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. tb s

2、train 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 、 bird ty

3、pe、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 population4特制内容epidemiology the factors lead children i

4、ll with tb contact tb amounts and toxicity. power of resistance . hereditary factor .5特制内容pathogenesybacterial 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 tb6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 reinfection tb and cause ch

6、eesy 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 to contact tb patient b

7、cg 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。 4872hr observation reacti

8、on。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。 infant never bcg vaccination indicat

9、e 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 function to be pressed down。 wrong with te

10、st or ppd ineffective13特制内容diagnosis bcg vaccination and natural infection positive reaction conditionresult infectionbcg vaccinationextent（1015mm) (59mm)to changeslowly (710d)faster 23ddurationto last lifetimeto last 34 yearsformdeep red hardred soft14特制内容diagnosis3 ： laboratory examination（1）find

11、tb specimen：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 fro

12、m common tb。easy passing placenta，therapeutic inefficacy。15特制内容diagnosis（2）immunology and molecular biology 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diagnosis4 ： chest x-ray to definite focus of infection position 、extent、category、activity condition。 to eva

13、luate and 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特制内容tuberculotherapy g

14、eneral treatment 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特制内容tuberculotherapy treatmen target to kill bacillus tuberculosis in focus to prevent disseminate。 therapeutic pr

15、inciple early treatment reasonable dosage combine medicine regularity take drug to insist 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 envi

16、ronment kill cell interior or exterior tb，sm /pza bacteriostatic：emb（ethambutol) eth(ethionamide)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 dru

17、g standard treatment： refer to asymptomatic primarily pulmonary tuberculosis usage：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 l

18、onger 34mo、shorter 2mo。 continue treatment stage combination two drugs to keep therapeutic 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 bacte

19、rium(-)，recovery fast ，recurrence less。 2hrz/4hr、2shrz/4hr、2ehrz/4hr23特制内容antituberculosis drugsmedicine 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(+) pat

20、ient pervasion bcg vaccination：to have an inoculation age is neonate. contraindicationcellular immunity deficiencyacute infectious disease convalescence stageregion eczema or general skin diseaseot（+）25特制内容tuberculosis preventiondrug prevention indication: 1 close to contact open pulmonary tuberculosis in family 2 lowe