《结核病总论英文》PPT课件

我国结核病的疫情状况,WHO93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,tuberculosis,factoroftuberculosisincidencerising：HIVspread.TBstrainoccurdrugresistance.fluidpopulationincreasing.ManagementTBpatientnotperfect、preventionandcurenotefficiency.Poverty、populationincreasing.,2,etiology,Mycobacterium、Acidfastness、G+、aerobe。Growthtorpidity,cultureneed4-6weeks.Typing:humantype、bovinetype、Birdtype、mousetype、mainhumantype。wayofinfection：respirationtract、digestivetrack、skinorplacenta.,3,Epidemiology,1infectionsources：openpulmonarytuberculosis2routeoftransmission:byrespirationwayordigestiontract.3susceptiblepopulation,4,Epidemiology,ThefactorsleadChildrenillwithTBContactTBamountsandtoxicity.powerofresistance.hereditaryfactor.,5,pathogenesy,bacterialnumber、toxicity、immunizationconditionCell-mediatedimmunereaction:macrophageswallowTBantigenpresentationThandmacrophageIL12CD+4TH1-IF-topromotemononuclearcell;togather、activation、proliferationanddifferentiationtoproducealexinandoxidase、digestiveenzymetokillTB,6,pathogenesy,IF-reinforcementCD+8、NKcellsactivitytophagocytosisTB.meanwhiletoleadhistoclasiadelayedallergy:Tcellmedia，macrophagetobeeffectorcell，tokillreinfectionTBandcausecheesynecrosisorholeformationAfterInfectionTB:primarydisease（5%），Secondarydisease（5%）,nottofallillalllive(90%),7,diagnose,Objectivetodiscoverfocal。Definitediseasecharacter、sizewhetherornotdeliverbacterium。,8,diagnose,1historyTBtoxicsymptomtocontactTBpatientBCGvaccinationacuteinfection:measles，pertussisSupersensitivityerythemanodosum、exanthematousconjunctivitis。,9,diagnose,2：OTtestagent：1/2000or1/10000PPDdose：0.1ML（OT5U）（or1U）。position：leftforearmpalmarisbelow1/3Infuseintracutaneousform6-10mmhillock。4872hrobservationreaction。,10,diagnosis,reaction6mmbyactivenessTB.。,12,diagnosis,negativereactionneverinfectionTBfirstInfectTBduring4-8weeksfalsenegativereaction，immunefunctiontobepresseddown。WrongwithtestorPPDineffective,13,diagnosis,BCGVaccinationandnaturalinfectionpositivereactioncondition,14,diagnosis,3：laboratoryexamination（1）findTBspecimen：sputum、gastricjuice、C.S.F、serouscavityliquid.method：smear、fluorescentstaining、BACTECsystem：culturefor2weeks，testmycobacteriametabolismproduction，todistinguishTBandatypical.mycobacteria.Ltuberclebacterium：mutationTB，form、construction、acid-faststainingdifferentfromcommonTB。Easypassingplacenta，therapeuticinefficacy。,15,diagnosis,（2）immunologyandmolecularbiologytestELISA（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,diagnosis,4：chestX-RAYTodefinitefocusofinfectionposition、extent、category、activitycondition。Toevaluateandfollowuptherapeuticefficacy。CTmorecleartofindthefocus、extentandspreadcondition。5：bronchofiberscopycheck：todefiniteEndotrachealmembraneTBandtuberculosisoftrachebronchiallymphnodes。6：lymphnodepuncturesmearorlymphadenbiopsytodiagnosis。,17,tuberculotherapy,generaltreatmentnutrition、totakearest。avoidingtocontactinfectiondisease。PrimarilyTBtreatmentinout-patientclinicandregularityreturnvisit。Reportepidemicsituation。,18,tuberculotherapy,TreatmentargetTokillBacillustuberculosisinfocustopreventdisseminate。therapeuticprincipleearlytreatmentReasonabledosageCombinemedicineRegularitytakedrugtoinsistonwholecourseSegmentingtreatment.,19,tuberculotherapy,Anti-tuberculosisdrugsWholegermicide：inacidandalkali，exteriorandinteriorofcellcankillgerm。(INHRFP)Halfgermicide：inacidoralkalienvironmentkillcellinteriororexteriorTB，SM/PZAbacteriostatic：EMB（ethambutol)ETH(ethionamide),20,tuberculotherapy,newantituberculosistoAntidrugresistantRifamate(containINH150mgRFP300mg)Rifater(INH,RFPPZA)olddrugderivant：RifapentineNewchemicals：Dipasic，todelayresistantINHdrugstandardtreatment：refertoasymptomaticprimarilypulmonarytuberculosisusage：INH+RFPEMBcourseoftreatment912month.,21,化疗方案,Twostagetherapyreferto：activenessprimarilypulmonaryTB:acutemiliarytuberculosis;brainTB;intensificationtherapy：（purpose）Combination34germicidedrugsLonger34mo、shorter2mo。continuetreatmentstageCombinationtwodrugstokeeptherapeuticeffectfor1218mo.(longerrang)or4mo.(Short-rang)。,22,化疗方案,short-rangetherapyWHOimportantstrategytocuretuberculosismechanismofactionisfastkillorganisminnercelloroutcell。Tosputumbacterium(-)，recoveryfast，recurrenceless。2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR,23,antituberculosisdrugs,medicinedoseadversereactionINH1020多发性神经炎，肝损害RFP1015可逆性肝损害，消化道症状。尿红色。PZA20-30肝损害，高尿酸血症。SM1520听神经损害,肾损害。EMB1520球后视神经炎。,24,Tuberculosisprevention,tocontrolsourceofinfection：smear(+)patientPervasionBCGvaccination：tohaveaninoculationageisneonate.contraindicationcellularimmunitydeficiencyacuteinfectiousdiseaseconvalescencestageRegioneczemaorgeneralskindiseaseOT（+）,25,Tuberculosisprevention,Drugpreventionindication:1Closetocontactopenpulmonarytuberculosisinfamily2lower3yearsinfanthavenotinnoculationBCG;butOT（+）3OTfrom（-）to（+）recently4OT(+)withtoxicsymptom5OT（+）andrecentlyillwithmeaslesorpertussis6OT（+）needlong-termtotakecorticosteroidsorimmunodepressant,26,Tuberculosisprevention,Approach1:INH10mg/kgcourseoftreatment69mo.Approach2:INH+RFP(10mg/kg)course3mo.,27,原发性肺结核（primarypulmonarytuberculosis),首次侵入肺部发生的原发感染原发综合症（primarycomplex)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,primarypulmonarytuberculosis,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,primarypulmonarytuberculosis,病理转归吸收好转进展扩大出现空洞支气管内膜结核或干酪性肺结核肿大