結(jié)核醫(yī)學課件與結(jié)核抗爭

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1、上海市(復旦大學附屬)公共衛(wèi)生臨床中心復旦大學附屬華山醫(yī)院盧洪洲與結(jié)核抗爭結(jié)核桿菌的發(fā)現(xiàn)TBincidence,2009(WHO)(WHO,2008)WHO,2008WHO,2008EstimatedTBcasesnotdetectedin2009(McNerneyandDaley,NatMed,2011)SpreadofBeijingcladeofM.tuberculosis影響中國結(jié)核發(fā)病率的關(guān)鍵因素人口流動問題？耐藥結(jié)核？艾滋病合并結(jié)核？診斷問題？潛伏感染活動？……高度人口流動每年流動人口人次達兩億兩千萬:主要從農(nóng)村到城市，以青、壯年為主每年出國旅游達幾百萬;國內(nèi)旅游有六億六千萬每

2、年從海外入境人數(shù)兩千萬經(jīng)常有短期內(nèi)大量人口聚集活動,例如2010上海Expo，來上海參加人數(shù)達七千三百萬之多耐藥結(jié)核Multidrug-resistant(MDR)tuberculosisisdefinedasdiseasecausedbystrainsofMycobacteriumtuberculosisthatareatleastresistanttotreatmentwithisoniazidandrifampicin.Extensivelydrug-resistant(XDR)tuberculosisreferstodiseasecausedbymultidrug-resista

3、ntstrainsthatarealsoresistanttotreatmentwithanyfluoroquinoloneandanyoftheinjectabledrugsusedintreatmentwithsecond-lineanti-tuberculosisdrugs(amikacin,capreomycin,andkanamycin)截至2009，報道過泛耐藥結(jié)核的國家Theboundariesandnamesshownandthedesignationsusedonthismapdonotimplytheexpressionofanyopinionwhatsoeveron

4、thepartoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.?WHO2009.Allrightsreserved耐藥結(jié)核的治療TBEpidemicDOT

5、SHIVEpidemicHIV合并結(jié)核感染估計的HIV/TB患者地理分布圖KennethMayer.CID.2010PoorlyFormedtoNoSignificantGranulomaFormationinSeverelyImmunosuppressedHIV(+)ComparedtowellFormedGranulomasinHIV(-)TBinHIV結(jié)核菌素試驗TuberculinTest>5mmisclassifiedaspositiveinHIV-positivepersonsFalsenegativeinlateHIVstageandoverwhelmingTBdiseas

6、eFalsepositive:InfectedwithMycobacteriaotherthanTB,e.g,MACBCGvaccination對HIV/TB感染診斷的意義有限免疫學診斷方法：ELISPOTAfairlysensitivemethodtodiagnoseHIV/TBCanbeusedtodetectlatentTBinHIV-infectedpatientsCanbeinfluencedbyCD4counts?CandistinguishMTBfromothermycobacterialinfectionorpreviousBCGvaccinationT-SPOT(ELI

7、SPOT)testESAT-6andCFP-10:twocommonusedmycobacterialtuberculosisantigens分子生物學診斷方法：Nucleicacidamplification(NAA)testMTB/RIF的快速分子診斷WHO建議的HIV/TB合作內(nèi)容預防HIV/TB異煙肼預防治療(IPT)診斷(ICF)感染控制(IC)抗反轉(zhuǎn)錄病毒治療（ART）3I’SLTBINewinpatientsandou