結(jié)核病總論英文

1、我國結(jié)核病的疫情狀況 WHO 93年宣布“全球結(jié)核病緊急狀態(tài)”，98 年又重申遏制結(jié)核病的行動刻不容緩。 全球現(xiàn)有結(jié)核病人2000萬，其中95在發(fā)展中 國家，每年還會新發(fā)生800-1000萬肺結(jié)核病， 其中75的病人年齡在1550歲。如不控制， 今后10年還將有9000萬人發(fā)病。 中國是全球22個結(jié)核病高負(fù)擔(dān)國家之一，結(jié)核 病人數(shù)位居世界第二位，僅次于印度. 據(jù)調(diào)查全國三分之一的人口已感染了結(jié)核菌； 受感染人數(shù)超過4億,受結(jié)核感染人群中有10 的人發(fā)生結(jié)核病 1 tuberculosis factor of tuberculosis incidence rising ： HIV spread.

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

3、d type、 mouse type 、 main human type。 way of infection：respiration tract、digestive track、skin or placenta. 3 Epidemiology 1 infection sources：open pulmonary tuberculosis 2 route of transmission: by respiration way or digestion tract. 3 susceptible population 4 Epidemiology The factors lead Children

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

5、ion、 proliferation and differentiationto produce alexin and oxidase 、 digestive enzymeto kill TB 6 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 reinfection TB and cause che

6、esy necrosis or hole formation After Infection TB : primary disease（5%）， Secondary disease （5%）, not to fall ill all live(90%) 7 diagnose Objective to discover focal 。 Definite disease character、size whether or not deliver bacterium。 8 diagnose 1 history TB toxic symptom to contact TB patient BCG va

7、ccination acute infection:measles，pertussis Supersensitivity erythema nodosum、exanthematous conjunctivitis。 9 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。 4872hr observation reaction。 10

8、diagnosis reaction 5mm(-) 5mm(+) 10-19mm(+) 20mm(+) Super reaction :induration、vesic 、 local ulceration (+)。 11 diagnosis significance positive reaction After BCG vaccination Older children positive reaction indicate to be ever infected with TB before。 Infant never BCG vaccination indicate new infec

9、tion recent。 Strong positive reaction indicate there is activeness TB.。 from（-）to（+）、from 10mm ,or increase 6mm by activeness TB.。 12 diagnosis negative reaction never infection TB first Infect TB during 4-8 weeks false negative reaction，immune function to be pressed down。 Wrong with test or PPD ine

10、ffective 13 diagnosis BCG Vaccination and natural infection positive reaction condition Result infectionBCG vaccination extent（1015mm) (59mm) to changeSlowly (710d)Faster 23d durationto last lifetimeto last 34 years formDeep red hardRed soft 14 diagnosis 3 ： laboratory examination （1）find TB specime

11、n：sputum、gastric juice、C.S.F、serous cavity liquid. method：smear、 fluorescent staining、 BACTEC system：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

12、TB。Easy passing placenta，therapeutic inefficacy。 15 diagnosis （2）immunology and molecular biology test ELISA（酶聯(lián)免疫吸附試驗） ELIEP（酶聯(lián)免疫電泳技術(shù)） DNA探針 PCR （聚合酶鏈?zhǔn)椒磻?yīng)） 線條DNA探針雜交試驗 ESR (血沉)。 16 diagnosis 4 ： chest X-RAY To definite focus of infection position 、extent、 category、activity condition。 To evaluate and

13、follow up therapeutic efficacy 。 CT more clear to find the focus、 extent and spread condition。 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 tuberculotherapy general tre

14、atment nutrition、to take a rest。 avoiding to contact infection disease 。 Primarily TB treatment in out-patient clinic and regularity return visit 。 Report epidemic situation。 18 tuberculotherapy Treatmen target To kill Bacillus tuberculosis in focus to prevent disseminate。 therapeutic principle earl

15、y treatment Reasonable dosage Combine medicine Regularity take drug to insist on whole course Segmenting treatment. 19 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 c

16、ell interior or exterior TB，SM /PZA bacteriostatic：EMB（ethambutol) ETH(ethionamide) 20 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 treat

17、ment： refer to asymptomatic primarily pulmonary tuberculosis usage：INH+RFPEMB course of treatment 912 month. 21 化療方案 Two stage therapy refer to：activeness primarily pulmonary TB: acute miliary tuberculosis;brain TB; intensification therapy：（purpose） Combination 34 germicide drugs Longer 34mo、shorter

18、 2mo。 continue treatment stage Combination two drugs to keep therapeutic effect for 1218mo.(longer rang)or 4mo. (Short-rang) 。 22 化療方案 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 fas

19、t ， recurrence less。 2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR 23 antituberculosis drugs medicine dose adverse reaction INH 1020 多發(fā)性神經(jīng)炎，肝損害 RFP 1015 可逆性肝損害，消化道癥 狀。尿紅色。 PZA 20-30 肝損害，高尿酸血癥。 SM 1520 聽神經(jīng)損害,腎損害。 EMB 1520 球后視神經(jīng)炎。 24 Tuberculosis prevention to control source of infection：smear(+) patient Pervasion BCG vaccination：to have an inoculation age is neonate. contraindication cellular immunity deficiency acute infectious disease convalescence stage Region eczema or general skin disease OT（+） 25 Tuberculosis prevention Drug prevention indication: 1 Close to contact open pulmonary tuberculo