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Impact of the COVID-19 Restrictive Measures on Tuberculosis Detection among Children and Adolescents COVID-19 限制性措施对儿童和青少年结核病检测的影响
Q4 Medicine Pub Date : 2024-07-05 DOI: 10.58838/2075-1230-2024-102-3-71-75
R. K. Varlamov, E. S. Prokopiev, E. Luginova
The objective: to assess impact of the COVID-19 restrictive measures on tuberculosis detection among children and adolescents.Subjects and Methods. For the analysis, materials from statistical collections and state statistics forms (Form No. 33) were used. Changes of the main epidemiological tuberculosis rates were assessed for two observation periods: before the pandemic (2017-2019) and during the pandemic (2020-2022). Statistical analysis methods were used.Results. The COVID-19 pandemic and related restrictive measures generally provided no significant impact on the coverage with preventive screening for tuberculosis of population in the Republic of Sakha (Yakutia). At the same time, during the pandemic, a slight reduction of the main epidemiological tuberculosis rates was noted both among adults and children. Despite this decrease, a deterioration in the structure of new tuberculosis patients was revealed, which indicated that the disease was not detected in a timely manner.
目的:评估 COVID-19 限制性措施对儿童和青少年结核病检测的影响。分析使用了统计资料和州统计表(第 33 号表格)。评估了两个观察期主要流行病学结核病发病率的变化:大流行前(2017-2019 年)和大流行期间(2020-2022 年)。采用了统计分析方法。COVID-19 大流行和相关限制性措施总体上对萨哈共和国(雅库特)人口结核病预防筛查的覆盖率没有产生重大影响。同时,在大流行病期间,成人和儿童的主要结核病流行率略有下降。尽管有所下降,但新肺结核病人的结构却有所恶化,这表明该疾病没有被及时发现。
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引用次数: 0
Postponed Results of Lung Resections for Disseminated Fibrous Cavernous Tuberculosis 播散性纤维空洞型肺结核肺切除术的延期结果
Q4 Medicine Pub Date : 2024-07-05 DOI: 10.58838/2075-1230-2024-102-3-58-63
D. E. Omelchuk, D. Krasnov, T. I. Petrenko, I. A. Bolshakova, A. A. Kochneva
The objective: to evaluate postponed results of lung resection for disseminated fibrous cavernous tuberculosis.Subjects and Methods. Postponed treatment results were evaluated 3–5 years after surgery, it was the time when patients were taken off the register at TB dispensary (TBD). Inpatient medical records (Form no. 003/u) and outpatient records (Form no. 025/u-04) were used as the source of information.Results. Out of 702 patients for whom postpones results were available, 571/702 (81.3%) were taken off the register 5 years after the surgery due to cure. Relapse with a chronic course of tuberculosis developed in 49/702 (7.0%) patients, and lethal outcome occurred in 82/702 (11.7%) patients (relapse and progression of tuberculosis were the cause in 51 patients, while surgical complications in 31 patients). Over all period of follow-up, 132 tuberculosis relapses were detected, but a significant limitation of this part of the study was the loss of patients for follow-up every year. By the period of “10 years or more”, there were only 139 people available for follow-up and among them 15 (10.8% ) relapses were registered.It was also found that the chances of an unfavorable outcome of tuberculosis treatment were more than 32 times higher in patients with an unfavorable immediate result of the surgery (including not resolved postoperative complications) versus the patients who achieved a favorable result after the surgery (OR = 32.14, 95 % CI 17.57 – 58.78, p<0.001, χ2 =218.8)
目的:评估肺切除术治疗播散性纤维空洞型肺结核的延期治疗效果。对术后 3-5 年的延期治疗结果进行评估,即患者从结核病防治所(TBD)登记册中删除的时间。信息来源为住院病历(表号 003/u)和门诊病历(表号 025/u-04)。在有延期结果的 702 名患者中,有 571/702 人(81.3%)在手术 5 年后因治愈而从登记册中删除。49/702(7.0%)名患者的肺结核复发并转为慢性病程,82/702(11.7%)名患者出现死亡(51名患者的病因是肺结核复发和进展,31名患者的病因是手术并发症)。在所有随访期间,共发现 132 例肺结核复发,但这部分研究的一个重要局限是每年都有患者失去随访机会。在 "10 年或 10 年以上 "期间,只有 139 人可以接受随访,其中有 15 人(10.8%)复发。研究还发现,手术后即刻出现不利结果(包括术后并发症未解决)的患者与手术后出现有利结果的患者相比,结核病治疗出现不利结果的几率要高出 32 倍多(OR = 32.14,95 % CI 17.57 - 58.78,P<0.001,χ2 = 218.8)。
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引用次数: 0
Treatment Results in Patients with Drug Resistant Tuberculosis (MDR, pre-XDR, XDR) and HIV Infection in Stavropol Region 斯塔夫罗波尔州耐药结核病(MDR、前XDR、XDR)和艾滋病毒感染患者的治疗结果
Q4 Medicine Pub Date : 2024-07-05 DOI: 10.58838/2075-1230-2024-102-3-64-70
N. A. Sosova, T. A. Zadremaylova, N. M. Konovalova, A. Abramchenko, M. I. Romanova, A. I. Gayda, A. G. Samoylova
The objective: to compare treatment effectiveness of drug resistant tuberculosis (MDR, pre-XDR, XDR) depending on the HIV status of patients in Stavropol Region from 2019 to 2022.Subjects and Methods. In a retrospective study, chemotherapy outcomes for pulmonary tuberculosis (TB) were evaluated with distribution by treatment regimens for MDR, pre-XDR, and XDR in 100 patients with drug resistant tuberculosis (MDR, pre-XDR, XDR and HIV infection (DR TB/HIV Group ) and 707 patients with drug resistant tuberculosis (MDR, pre-XDR, and XDR) (and negative HIV status (DR TB Group). The immune status of patients in DR TB/HIV Group and its impact on the effectiveness of tuberculosis treatment were analyzed.Results. Effective treatment (definitions are given according to the Guidelines) was statistically significantly more frequently registered in DR TB Group versus DR TB/HIV Group (59% and 48%, respectively, p<0.05). Treatment failure was statistically significantly more frequently registered in patients in DR TB/HIV Group versus DR TB Group (42% and 26%, respectively, p<0.05). In DR TB/HIV Group, the lowest effectiveness (33%) of tuberculosis treatment was noted in the patients with CD4 count below 200 cells/µL. Among those died, the median time to death from the start of tuberculosis treatment was 12 months in DR TB Group, 8 months in DR TB/HIV Group, and 4 months in the subgroup of patients with CD4 count below 100 cells/µL.
目的:比较2019年至2022年斯塔夫罗波尔州根据患者的艾滋病毒感染状况对耐药结核病(MDR、前XDR、XDR)的治疗效果。在一项回顾性研究中,对100名耐药结核病(MDR、前XDR、XDR和HIV感染)患者(DR TB/HIV组)和707名耐药结核病(MDR、前XDR和XDR)患者(HIV阴性(DR TB组))的肺结核(TB)化疗结果进行了评估,并按MDR、前XDR和XDR治疗方案进行了分配。分析了 DR TB/HIV 组患者的免疫状况及其对结核病治疗效果的影响。据统计,DR TB 组与 DR TB/HIV 组相比,有效治疗(根据《指南》给出的定义)的比例明显更高(分别为 59% 和 48%,P<0.05)。DR TB/HIV 组与 DR TB 组相比,治疗失败的比例明显更高(分别为 42% 和 26%,P<0.05)。在 DR TB/HIV 组中,CD4 细胞计数低于 200 cells/µL 的患者的结核病治疗有效率最低(33%)。在死亡患者中,肺结核 DR TB 组从开始结核病治疗到死亡的中位时间为 12 个月,肺结核 DR TB/HIV 组为 8 个月,CD4 细胞数低于 100 个/µL 的亚组患者为 4 个月。
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引用次数: 0
Lung Imaging for Suspected Tuberculosis in the Pregnant (Review) 孕妇疑似肺结核的肺部成像(回顾)
Q4 Medicine Pub Date : 2024-07-05 DOI: 10.58838/2075-1230-2024-102-3-76-83
O. O. Vinokurova, A. Vinokurov, A. V. Petryaykin, V. N. Zimina, A. L. Yudin
The review presents modern ideas about X-ray examination for diagnosis of lung diseases including tuberculosis in the pregnant. The use of X-ray diagnostic tools in the pregnant is limited due to the lack of information about modern capabilities of equipment and special protection, and often by X-ray phobia among patients and physicians. The article presents data on the physical parameters of modern X-ray methods (digital radiography, low-dose CT) and highlights methods free of ionizing radiation, which are gradually entering phthisiologic practice.
这篇综述介绍了 X 射线检查诊断肺部疾病(包括孕妇肺结核)的现代理念。由于缺乏有关现代设备能力和特殊保护措施的信息,以及患者和医生对 X 射线的恐惧,孕妇对 X 射线诊断工具的使用受到了限制。文章介绍了现代 X 射线方法(数字射线照相术、低剂量 CT)的物理参数数据,并重点介绍了逐渐进入临床实践的无电离辐射方法。
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引用次数: 0
Sarcoidosis Phenotyping: Analysis of Current Approaches (Review) 肉样瘤病表型分析:当前方法分析(综述)
Q4 Medicine Pub Date : 2024-07-05 DOI: 10.58838/2075-1230-2024-102-3-84-94
A. A. Vizel, S. N. Avdeev, I. Vizel’, G. Shakirova
The review analyzes publications devoted to the formation of phenotypes in sarcoidosis patients. It has been noted that there is a certain difficulty in phenotyping the disease that can affect all human organs and systems. The article demonstrates the trend to shift from Scadding radiographic stages of intrathoracic sarcoidosis, based on radiography, to phenotypes based on high-resolution computed tomography. It presents phenotypes based on such parameters as organ damage, respiratory dysfunction, laboratory and genetic data, and treatment effects. The authors note that phenotypes should be applicable to clinical practice and clearly reflect differences between patients and the likelihood of clinically significant outcomes.
这篇综述分析了专门研究肉样瘤病患者表型形成的出版物。文章指出,肉样瘤病可影响人体的所有器官和系统,在对该病进行表型方面存在一定的困难。这篇文章展示了胸内肉样瘤病的表型从以放射摄影为基础的斯卡丁放射分期向以高分辨率计算机断层扫描为基础的表型转变的趋势。文章介绍了基于器官损伤、呼吸功能障碍、实验室和遗传数据以及治疗效果等参数的表型。作者指出,表型应适用于临床实践,并清楚地反映出患者之间的差异以及临床显著结果的可能性。
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引用次数: 0
Clinical and Radiological Characteristics of Respiratory Tuberculosis Treatment Failures in Children and Adolescents and Timing of their Detection Depending on Examination Method 儿童和青少年呼吸道结核病治疗失败者的临床和放射学特征及其因检查方法而异的发现时机
Q4 Medicine Pub Date : 2024-07-04 DOI: 10.58838/2075-1230-2024-102-3-41-47
I. Petrakova, M. Gubkina, I. Tyurin
The objective: selection of optimal timing for chest CT to identify respiratory tuberculosis treatment failures in children and adolescents through clinical and radiological comparison.Subjects and Methods. A retrospective comparative study was conducted. Totally 70 patients aged from 2 to 17 years with various clinical forms of respiratory tuberculosis were examined. Retrospectively, patients were divided into 3 groups: Group 1 (35 people) – CT was performed before the treatment start and, as the first control, after 2-3 months of chemotherapy; Group 2 (17 people) had a CT before the chemotherapy start and after 2-3 months – plain X-ray (or in combination with linear tomography), CT control – after 6-9 months after the chemotherapy start; Group 3 (18 people) included patients who had only plain X-ray (or in combination with linear tomography) before and during chemotherapy, CT was first performed after treatment failureResults. In all groups, in more than 40% of cases, radiological changes were the only informative criterion of treatment failure. CT performed in the early stages was optimal for timely detection of treatment failure: before the chemotherapy start and in 2-3 months (Group 1). In patients of Groups 2 and 3, opportunities for timely correction of chemotherapy were missed due to inadequate assessment of pathological changes. CT performed after 6-9 months of treatment reliably revealed irreversible changes in 53% and 78% (Groups 2 and 3), respectively.
目的:通过临床和放射学对比,选择胸部 CT 的最佳时机来识别儿童和青少年呼吸道结核治疗失败。进行回顾性对比研究。共检查了 70 名 2 至 17 岁患有各种临床形式呼吸道结核的患者。回顾性研究将患者分为 3 组:第 1 组(35 人)--在治疗开始前进行 CT 检查,化疗 2-3 个月后作为首次对照;第 2 组(17 人)在化疗开始前进行 CT 检查,化疗 2-3 个月后进行普通 X 光检查(或结合线性断层扫描),化疗开始 6-9 个月后进行 CT 对照;第 3 组(18 人)包括化疗前和化疗期间仅进行普通 X 光检查(或结合线性断层扫描)的患者,治疗失败后首次进行 CT 检查。在所有组别中,超过 40% 的病例的放射学变化是治疗失败的唯一参考标准。在化疗开始前和 2-3 个月内的早期阶段进行 CT 是及时发现治疗失败的最佳方法(第 1 组)。在第 2 组和第 3 组患者中,由于病理变化评估不充分,错过了及时纠正化疗的机会。在治疗 6-9 个月后进行的 CT 检查中,分别有 53% 和 78%(第 2 组和第 3 组)的患者可靠地发现了不可逆的病变。
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引用次数: 0
Possibilities of Using Nootropic Drugs to Reduce Neurotoxic Reactions Caused by Anti-tuberculosis Drugs in Experimental Conditions 在实验条件下使用促诺特普酶药物减轻抗结核药物引起的神经毒性反应的可能性
Q4 Medicine Pub Date : 2024-07-04 DOI: 10.58838/2075-1230-2024-102-3-6-11
G. Mozhokina, A. G. Samoylova, I. A. Vasilyeva
The objective: to evaluate the neuroprotective activity of cytoflavin and combinations of mexidol with vitamin B6 or Magne B6 by changes in behavioral reactions in rats during in-take of a neurotoxic combination of anti-tuberculosis drugs.Subjects and Methods. Non-linear female rats divided in 4 groups were used in this study. For 14 days, all rats received a combination of Mxf+Lzd+Cs+Pto daily. Additionally, rats of Group 2 were administered cytoflavin before administration of the basic combination; Group 3 – Mexidol + vitamin B6; Group 4 - Mexidol + Magne B6. Doses of anti-tuberculosis drugs, cytoflavin, Mexidol, vitamin B6 and Magne B6 correspond to the recommended doses for humans. The manifestation of neurotoxicity was assessed by changes in behavioral reactions by Open Field Test.Results. Neurotoxicity caused by the combination Mxf+Lzd+Cs+Pto was manifested by a decrease in motor activity, exploratory activity and grooming. With cytoflavin administration, all parameters of behavioral reactions in rats improved. When using Mexidol with vitamin B6, only a slight decrease in grooming versus the baseline level was observed. There was a less qualitative decrease in neurotoxicity manifestations with administration of Mexidol in combination with Magne B6.
目的:通过大鼠在服用具有神经毒性的抗结核药物组合时行为反应的变化,评估细胞黄素以及甲西多尔与维生素 B6 或 Magne B6 组合的神经保护活性。本研究使用非线性雌性大鼠,分为 4 组。所有大鼠每天服用 Mxf+Lzd+Cs+Pto 组合药物 14 天。此外,第 2 组大鼠在服用基本组合前服用了细胞黄素;第 3 组--Mexidol + 维生素 B6;第 4 组--Mexidol + Magne B6。抗结核药物、细胞黄素、Mexidol、维生素 B6 和 Magne B6 的剂量与人类的建议剂量一致。神经毒性的表现通过开阔地试验的行为反应变化进行评估。Mxf+Lzd+Cs+Pto组合造成的神经毒性表现为运动活动、探索活动和梳理活动的减少。给大鼠服用细胞黄素后,其行为反应的所有参数都有所改善。在使用美西多和维生素 B6 的情况下,与基线水平相比,仅观察到大鼠的梳理能力略有下降。在同时服用美西多和镁 B6 的情况下,神经毒性表现的下降幅度较小。
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引用次数: 0
Diagnosis of Drug Resistance of M. tuberculosis in the Regions of the Siberian Federal District 西伯利亚联邦区结核杆菌耐药性诊断
Q4 Medicine Pub Date : 2024-07-04 DOI: 10.58838/2075-1230-2024-102-3-48-57
N. V. Stavitskaya, I. G. Felker, E. K. Nemkova
The objective: to assess possibilities for timely diagnosis of drug resistance of M. tuberculosis in the regions of the Siberian Federal District (SFD) with a high burden of drug resistant tuberculosis.Subjects and Methods. The retrospective analysis included federal and sectorial statistical reporting data (Form no. 33, Form no. 8, Form no. 30, Form no. 7-TB, Form no. 8-TB), forms of non-recurrent statistical surveillance VR-5MLU, Form no. 68, data from Visit Reports by specialists of Novosibirsk Tuberculosis Research Institute by the Russian Ministry of Health for 2021 – 9 months of 2023.Results. All laboratories of TB units in the regions of the Siberian Federal District are equipped with equipment for rapid molecular genetic diagnosis of M. tuberculosis, however, the majority of laboratories have no possibility to conduct rapid molecular genetic DST to fluoroquinolones. In a number of regions no DST to levofloxacin and moxifloxacin is performed. Susceptibility testing to linezolid and bedaquiline is conducted extremely rarely. Susceptibility testing to delamanid is performed in single cases and only in one region. To achieve treatment effectiveness rates defined in Edict no. 19 by Russian Ministry of Health dated February 07, 2023, it is necessary to equip TB units with modern equipment for rapid DST, organize an uninterrupted supply of consumables, as well as train laboratory personnel in the shortest possible time.
目的:评估在耐药性结核病高发的西伯利亚联邦区(SFD)及时诊断结核杆菌耐药性的可能性。回顾性分析包括联邦和部门统计报告数据(第33号表、第8号表、第30号表、第7-结核病表、第8-结核病表)、非经常性统计监测表VR-5MLU、第68号表、俄罗斯卫生部新西伯利亚结核病研究所专家2021-2023年9个月的访问报告数据。西伯利亚联邦区各州结核病防治单位的所有实验室都配备了结核杆菌快速分子遗传学诊断设备,但大多数实验室无法对氟喹诺酮类药物进行快速分子遗传学 DST 检测。一些地区没有对左氧氟沙星和莫西沙星进行 DST 检测。对利奈唑胺和贝达喹啉的药敏试验极少进行。对地拉那米德的药敏试验仅在一个地区的单个病例中进行。为了达到俄罗斯卫生部 2023 年 2 月 7 日第 19 号敕令规定的治疗有效率,有必要为结核病防治单位 配备用于快速 DST 检测的现代化设备,组织不间断的耗材供应,并在尽可能短的时间内对实验室人员 进行培训。
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引用次数: 0
Results of Treatment of Patients with Multiple Drug Resistant Tuberculosis among Key Populations during the COVID-19 Pandemic in Dushanbe, Tajikistan 塔吉克斯坦杜尚别 COVID-19 大流行期间主要人群中多重耐药结核病患者的治疗结果
Q4 Medicine Pub Date : 2024-07-04 DOI: 10.58838/2075-1230-2024-102-3-24-33
Z. Tilloeva, A. S. Mirzoev
The objective: to identify changes in effectiveness of treatment of multiple drug resistant tuberculosis among key populations in Dushanbe, including the period of the COVID-19 pandemic.Subjects and Methods. Retrospective study of medical records of 431 MDR TB patients registered for treatment in Dushanbe was conducted (2017-2019 - Group 1 and 2020-2021 - Group 2 (the COVID-19 pandemic period)).Results. The duration of treatment was 15.4±6.9 months in Group 1, and 10.8±4.3 months in Group 2, which was due to the introduction of short-course regimens in that group. At the same time, in Group 2 there was an increase in effectiveness of MDR TB treatment to 85% versus 80% in Group 1, which was due to the use of new drugs and regimens containing them. In Group 1, a statistically significant association was found between MDR TB treatment failure and the following parameters: male gender (RR=2.3 (1.36-4.04), p=0.002), positive HIV status (RR=2.35 (1.37-4.05), p=0.011), hepatitis C infection (RR=3.0 (1.87-4.8), p <0.001), alcohol (RR=3.2 (1.96-5.2), p<0.001) and substances abuse (RR=3.99 (2.5-6.2), p<0.001), previous imprisonment (RR=2.6 (1.48-4.6), p<0.001), unemployment (RR=3.5 (1.8-6.7), p <0.001), and homelessness (RR=5.0 (3.9-6.5), p=0.0011). In Group 2, failure of MDR TB treatment was statistically significantly associated with hepatitis C (RR=3.3 (1.5-7.2), p=0.02), alcohol and drug abuse (RR= 4.4 ( 1.95-10.1). p =0.026), as well as (unlike Group 1) labor migration (RR=3.0 (1.45-6.2), p=0.0068), in-patient treatment (RR=3.8 (1.36-10.64), p=0.0056), while there was no association with HIV status.
目的:确定杜尚别重点人群耐多药结核病治疗效果的变化,包括COVID-19大流行期间。对杜尚别市登记治疗的 431 名多重耐药结核病患者的医疗记录进行了回顾性研究(2017-2019 年--第一组和 2020-2021 年--第二组(COVID-19 大流行期间))。第 1 组患者的治疗时间为(15.4±6.9)个月,第 2 组患者的治疗时间为(10.8±4.3)个月,这是因为该组采用了短程治疗方案。与此同时,第 2 组 MDR 结核病的治疗有效率从第 1 组的 80%提高到 85%,这是因为使用了新药和含有新药的治疗方案。在第 1 组中,MDR TB 治疗失败与以下参数之间存在统计学意义上的显著关联:男性(RR=2.3(1.36-4.04),P=0.002)、HIV 阳性(RR=2.35(1.37-4.05),P=0.011)、丙型肝炎感染(RR=3.0(1.87-4.8),P<0.001)、酒精(RR=3.2(1.96-5.2),P<0.001)和药物滥用(RR=3.99(2.5-6.2),P<0.001)、曾入狱(RR=2.6(1.48-4.6),P<0.001)、失业(RR=3.5(1.8-6.7),P<0.001)和无家可归(RR=5.0(3.9-6.5),P=0.0011)。在第 2 组中,MDR TB 治疗失败与丙型肝炎(RR=3.3 (1.5-7.2),P=0.02)、酗酒和吸毒(RR=4.4 ( 1.95-10.1).026),以及(与第 1 组不同的是)劳动力迁移(RR=3.0(1.45-6.2),p=0.0068)、住院治疗(RR=3.8(1.36-10.64),p=0.0056),而与艾滋病毒感染状况没有关联。
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引用次数: 0
Assessment of Probability of Pulmonary Fibrosis Progression in Patients with Interstitial Lung Diseases to Determine Further Treatment Tactics 评估间质性肺病患者肺纤维化进展的概率以确定进一步的治疗策略
Q4 Medicine Pub Date : 2024-07-04 DOI: 10.58838/2075-1230-2024-102-3-34-40
A. A. Lukashevich, O. A. Yudina, L. S. Bogush, E. I. Davidovskaya, M. I. Dyusmikeeva, A. F. Belko
The objective: to develop a method for assessing the probability of progression of pulmonary fibrosis in patients with interstitial lung diseases in order to determine further treatment tactics.Subjects and Methods. 80 patients with interstitial lung diseases underwent lung biopsies with consequent morphological and immunohistochemical tests. The group with progressive fibrosis consisted of 42 patients. The prognostic model was built using the binary logistic regression method.Results. A statistical model was developed in the form of a regression equation consisting of 3 parameters: the presence of a morphological pattern of interstitial fibrosis; intensity of CTGF expression; and intensity of TGF-β expression. This mathematical model makes it possible to predict the progression of pulmonary fibrosis in patients with interstitial lung diseases with 83.3% sensitivity and 84.2% specificity.
目的:开发一种评估间质性肺病患者肺纤维化进展概率的方法,以确定进一步的治疗策略。80名间质性肺病患者接受了肺活检,并进行了形态学和免疫组化检测。进行性纤维化组包括 42 名患者。采用二元逻辑回归法建立预后模型。以回归方程的形式建立的统计模型由 3 个参数组成:是否存在间质纤维化的形态模式;CTGF 的表达强度;TGF-β 的表达强度。该数学模型可预测肺间质疾病患者肺纤维化的进展,灵敏度为 83.3%,特异度为 84.2%。
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引用次数: 0
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Tuberculosis and Lung Diseases
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