环介导等温扩增技术在检测痰标本结核分枝杆菌中的应用

目的评价结核分枝杆菌环介导等温扩增技术（LAMP）快速检测试剂盒的临床应用效果。方法选取肺结核患者183例（肺结核组）和非肺结核患者120例（对照组）。采用涂片抗酸染色、罗氏培养法和LAMP对痰标本进行检测，采用结核分枝杆菌核酸扩增荧光检测试剂盒（TB- PCR）检测罗氏培养与LAMP结果不符的标本，分析LAMP与罗氏培养的检出率及两者的符合率。结果去除经鉴定为非结核分枝杆菌的10例标本，涂片抗酸染色、罗氏培养法和LAMP的阳性检出率分为64.1%（111/173）、64.7%（112/173）、78.6%（136/173）。LAMP与抗酸染色、罗氏培养阳性检出率的差异有统计学意义（P＜0.01）,抗酸染色与罗氏培养比较差异无统计学意义（P＞0.05）。以罗氏培养为金标准，LAMP检测的灵敏度、特异度、阳性预测值和阴性预测值分别为88.5%（108/122）、82.3%（149/181）、77.1%（108/140）、91.4%（149/163），LAMP检测与罗氏培养的符合率为84.8%（257/303）。结论结核分枝杆菌环介导等温扩增技术的灵敏度和特异度高，具有简单易行、快速准确的特点,在肺结核患者的早期诊断中将发挥重要作用。     

免疫功能正常的进展性播散型组织胞浆菌病1例

患者男,75岁,农民。因“畏寒、发热伴咳嗽、胸痛1个月”入院。患者1个月前出现畏寒、发热伴咳嗽、胸痛,最高体温39℃,疼痛以胸骨下及左侧胸部为主,深呼吸加重。2012-12-04当地医院胸部CT检查示：右肺上叶纤维硬结灶、右下肺感染性病变,左上肺及右下肺可见散在小结节影;血常规：红细胞2.31×1012/L,血红蛋白69g/L。住院期间给予哌拉西林三唑巴坦针抗感染治疗,症状未见好转,2012-12-10转入我科,查体：T37.8℃、BP128/72mmHg;神志清晰,消瘦明显,全身皮肤黏膜无黄染及皮疹、出血点,浅表淋巴结无肿大,颈软,颈静脉无怒张,桶状胸,胸骨中段压痛明显,两肺未闻及干湿性啰音,心率96次/min,律齐,各瓣膜听诊区未闻及明显病理性杂音。腹平软,肝脾肋下未及,双肾区无叩痛,双下肢无浮肿,双侧巴氏征（-）。患者有吸烟史40年,1包/d,近来吸烟较前减少,有饮酒史,否认食物药物过敏史,否认肝炎及结核等传染病史,曾经从事山货贩卖数年。入院后给予头孢吡肟针静脉滴注抗感染治疗,同时联合化痰等对症支持治疗。入院后进一步完善相关检查,血常规：白细胞11.5×109/L,中性粒细胞68.20%,淋巴细胞14.50%,嗜酸性粒细胞6.80%,红细胞2.50×1012/L,血红蛋白74g/L,红细胞压积0.21;C 反应蛋白74.50mg/L;红细胞沉降率＞140mm/h;肝肾功能基本正常;白蛋白24.3g/L,球蛋白38.2g/L;抗结核抗体阳性;大、小便常规、急诊肌钙蛋白、血凝常规、肿瘤指标、抗核抗体、肝炎抗体、抗HIV抗体、梅毒抗体均无异常;总IgE 3765.00IU/ml;T淋巴细胞亚群CD4/CD81.90;腹部B超检查肝、脾未见肿大,肾上腺未见占位;心电图显示窦性心律。入院当天由于患者胸痛明显,急诊胸部增强CT检查显示：肺门及右下肺斑片影,肿瘤考虑;两肺感染性病变伴少量支气管扩张;双侧胸膜病变,右侧少量胸腔积液;右侧肩胛骨及胸骨中段骨质缺损,转移灶考虑（图1、2）。入院第2天行胸骨病变部位穿刺针吸涂片检查结果提示：涂片内大量脓性渗出组织中见小块状红染坏死样物及数个多核细胞,结核性炎首先考虑。由于入院后抗感染治疗1周体温未见明显下降,多次痰涂片找抗酸杆菌及癌细胞菌阴性,痰培养未见致病菌,于2012-12-17行纤维支气管镜检查,见右下叶支气管开口脓性分泌物,吸出后管腔通畅,分泌物及刷片、灌洗液检查未见异常;胸腰椎MRI检查示：胸腰骶椎及部分附件、双侧骶髂关节多发异常信号,转移首先考虑;头颅MRI检查显示老年性脑改变,骨骼ECT检查显示：胸骨、右侧锁骨、双侧多根肋骨、右侧肩胛骨、胸腰椎、右侧骶髂关节、右侧髋骨、左坐骨、右股骨上段示踪剂分布浓聚,提示骨转移灶存在。由于不能排除肺癌骨转移及血液系统恶性肿瘤,分别于19日、24日行经皮肺穿刺、右肩胛骨病变部位穿刺及骨穿检查。骨髓涂片显示：粒系增生活跃,红系增生减低;骨髓活检显示造血组织增生底下。肺穿刺及肩胛骨穿刺组织病理提示：肺组织内见多量泡沫状细胞聚集,胞浆内可见PAS染色阳性之红色小孢子（图4、5）,病变符合组织胞浆菌感染。2013-01-01给予伊曲康唑针静脉滴注（前3天0.2g,2次/d,此后0.2g,1次/d）抗真菌治疗;治疗后体温逐渐恢复正常,14d后复查血常规：白细胞8.0×109/L,中性粒细胞76.80%,淋巴细胞12.00%,嗜酸性粒细胞4.10%;14d后给予伊曲康唑片0.2g,2次/d口服治疗,服药时与可乐同服。患者出院后一直门诊随诊,体温正常,2013-03-14复查胸部CT显示右下肺病灶明显吸收,仅遗留少许纤维条索病灶（图3）,复查总IgE 2753.00I-U/ml,较前明显下降。     

Mathematical model on pulmonary and multidrug-resistant tuberculosis patients with vaccination

Tuberculosis is a global epidemic disease and almost two billion people across the globe are infected with the tuberculosis bacilli. Many countries like China, Europe and United States has achieved dramatic decrease in TB mortality rate but country like India is still struggling hard to control this epidemic. Jharkhand one of the states of India is highly epidemic toward this disease. We propose a mathematical model to understand the spread of tuberculosis disease in human population for both pulmonary and drug-resistant subjects. A number of new vaccines are currently in development. Keeping in mind, vaccination as one of the treatment for TB patients may be infant or adult in future; an assumption for the transfer of proportion of susceptible population to the vaccination class is considered. Quarantine class is also considered in our epidemic model for multidrug-resistant patients, and it is observed that it may play a vital role for controlling the disease. Threshold and equilibria are obtained and the condition for epidemic under different conditions of threshold is established. Real parametric values of the Jharkhand state are taken into account to simulate the system developed, and the results so obtained validate our analytical results.     

Can HIV invade a population which is already sick?

It is known that an HIV infection when concomitant with another disease such as tuberculosis or pneumonia is a lot more lethal than HIV alone. We introduce two mathematical models for which if the concomitant diseases are prevalent enough in a given population and if double infections are lethal enough then HIV cannot take hold in this population. This provides an alternative (or a complement) to the theory that what determines whether a population will suffer an HIV epidemic is its sexual behavior. Our point of view may be relevant to the situation in Southeast Asia.     

COPD急性加重合并活动性肺结核患者的危险因素及临床特征分析

目的分析慢性阻塞性肺疾病（COPD）急性加重合并活动性肺结核患者的危险因素及临床特征,以指导临床治疗。方法选取COPD急性发作合并活动性肺结核患者42例（合并组）及同期单纯COPD急性发作的患者72例（对照组）,比较两组患者的临床特征,并采用单因素分析及logistic回归分析其危险因素。结果两组患者的部分临床特征有统计学差异（均P＜0.05）。单因素分析表明,吸烟史、营养不良、长期吸入糖皮质激素史及既往有肺结核史是COPD急性发作合并活动性肺结核的主要危险因素（均P＜0.05）。多因素分析发现,营养不良（OR=4.100,95%CI：1.471～11.431）、长期吸入糖皮质激素史（OR=2.695,95%CI：1.078～6.739）及既往肺结核史（OR=11.102,95%CI：3.076～40.065）为独立危险因素（均P＜0.05）。结论根据危险因素早期识别合并活动性肺结核的高危COPD患者,可尽早明确诊断,给予积极治疗。     

Mathematical analysis of a model for the transmission dynamics of bovine tuberculosis

A deterministic model for studying the transmission dynamics of bovine tuberculosis in a single cattle herd is presented and qualitatively analyzed. A notable feature of the model is that it allows for the importation of asymptomatically infected cattle (into the herd) because re‐stocking from outside sources. Rigorous analysis of the model shows that the model has a globally‐asymptotically stable disease‐free equilibrium whenever a certain epidemiological threshold, known as the reproduction number, is less than unity. In the absence of importation of asymptomatically infected cattle, the model has a unique endemic equilibrium whenever the reproduction number exceeds unity (this equilibrium is globally asymptotically stable for a special case). It is further shown that, for the case where asymptomatically infected cattle are imported into the herd, the model has a unique endemic equilibrium. This equilibrium is also shown to be globally asymptotically stable for a special case. Copyright © 2011 John Wiley & Sons, Ltd.     

具有年龄结构的结构病模型的研究

根据结核病的传染特征，建立了一个具有年龄结构的结核病微分方程模型，对模型的性态进行了分析，得到了该模型平衡解唯一存在的条件。     

脊椎结核患儿手术后发生喉水肿的因素分析

姜虹，周高岚．脊椎结核患儿手术后发生喉水肿的因素分析．数理统计与管理，１９９８，１７（３），１～３．根据数量化理论Ⅱ和４６３例患儿的临床研究，分析了脊椎结核患儿手术后发生喉水肿的主要原因，为今后的医疗实践提供了依据，证实了数量化理论Ⅱ的应用价值     

基于灰色预测模型的新疆肺结核疫情分析

借助灰色系统理论对新疆2004-2010年肺结核发病率进行研究,建立不同维度的静态GM(1,1)模型与动态等维递补灰预测模型对数据进行模拟和预测.针对新疆肺结核疫情发病率数据,探索建立新疆肺结核疫情传播预测模型,为肺结核防治提供科学依据.     

Tuberculosis model with relapse via fractional conformable derivative with power law

The present study explores the tuberculosis dynamics with relapse with a nonlocal conformable derivative in the Caputo sense. The real data of tuberculosis cases since 2002 to 2017 are used to the set the parameters. The numerical results with the realistic parameters are chosen and present the graphical results. Further, we assign different values to the fractional parameters α and β and discuss its effect on the system variables. The use of these two fractional operators on the model simultaneously with realistic data gives reliable results.     

Estimation of the number of components of finite mixtures of multivariate distributions

An estimator of the number of components of a finite mixture ofk-dimensional distributions is given on the basis of a one-dimensional independent random sample obtained by a transformation of ak-dimensional independent random sample. A consistency of the estimator is shown. Some simulation results are given in a case of finite mixtures of two-dimensional normal distributions.