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结核病防治培训教材——临床篇
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《结核病防治培训教材——临床篇》主要供从事结核病临床诊疗的医务人员培训使用,由多年从事结核病临床和防治工作的资深专家编写,知识全面、专业性强,能够满足广大结核病临床医务人员培训和日常学习的需求。为了突出学习重点,便于学习和理解,每章节均明确提出学习目的和知识要点,在文后设计测试题,并提供了参考答案。
本书内容包括结核潜伏感染、结核病分类、结核病实验室诊断及病理学诊断、结核病影像学检查、肺结核诊断与鉴别诊断、结核病治疗、常见肺外结核病诊断及治疗、肺结核常见急症处理、抗结核药物不良反应及处理、特殊人群结核病治疗、临床常用操作技术等12章,涵盖了结核病防治工作的各个方面。本书将体现结核病防治一体、医防结合的思想,力求既做到跟踪世界前沿,又结合编者多年积累的实践和广见卓识,体现出我国结核病防治工作所取得的新成就和新经验。本书每章首先提出学习目的,课程后提炼培训要点,并附课后练习题。
周林:中国疾控中心结核病预防控制中心患者关怀部主任,卫生部结核病和艾滋病防治专家组专家;中国防痨协会科学技术与学术交流委员会副主任委员。初乃惠:医学博士,主任医师,博士研究生导师,现任首都医科大学附属北京胸科医院结核一科主任,药物临床试验机构办公室主任。从事结核病临床、科研、教学工作20余年,主要致力于结核病极其相关疾病的诊断、治疗。
第一章 概述第一节 结核病病原学 / 001第二节 结核病疫情与危害 / 003第三节 我国结核病防治策略 / 005第二章 结核潜伏感染第一节 结核潜伏感染检查方法 / 012第二节 结核潜伏感染筛查和预防性治疗对象 / 015第三节 结核潜伏感染的化学预防 / 016第四节 结核潜伏感染的免疫预防 / 021第三章 结核病分类第一节 国际疾病分类中的结核病分类 / 027第二节 结核病分类标准 / 030第四章 结核病实验室诊断及病理学诊断第一节 细菌学诊断方法 / 038第二节 分子生物学诊断技术 / 050第三节 免疫学诊断方法 / 056第四节 病理学诊断 / 060第五章 结核病影像学检查第一节 肺结核影像学检查方法 / 068第二节 肺结核的影像诊断 / 071第三节 常见肺外结核的影像诊断 / 101第六章 肺结核诊断与鉴别诊断第一节 肺结核临床表现 / 132第二节 肺结核诊断标准 / 136第三节 耐药结核病诊断 / 138第四节 肺结核鉴别诊断 / 140第七章 结核病治疗第一节 抗结核药物 / 153第二节 利福平敏感结核病治疗 / 167第三节 利福平耐药结核病治疗 / 171第四节 结核病患者的治疗监测和疗效评价 / 175第五节 结核病中医中药治疗 / 178第八章 常见肺外结核诊断及治疗第一节 结核性脑膜炎 / 183第二节 淋巴结结核 / 187第三节 泌尿生殖系统结核 / 190第四节 结核性腹膜炎 / 197第五节 脊柱结核 / 201第九章 肺结核常见急症处理第一节 咯血 / 206第二节 自发性气胸 / 213第三节 呼吸衰竭 / 219第四节 慢性肺源性心脏病 / 225第十章 抗结核药物不良反应及处理第一节 药物不良反应概述 / 234第二节 抗结核药物常见不良反应 / 235第三节 抗结核药物不良反应处理 / 243第四节 抗结核药物不良反应的预防 / 249第十一章 特殊人群结核病治疗第一节 儿童结核病的治疗 / 253第二节 老年结核病的治疗 / 257第三节 结核病合并糖尿病的治疗 / 261第四节 结核分枝杆菌/ 人类免疫缺陷病毒双重感染的治疗 / 261第五节 结核病合并妊娠的治疗 / 264第十二章 临床常用操作技术第一节 标本采集、运输及保存 / 270第二节 胸腔穿刺 / 274第三节 腰椎穿刺 / 276第四节 胸腔闭式引流术 / 278附录 / 283附录1 中英文名词对照表 / 283附录2 参考答案 / 287参考文献 / 302
结核病是以呼吸道传播为主要传播途径的传染性疾病,其中肺结核是我国法定的乙类传染病。中国是全球30 个结核病高负担国家之一,2021 年全球结核病报告估算我国新发结核病患者约84.2 万人,其中耐多药肺结核患者6.2 万人,新发结核病和耐利福平结核病患者数均位于全球第二位。早期发现、规范治疗并治愈结核病患者是防止结核病进一步传播和控制结核病流行最重要的措施。既往多项研究发现,导致患者诊断延误的原因,除患者未及时就诊外,还包括医务人员结核病诊断知识不足。诊断延误不仅延长了结核病的传播时间,同时也加重了结核病对患者身体造成的损害,增加了治疗难度。
为提高各级医疗机构医务人员,尤其是结核病定点医疗机构医务人员结核病预防、诊断、治疗及管理技能,中国防痨协会和中国疾病预防控制中心结核病预防控制中心组织专家编写了“中国结核病防治人才培训项目(星辰计划)”系列培训教材。《结核病防治培训教材—临床篇》重点介绍了结核病的病原学、结核病疫情与危害、我国结核病防治策略、结核潜伏感染检查、诊断与预防性治疗新技术,以及肺结核、耐药结核病及肺外结核的实验室诊断及病理学诊断、影像学检查、鉴别诊断与治疗,详细介绍了肺结核常见急症处理、抗结核药物不良反应及处理和特殊人群结核病治疗等内容,介绍了4 个临床常用操作技术。各章节内容尽可能涵盖近年结核病研究和结核病诊断新技术、治疗新药及新方案等内容。为了突出学习重点,便于学习和理解,每章节均明确提出学习目的和知识要点,在文后设计练习题,并提供了参考答案。
本教材内容全面,指导性和操作性强,适用于从事结核病诊断和治疗的各级医疗机构医务人员学习,可做医务人员结核病诊断及治疗的规范化培训之用,也可做结核病临床诊疗工作人员工作时的工具书。
由于时间有限,编写过程中可能存在不足之处,有待在实践中进一步完善。
编者
2023 年8 月
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