原发型肺结核PPT课件.ppt

发病数居前五位的病种为：肺结核、乙型肝炎、梅毒、丙肝、痢疾，占发病总数的90.06%死亡数居前五位的病种为：艾滋病、肺结核、狂犬病、乙型肝炎、丙肝，占死亡总数的91.05%。卫生部2009年3月10日,2009年2月全国法定传染病疫情报告（2009年2月1日零时至2月28日24时）,1,发病数居前五位的病种为：肺结核、乙型肝炎、麻疹、梅毒、痢疾，占发病总数的88.40%死亡数居前五位的病种为：艾滋病、肺结核、狂犬病、乙型肝炎、流脑，占死亡总数的88.82%。卫生部2008年3月10日,2008年2月全国法定传染病疫情报告（2008年2月1日零时至2月28日24时）,2,发病数居前五位的病种为：肺结核、乙型肝炎、梅毒、痢疾、麻疹，占报告发病总数的86.89%死亡数居前五位的病种为：狂犬病、肺结核、乙型肝炎、艾滋病、流脑，占报告死亡总数的89.58%。卫生部2007年3月12日,2007年2月全国法定传染病疫情报告（2007年2月1日零时至2月28日24时）,3,2007年与2006年相比,与2006年相比，2007年甲乙类传染病中，呼吸道传染病和血源及性传播传染病报告发病率分别上升3.55%和6.96%。呼吸道传染病中的猩红热和麻疹上升幅度较大，病例数分别上升了20.61%和8.88%；血源及性传播传染病中的艾滋病、丙肝和梅毒上升幅度较大，病例数分别上升了45.04%、30.01%和24.09%。自然疫源及虫媒传染病和肠道传染病报告发病数分别较2006年下降19.20%和9.19%。,4,PrimaryPulmonaryTuberculosis,5,Threelandmark-humancontrolTBMar,1882RobertKoch(Germany)Effectivechemotherapeutics（1944SM；1950INH）ProtocolsinMolecularBiologyusedinTBresearch,Significantprogressinchemotherapy,Greatlyimproveefficacy,Overview,6,TuberculoticcurrentsituationAIDSandTBco-infectionabout40-50%AIDSandTBShowedadverseeffectsoneachotherHIVleadtoPotentialTBexposeanddeteriorateTBbecomeanearlycomplicationafterinfectedwithHIVTBleadtoAIDSprogressionanddeathMostdiedofPneumocystiscariniidisease,bacterialpneumoniaafewdiedofTB,Overview,7,TuberculoticimmunizationCellularimmunityIncidenceofinfectiondependson：Amount,flora,toxicumofbacterialImmunefunctionofbodyAffectability（geneticfactor)：PatientwithAntigenHLA-Bw35,incidenceofTB(relativerisk7.38),TBM(relativerisk15.21),Overview,8,ClassificationofTB,primarypulmonarytuberculosis（l型）Hematogenousdisseminatedpulmonarytuberculosis（ll型）SecondarypulmonaryTuberculosis（lll型）Tuboerculuspleurisy;tuberculouspleuritis（lV型）Extrapulmonarytuberculosis（V型）,9,PrimaryPulmonaryTuberculosis：oneofthemostcommonclinicaltypeinchildrenprimaryinfectionPrimaryPulmonaryTuberculosis：PrimaryComplexTuberculosisofBronchialLymphnodes,10,Primarycomplex原发综合征,primarylesionslymphangitisLymphadenitis,11,TuberculosisofBronchialLymphnodes支气管淋巴结结核（胸内淋巴结结核）Thescopeofprimarylesionsaresmallorhasbeenabsorbed,12,Pathology,Location:Right-SidedMostly，Subpleuralbottomoflobussuperiorpulmonisupsideoflobusinferiorpulmonisbasiclesion：Exudativelesions(渗出)Proliferativelesions(增殖)Caseousnecrosis(坏死),13,ChiefPathologycharacteristic:EpithelioidcellsnodulesLangerhanscellularinfiltrationAhighdegreeofallergystatusinchild,ExtensiveinflammatoryaroundlesionsTheyounger,themoreobviouslargelesions,result,14,Pathologicalprognosis1）AbsorptionCompleteabsorption、CalcificationorScleromaCalcifiedlesionsoccuratleast6to12months2）progressionExpandlesionsBronchiallymphfistulaAtelectasis、EmphysemaTuberculouspleurisy3）DeteriorationHematogenousdissemination,15,、clinicalmanifestation,()symptom：1、fever2、PoisoningsymptomsofTBanorexia、acratia、Sweating（盗汗）3、respiratorysymptomLittle，MayhaveadrycoughPerformanceinaseriouscondition：cough，Alargenumberofsputum，hemoptysis，dyspnea,16,4、Oppressionsymptom：OppressRecurrentLaryngealNerveHoarsenessOppresstrachea,bronchusCough,Wheeze（喘鸣）、ExpiratoryorInspiratoryobstructionOppressveinsPuffinessoffaceOppressphrenicnerveNausea,vomiting,hiccup,、clinicalmanifestation,17,、clinicalmanifestation,()signsPulmonarysigns:lessExtra-pulmonarySigns：Herpesconjunctivitis、SkinerythemanodosumorMultipleone-offarthritis,18,、diagnose,Significanceofearlydiagnosis()History：Askedindetailabout:HistoryofexposureandBCGvaccination,HistoryofinfectiousdiseasesNoticenutritionalstate,immunefunction()clinicalmanifestation,19,()PPD-TestPPD（ProteinPurifiedDerivative）纯蛋白衍化物Method：intradermalinjections0.1ml(皮内注射)（含5个结核菌素单位）,、diagnose,20,()PPD-Test,PPD-Test-positiveclinicalsignificance:AfterBCGvaccinationHavebeeninfectedwithTBSufferingfromtuberculosis,thereisanewdiseaseactivityClinicalcure,TBisnotdeadFromnegativetopositiveorthelevelofthereaction20mm，Andanincrease6mm,showthatthereisnewlyinfected,广泛推行BCG接种后，PPD试验的诊断价值受到一定限制,21,()PPD-Test,PPD-Test-negativeclinicalsignificance：NotinfectedwithTBInpre-allergicstage:aftertheinitialinfection48weeksImmunesystemhypofunctionortemporaryinterference.(Falsenegative)PPDexpiredortechnicalmisconduct.,22,()X-rayexamination1、Primarycomplex：Primarylesion、Cord-likelymphaticvesselsSwollenlymphnodes,、diagnose,23,原发综合症女，3岁，初染病灶在右上叶基部，支气管淋巴结肿大,24,()X-rayexamination,2、TuberculosisofBronchialLymphnodes：Cancertype（nodulartype）,25,左侧支气管淋巴结结核肿瘤型女，6岁。母有开放性肺TB，病史2年,26,()X-rayexamination,2、TuberculosisofBronchialLymphnodes：Infiltratingtype（Inflammationtype）,27,右侧支气管淋巴结结核浸润型女，5岁。脑脊液呈典型TBM改变,28,支气管淋巴结结核伴发淋巴结周围炎,29,()otherauxiliaryexamination1、Findingtuberclebacillusinsputumorgastricjuice2、Superficiallymphnodebiopsy3、Peripheralblood4、ESR5、Flexiblebronchofiberscopeexamination6、AntibodyofTB,、diagnose,30,、DifferentialDiagnosis,1、beforeChestX-rayinspectionURI、tracheitis、rheumaticfever2、AfterChestX-rayinspectionpneumonia、bronchiectasis,31,、treatment,principle：early,combine,appropriateamount,regularity、wholerangeUntreatedTB:atleast10persons/per100personsresistantforaanti-TBdrug,thereisatleast1person/per100personsresistantforMDR-TB(multi-drugresistant).Re-treatedTB(previousacceptedanti-TBtreatmentmorethanonemonth):atleast20persons/per100personsofadrugresistance,7persons/per100personsMDR-TB.course：Short-termtherapygeneraltreatment：Rest,Nutrition,regularlife,32,Drugtherapy：6HR或9HR，Serious：addonS2月（2SHR/46HR）orZ3月（3HRZ/36HR）DrugClassification：USAMaximumeffect，Minimaltoxicityeg：INH、RFPGreatereffect，Greatertoxicityeg：SM、EMB、PZAMinimaleffect，Maximumtoxicityeg：KM,、treatment,33,thebasicmechanismofShorttreatment：FastkilltuberclebacillusinthebodayDifferentpropagationspeedinsideandoutsideoftheCellsThebasiccharacteristicsofshort-termtherapy:1、sputumcultureturnnegtivequickly2、lowincidenceofthelong-termrecurrence3、fullcourseoftreatmentfailureless,thehighrateofsputumculture