原发型肺结核.ppt

发病数居前五位的病种为：发病数居前五位的病种为：肺结核肺结核、乙型肝炎、乙型肝炎、梅毒、丙肝梅毒、丙肝 、痢疾，占发病总数的、痢疾，占发病总数的90.06%90.06%死亡数居前五位的病种为：艾滋病、死亡数居前五位的病种为：艾滋病、肺结核肺结核、狂、狂犬病、乙型肝炎、丙肝，占死亡总数的犬病、乙型肝炎、丙肝，占死亡总数的91.05%91.05%。卫生部卫生部 2002009 9年年3 3月月1010日日2009年2月全国法定传染病疫情报告（2002009 9年年2 2月月1 1日零时至日零时至2 2月月2828日日2424时）时）1 1发病数居前五位的病种为：发病数居前五位的病种为：肺结核肺结核乙型肝炎、乙型肝炎、麻疹、梅毒、痢疾，占发病总数的麻疹、梅毒、痢疾，占发病总数的88.40%88.40%死亡数居前五位的病种为：艾滋病、死亡数居前五位的病种为：艾滋病、肺结核肺结核、狂、狂犬病、乙型肝炎、流脑，占死亡总数的犬病、乙型肝炎、流脑，占死亡总数的88.82%88.82%。卫生部卫生部 2002008 8年年3 3月月1010日日2008年2月全国法定传染病疫情报告（2002008 8年年2 2月月1 1日零时至日零时至2 2月月2828日日2424时）时）2 2发病数居前五位的病种为：发病数居前五位的病种为：肺结核肺结核、乙型肝炎、乙型肝炎、梅毒、痢疾、麻疹梅毒、痢疾、麻疹，占报告发病总数的占报告发病总数的86.89%86.89%死亡数居前五位的病种为：狂犬病、死亡数居前五位的病种为：狂犬病、肺结核肺结核、乙、乙型肝炎、艾滋病、流脑，占报告死亡总数的型肝炎、艾滋病、流脑，占报告死亡总数的8 89.58%9.58%。卫生部卫生部 2002007 7年年3 3月月1 12 2日日2007年2月全国法定传染病疫情报告（2002007 7年年2 2月月1 1日零时至日零时至2 2月月2828日日2424时）时）3 32002007年与年与2002006年相比年相比与与20062006年相比，年相比，20072007年甲乙类传染病中，呼吸道传染病年甲乙类传染病中，呼吸道传染病和血源及性传播传染病报告发病率分别上升和血源及性传播传染病报告发病率分别上升3.55%3.55%和和6.96%6.96%。呼吸道传染病中的呼吸道传染病中的猩红热猩红热和和麻疹麻疹上升幅度较大，病例数分别上升了上升幅度较大，病例数分别上升了20.61%20.61%和和8.88%8.88%；血源及性传播传染病中的血源及性传播传染病中的艾滋病艾滋病、丙肝丙肝和和梅毒梅毒上升幅度较大，病例数分上升幅度较大，病例数分别上升了别上升了45.04%45.04%、30.01%30.01%和和24.09%24.09%。自然疫源及虫媒传染病和肠道传染病报告发病数分别较自然疫源及虫媒传染病和肠道传染病报告发病数分别较20062006年下降年下降19.20%19.20%和和9.19%9.19%。4 4Primary Pulmonary Tuberculosis5 5Three landmark-Three landmark-human control TBhuman control TBn nMar,1882 Robert Koch(Germany)Mar,1882 Robert Koch(Germany)n nEffective Effective chemotherapeuticschemotherapeutics（1944194419441944SMSM；1950 INH 1950 INH）nProtocols in Molecular Biology used in TB researchSignificant progress in chemotherapyGreatly improveefficacy Overview6 6T Tuberculoticuberculotic current situationcurrent situationn nAIDS and TB co-infection about 40-50%AIDS and TB co-infection about 40-50%n nAIDS and TB AIDS and TB Showed adverse effects on each otherShowed adverse effects on each otherHIVHIV lead to Potential TBTB expose and deteriorate TB become an early complication after infected with HIVTB become an early complication after infected with HIVTB TB lead to AIDSAIDS progression and deathMost died of Pneumocystis carinii diseasebacterial pneumoniaMost died of Pneumocystis carinii disease,bacterial pneumoniaa few died of TBa few died of TB Overview7 7Tuberculotic immunizationCellular immunityCellular immunityIncidence of infection depends on：Amount,flora,toxicum of bacterialImmune function of bodyAffectability（genetic factor)：Patient with Antigen Patient with Antigen HLA-Bw35HLA-Bw35,incidence of,incidence of TBTB (relative risk 7.38),(relative risk 7.38),TBM TBM(relative risk 15.21)(relative risk 15.21)Overview8 8Classification of TB primary pulmonary tuberculosisprimary pulmonary tuberculosis（l l型）型）Hematogenous disseminated pulmonary Hematogenous disseminated pulmonary tuberculosistuberculosis（ll ll型）型）Secondary pulmonary TuberculosisSecondary pulmonary Tuberculosis（llllll型）型）Tuboerculus pleurisy;tuberculous pleuritisTuboerculus pleurisy;tuberculous pleuritis（lVlV型）型）Extrapulmonary tuberculosis Extrapulmonary tuberculosis（V V型）型）9 9Primary Pulmonary Tuberculosis ：one of the one of the most commonmost common clinical type in children clinical type in childrenprimary infectionprimary infection Primary Pulmonary Tuberculosis ：Primary ComplexPrimary Complex Tuberculosis of Bronchial Lymph nodesTuberculosis of Bronchial Lymph nodes1010Primary complex原发综合征primary lesionslymphangitisLymphadenitis1111 Tuberculosis of Bronchial Lymph nodes 支气管淋巴结结核 （胸内淋巴结结核）The scope of primary lesions areThe scope of primary lesions are small or has been small or has been absorbedabsorbed1212 PathologyuLocation:Location:u Right-Sided Mostly，Subpleuralu bottom of lobus superior pulmonisu upside of lobus inferior pulmonisubasic lesion basic lesion：Exudative lesions Exudative lesions(渗出)Proliferative lesions Proliferative lesions(增殖)Caseous necrosis(坏死)1313Chief Pathology characteristic:Epithelioid cells nodulesLangerhans cellular infiltration A high degree of allergy status in child A high degree of allergy status in childExtensive inflammatory around lesionsExtensive inflammatory around lesionsThe younger,the more obvious large lesionsThe younger,the more obvious large lesionsresult1414uPathological prognosisPathological prognosis1 1）AbsorptionAbsorptionComplete absorption、Calcificationor Scleroma Calcified lesions occur Calcified lesions occur at leastat least 6 to 12 months 6 to 12 months 2 2）progressionprogressionExpand lesionsBronchial lymph fistulaAtelectasis、EmphysemaTuberculous pleurisy3 3）DeteriorationDeterioration Hematogenous dissemination1515、clinical manifestation()symptom：1 1、feverfever 2 2、PoisoningPoisoning symptoms of TB anorexia、acratia、Sweating（盗汗）（盗汗）3 3、respiratory symptomrespiratory symptom Little，May have a dry cough Performance in a serious conditionPerformance in a serious condition：cough，A large number of sputum，hemoptysis，dyspnea1616 4 4、Oppression symptomOppression symptom：Oppress Recurrent Laryngeal Nerve HoarsenessOppress trachea,bronchus Cough,Wheeze（喘鸣）、Expiratory or Inspiratory obstructionOppress veins Puffiness of faceOppress phrenic nerve Nausea,vomiting,hiccup、clinical manifestation1717、clinical manifestation()signsPulmonary signs:less Extra-pulmonary Signs：Herpes conjunctivitisHerpes conjunctivitis、Skin erythema nodosumSkin erythema nodosum oror Multiple one-off arthritisMultiple one-off arthritis1818、diagnoseSignificance of early diagnosisSignificance of early diagnosis()HistoryHistory：Asked in detail aboutAsked in detail about:History of exposure and BCG vaccination,History of exposure and BCG vaccination,History of infectious diseases History of infectious diseasesNotice nutritional state,immune function()clinical manifestation1919()PPD-TestPPD-Test PPDPPD（Protein Purified DerivativeProtein Purified Derivative）纯蛋白衍化物纯蛋白衍化物Method：intradermal injections 0.10.1ml ml(皮内注射皮内注射)（含含5 5个结核菌素单位）个结核菌素单位）、diagnose2020()PPD-TestPPD-Test-positive clinical significance:PPD-Test-positive clinical significance:After BCG vaccinationAfter BCG vaccinationHave been infected with TBHave been infected with TBSuffering from tuberculosis,there is a new disease activitySuffering from tuberculosis,there is a new disease activityClinical cure,TB is not deadClinical cure,TB is not deadFrom negative to positive or the level of the reaction From negative to positive or the level of the reaction 20mm 20mm，And an increase 6mm,And an increase 6mm,show that show that there is newly infectedthere is newly infected广泛推行BCG接种后，PPD试验的诊断价值受到一定限制2121()PPD-TestPPD-Test-negative clinical significancePPD-Test-negative clinical significance：Not infected with TBNot infected with TB In pre-allergic stage:after the initial infection 4 8 weeksIn pre-allergic stage:after the initial infection 4 8 weeks Immune system hypofunction or temporary interference.Immune system hypofunction or temporary interference.(False negative)(False negative)PPD expired or technical misconduct.PPD expired or technical misconduct.2222()X-ray examinationX-ray examination 1 1 1 1、Primary complexPrimary complex ：Primary lesion、Cord-like lymphatic vesselsSwollen lymph nodes、diagnose2323原发综合症 女，3岁，初染病灶在右上叶基部，支气管淋巴结肿大2424()X-ray examination2 2、Tuberculosis of Bronchial Lymph nodesTuberculosis of Bronchial Lymph nodes ：Cancer typeCancer type（nodular type）2525左侧支气管淋巴结结核肿瘤型女，6岁。母有开放性肺TB，病史2年2626()X-ray examination 2 2、Tuberculosis of Bronchial Lymph nodesTuberculosis of Bronchial Lymph nodes ：Infiltrating type（Inflammation type）2727右侧支气管淋巴结结核浸润型女，5岁。脑脊液呈典型TBM改变2828支气管淋巴结结核伴发淋巴结周围炎2929()other auxiliary examination1、Finding tubercle bacillus in sputum or gastric juice2、Superficial lymph node biopsy3、Peripheral blood4、ESR 5、Flexible bronchofiberscope examination6、Antibody of TB、diagnose3030、Differential Diagnosis1 1、before Chest X-ray inspectionbefore Chest X-ray inspectionURI、tracheitis、rheumatic fever2 2、After Chest X-ray inspectionAfter Chest X-ray inspectionpneumonia、bronchiectasis3131、treatmentprincipleprinciple：early,combine,appropriate amount,regularity、whole rangeUntreated TB:Untreated TB:at least 10 persons/per 100 persons at least 10 persons/per 100 persons resistant for a anti-TB drug,there is at least 1 person/per resistant for a anti-TB drug,there is at least 1 person/per 100 persons resistant for MDR-TB(multi-drug resistant).100 persons resistant for MDR-TB(multi-drug resistant).Re-treated TBRe-treated TB(previous accepted anti-TB treatment more (previous accepted anti-TB treatment more than one month):at least 20 persons/per 100 persons of a than one month):at least 20 persons/per 100 persons of a drug resistance,7 persons/per 100 persons MDR-TB.drug resistance,7 persons/per 100 persons MDR-TB.course：Short-term therapyShort-term therapygeneral treatment：Rest,Nutrition,regular life3232Drug therapyDrug therapy：6HR或9HR，SeriousSerious：add on S2S2月（月（2 2SHR/46HRSHR/46HR）or Z3Z3月（月（3 3HRZ/36HRHRZ/36HR）Drug ClassificationDrug Classification：USAUSA Maximum effect effect，Minimal toxicityMinimal toxicity egeg：ININHH、R RFPFP Greater effectGreater effect，Greater toxicityGreater toxicity egeg：S SMM、E EMBMB、P PZ ZA A Minimal effectMinimal effect，Maximum toxicitytoxicity egeg：K KMM、treatment3333the basic mechanism of Short treatmentthe basic mechanism of Short treatment ：Fast kill tubercle bacillus in the boday Different propagation speedinside and outside of the CellsThe basic characteristics of short-term therapy:The basic characteristics of short-term therapy:1 1、sputum culture turn negtive quicklysputum culture turn negtive quickly22、low incidence of the long-term recurrencelow incidence of the long-term recurrence33、full course of treatment failure less,the high rate of full course of treatment failure less,the high rate of sputum culture turn negtivesputum culture turn negtive4 4、with less drug side effectswith less drug side effectshigh efficacy,less toxicity,few cost,and could high efficacy,less toxicity,few cost,and could prevent drug-resistant strainsprevent drug-resistant strains、treatment3434 PrognosisClinical symptoms:turn for the better after 36 after 36 monthsmonthsRequired 2-year improvement in pathologicalRequired 2-year improvement in pathologicalrecoveryquiescenceprogressiondeteriorationLow immunization35352024/5/8 2024/5/8 周三周三3636.