanghai,China.I write to present one case report of tuberculosis（TB）-associated uveitis after corticosteroid treatment for Vogt-Koyanagi-Harada（VKH）disease.

Immunosuppressive Treatment of Non-infectious Uveitis:History and Current Choices

Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosuppressive treatment for uveitis since first introduced in 1950 s,its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs,classified into alkylating agent,antimetabolites and T cell inhibitors,have been widely used as corticosteroid-sparing agents,each with characteristic safety/tolerance profiles on different uveitis entities. Recently,biologic agents,which target specific molecules in immunopathogenesis of uveitis,have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However,lack of large randomized controlled clinical trials,concerns about efficacy and safety of long-term usage,and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs(from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation,but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities(conventional immunosuppressive agents,biologics and local drug delivery systems) on hand,the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists' choices of immunosuppressive agents may be complex and may include personal familiarity,treatment availability,safety/tolerability,effectiveness,patient compliance,cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness,which are believed to be the two most important factors affecting treatment decision making.

Hepatic segmentectorny for treatment of hepatic tuberculous pseudotumor

BACKGROUND: This study was designed to explore the preoperative diagnosis and surgical modality of patients with hepatic tuberculous pseudotumor. METHODS: Of 682 patients who had undergone liver resection from January 1988 to December 2004, 8 were confirmed pathologically as having hepatic tuberculous pseudo-tumor after operation. Their clinical features, laboratory findings, results of preoperative imaging and surgical modality of the 8 patients were analyzed. RESULTS: In these patients,5 were misinterpreted as having other types of liver tumor and 3 were confirmed as having liver tuberculous pseudotumor preoperatively. All the 8 patients underwent hepatic segmentectomy and local hepatic resection. Seven had no tumor recurrence after follow-up for 4 years. CONCLUSIONS: Hepatic tuberculous pseudotumor was highly suspected for the patients with hepatic occupying-space lesions who had a history of tuberculosis. Fine needle aspiration liver biopsy guided by B-mode ultrasound and CT scan could confirm the diagnosis. They are of vital importance in the pathological diagnosis of the tumor. Therapeutic modalities included all kinds of hepatic segmentectomy and postoperative administration of antituberculous agents for the enhancement of the therapeutic effects.

Treatment of Tuberculous Pleurisy with Effusion by Artificial Pneumothorax

patients were divided into two groups at random. The patients of two groups were all given standard treatments with anti-tuberculous drugs. Treatment group received artificial pneumothorax to help the cure. Results showed that the frequency and quantity of drawing liquid in the treatment group were obviously less than those in the control group and the duration of the complete liquid absorption was shortened markedly in the treatment group and that total effective rate in treatment group (92.5%) was obviously higher than that of the control group (83.33%). We found that the artificial pneumothorax could raise the intra-pleural pressure by 0.20-0.39 kpa, reduce leakage in parietal pleurae and increase the absorption in visceral layer evidently. As it can isolate the two layers of pleurae from one another by the air in thorax, the incidence of pleurae adhesion can be decreased.

Baseline HBV Load Increases the Risk of Anti-tuberculous Drug-induced Hepatitis Flares in Patients with Tuberculosis

Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.

Prevalence of tuberculous peritonitis in the North of Iraq and sociodemographic comparison with pulmonary tuberculosis

Objective:Tuberculosis continues to be an important health problem in the world.Despite the widespread impression that abdominal tuberculosis is rare today,the disease is still endemic in developing world and is reemerging in the West.The aim is to review our local experience with tuberculous peritonitis.Methods:Between January 2000 and December 2006,the case records of histologically documented tuberculous peritonitis (TBP) diagnosed and treated at the tuberculosis coordinating center in Erbil city,Iraq were reviewed.Comparisons were made with pulmonary tuberculosis patients regarding socio-demographic,clinical and laboratory findings.Results:Forty one cases of TBP were diagnosed during the study period.Their age range was 26-72 years(46±17),with a male:female ratio of 1.5;1.The median duration of symptoms before diagnosis was 6 weeks(range;10 days to 18 months.).Eleven patients(26.8%) had comorbid conditions and 6 patients (14.6%) had a history of positive contact with Tuberculosis(TB) case.Presenting symptoms were abdominal distension(70%),abdominal pain(65%),fever(68%),anorexia(65%) and weight loss(44%).Four patients had pulmonary symptoms;cough and/ dyspnoea(n= 2 ) and cough(n= 2).Chest X-ray changes consistent with pulmonary tuberulosis(PTB) were seen in 25%.Tuberculous peritonitis was diagnosed by laparoscopy (n=29) and laparotomy(n= 12).Adverse effects of TB drugs occurred in nearly 40%,consisting of hepatitis(n= 2),nausea/vomiting(n= 11),rash(n = 2) and encephalopathy(n = 1).Hemoglobin and serum albumin levels were significantly lower in tuberculous peritonitis(TBP)TBP patients(P =0.027 and 0. 003,respectively).There was a significantly greater occurrence of adverse effects(P【0.001) in TBP patients. No significant differences between TBP and PTB were demonstrated in regard to age and sex distribution, non-specific symptoms(fever,weight loss,and anorexia) and erythrocyte sedimentation rate.All were treated with standard regimens and responded to treatment.Conclusion:Tuberculous peritonitis is prevalent in our population.Therefore.TBP should be considered in patients presenting with abdominal symptoms and nonspecific constitutional symptoms,particularly in young patients.Laparoscopy and laparotomy with tissue biopsy was the specific diagnostic procedure.

玄府学说在葡萄膜炎中的研究进展

葡萄膜炎是临床上常见的眼科疾病,治疗棘手,易反复发作甚至致盲。目前葡萄膜炎的治疗措施主要有糖皮质激素、睫状肌麻痹剂、非甾体类抗炎药、免疫抑制剂等药物疗法,以及近年研发的新型生物制剂等手段,均有一定的优势和不足。近年来,使用中医玄府理论治疗眼病的研究颇多,相关研究显示,开通玄府在保护视神经损害方面疗效确切。为了进一步探究玄府学说在葡萄膜炎中的合理应用,本文综述了玄府学说的定义、特性,与葡萄膜炎病因病机的关系,进而阐述葡萄膜炎的眼玄府理论在临床中的治法治则。本文可为临床治疗葡萄膜炎提供新的思路与理论依据。

前葡萄膜炎中医证素特点研究

目的研究与总结前葡萄膜炎(AU)中医证素特点,为AU的规范临床辨证论治提供参考。方法收集中国知网、万方、维普数据库从建库至2023年3月31日正式发表的关于AU中医证型的相关文献,对中医证名进行规范化处理以及证型的拆解,将文献中筛选出的证型条目及病例数归纳建立Excel软件数据库。对病位证素及病性证素进行频数、频率描述分析,对证素进行系统聚类分析和关联规则分析。结果(1)一般情况:纳入文献24篇,总病例数1,685例。(2)证型及证素分布:频率排名前5位的证型有肝经风热证(329次,19.53%)、肝胆火炽证(224次,13.29%)、肝火炽盛证(205次,12.17%)、阴虚火旺证(166次,9.85%)、肝胆湿热证(94次,5.58%)。(3)证素特点:病位证素有5个,以频率从高到低排名依次是肝(1,035次,61.42%)、胆(335次,19.88%)、表(163次,9.64%)、肾(117次,6.94%)、脾(55次,3.26%)。病性证素类型共13种,热病性出现频次最高,为1,447次(85.88%)。以虚性、实性进行分类分析,实性证素共出现了2,458次(76.42%),虚性证素共出现了758次(23.56%);其中,热证素在实性证素中出现频次最高,共1,447次(44.99%);阴虚证素在虚性证素中出现频次最高,共374次(11.63%)。(4)证素关联规则分析:共得到8条强关联规则,其中二项强关联规则5个,三项强关联规则3个,推断出5个基础证候,分别为肝火炽盛证、风热证、湿热证、肝胆火炽证、肝经风热证。关联规则网状图显示肝与热的关联最强,推断基础证候为肝火炽盛。结论肝经风热、肝胆火炽、肝火炽盛3个证型是前葡萄膜炎患者的主要证型。前葡萄膜炎的重要病位证素为肝,重要病性证素为热,病性特点以实证为主。

年龄对结核性胸膜炎患者抗结核治疗后血生化指标的影响

目的:探究年龄对结核性胸膜炎患者抗结核治疗后血生化指标的影响。方法:选取本院2019年5月至2022年5月期间收治的142例结核性胸膜炎患者作为研究对象。根据世界卫生组织(World Health Organization,WHO)年龄划分标准将患者分为老年组(n=29,年龄>59岁)、中年组(n=40,44岁<年龄≤59岁)、青年组(n=73,年龄≤44岁)。三组均进行抗结核治疗,分析比较三组的治疗效果,实验室指标和血生化指标水平。结果:三组治疗效果比较差异无统计学意义。三组治疗前及治疗后的γ-干扰素(Interferon-γ,INF-γ)与结核分歧杆菌脱氧核苷酸(Mycobacterium tuberculosis DNA,TB-DNA)阳性率比较无统计学差异。三组治疗前血生化指标比较差异无统计学意义;治疗后,三组肌酐(Creatinine,Cr)、尿素氮(Blood urea nitrogen,BUN)、尿酸(Uric acid,UA)、总胆红素(Total bilirubin,TBIL)、总蛋白(Total Proteins,TP)、谷丙转氨酶(Alanine transaminase,ALT)比较差异有统计学意义;中年组Cr、TP水平低于老年组与青年组,老年组与中年组BUN、UA、TBIL、ALT水平高于青年组(P<0.05)。结论:结核性胸膜炎患者抗结核治疗后的血生化指标水平变化受年龄影响,对中老年患者较大。

氟米龙滴眼液与妥布霉素地塞米松滴眼液对急性前葡萄膜炎的临床观察

目的氟米龙滴眼液与妥布霉素地塞米松滴眼液治疗急性前葡萄膜炎的临床效果对比。方法选择2021年1月至2023年8月通许第一医院86例急性前葡萄膜炎患者。运用治疗方式的不同分组,研究组(n=43)以妥布霉素地塞米松滴眼液治疗,参照组(n=43)以氟米龙滴眼液治疗,对比分析各组患者治疗效果、细胞因子、治愈时间和复发情况与生活质量。结果研究组治疗有效率(95.35%)高于参照组(81.40%),差异具有统计学意义(P<0.05);两组治疗后细胞因子水平均低于治疗前,差异均有统计学意义(P<0.05),但治疗后研究组细胞因子水平与参照组对比差异无统计学意义(P>0.05);治疗后两组生活质量评分均升高,研究组高于参照组,差异均有统计学意义(P<0.05);研究组随访6个月、12个月复发率均低于参照组,差异均有统计学意义(P<0.05)。结论妥布霉素地塞米松滴眼液与氟米龙滴眼液治疗急性前葡萄糖膜炎均能有效抑制细胞炎性因子,但妥布霉素地塞米松滴眼液复发率更低,治疗效果较好,可提高患者生活质量。

Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with TBLN Having Different Anti-TB Treatment Background

Objective The influence of anti-tuberculosis （TB） treatment history on tuberculous lymphadenitis （TBLN） diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN. Methods In this study, suspected patients with TBLN and having different anti-T8 treatment background were enrolled. All the samples were tested simultaneously by histology, ZiehI-Neelsen （ZN） staining, mycobacterial culture （culture）, Xpert MTB/RIF （xpert）, real-time PCR, and high-resolution melting curve PCR （HRM）. Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed. Results In our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture （P 〈 0.0001）. In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert （P 〈 0.05）. However, the treatment history did not affect the performance of remaining tests （P 〉 0.05）. For rifampicin drug susceptibility test （DST）, the anti-T8 treatment showed only significant influence on the success rate of culture DST （P = 0.001）, but not on those of Xpert and HRM tests （P 〉 0.05）. Conclusion Other tests as welt as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.

综合护理干预对葡萄膜炎患者治疗依从性及预后的影响

目的观察葡萄膜炎患者予以综合护理对患者预后和治疗依从性的影响分析。方法临床纳入2020年8月至2022年8月在郑州大学第一附属医院收治的葡萄膜炎患者98例,根据随机双盲法分组,分为对照组(n=49)、研究组(n=49),研究组予以综合护理干预,对照组予以基础护理,分析两组护理后的治疗依从性指标评分,包括定期复查、适当运动、合理饮食、正确用药等;应用低视力生活质量量表(CLVQOL)分析两组的干预前、干预后1个月、干预后3个月、干预后半年的生活质量评分;分析两组的不良反应情况。结果与对照组相比,研究组的治疗依从性指标评分,包括定期复查、适当运动、合理饮食、正确用药评分均大幅度增高,差异有统计学意义(P<0.05);与干预前相比,两组在干预后1个月、干预后3个月、干预后半年的CLVQOL评分均有提升,但与对照组相比,研究组在干预后1个月、干预后3个月、干预后半年的CLVQOL指标评分大幅度提高,差异有统计学意义(P<0.05);与对照组相比,研究组护理后发生前后房粘连、巩膜膨隆、瞳孔闭锁、粘连等不良反应大幅度减低,差异有统计学意义(P<0.05)。结论葡萄膜炎患者予以综合护理可提高患者的遵医嘱治疗依从性,提高患者的生活质量,值得临床应用。

幼年特发性关节炎相关葡萄膜炎诊疗中国专家共识(2023)

幼年特发性关节炎(juvenile idiopathic arthritis,JIA)是儿童时期常见的风湿免疫性疾病。幼年特发性关节炎相关葡萄膜炎(juvenile idiopathic arthritis-associated uveitis,JIA-U)是JIA重要的关节外并发症,主要表现为隐匿起病的虹膜和睫状体前部非肉芽肿性炎症(虹膜睫状体炎),是造成儿童时期残疾和失明的重要原因之一。近年来,美国风湿病学会(American College of Rheumatology,ACR)及欧洲儿科风湿病学的单一枢纽和接入点(Single Hub and Access Point for Pediatric Rheumatology in Europe,SHARE)先后均发表了JIA-U的临床指南,但我国尚缺乏诊疗相关指导性文件。为进一步加强该病的临床认知和诊疗规范,中华医学会儿科学分会免疫学组、中国儿童风湿免疫病联盟、国家儿童健康与疾病临床研究中心风湿免疫联盟联合眼科专家共同制定了《幼年特发性关节炎相关葡萄膜炎诊疗中国专家共识(2023)》,在疾病筛查、诊断、治疗等方面达成初步共识,以供临床参考。

补肾明目口服液对慢性葡萄膜炎患者的临床疗效

目的考察补肾明目口服液对慢性葡萄膜炎患者的临床疗效。方法146例(146眼)患者随机分为对照组和观察组,每组73例,2组均给予常规治疗,同时对照组给予雷公藤多苷片,观察组在对照组基础上加用补肾明目口服液,疗程3个月。检测临床疗效、血清炎性因子(IL-2、TNF-α、IFN-γ)、免疫功能指标(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、生活质量(VRQoL评分)、复发率变化。结果观察组总有效率高于对照组(P<0.05),复发率更低(P<0.05)。治疗后,2组血清炎性因子、CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)降低(P<0.05),CD_(8)^(+)、VRQoL评分升高(P<0.05),以观察组更明显(P<0.05)。结论补肾明目口服液可安全有效地降低慢性葡萄膜炎患者炎性水平,增强免疫功能,改善生活质量。

温脾活血汤联合2HRZE/4HR方案治疗结核性胸膜炎的临床疗效与机制研究

目的:探讨温脾活血汤联合2HRZE/4HR方案治疗结核性胸膜炎的临床疗效与机制。方法:选择该院60例湿性结核性胸膜炎患者作为研究对象,所有患者的受试时间为2020年3月至2021年3月。将符合纳入标准的患者随机分为观察组和对照组,各30例。两组患者均采取2HRZE/4HR抗结核方案和规律的胸腔穿刺抽液治疗,观察组患者加服温脾活血汤。两组患者均完成6个月的治疗。观察两组患者治疗前、治疗1个月后、治疗2个月后和疗程结束后的4个时期各项中医症状,外周血CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)比值、胸膜厚度、肺通气功能指标[第1秒用力呼气容积(FEV_(1))、第1秒用力呼气容积占用力肺活量百分比(FVE_(1)/FVC)]、血清肿瘤坏死因子α(TNF-α)、白细胞介素2(IL-10)、白细胞介素33(IL-33)、γ干扰素(IFN-γ)、γ干扰素诱导蛋白10(IP-10)以及单核细胞趋化蛋白-1(MCP-1)等指标水平。结果:观察组患者的治疗总有效率为96.67%(29/30),明显高于对照组的80.00%(24/30),差异有统计学意义(P<0.05)。治疗1个月、2个月和疗程结束后,观察组患者发热、胸胁疼痛、气促、咳嗽、咯血以及中医症状积分总分明显低于对照组(P<0.05);观察组患者CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平明显高于对照组(P<0.05),CD8^(+)水平明显低于对照组(P<0.05);观察组患者胸膜厚度明显低于对照组(P<0.05);观察组患者FEV_(1)、FVE_(1)/FVC水平明显高于对照组(P<0.05);观察组患者血清TNF-α、IL-2、IL-10、IFN-γ和MCP-1水平明显低于对照组(P<0.05),上述差异均有统计学意义。结论:温脾活血汤联合2HRZE/4HR方案治疗结核性胸膜炎的疗效较好,可有效降低患者胸膜厚度,减轻机体炎症反应,改善患者免疫水平。

Blau综合征一例

Blau综合征是一种罕见的遗传性疾病,其特征为肉芽肿性关节炎、葡萄膜炎和皮炎三联征。患者通常表现出多系统受累,包括眼部、皮肤和骨骼异常。Blau综合征发病率极低,全球范围内儿童中的患病率不到百万分之一。本次多学科会诊为一例21岁的青年女性患者,病程始于儿童时期,表现为患者多关节肿痛、皮肤病变、眼睑分泌物增多,确诊为葡葡膜炎,并伴高血压和动脉异常等。患者自6岁开始接受激素治疗,并尝试了多种药物治疗,在改善关节肿痛和眼部症状方面有一定疗效。通过罕见病多学科会诊,以明确患者的分子诊断、多系统评估、治疗方案的选择与制订。同时通过本病例的报道,提高临床医师对Blau综合征诊断和综合治疗策略的认知,从而提高罕见病的管理和治疗水平。