结核病是结核分枝杆菌引起的疾病,可以透过空气在人与人之间传播。任何器官都有可能受感染,但主要影响肺部(疫苗接种主要预防的也是肺结核)。[1]X研究来源结核菌在潜伏期呈冬眠状态,没有任何迹象或症状。当结核菌变得活跃时,才会慢慢出现症状。大多数人受感染后,一生也不发病。如果不接受治疗或治疗不当,会造成死亡。所以,你一定要学会识别结核病的迹象和症状。[2]X
可靠来源
Centers for Disease Control and Prevention
前往来源
步骤
部分 1
部分 1 的 3:
了解风险因素
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1
小心高风险区。[3]X
可靠来源
Mayo Clinic
前往来源
住在或到过以下地方,甚至是接触住在或到过这些地方的人,都有可能使你感染结核菌。在世界许多地方,由于医疗保健政策、缺乏金钱或资源、人口过多等原因,要预防、诊断和治疗结核病十分困难。许多结核病案例未被发现和治疗,造成病菌传播。前往和离开这些地区的飞机也可能有结核菌,因为机舱属于封闭空间,通风率不高。
撒哈拉以南非洲地区
印度
中国
俄罗斯
巴基斯坦
东南亚
南美洲
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2
检查你的工作和生活环境。[4]X
可靠来源
Centers for Disease Control and Prevention
前往来源
过度拥挤、通风不良的地方,使细菌容易在人群中传播。如果周围的人没有接受健康检查,或缺乏检查设备,情况可能更糟糕。需要留意以下地方:
监狱
移民局
养老院或疗养院
医院或诊所
难民营
收容所
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3
注意你本身的免疫力。[5]X
可靠来源
Mayo Clinic
前往来源
一些会降低自然免疫力的身体状况可能会带来麻烦。免疫系统无法正常运作的人很容易感染各种疾病,包括结核病。这些身体情况包括:
人体免疫缺损病毒或艾滋病
糖尿病
末期肾病
癌症
营养不良
年龄(幼儿免疫系统尚未发育成熟,老年人的免疫力可能会下降)
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4
确认你服用的药物是否会影响免疫功能。[6]X
可靠来源
Centers for Disease Control and Prevention
前往来源
滥用任何物质都会降低身体的自然免疫力,包括酒精、烟草和通过静脉注射的药物。某些癌症会增加感染结核菌的风险,化疗也一样。长期使用类固醇和预防移植器官排斥的药也会影响免疫力。用来治疗类风湿关节炎、狼疮、炎性肠病(克隆氏症、溃疡性结肠炎)和银屑病等自体免疫病的药也一样。
部分 2
部分 2 的 3:
认识肺结核的迹象和症状
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1
留意不寻常的咳嗽。[7]X
可靠来源
American Lung Association
前往来源
结核菌主要感染肺部,会分解肺部组织。身体的自然反应是通过咳嗽清除侵入肺部的刺激物。想一想你已经咳嗽多久了。结核病一般持续超过3周,可能伴随着其它令人担忧的迹象,比如血痰。
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4
注意体重下降和食欲不振。身体会对结核分枝杆菌做出复杂反应,以致无法好好吸收营养,蛋白质代谢也出现变化。[11]X研究来源 Gupta K.B. Gupta R. et al. Tuberculosis and Nutrition. Lung India. 2009 Jan-Mar; 26(1): 9–16这些改变可能在你没有察觉的情况下持续好几个月。
照照镜子,观察身体是否有任何变化。如果骨骼轮廓清晰可见,表示身体缺乏蛋白质和脂肪,肌肉质量不足。
称体重,并和最近一次健康的时候量的体重作比较。体重变化因人而异,但是如果发生剧变,一定要告诉医生。
留意衣服是否日渐宽松。
记录你多久进食一次,并和身体还很健康的时候作比较。
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5
不要忽略发烧、发冷和盗汗。细菌通常在正常体温(37摄氏度或98.6华氏度)下繁殖。大脑和免疫系统会对此做出反应,提高体温,阻止细菌繁殖。身体其它部分察觉到体温变化,会试着适应这个新温度。所以,肌肉会收缩(发抖),使你发冷。结核病也会促使身体分泌引起发烧的炎症性蛋白质。[12]X研究来源Dall L., Stanford J.F. 1990. Fever, Chills, and Night Sweats. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 211.
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6
提防潜伏性结核感染。潜伏性结核菌处于冬眠状态,不会传染。它们只是居住在体内,不会造成伤害。如上所述,当免疫力下降时,结核菌会再次变得活跃。随着年龄增长,免疫力下降,结核菌也会变得活跃。有时候,结核菌也会因为其它未知原因而再次活跃起来。[13]X
可靠来源
Mayo Clinic
前往来源
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2
按医生要求接受潜伏性结核感染筛查。[18]X
可靠来源
Centers for Disease Control and Prevention
前往来源
即使你不认为自己患有结核病,医生也可能要求你进行筛查。医疗保健从业者刚开始工作时,必须进行筛查,之后每年复查一次。要前往或刚从高风险国家回来?免疫力下降?工作或居住环境拥挤、不通风?那么你也应该接受检查。只要和初级护理医生预约,就能进行结核病检查。
潜伏性结核感染不会引发任何症状或疾病,而且不会传染。然而,5到10%潜伏性结核感染案例最终会演变成结核病。[19]X
可靠来源
Centers for Disease Control and Prevention
前往来源
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3
进行纯蛋白衍生物(PPD)试验。[20]X
可靠来源
Centers for Disease Control and Prevention
前往来源
这项检查也被称为结核菌素皮肤试验(TST),或曼托试验。医生用棉签沾水,清洁某处皮肤,然后在皮内注射纯蛋白衍生物。注射处会出现一个小肿块。不要用绷带包扎,以免改变注射液的位置。反之,给身体数小时的时间吸收注射液。
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4
了解如何诠释检查结果。[21]X
可靠来源
Centers for Disease Control and Prevention
前往来源
医生会根据硬结直径和个人状况判断结果呈阳性或阴性。不管你被归类为哪一组,超过某个尺寸即为阳性结果(患有结核病)。如果是无风险因素者,15毫米以上为阳性。如果有上面列出的风险因素,10毫米以上为阳性。如果以下状况适用于你,那么5毫米以上为阳性结果:
接受化疗或服用抑制免疫力的药
长期使用类固醇
感染人类免疫缺陷病毒
曾近距离接触过结核病患者
接受器官移植的人
X线胸透显示纤维化病变
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5
进行γ-干扰素释放试验(IGRA),代替纯蛋白衍生物皮内试验。[22]X
可靠来源
Centers for Disease Control and Prevention
前往来源
这项血液试验比纯蛋白衍生物试验更快、更准,但成本也更高。如果医生选择做这个试验,他会抽取你的血液样本,送到实验室分析。在24小时内就能得出结果,医生会在下一次会面中给你仔细讲解结果。干扰素水平高(与实验室预设的正常值比较)为阳性,表示你患有结核病 。
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6
跟进测试结果。[23]X
可靠来源
Centers for Disease Control and Prevention
前往来源
不管是皮内试验还是血液测试,阳性结果最起码意味着潜伏性结核感染。为了确定你是否患有活跃性结核病,医生会安排你进行X线胸透 。胸透结果正常的患者被诊断为潜伏性结核感染,并接受预防性治疗。胸透结果异常,加上皮内试验或血液测试呈阳性,则被诊断为活跃性结核病。
医生也会让你做痰培养。阴性结果表示患有潜伏性结核感染,阳性结果则是患有结核病。
注意,由于很难收集婴儿和幼儿的痰液样本,所以儿童不需要做这项测试,医生会根据其它试验结果做出诊断。[24]X
可靠来源
Centers for Disease Control and Prevention
前往来源
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7
确诊后,遵循医生的建议。如果X线胸透和痰培养确认了活跃性结核病,医生会给你开多种药物进行治疗。[25]X
可靠来源
Centers for Disease Control and Prevention
前往来源
如果X线胸透结果呈阴性,患者被诊断为潜伏性结核感染。严格遵循医生的治疗指示,防止潜伏性结核感染变得活跃。结核感染是要向疾控中心报告的疾病,治疗方法包括直接监督治疗,患者需要在一名医疗工作者的监督下服用每一剂药物。