Table of Content

20 March 2010, Volume 32 Issue 3

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A study on the usage of second-line anti-tuberculosis drugs in China

Hu Yuanlian，He Guangxue，Liu Zhimin，Zheng Jianli，Xing Chao

Chinese Journal of Antituberculosis. 2010, 32(3):  123-128. 

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Objective To investigate the usage of second-line anti-tuberculosis drugs (SLD) in medical institutions at all levels, and provide scientific evidence for policy development in China.  Method A stratified purposive sampling method were adopted, and a total of 12 provinces were involved in the cross sectional survey. Questionnaires were performed to all TB prevention and control institutions, tuberculosis specialist hospitals, general hospitals and rural health clinics at each level.  Results A total of 4782 institutions were involved in the survey, and 72.6% of them have used SLD. The proportion of institutions using SLD decreased by level, as follows: 87.0% for provincial level, prefecture and city level 83.4%, district level 72.0%, township level 70.3%.The proportion of SLD use varied between different type of institutions, with 98.7% of TB institutions which were based in tuberculosis, chest, pulmonary hospital, as well as designated hospitals, 100% of TB special hospital, 99.4% of general hospital. However, only 22.9% of TB institutions which are based in CDC used SLD. For the usage of different kind of SLD, there were great variations in terms of proportion of institutions using. Among them, Amikacin(49.6%), Ofloxacin(42.3%), Levofloxacin(66.2%), Ciprofloxacin(39.5%) had a higher proportion. Only 92 （1.9%）institutions perform drug susceptibility testing (DST) for first-line TB drug. Factors affecting the use of SLD are: region, type of institution, whether there are TB clinics and wards, number of beds for tuberculosis patients, whether perform sputum smear, whether perform sputum culture (P all<0.001) and patients smear-positive rate (P<0.05) etc. Drug susceptibility testing is not the influencing factors for SLD use (P=0.771). Conclusion SLD is commonly used in China. The use of SLD varied between different level, different kind, and different type of institutions. DST is seldom performed. Therefore China should develop a policy on the rational use of SLD, and promote DST for SLD.

Analysis on effects of World Bank Loaned TB Control Project in Shanxi Province during 2002—2007

Xian Xiaoping,Guo Liujia,Zhang Tianhua,Chen Guanghua,LiuWeiping

Chinese Journal of Antituberculosis. 2010, 32(3):  129-133. 

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Objective To analyze the effects of World Bank Loaned TB Control Project in Shanxi Province during 2002—2007 and provide evident base for sustainable development of TB control in Shanxi Province.   Methods Quarterly reports of the project from 107 districts/counties were analyzed and statistical analysis were made for main indicators including DOTS coverage rate, registration rate of TB suspects and of pulmonary TB cases and cure rate etc.   Results Shanxi started DOTS strategy in 2002 and its DOTS coverage rate reached 100% in 2005. During 2002—2007, the whole province admitted a total of 386-281 cases of TB suspects, and registration rate of TB suspects rose by year. 61-293 cases of smear positive pulmonary TB cases were detected. Among which, 45-123 were new smear positive. Registration rate of new smear positive were 20.45/100000 averagely, and during 2004—2007, detection rate of new smear positive were 87.72% averagely. Cure rate for new smear positive and retreatment positive cases were 90.6% and 81.7% respectively.  Conclusion The project has accelerated the rapid expansion of the DOTS strategy, improved TB detection and cure rates, and produced obvious social and economic benefits.

ect analysis of Hubei WB/DFID TB Control Project from Jan 2002 to

Hou Shuangyi,Ye Jianjun,Zhan Faxian,Xiong Changfu,Yang Chengfeng,Wang Xiaojing,Xiao Aiqing,Zhao Dingyuan,Li Guoming,Zhou Liping,Li Aiguo,Luo Junmin,Liu Xun,Wang Wen

Chinese Journal of Antituberculosis. 2010, 32(3):  136-139. 

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Objective To analyze the effect of Hubei WB/DFID TB control project and provide scientific basis for sustainable development of TB control work in Hubei.  Method Final project assessment data were used for analysis and evaluation of the implementation of the project from 2002 to 2009.   Results DOTS coverage rate in project area has reached 100%. The attendance rate of suspected TB patients increased from 112.08/100000 to 305.66/100-000. The detection rate of new smear positive pulmonary TB cases rose from 44.3% to 72.6%. The cure rate is 94.0% for smear positive patients, and 94.7% for new smear positive and 89.9% for retreatmentcases. The direct economic benefit of the project is 20.43 times of the cost in patients’ detection and treatment.  Conclusion s This project implemented well in Hubei. The DOTS coverage, the case detection rate of new smear positive patients and the cure rate of smear positive patients have all reached the project requirements, and achieved good economic and social benefits. However, the tasks remain tough in maintaining the Results and ensuring the sustainable development of TB prevention and control work after the end of the project.

tudy on mental health and social support in hospitalized patients with pulmonary tub

Qin Chao，Zhang Weiping,Wu Qi

Chinese Journal of Antituberculosis. 2010, 32(3):  140-143. 

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Objective To study psychological factors and social support situation in hospitalized patients with pulmonary tuberculosis.   Methods Questionnaires were performed in 116 hospitalized patients with tuberculosis(study group) and 90 healthy volunteers(healthy control group) using Symptom Checklist 90(SCL-90)and Social Support Rating Scale(SSRS)．Statistical analyses were made on the medians of various indicators by non-parametric statistical Methods and partial rank correlation analysis.   Results The number of positive items and the assessment index means in five factors which include somatization, obsessive-compulsive symptoms, depression, anxiety, and terror are higher than those of healthy control group. SCL-90 symptom self-assessment Results do not show differences between different levels of education. SSRS Results in subjective supports, use of support and overall score of support are lower than those of the healthy control group, while there is no difference in objective support. No difference is found between different marriage statuses.   Conclusion s Hospitalized patients with pulmonary tuberculosis have poor mental health status. Subjective support and the use of supports is also low for them. Therefore comprehensive treatment, including psychological intervention should be implemented to TB patients.

Analysis on surgical resection in 112 cases with tuberculous empyema

Gong Changfan,Bai Lianqi,Yan Dongjie,Dou Xuejun

Chinese Journal of Antituberculosis. 2010, 32(3):  144-146. 

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Objective To explore the efficacy and indication of surgical resection in tuberculous empyema.  Methods 112 patients with tuberculous empyema hospitalized from January 1999 to the end of 2008 receivedsurgical resection therapy. All patients included 49 cases with complete tuberculous empyema, 1 case with pulmonary tuberculosis combined with complete tuberculous empyema,53 cases with tuberculous encapsulated empyema, 3 cases with pulmonary tuberculosis combined with encapsulated empyema and 6 cases with tuberculous empyema combined with broncho pleural fistula.  Results The modes of surgical treatment included: pleural fibrotic plastictomy in 67 cases, pleuropneumonectomy in 10 cases, pleurolobectomy in 4 cases, pleuropneumoresection in 6 cases, pleural fibrotic plastictomy combined with thoracoplasty in 18 cases and other operations in 7 cases. The overall clinical cure rate was 95.0%. The rate of complication was 12.5%. The mortality was 0.9%.   Conclusion s The operation should be performed as eraly as possible when patients developed chronic tuberculous empyema. Surgical therapy is the only effective way in chronic tuberculous empyema.

Exploration of TB prevention and control measures in colleges

Liu Qingfu

Chinese Journal of Antituberculosis. 2010, 32(3):  147-150. 

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Objective To explore the tuberculosis control measures in colleges.  Methods TB prevention measures during 2003 to 2007 in 10 collegesin Thai’an were implemented. Measures include health education, setting up student administrators for TB report, freshmen TB screening, preventive therapy, DOT management and close contact investigation etc. Results In contrast with freshmen, sophomores have a significantly higher rate in term of core knowledge awareness(P<0.001),18 cases were detected by passive identification, accounting for 10.7%, 101 cases detected by freshmen TB screening, accounting for 60.1%, 43 cases by student administrators, accounting for 25.6%, and close contacts investigations found 6 cases, accounting for 3.6%. 100% of cases were under DOT management, 100%of cure rate for smear positive patients. TB incidence is significantly lower for students acceptting preventive therapy (χ²=43.634; P<0.001).  Conclusions The prevention measures including health education, setting up administrator for student TB report, freshmen TB screening, preventive therapy, DOT management and close contact investigation play an important role in early detection of TB cases and reducing the spread of TB in colleges.

Antibiotic application related to anti-tuberculosis second line drugs in general hospitals and TB special hospital in Shenzhen

Xu Li,Yang Yingzhou,Wu Qingfang,Guan Hongyun,Zhang Yuhua,Li Mingzhen

Chinese Journal of Antituberculosis. 2010, 32(3):  151-154. 

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Objective To investigate the antibiotic application related to anti-TB second-line drug (SLD)in general hospitals and TB specialist hospital in Shenzhen, and to provide a reliable basis for rational use of antibiotics and their scientific management. Methods Three general hospitals，including 245 inpatient cases from respiratory disease, digestive and urologic departments，and 96 cases fromTB special hospital were investigated in order to understand their application of antibiotic related to anti-Tuberculosis SLD. Cases were selected sequentiallyby their inpatient record number and investigated by recording the types and time period of applied antibiotic related to anti-tuberculosis second line drugs（SLD）.   Results Only 15.9% of all inpatient cases had drug susceptibility test, and 59.6% of cases had ever applied antibiotic related to anti-tuberculosis second line drugs. The majority applied Fluoroquinolone, accounting for 49.8%, followed by Macrolides, accounting for 9%. Fluoroquinolone classes are mostly focused on the use of levofloxacin and moxifloxacin, while the macrolides are more concentrated in azithromycin and clarithromycin; Department of Respiratory Medicine used more often, accounting for 75.1%. Among 96 cases of PTB from TB special hospital, 65 cases of them are diagnosed as PTB without other bacterial infection, and 52% of them combined use of second line anti-TB drugs; 31 cases of PTB complicating with other bacterial infection all applied SDL, and 81% of them had no DST Results . The majority applied Fluoroquinolone, accounting for 89%, and focused on Levofloxacin. Aminoglycoside antibiotics is seldom used.  Conclusion s The PTB treatment is not standard in TB special hospital. Use of antibiotic was more of empiric-based. Fluoroquinolone and Macrolides were excessively used both in general and TB special hospitals in Shenzhen.

-α gene polymorphisms in Chinese Han population of patients with pulmonary tub

Yang Hui,Liang Zhaohai,Feng Tiejian,Wang Feng

Chinese Journal of Antituberculosis. 2010, 32(3):  155-159. 

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Objective To investigate the association of TNF-α gene promoter region polymorphisms at position -238A/G and -308A/G with susceptibility to pulmonary tuberculosis（PTB）by a case-control study.   Methods Using polymerase chain reaction with sequence specific primer(PCR-SSP)/sequencing method, the single nucleotide polymorphisms (SNPs) of the promoter region of TNF-αgene at position -238 and -308 were detected in 200 pulmonary tuberculosis patients(group PTB) and 197 normal healthy individuals(group NHS) in the Han population from Shenzhen of China. The genotype frequencies and allele frequencies had been directly count out and χ² test was used to evaluate the difference of genotype frequencies distribution between two groups. Haplotypes were analyzed by SHEsis software (P=0.05).  Results There was no significant difference in genotype frequencies and allele frequencies of TNF-αgene promoter region at position  -238 (A/G) and -308(A/G) between two groups (P>0.05). There was no significant difference in haplotype frequencies between two groups (P>0.05).   Conclusion s The polymorphisms at position -238 and -308 in promoter region of TNF-αgene in Chinese Han population may not be associated with susceptibility to pulmonary tuberculosis.

Study on clinical efficacy of four-drug fixed-dose combinations in tuberculosis treatment

Zhong Qiu，Gao Cuinan,Fang Lanjun,Cheng Yuhui,Li Jianwei,Mo Zhuoding

Chinese Journal of Antituberculosis. 2010, 32(3):  162-167. 

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Objective To study the short-term efficacy and safety of four-drug fixed-dose combinations (FDC) in tuberculosis treatment.  Methods 540 registered smear positive pulmonary tuberculosis cases in six countiesof Zhanjiang citywere divided into 2 groups,with the case group takingFDC and control group taking the blister pack. The clinical manifestation, treatment outcome and adverse reaction were compared between two groups.   Results (1) the cure rates for FDC group and control group were 94.4% and 92.2% respectively. There was no significant difference between two groups（χ²=1.071, P=0.301）. (2) Related clinical symptoms (such as cough, chest pain, fatigue, night sweats, fever, hemoptysis) both gradually improved, no significant difference between the two groups (P>0.05); (3) The sputum conversion rates at the end of 2_nd and 3_rd month were 90.7% and 94.1% in the FDC group and 89.6% and91.9% in the control group, and no significant difference between two groups(P>0.05). Chest radiography showed that the cavity closure rate at the end of treatment in the FDC group was 78.2%, higher than that in the control group (61.2%).(4) In the FDC group and the control group, the rate of adverse reactions was 21.5% and 20.0% respectively, with no significant difference between the two groups (P>0.05). In the intensive phase, gastrointestinal adverse reactions in the control group were significantly greater than the FDC group (P<0.05). The abnormal rate of blood routine and liver function was similar in the two groups. The discontinuation rate due to adverse reactions in FDC group was higher than control group.   Conclusion Four-drug FDCs and blister pack drug have equal efficacy in TB treatment, and similar incidence of adverse reactions. FDCs showed great advantages in TB patients management. Therefore, it is recommended to apply FDCs in National TB Program.

Diagnostic value of fiberoptic bronchoscopy in atypical pulmonary tuberculosis with no sputum or negative sputum smear

ChangZhanping,Peng Xun,Wang Hongfen,Peng Weiping,Cao Lihua

Chinese Journal of Antituberculosis. 2010, 32(3):  167-170. 

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Objective To study the diagnostic value of fiberoptic bronchoscopy in atypical pulmonary tuberculosis with no sputum or negative sputum smear.  Methods Bronchial brushing, and rapid culture forMycobacterium tuberculosisin bronchoalveolar fluid(BALF) were performed for 201 cases with atypical pulmonary tuberculosis with no sputum or negative sputum smear and only 61 cases underwent transbronchial lung biopsy. All patients underwent sputum acid-fast staining andrapid culture forMycobacterium tuberculosisin sputum after using fiberoptic bronchoscopy.  Results  Of 201 cases,67.2%(135/201) were confirmed by bronchial brushing,83.6%(168/201) were confirmed by rapid culture forMycobacterium tuberculosisin BALF. Among the 61 cases underwent transbronchial lung biospy, pulmonary tuberculosis was confirmed in 39 cases(63.9%). Among the 201 cases underwent sputum acid-fast staining and rapid culture forMycobacterium tuberculosisin sputum after using fiberoptic bronchoscopy,28.9%(58/201) were confirmed by sputum acid-fast staining, 57.2%(115/201) were confirmed by rapid culture forMycobacterium tuberculosisin sputum.  Conclusion Fiberoptic bronchoscopy plays an important role in the diagnosis of atypical pulmonary tuberculosis with no sputum or negtive sputum acid-fast staining,and that rapid culture forMycobacterium tuberculosisin BALF is of significant value. It may increase the diagnosic rate of atypical pulmonary tuberculosis to apply different sampling Methods according to being found by the fiberoptic bronchoscopy.

Analysis on clinical correlated factors of 80 cases of elderly pulmonary tuberculosis complicated by fungus infection

Li Jinsheng,Yu Rongshen,Wang Fusheng,Chen Yu

Chinese Journal of Antituberculosis. 2010, 32(3):  171-173. 

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Objective To study the risk factors, clinical character and means of diagnosis of elderly pulmonary tuberculosis with fungus infection.   Methods Results of fungus culture, basis disease and therapy in elderly pulmonary tuberculosis were analyed.   Results The elderly pulmonary tuberculosis alway had long history of using antibiotic therapy and they were easily affected by fungus infection especially by candida albicans(70%)， The resistant rates were low in candida albicans. the incidence of fungi infection increased with the increase of lung lesion areas,especially lesion areas were more than three lung fields (75%). The patients with pulmonary tuberculosis complicated with fibrosis were easily infected by fungi (80%).  Conclusion It is common that fungal infection occurredin elderly pulmonary tuberculosis cases. Standardized application of antibiotic and hormone should be strengthened to reduce the rate of fungal infection and their resistance rater, which will be contribute to tuberculosis control and reduce death rate.

Analysis of the ~(99m)TC-DTPA renal dynamic scintigraphy characteristics of the patients with renal tuberculosis

Zhang Ting,Yao Hao,Wang Zhizhong,Wang Qinyuan,Su Jiagui,Li Ya,He Baoming,Ye Yixiu

Chinese Journal of Antituberculosis. 2010, 32(3):  174-176. 

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Objective To investigate the _99-mTC-DTPA kidney dynamic scintigraphy of patients with renal tuberculosis and to analyze the changes of kidney function in different stages of renal tuberculosis.   Methods Classify the renal function curve (Level 0～5), analyze GFR, peak time, half-time and 20 minutes remaining row of data changes of these levels, and account the ipsilateral and contralateral kidney renal function curve classification.   Results The renal function curve classification is related to the GFR (0 and 5, P=0.001), the renal function with a higher kidney function will be seriously damaged. GFR will decrease significantly and affects the contralateral kidney. When the ipsilateral renal function curve is above level 3, the contralateral level 1 and 2 will account for 42% and level 3 will account for 25%.   Conclusion To evaluate the current situation of the patient’s kidney function, the renal dynamic scintigraphy will be more sensitive and effective than other imaging Methods .

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SHI Jing-Yun, XIAO He-Ping, CHEN Gang

Chinese Journal of Antituberculosis. 2010, 32(3):  179-180. 

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