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Cited by 3 publications
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Objective Tuberculous peritonitis (TP) can cause multiple infections of surrounding organs and tissues, leading to organ failure and endangering life safety. In this research, the relationship between adenosine deaminase (ADA), NLRP3 inflammasome, and TP and its clinical significance will be deeply explored, so as to provide new directions and reliable reference opinions for future clinical diagnosis and treatment. Methods Altogether, 59 TP patients (research group, RG) and 52 non-TP patients (control group, CG) who were admitted to our hospital from May 2014 to June 2018 were regarded as research objects. Ascites samples of RG before treatment (admission) and one month after treatment and CG before treatment were obtained, and the ADA and NLRP3 levels were tested to evaluate the clinical and prognostic significance of the two in TP. Results Before treatment, ADA and NLRP3 in RG were higher than CG ( P < 0.05), and the sensitivity and specificity of combined detection of the two in predicting TP occurrence were 89.83% and 73.08% ( P < 0.05). In addition, ADA and NLRP3 in RG patients were positively correlated with the disappearance time of abdominal pain and ascites ( P < 0.05) and had excellent predictive effect on the adverse reactions during treatment ( P < 0.05). After treatment, both in RG patients decreased, which was inversely proportional to the clinical efficacy ( P < 0.05). Prognostic follow-up manifested that ADA and NLRP3 in relapse patients were higher than those without recurrence after treatment ( P < 0.05). Conclusion The increase of ADA and NLRP3 in TP is relevant to the adverse reactions during treatment, clinical efficacy, and prognosis recurrence after treatment. It can be used as a disease marker to confirm, intervene, and evaluate TP progression promptly.
Objective Tuberculous peritonitis (TP) can cause multiple infections of surrounding organs and tissues, leading to organ failure and endangering life safety. In this research, the relationship between adenosine deaminase (ADA), NLRP3 inflammasome, and TP and its clinical significance will be deeply explored, so as to provide new directions and reliable reference opinions for future clinical diagnosis and treatment. Methods Altogether, 59 TP patients (research group, RG) and 52 non-TP patients (control group, CG) who were admitted to our hospital from May 2014 to June 2018 were regarded as research objects. Ascites samples of RG before treatment (admission) and one month after treatment and CG before treatment were obtained, and the ADA and NLRP3 levels were tested to evaluate the clinical and prognostic significance of the two in TP. Results Before treatment, ADA and NLRP3 in RG were higher than CG ( P < 0.05), and the sensitivity and specificity of combined detection of the two in predicting TP occurrence were 89.83% and 73.08% ( P < 0.05). In addition, ADA and NLRP3 in RG patients were positively correlated with the disappearance time of abdominal pain and ascites ( P < 0.05) and had excellent predictive effect on the adverse reactions during treatment ( P < 0.05). After treatment, both in RG patients decreased, which was inversely proportional to the clinical efficacy ( P < 0.05). Prognostic follow-up manifested that ADA and NLRP3 in relapse patients were higher than those without recurrence after treatment ( P < 0.05). Conclusion The increase of ADA and NLRP3 in TP is relevant to the adverse reactions during treatment, clinical efficacy, and prognosis recurrence after treatment. It can be used as a disease marker to confirm, intervene, and evaluate TP progression promptly.
In recent years, the incidence of tuberculous peritonitis increased. Peritoneal tuberculosis is difficult to diagnose, and often the diagnosis is verified with significant delay. In clinical practice, a quick and affordable diagnostic radiology method, ultrasonography (USG), is proposed for patients with suspected tuberculous peritonitis. The study was aimed to describe the sonographic semiology of tuberculous peritonitis, to create the integrated scale for the individual peritoneal tuberculosis sonographic symptoms significance assessment, and to determine the role of ultrasound imaging in the diagnosis verification. Retrospective study of the invasive and ultrasound investigation results of 37 patients with confirmed tuberculous peritonitis was carried out in 2009–2019. Similar data obtained by investigation of 28 patients with the disorders which often mimic the tuberculous peritonitis (peritoneal carcinomatosis and sarcoidosis, non-specific ascites) were used as a comparison group. Direct and indirect signs of peritoneal lesion in patients with tuberculosis were identified. On the basis of that, an integral scale for the individual sonographic symptoms significance assessment was created. Each sonographic symptom received a 0–3 score. Assessment of those sonographic signs visualization allowed us to evaluate the probability of the disorder’s tuberculous etiology. The following data were obtained: score under 4 corresponded to low probability, score 5–8 corresponded to medium probability, and score over 9 corresponded to high probability of tuberculous peritonitis based on the visualization of all described songraphic symptoms. The proposed integrated scale for the sonographic signs assessment allows the clinician to verify the tuberculous peritonitis diagnosis based on the ultrasound imaging data or to select the further tactics of diagnosis.
1 Московский городской научно-практический центр борьбы с туберкулёзом Департамента здравоохранения города Москвы, Москва, Российская федерация 2 Российский национальный исследовательский медицинский университет им. н.и. Пирогова, Москва, Российская федерация Цель: определить оптимальную тактику диагностики и хирургического лечения абдоминального туберкулёза (АТ). Материал и методы: в период с 2012 по 2018 г.г. в туберкулёзном хирургическом отделении клиники № 2 Московского городского научно-практического центра борьбы с туберкулёзом были обследованы и оперированы 229 пациентов с АТ. В комплекс обследования пациентов включали полипозиционную рентгенографию и КТ органов брюшной полости и грудной клетки, УЗИ органов брюшной полости, диагностическую видеолапароскопию, лабораторные и морфологические методы исследования. Всего проведено 345 операций, включая релапаротомии. Оперативные вмешательства всем больным были выполнены в сроки от 6 до 68 часов от момента заболевания. Результаты: выявлено, что туберкулёз лёгких имелся у подавляющего числа больных (n=207; 90,4%). ВИЧ инфекция также диагностирована у большинства пациентов (n=172; 75,1%). Наиболее частыми показаниями к оперативному лечению были перитониты на почве перфораций туберкулёзных язв различных отделов кишечника (n=89; 38,9%), туберкулёз брюшины (n=52; 22,7%), острая кишечная непроходимость туберкулёзной природы (n=56; 24,5%). Указанные осложнения были причиной проведения экстренных или срочных оперативных пособий, зачастую достаточно расширенного объёма. Зачастую, диагноз АТ у большинства пациентов был установлен на основании интраоперационных находок. Клиническая картина в большинстве случаев была неспецифична. Предположить туберкулёзную природу ургентного хирургического заболевания можно было лишь у пациентов с ранее диагностированным туберкулёзом лёгких. Заключение: несвоевременное выявление хирургических осложнений туберкулёза органов брюшной полости ввиду стёртости симптоматики, отсутствие настороженности у хирургов относительно АТ, определяют низкую эффективность оперативного лечения и неадекватность хирургической тактики. Летальность у больных в послеоперационном периоде остаётся достаточно высокой (19,2%), в основном за счёт пациентов с развившимся вторичным перитонитом на фоне перфоративных туберкулёзных язв кишечника (28,1%). АТ следует рассматривать как хирургическую проблему, особенно в случаях развития осложнений. Для решения задач ранней диагностики, пациенты с подозрением на туберкулёз органов брюшной полости, должны наблюдаться совместно хирургом и фтизиатром. Ключевые слова: абдоминальный туберкулёз, туберкулёз брюшины, перфорация язвы, ВИЧ инфекция.Для цитирования: Плоткин ДВ, Решетников МН, Гафаров УО, Беленцева ОВ, Степанов ЕА, Синицын МВ. Абдоминальный туберкулёз: возвращение в хирургию. Вестник Авиценны. 2019;21(1):101-9. Available from: http://dx.Objective: Еo determine the optimal tactics of diagnosis and surgical treatment of abdominal tuberculosis (AT). Methods: In the period from 2012 to 2018 years, 229 patients with AT were exam...
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