结核病总论英文【专业研究】

1、我国结核病的疫情状况,WHO 93年宣布“全球结核病紧急状态”，98年又重申遏制结核病的行动刻不容缓。 全球现有结核病人2000万，其中95在发展中国家，每年还会新发生800-1000万肺结核病，其中75的病人年龄在1550岁。如不控制，今后10年还将有9000万人发病。 中国是全球22个结核病高负担国家之一，结核病人数位居世界第二位，仅次于印度. 据调查全国三分之一的人口已感染了结核菌；受感染人数超过4亿,受结核感染人群中有10的人发生结核病,1,特制内容,tuberculosis,factor of tuberculosis incidence rising ： HIV spread. T

2、B strain occur drug resistance . fluid population increasing. Management TB patient not perfect、prevention and cure not efficiency. Poverty、population increasing.,2,特制内容,etiology,Mycobacterium 、 Acid fastness、G+、aerobe。 Growth torpidity , culture need 4-6 weeks. Typing : human type 、 bovine type 、 B

3、ird type、mouse type 、 main human type。 way of infection：respiration tract、digestive track、skin or placenta.,3,特制内容,Epidemiology,1 infection sources：open pulmonary tuberculosis 2 route of transmission: by respiration way or digestion tract. 3 susceptible population,4,特制内容,Epidemiology,The factors lea

4、d Children ill with TB Contact TB amounts and toxicity. power of resistance . hereditary factor .,5,特制内容,pathogenesy,bacterial number、toxicity、immunization condition Cell-mediated immune reaction:macrophage swallow TBantigen presentation Th and macrophageIL12CD+4TH1-IF-to promote mononuclear cell; t

5、o gather、activation、proliferation and differentiationto produce alexin and oxidase 、 digestive enzymeto kill TB,6,特制内容,pathogenesy,IF-reinforcement CD+8 、NK cells activity to phagocytosis TB. meanwhile to lead histoclasia delayed allergy : T cell media，macrophage to be effector cell，to kill reinfect

6、ion TB and cause cheesy necrosis or hole formation After Infection TB : primary disease（5%），Secondary disease （5%）, not to fall ill all live(90%),7,特制内容,diagnose,Objective to discover focal 。 Definite disease character、size whether or not deliver bacterium。,8,特制内容,diagnose,1 history TB toxic symptom

7、 to contact TB patient BCG vaccination acute infection:measles，pertussis Supersensitivity erythema nodosum、exanthematous conjunctivitis。,9,特制内容,diagnose,2 ：OT test agent：1/2000 or 1/10000 PPD dose：0.1ML（OT 5U）（or 1U）。 position：left forearm palmaris below 1/3 Infuse intracutaneous form 6-10mm hillock

8、。 4872hr observation reaction。,10,特制内容,diagnosis,reaction 5mm(-) 5mm(+) 10-19mm(+) 20mm(+) Super reaction :induration、vesic 、 local ulceration (+)。,11,特制内容,diagnosis,significance positive reaction After BCG vaccination Older children positive reaction indicate to be ever infected with TB before。 Inf

9、ant never BCG vaccination indicate new infection recent。 Strong positive reaction indicate there is activeness TB.。 from（-）to（+）、from 10mm ,or increase 6mm by activeness TB.。,12,特制内容,diagnosis,negative reaction never infection TB first Infect TB during 4-8 weeks false negative reaction，immune functi

10、on to be pressed down。 Wrong with test or PPD ineffective,13,特制内容,diagnosis,BCG Vaccination and natural infection positive reaction condition,14,特制内容,diagnosis,3 ： laboratory examination （1）find TB specimen：sputum、gastric juice、C.S.F、serous cavity liquid. method：smear、 fluorescent staining、 BACTEC s

11、ystem：culture for 2 weeks，test mycobacteria metabolism production，to distinguish TB and atypical .mycobacteria. L tubercle bacterium：mutation TB，form、construction、acid-fast staining different from common TB。Easy passing placenta，therapeutic inefficacy。,15,特制内容,diagnosis,（2）immunology and molecular b

12、iology test ELISA（酶联免疫吸附试验） ELIEP（酶联免疫电泳技术） DNA探针 PCR （聚合酶链式反应） 线条DNA探针杂交试验 ESR (血沉)。,16,特制内容,diagnosis,4 ： chest X-RAY To definite focus of infection position 、extent、category、activity condition。 To evaluate and follow up therapeutic efficacy 。 CT more clear to find the focus、 extent and spread con

13、dition。 5：bronchofiberscopy check：to definite Endotracheal membrane TB and tuberculosis of trachebronchial lymph nodes。 6：lymph node puncture smear or lymphaden biopsy to diagnosis。,17,特制内容,tuberculotherapy,general treatment nutrition、to take a rest。 avoiding to contact infection disease 。 Primarily

14、 TB treatment in out-patient clinic and regularity return visit 。 Report epidemic situation。,18,特制内容,tuberculotherapy,Treatmen target To kill Bacillus tuberculosis in focus to prevent disseminate。 therapeutic principle early treatment Reasonable dosage Combine medicine Regularity take drug to insist

15、 on whole course Segmenting treatment.,19,特制内容,tuberculotherapy,Anti-tuberculosis drugs Whole germicide：in acid and alkali，exterior and interior of cell can kill germ。(INH RFP) Half germicide：in acid or alkali environment kill cell interior or exterior TB，SM /PZA bacteriostatic：EMB（ethambutol) ETH(e

16、thionamide),20,特制内容,tuberculotherapy,new antituberculosis to Anti drug resistant Rifamate(contain INH 150mg RFP300mg) Rifater(INH,RFP PZA) old drug derivant：Rifapentine New chemicals：Dipasic，to delay resistant INH drug standard treatment： refer to asymptomatic primarily pulmonary tuberculosis usage：

17、INH+RFPEMB course of treatment 912 month.,21,特制内容,化疗方案,Two stage therapy refer to：activeness primarily pulmonary TB: acute miliary tuberculosis;brain TB; intensification therapy：（purpose） Combination 34 germicide drugs Longer 34mo、shorter 2mo。 continue treatment stage Combination two drugs to keep t

18、herapeutic effect for 1218mo.(longer rang)or 4mo. (Short-rang) 。,22,特制内容,化疗方案,short-range therapy WHO important strategy to cure tuberculosis mechanism of action is fast kill organism inner cell or out cell。 To sputum bacterium(-)，recovery fast ，recurrence less。 2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR,23,特制内容,

19、antituberculosis drugs,medicine dose adverse reaction INH 1020 多发性神经炎，肝损害 RFP 1015 可逆性肝损害，消化道症状。尿红色。 PZA 20-30 肝损害，高尿酸血症。 SM 1520 听神经损害,肾损害。 EMB 1520 球后视神经炎。,24,特制内容,Tuberculosis prevention,to control source of infection：smear(+) patient Pervasion BCG vaccination：to have an inoculation age is neonat

20、e. contraindication cellular immunity deficiency acute infectious disease convalescence stage Region eczema or general skin disease OT（+）,25,特制内容,Tuberculosis prevention,Drug prevention indication: 1 Close to contact open pulmonary tuberculosis in family 2 lower 3 years infant have not innoculation

21、BCG; but OT（+） 3 OT from（-）to （+）recently 4 OT(+) with toxic symptom 5 OT（+）and recently ill with measles or pertussis 6 OT（+）need long-term to take corticosteroids or immunodepressant,26,特制内容,Tuberculosis prevention,Approach 1 : INH 10mg/kg course of treatment 69mo. Approach 2 : INH+RFP(10mg/kg) course 3 mo.,27,特制内容,原发性肺结核（primary pulmonary tuberculosis),首次侵入肺部发生的原发感染 原发综合症（primary complex)原发病灶+局部病变淋巴结+淋巴管 支气管淋巴结结核 (胸腔内肿大淋巴结结核),28,特制内容,primary pulmonary tuberculosis,病理 部位:右侧肺上叶底部、下叶上部 基本病变：渗出（炎症细胞 单核细胞 纤维蛋白）、增殖（结核结节 结核肉芽肿）、坏死（干酪样坏死）。 炎症特征：上皮样细胞结节、langerhans细胞浸润,29,特制内容,primary pu