【摘要】 目的 探讨粟粒性脑结核及与其需要鉴别疾病的MRI特点。 方法 2007年12月-2009年10月，对11例粟粒性脑结核患者的MRI平扫及增强表现进行分析，总结其MRI特征性表现。 结果 病史上粟粒性脑结核多存在血行播散型肺结核，平扫表现为多发小片影，增强后表现为弥漫分布的小环状或结节状强化灶，大小趋向一致，多为2 mm左右，可合并结核性脑膜炎及脑积水。 结论 粟粒性脑结核的MRI平扫表现不典型，增强表现有一定特征性，认识其特点可以和其它常见的颅内多发病变进行鉴别。【Abstract】 Objective To analyze the MRI appearances of cerebral military tuberculosis and other diseases that need to differentiate. Methods From December 2007 to October 2009, the MRI appearances of 11 cases on the plain scan and the enhanced MRI scan after injection of Gd-DTPA were reviewed and summarized. Results The cases of cerebral military tuberculosis usually had the history of military pulmonary tuberculosis, showed multiple lesions in fragments on plain scan, and the lesions distributed diffusely after enhancement, showed as ring form or nodosity. The size tended to be uniform, often 2 mm in diameter approximately. Tuberculosis meningitis and hydrocephalus could accompany. Conclusion The manifestation of plain MRI is not typical, and the enhancement MRI is imperative. Some characteristic appearances can be found after injection of Gd-DTPA, and these characteristic appearances could be helpful to differentiate with other multiple intracranial diseases.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
ObjectiveThe diagnostic efficacy of long non-coding RNA (lncRNA) for tuberculosis was evaluated by systematic review. MethodsData from PubMed, Web of Science, Cochrane Library, Embase, CMJFD, CNKI and WanFang Data were searched. Literatures on the diagnostic value of lncRNA in tuberculosis from the database establishment to August 20, 2024 were selected, and the quality of literatures was assessed using QUADAS-2 tool. Meta-Disc 1.0 software tested the threshold heterogeneity of the included studies. Stata 18.0 software calculated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and other effect sizes, and performed subgroup analysis and meta regression to explore the source of heterogeneity. Deeks funnel plot evaluates publication bias. Results A total of 28 case-control studies were included in 14 literatures. The meta-results showed that the combined sensitivity was 0.88 (95%CI 0.81 to 0.93), the specificity was 0.90 (95%CI 0.84 to 0.94), and the PLR was 9.05 (95%CI 5.16 to 15.87). The NLR and DOR were 0.13 (95%CI 0.08 to 0.22) and 67.96 (95%CI 27.27 to 169.39), and the AUC were 0.95 (95%CI 0.93 to 0.97). Subgroup analysis showed that lncRNA was more effective in the diagnosis of tuberculosis when PMBC samples, lncRNA expression was down-regulation, the study sample size was ≤100, there was cut-off value, GAPDH was used as the internal reference, and RNA extraction kit was used. meta regression indicated that lncRNA expression level and sample size were the main sources of heterogeneity. Conclusion LncRNA has high accuracy in the diagnosis of tuberculosis, and is expected to become a new biomarker to assist the diagnosis of tuberculosis.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
Objective To systematically review the treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients, and to provide evidence for treatment. Methods Databases including PubMed, Web of Science, ScienceDirect, CNKI, WanFang Data and VIP were electronically searched to collect literature related to MDR-TB from inception to April 28th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.0.5 software, subgroup and meta-regression analyses were performed based on sample size, survey time, etc. Results A total of 36 studies involving 7 981 patients were included. The results of meta-analysis showed that the overall treatment success rate of MDR-TB patients was 60% (95%CI 56% to 63%). The subgroup analysis showed that the treatment success rates of MDR-TB were 49% (95%CI 41% to 58%) from 1992 to 2010, 62% (95%CI 58% to 65%) from 2011 to 2015, and 62% (95%CI 55% to 68%) from 2016 to 2020; those with sample size above 100 and less than 100 were 60% (95%CI 55% to 65%) and 59% (95%CI 54% to 63%), respectively; those with average age above 45 and less than 45 were 58% (95%CI 51% to 65%) and 56% (95%CI 53% to 59%); those of MDR-TB were 63% (95%CI 57% to 68%) in central China, 63% (95%CI 52% to 73%) in the Northwest, 60% (95%CI 55% to 65%) in the Southeast, and 53% (95%CI 48% to 58%) in the Northeast. Conclusions The overall success rate of treatment for MDR-TB patients in China is low. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
Objective To evaluate the cl inical effectiveness and advantages of one-stage posterior debridement, bone graft, and internal fixation for thoracic tuberculosis. Methods The data were retrospectively analysed, from 21 cases of thoracic tuberculosis undergoing one-stage posterior debridement, bone graft, and internal fixation between June 2007 andNovember 2009. There were 16 males and 5 females with an average age of 42.2 years (range, 22-73 years). The average disease duration was 13.2 months (range, 7-21 months). The lesions were located at the level of T5, 6 (1 case), T6, 7 (1 case), T8, 9 (4 cases), T9, 10 (3 cases), T10, 11 (5 cases), T11, 12 (6 cases), and T9-11 (1 case). According to the Frankel grading criterion, the neurological function was rated as grade B in 2 cases, grade C in 6 cases, grade D in 10 cases, and grade E in 3 cases. The preoperative Cobb angle was (26.3 ± 9.2)°. The erythrocyte sedimentation rate (ESR) was (35.9 ± 11.2) mm/ 1 hour. Results Thoracic tuberculosis was confirmed in postoperative pathological examination in all 21 cases. All incisions healed primarily without fistules formation. The average follow-up time for 21 patients was 16.2 months (range, 1-3 years). Bony fusion was achieved within 7-12 months (mean, 9 months) without pseudoarthrosis. No loosening and breakage of internal fixation were found, and no local recurrence occurred. The ESR decreased to (25.1 ± 8.9) mm/1 hour at 1 week postoperatively, showing significant difference when compared with preoperative value (t=5.935, P lt; 0.01); it decreased to (14.1 ± 4.6) mm/1 hour at 3 months postoperatively. According to Frankel grade, the neurological function was significantly improved at 1 year after operation (χ2=13.689, P=0.003). The average Cobb angle was (17.1 ± 4.5)° at 1 years postoperatively, showing significant difference when compared with preoperative value (t=7.476, P lt; 0.01). Conclusion One-stage posterior debridement, bone graft, and internal fixation has a good cl inical effectiveness for thoracic tuberculosis with less injury and complete focal cleaning, as well as a goodeffectiveness of spinal canal decompression and kyphosis deformity correction.