抗结核药物副反应(江苏)

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1、卢水华2012.9.21抗结核药物副反应上海市公共卫生临床中心复旦大学附属公共卫生临床中心临床表现不典型肺外结核多见全身播散多见症状不典型合并症多见X线表现不典型PPD多阴性痰菌阳性率低治疗反应差WHO在2007年出版了关于提高涂阴肺结核及肺外结核诊断的方法，新方法强调了临床诊断的重要性，与培养方法相比，临床标准可以诊断89%~96%的涂阴肺结核和肺外结核亟待结核病诊疗新方法结核病诊断困难TBdiagnostictoolsBacteriology:Smear,Culture,Strainidentification,MolecularbiologyEndosco

2、py:Bronchoscopy,ThoracoscopyRadiology:MRICTImmunology:ELISAPPDELISPOTEssentialLaboratoryTestsATS2005Themeantimesavingis:19.3daysforisolatedculture24.5daysforstainidentification21.9daysforDST65.7daysinallAtime-savingmethodforTBdiagnosisBACTECtechniqueMODSTLANRACRICepheidHainLAMPProbeT

3、ecAmplicorINNOLipaProteomeNAAAMTDPCRNewTechnologiesCommercialproductforNAAFDA-approvedGenProbeMTD(GenProbe)RocheAmplicorMTB(Roche)Tuberculinskintest(TST)OT(oldtuberculin)vsPPD(purifiedproteinderivative)PPD-C(50IU/ml,1ug)vsBCG-PPD(20IU/ml,0.4ug)Tuberculintestingdisadvantages100yearsol

4、dCrudemixofantigensFalsenegativesSevereillness(inclTB)Immunosuppression(egHIV)FalsepositivesBCGNontuberculousinfectionAnamnesticrecallIncorrectinterpretationInterferon-gammareleaseassaysfordiagnosisofTBQuantiferon-TBGoldELISAT-Spot.TBELISPOTCurrentversions–morespecificTBantigensESAT-

5、6CFP-10TB7.7Metanalysis:NewtestsforthediagnosisoflatentTB:AreasofuncertaintyandrecommendationsforresearchMenziesDetal2007Sensitivity(22studies)Forestplotofstudiesestimatingsensitivityofthe3testsinpatientswithactiveTBasasurrogateforlatentTB:00.20.40.60.81.0AllELISPOT(11studies)Sensiti

6、vity%88AllQFT(12studies)76AllTST(14studies)70Only3studiesmadedirecthead-to-headcomparisonsMetanalysis:NewtestsforthediagnosisoflatentTB:AreasofuncertaintyandrecommendationsforresearchMenziesDetal2007Specificity(21studies)Forestplotofstudiesestimatingspecificityofthe3testsinpopulation

7、satverylowriskforlatentTB:00.20.40.60.81.0ELISPOT(4studies)Specificity%90QFT(9studies)97BCGvaccinated96NotBCGvaccinated100TST(8studies)66BCGvaccinated56NotBCGvaccinated98Metanalysis:NewtestsforthediagnosisoflatentTB:AreasofuncertaintyandrecommendationsforresearchPrinciplefindings:Not

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