Objective To evaluate the diagnostic value of all diagnostic tests detecting the ethambutol resistance in Mycobacterium tuberculosis. Methods PubMed, EMbase, Chinese Biomedical Database (CBM), Chinese Scientific Journals Full-Text Database (CSJD), and Chinese Journal Full-text Database (CJFD) were searched, and QUADAS items were used to evaluate the quality of included studies. Meta-disc software was used to handle data from included studies. Such index as sensitivity, specificity, and SROC were applied to assess the diagnostic value of individual diagnostic test. Results Nine studies were included. The results of meta-analyses showed that compared with proportion method, the summary sensitivity, summary specificity, positive likelihood ratio, negative likelihood ratio, and SROC area under curve of a nitrate reductase assay were 92%, 99%, 30.50, 0.13, and 0.975 2, respectively, while compared with BACTEC 460 TB, the above mentioned indexes of BACTEC MGIT 960 System were 92%, 99%, 6.27, 0.11, and 0.9, respectively. Bacteriophage biological amplification method revealed relative good analysis effectiveness on MB/BacT. Conclusion According to the results, it is recommended that nitrate reductase assay can replace proportion method as screening test of ethambutol resistance in Mycobacterium tuberculosis, and BACTEC MGIT 960 System can replace BACTEC 460 as final diagnostic test of ethambutol resistance in Mycobacterium tuberculosis.
Objective To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.
Objective To assess the quality of diagnostic studies on detecting the tuberculosis antibody to diagnose tuberculosis.Methods CBM (1978 to 2006) and VIP (1994 to 2006) were searched; any author-claimed diagnostic studies which used the dot immunogold filtration assay (DIGFA) to detect the tuberculosis antibody and to diagnose tuberculosis were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was used to assess the quality of included diagnostic studies by two reviewers independently.Results Thirty-eight papers were included and assessed. We found that most of the quality items were not met with QUADAS. Most papers adopted the retrospective diagnostic case-control design. Thirty-one papers did not describe the selection criteria clearly, 18 did not describe whether all the included patients were verified by using a reference standard of diagnosis, 36 did not describe whether the index test results were interpreted without knowledge of the results of the reference standard, 37 did not report the uninterpretable/intermediate test results, and 34 did not report the withdrawals from the study.Conclusion There are few high quality studies on using DIGFA to detect tuberculosis antibody to diagnose tuberculosis.
Objective To evaluate the efficacy and safety of rifampicin plus pyrazinamide versus isoniazid for prevention of tuberculosis among persons with or without HIV-infection respectively. Methord Meta-analysis of randomized controlled trials(RCT) and quasi-randomized controlled trials(quasi RCT) that compared rifampicin plus pyrazinamide for 2-3 months with isoniazid for 6-12 months. Endpoints were development of active tuberculosis, severe adverse effects, and death. Treatment effects were summarized as risk difference (RD) with 95% confidence interval (CI). Results Three trials conducted in HIV-infected patients and 3 trials conducted in HIV-uninfected persons were identified. The rates of tuberculosis in the rifampicin plus pyrazinamide group were similar to that in the isoniazid group, whether the subjects were HIV-infected patients or not (for HIV-infected patients: pooled RD= 0%, 95%CI: -1% to 2%, P=0.89; for HIV-uninfected persons: pooled RD=0%, 95%CI: -2% to 1%, P=0.55). There was no difference in mortality between the two treatment groups (for HIV-infected patients: pooled RD=-1%, 95%CI: -4% to 2%, P=0.53; for HIV-uninfected persons: pooled RD=0%, 95%CI: -1% to 1%, P=1.00). However, both subgroup analyses showed that a higher incidence of all severe adverse events was associated with rifampicin plus pyrazinamide than isoniazid among HIV-uninfected persons (one: RD=29%, 95%CI: 13% to 46%; P=0.000 5; another: RD=7%, 95%CI: 4% to 10%; Plt;0.000 1). Conclusion Rifampicin plus pyrazinamide is equivalent to isoniazid in terms of efficacy and mortality in the treatment of latent tuberculosis infection. However, this regimen increases risk of severe adverse effects compared with isoniazid in HIV-uninfected persons.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
ObjectiveTo summarize the clinical manifestations,diagnosis and treatment of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis. MethodsOne proven diagnosed case of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis was analyzed. Related publications of case reports and articles from Wanfang Data and China Hospital Knowledge Database were also reviewed. ResultsA total of 15 cases were reported,in which 9 cases with complete clinical data. There were 7 males and 2 females,with a mean age of 31.2±15.83 years. The infected tissues were as follows:lung(6 cases),liver(2 cases),spleen(1 case),lymph node(2 cases),pleural(3 cases),peritoneum(2 cases),meninges(1 case),two or more sites infection(5 cases). The most clinical manifestations were fever,hepatosplenomegaly and enlarged lymph glands. The common laboratory abnormalities were liver dysfunction,pancytopaenia and haemophagocytosis in bone marrow. Treatment and outcomes:immunotherapy(5 cases,3 cases with intravenous immunoglobulin and 5 cases with steroid therapy) and anti-tuberculosis (14 cases). 3 cases were cured,6 cases improved and 6 died. ConclusionThere were no specific indexes of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis. Early proven diagnosis and administration of anti-tuberculosis and immunotherapy is essentials of effective therapy.
【摘要】 目的 探讨低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核的手术方式及术后疗效。 方法 2002年3月-2009年7月收治颈胸段脊柱结核16例，男11例，女5例；年龄18~52岁，平均38岁。其中位于颈6-胸1者2例，颈7-胸1者5例，胸1-2者4例，胸2-3者3例，胸1-3者2例。神经功能Frankel分级为：B级4例，C级7例，D级3例，E级2例。手术行低位下颈椎前方入路联合胸骨柄劈开术，术中彻底清除结核肉芽组织、脓液、死骨并进行脊髓减压，取自体髂骨块植骨重建中前柱、前方钛板内固定。术后佩戴头颈胸支具6个月，正规抗痨18个月。术前后凸Cobb角为25~60°，平均为37.5°。 结果 全部患者均获得随访，随访时间2~8年，平均3年。均获得骨性融合，融合时间为5～8个月，无螺钉松动、脱落及钢板断裂等并发症发生。神经功能恢复按Frankel分级，平均改善3.6个级别；结核病变无复发，术后后凸Cobb角明显改善，为15～35°，平均22.6°，末次随访后凸角无明显丢失。1例术后出现暂时性声音嘶哑，术后1个月恢复。 结论 低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核，病灶显露充分，植骨内固定，重建脊柱稳定性，矫正后凸畸形可靠。【Abstract】 Objective To explore the clinical characteristics of cervico-thoracic junction spinal tuberculosis (CTJST) and to observe the therapeutic effect of lower anterior cervical approach combined with presternum-splitting approach on CTJST. Methods The clinical data of 16 patients with cervicothoracic junction spinal tuberculosis from Match 2002 to July 2008 were retrospectively analyzed. According to the Frankel grades, four patients were in grade B, seven were in grade C, three were in grade D, and two were in grade E. There were 11 males and five females with a average age of 38 years ranging from 18 to 52 years. All patients underwent radical excision of epidural granulation tissue/abscess and necrotic bone, whilst a proper tricortical iliac crest autograft and anterior titanium plate were placed to reconstruct the anteromedian spinal column, followed by chemotherapy for 18 months and immobilization in a brace for six months. The mean Cobb angle was 37.5° (ranged from 25° to 60°) before surgery. Results All patients were followed up for two to eight years (three years on average), and got complete bone fusion within five to eight months postoperatively. There were no pull out and breakage of screws or plates.Spinal cord functional recovery improved on average 3.6 degree according Frankel standard, without recurrence of the disease or loss of Cobb angle till the last follow up. There was a statistically significant improvement in the Cobb angles from 22.6° to 37.5° (Plt;0.01) in average. However, two patients appeared transient hoarse voice after surgery, and the symptoms were alleviated one month after the operation. Conclusion Lower anterior cervical approach combined with presternum-splitting approach for CTJST may provide adequate exposure to the lesion, keep the bone graft with internal fixation and spinal stability, and correct the kyphosis.
目的：分析白塞氏病合并结核感染的临床特点及相关因素。方法：回顾分析2002年至今四川大学华西医院临床免疫科收治的初诊为白塞氏病且合并结核感染的病历资料，并结合相关文献分析可能的相关因素。结果：37例首诊为白塞氏病的患者中有10例（29.7%）合并结核感染，4例（10.8%）既往有结核病史，经抗结核或/和抗白塞氏病治疗后好转。结论：应警惕白塞氏病与结核感染并存，结核感染的临床表现可能和白塞氏病相混淆，需做好鉴别诊断并合理治疗。