Table of Content

20 June 2011, Volume 33 Issue 6

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Analysis of the 5~(th) tuberculosis epidemiological sampling survey of Guangdong province

Zhong Qiu,Yin Jianjun,Qian Ming,Zhou Lin,Chen Tao,Li Jianwei,Huang Guiqing,Jiang Li

Chinese Journal of Antituberculosis. 2011, 33(6):  317-322. 

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Objective To understand the epidemiological features of tuberculosis in Guangdong province in order to evaluate the implementation of tuberculosis control strategy from 2001 to 2010. Methods Stratified cluster random sampling Methods were used for this survey. Patients were diagnosed through inquiry of suspected symptoms, chest radiograph, sputum smear test,Mycobacterium tuberculosisculture and drug resistant test. The social-economic survey and awareness survey were conducted through questionnaires. Results 1) The prevalence of active pulmonary tuberculosis was 229.97/100 000 among which smear positive tuberculosis (39.75/100 000) and bacterial positive tuberculosis(62.46/100 000). 2) The prevalence status was higher in male (χ²=59.1,P＜0.01）, elderly population (χ²=89.3,P＜0.01）, rural areas (χ²=19.0,P＜0.01）,andless developed areas(χ²=28.7,P＜0.01）, the total drug resistant rate was 22.0%. 3) Compared with the survey data of 2000 and 1990, the prevalence of active tuberculosis decreased 36.8% and 60.4% respectively, the smear positive tuberculosis declined 66.7% and 71.7% respectively. Conclusion 1) Remarkable progress in TB control work were made over the past decade in Guangdong province. The epidemic continues to show a downward trend, and the active tuberculosis decreased 60.4% in comparison with the baseline of 1990, the annual descending rate of smear positive PTB was 10.4%. Guangdong finished the TB control target set by WHO ahead of schedule, and the annual descending rate closed to the world level. 2) Guangdong province still have high tuberculosis burden with the challenge from drug resistant tuberculosis. National tuberculosis control strategy should be implemented thoroughly with more support for the less developed regions.

Characteristics of registered pulmonary tuberculosis patients in ethnic minority population in 2009

Liu Eryong,Zhou Lin,Wang Huaifeng,Du Xin,Cheng Shiming

Chinese Journal of Antituberculosis. 2011, 33(6):  323-327. 

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Objective To analyze the characteristics of active tuberculosis and new smear positive pulmonary tuberculosis(PTB) registered among ethnic minority population in China,and provide evidence for TB control strategies development for ethnic minority population. Methods In 2009,a total of 974 489 cases of PTB patients and 449 113 cases of new smear positive PTB patients were registered nationally,patients were divided into 7 age groups,including <15,15—,25—,35—,45—,55—,and ≥65.The occupational and geographical distribution of PTB among ethnic minority population was also analyzed. Results  In 2009, a total of 102 844 and 42 013 cases of minority active PTB and new smear positive PTB patients were registered, accounting for 10.6% and 9.4% of total cases registered nationally respectively. For different age categories,>65 age group has the highest number of active cases, accounting for 17.7%（18 178/102 844）. Twenty-five to thirty-four age group has the highest number of new smear positive cases, accounting for 18.6%（7 827/42 013）. For occupational distribution, the majority were farmers accounting for 72.7%（74 765/102 844）. In Herdsman living with TB, 78.8% （3 858/4 894）were from minority population. Fifty-eight point three percent （59 921/102 844）of minority TB patients lived in western region of China. Conclusions  Minority population showed different characteristics in terms of age, gender, occupational and geographical distribution. The strategy of minority TB prevention should focus on western region and farmers.

Analysis of TB case detection through investigation of close contacts of smear positive pulmonary tuberculosis patients

Gao Cuinan,Tan Qingyun,Xu Zhuowei,Luo Shaoxia

Chinese Journal of Antituberculosis. 2011, 33(6):  328-330. 

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Objective To investigate the status of TB case detection through investigation of close contacts of smear positive tuberculosis patients, provide scientific basis for the development of TB prevention and control strategy. Methods The household close contacts of 1 138 smear positive TB cases were investigated by X-ray and sputum smear test. The yield of TB cases in patient’s spouses, parents and children and in contacts with or without suspicious TB symptoms were analyzed respectively. The yield in contacts of patients with different level of smear Results was also compared. Results The yield of active PTB was 3.3% in household close contacts of smear positive PTB cases. The detection rate of active PTB was highest in spouses which was 1.9 times and 16 times higher than in the parents and the children of patients, respectively. The detection rate was 6.4 times higher in close contacts with suspicious TB symptoms than without symptoms. And the detection rate between these two groups are significant different（μ＝7.8，P＜0.01). Conclusions The prevalence of active PTB is significantly higher in household contacts than in general population, especially for the spouses of the patients. We should give special attention to contacts with suspicious TB symptoms and household contacts of patients with higher level of bacterial discharge. Therefore, we should strengthen the monitoring and examination of close contacts of smear positive PTB patients in order to detect the patients as early as possible and shorten the TB spreading period to the healthy population.

Analysis of tuberculosis health promotion intervention among middle school students in Baoan district of Shenzhen city

Lu Tanwang,Liu Jinhong,Zhao Meigui,Zhang Lei,Long Weijun

Chinese Journal of Antituberculosis. 2011, 33(6):  331-335. 

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Objective To understand the awareness situation of TB knowledge among middle school students and the effect of the health promotion intervention, provide a scientific basis for the development of TB control strategies.  Methods The students of five high schools were selected through stratified random sampling method. Students were investigated through the self-administered questionnaire before and after the intervention to identify the awareness of TB knowledge and evaluate the effect about the intervention.  Results The TB awareness rate rose from 81.5% to 85.5% before and after the intervention, before the intervention, only 55.3% of the students knew sputum examination is a simple and effective way in TB diagnosis, but after the intervention this rate increased to 80.8%; And the awareness rate about TB transmission route rose from 84.8% to 95.2%; The awareness rate of the designated TB prevention agencies rose from 42.8% to 65.0%.  Conclusion Through the health promotion intervention in combination with a variety of publicity activities, the overall awareness of TB knowledge had an obvious improvement; The health promotion intervention should figure to the characteristics of the students and strengthen their consciousness of knowledge transmission to the outside world.

Analysis of the reasons affecting the arrival of referral pulmonary tuberculosis patients reported through internet-based infectious disease reporting system in Shenzhen city

Lv Jianwen,Yang Yingzhou,Lv Deliang,Wu Qingfang,Zhang Yuhua,Guan Hongyun,Li Mingzhen

Chinese Journal of Antituberculosis. 2011, 33(6):  336-339. 

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Objective To analyze the factors affecting the arrival of reported pulmonary tuberculosis (PTB) patients reported by internet-based infectious disease reporting system to TB institutions after referral, and provide scientific basis for targeted measures in improving the referral in place rate.  Methods This is a case-control design. Patients referral in Apr.2010 were investigated by questionnaire, SPSS 13.0 software is used for statistical analysis.Results A total of 165 cases were investigated, of which 81 cases in non-arrival group, and 84 cases in arrival group. In non-arrival group, only 42.0% of patients were informed of the TB free policy by the doctors which is significantly lower than arrival group（57.1%）(P<0.05). Eighty-one point five percentof patients felt the transportation was inconvenient in non-arrival group, this is significantly higher than that in arrival group （61.9%）(P<0.05). There is a synergistic effect for free policy awareness and inconvenient transportation. Conclusions The major factors affecting the arrival in place were the awareness of the national TB free policy and inconvenient transportation.

 Analysis of case detection and treatment management of pulmonary tuberculosis in Pinggu district from 2005 to 2009

Li Guohong,Miao Runqing,Yu Yonglong,Wang Yuezhen

Chinese Journal of Antituberculosis. 2011, 33(6):  340-346. 

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Objective Through retrospective analysis of the status ofpulmonary tuberculosis(PTB) registration and treatment management of Pinggu District from 2005 to 2009, to explore the PTB case detection and management model in mountainous and rural areas. Methods Five hundred and sixty-three PTB cases registered from 2005 to 2009 were analyzed in terms of case detection method, reporting and management and treatment outcome by descriptive epidemiological method. The task issued by Beijing research institute of Tuberculosis Control for Pinggu district in these 5 years was to detect a total of 280 cases PTB new smear-positive PTB patients. Results From 2005 to 2009, a total of 563 active PTB cases were registered in Pinggu District, of which 381 cases were from mountainous areas, accounting for 67.7% with the average annual registration rate of 32.86/100 000; the remaining 182 PTB cases were from plain areas, accounting for 32.3%, with the average annual registration rate of 22.12/100 000. The registration rate of TB patients in mountainous areas was significantly higher than that in plain areas(χ²=19.562, P<0.001). From 2005 to 2009, the average annual registration rate of smear-positive PTB patients was 13.27/100 000, the case detection model of these patients were mainly through referral and passive case finding, accounting for 94.1%(530/563), the average task completion rate was 83.9%(235/280). Jinhai town is a high TB prevalence area in Pinggu district. In these 5 years, a total of 118 active PTB cases were registered in this area, accounting for 21% of that in Pinggu District, among which 22 cases were complicated with silicosis accounting for 37.9% (22/58). All patients were managed under DOTS by household supervisor, and the smear conversion rate of new smear-positive PTB patients was 79.6%(187/235) at the end of intensive periods and the cure rate was 88.9%(209/235).  Conclusions The focus of TB control work should be placed in rural and mountainous area. In order to effectively control the transmission of PTB, we should discover the new smear positive PTB patients timely and proactively, and give standardized and thorough treatment.

A survey of quality of life of new smear positive pulmonary tuberculosis patients in floating and household population in Guangzhou city

He Peixian,Gao Cuinan,Xu Zhuowei,Zhong Qiu

Chinese Journal of Antituberculosis. 2011, 33(6):  347-349. 

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Objective To understand the qualities of life of new smear positive pulmonary tuberculosis (PTB) patients in floating and household population and the risk factors affecting the quality in Guangzhou city. Methods A self-designed questionnaire was administered to 200 cases of new smear positive PTB patients, 100 in floating and in household population each. The quality of life was compared between the two groups. 205 pieces of questionnaires were sent out, 200 pieces were collected for analysis, among which 119 from male and 81 from female patients. The valid response rate of questionnaires was 97.5%.  Results In comparison with 2 months before the treatment, 16.0%,47.0%, 24.0%, 8.0% and 5.0% of floating patients felt much better, better, similar, worse, and much worse respectively. This was compared with 11.0%, 68.0%, 11.0%, 8.0% and 2.0% in household population. The difference is statistically different between floating and household population(χ²=15.78,P<0.05). The patients in household population had a more obvious improvement in health status than patients in floating population. The score for the impact of emotion on quality of life is (1.61±0.49), and （1.38±0.58） respectively for floating population and household population, and they were significantly different between the two groups (t=3.33,P<0.05). Conclusions The quality of life of floating population is low.

Analysis of the expression profile for serum small RNAs from tuberculosis patients

Zhong Qiu,Zhou Lin,Qian Ming,Chen Tao,Chen Liang,Li Haicheng

Chinese Journal of Antituberculosis. 2011, 33(6):  350-356. 

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Objective To analyze the expression profile of serum small RNAs (sRNA) from tuberculosis (TB) patients, and find a new way to study the regulatory mechanisms in the process of tuberculosis.  Methods Small RNAs from Solexa deep sequencing covered almost every kind of RNA, including miRNA, siRNA, piRNA, rRNA, tRNA, snRNA, snoRNA，repeat associated sRNA and degraded tags of exon or intron. By comparing our sequences with those in databases and picking out the overlap on genome location between our data and the databases, sRNAs can be annotated into different categories. Those which can not be annotated will be used to predict novel miRNA by the self-developed software Mireap. Results In the sera from non-TB patients group, 109 630 different types containing 2 759 795 sequences of small RNAs were found,in which there were 84 different types containing 1 433 sequences of miRNA candidates. In the sera from TB patients group, 97 614 different types containing 1 452 119 sequences of small RNAs were found, in which there were 65 different types containing 755 sequences of miRNA candidates.  Conclusion  The expression profiles of serum small RNAs are different between TB patients and non-TB patients.

An analysis on N-acetytransferase 2 genetic polymorphisms in 155 Hans Chinese patients with tuberculosis

Li Xinjie,Wang Yunnan，Zou Yonghong，He Gang，Yin Xiaomao,Zhang Yanbin，Su Wenjie，Liu Zhihui

Chinese Journal of Antituberculosis. 2011, 33(6):  357-360. 

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Objective To determine the distribution of N-acetyltransferase 2 (NAT2) genetic polymorphisms in Chinese Hans TB patients.  Methods The specific gene sequence of NAT2 from peripheral blood lymphocytes were detected by PCR-DNA sequencing technique and the common sites of single nucleotide polymorphism were analysed. These Results were compared with the data of healthy population reported in other articles.Results Of 155 Chinese Hans TB patients, the alleles genetic frequencies of NAT2*4, NAT2*5A, NAT2*5B, NAT2*5C, NAT2*6, and NAT2*7 were 50.7%, 0.6%, 4.8%, 1.0%, 28.7% and 14.2% respectively. 11 genotypes as follow were detected: NAT2*4/4, NAT2*4/5A, NAT2*4/5B, NAT2*4/5C, NAT2*4/6, NAT2*4/7, NAT2*5B/6, NAT2*5B/7, NAT2*6/6, NAT2*6/7 and NAT2*7/7. According to the metabolic phenotype, these genotypes were divided into fast type（NAT2*4/4）, intermediate type（NAT2*4/5A, NAT2*4/5B, NAT2*4/5C, NAT2*4/6, NAT2*4/7） and slow type (NAT2*5B/6, NAT2*5B/7, NAT2*6/6, NAT2*6/7, NAT2*7/7). And their frequencies were 23.2%，54.9%（1.3%，3.2%，1.9%，34.9%，13.6%），and 21.9% (1.9%，4.5%，5.8%，9.0%，0.6%), respectively.There are significant difference in the phenotype distribution between TB patients and healthy population (χ²=11.93，P<0.01). Conclusion s The intermediate type of NAT2 genotype in Chinese Hans TB patients was main form, and NAT2 genotype distribution may be associated with TB susceptibility.

Comparing analysis of Mycobacterium Bactec MGIT960 culture with Lowenstein-Jensen culture method

Zhang Juan,Jiang Jun,Zhang Hong,Jia Lin,Wei Chengcui,Shi Lian,Ma Jinghong,Yang Lijun

Chinese Journal of Antituberculosis. 2011, 33(6):  361-365. 

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Objective To compare the using value of the automatic BACTEC MGIT960 system with Lowenstein-Jensen (L-J) culture method in culture, identification and drug susceptibility test of Mycobacterium. Methods A total of 435 cases (including 319 male patients and 116 female patients with average age 52.3 years) were detected by sputum smear for acid-fast staining, L-J culture and MGIT960 liquid culture, respectively. The culture-positive samples were further performed drug susceptibility test on isoniazid (INH), rifampicin (RIF), streptomycin (STR) and ethambutol (EMB) using the absolute concentration method on L-J medium and MGIT960 method, respectively. Their culture-positive rate, culture time and coincidence rate were analyzed.  Results The positive coincidence rate of MGIT960 and L-J culture with sputum smear were 90.8% (187/206) and 89.3% (184/206), respectively. The coincidence rate of MGIT960 and L-J culture was 92.8% (219/236). Their average culture times were 9.5 days and 31.5 days, respectively. The coincidence rate of INH、RIF、STR and EMB drug susceptibility test using MGIT960 and L-J culture method was 92.7%, 95.9%, 91.8% and 97.3%, respectively.  Conclusions The sensitivity and specificity of automatic MGIT960 are higher than L-J method. The report time of MGIT960 reduced to 9.5 days. The automatic MGIT960 is ideal for the rapid mycobacterial culture, identification and drug susceptibility test.

A study of pulmonary surfactant associated protein A、D for diagnosis in pulmonary tuberculosis

Hu Hua,Ju Yunfei,Xu Yong,Meng Fanmin,Chi Jingyu,Yang Yan,Li Xuezheng

Chinese Journal of Antituberculosis. 2011, 33(6):  366-368. 

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Objective To study the expression of pulmonary surfactant associated protein A、D(SP-A、SP-D) and their correlation in patients with pulmonary tuberculosis  Methods The expression of SP-A、SP-D of sputum and serum in 50 patients with smear positive pulmonary tuberculosis, 51 patients with smear negtive pulmonary tuberculosis,30 patients with COPD and 85 healthy volunteers were detected by ELISA.  Results The expression of SP-A、SP-D of sputum in patients with smear positive pulmonary tuberculosis were correlated with the amount ofmycobacterium tuberculosisin sputum from these patients.The expression of SP-A、SP-D of serum in patients with pulmonary tuberculosis were significant higher than that of others（P<0.05）.But the expression of SP-D of sputum in patients with pulmonary tuberculosis were significant lower than that of others（P<0.01）. Conclusions The expression of SP-A、SP-D in patients are correlated with pulmonary tuberculosis. They may be an adjuvant marker to diagnose pulmonary tuberculosis.

Analysis of efficacy evaluation of B-ultrasound on the patients with tuberculous pleurisy pleural treated by injection of urokinase

Peng Dehu,Lin Zhaoyuan,Shi Lin,Hu Jinxing,Luo Liquan

Chinese Journal of Antituberculosis. 2011, 33(6):  369-371. 

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Objective To study analysis of efficacy evaluation of B-ultrasound on the patients with tuberculous pleurisy pleural treated by injection of urokinase.  Methods 113 cases of patients with tuberculous pleurisy pleural were collected from January to June of 2009. in 20 of whom the Results of Ultrasonography was analyzed after and before the treatment by injection of urokinase. Results There are three types of B-mode ultrasonic images in tuberculous pleural effusion: type Ⅰ is 49(43.4%),type Ⅱ 51(45.1%) and type Ⅲ 13(11.5%). No injected urokinase into pleural cavity: the incidence rate ofpleural thickening was 12.2% in type Ⅰ, 69.4% in typeⅡand 100% in type Ⅲ. There were significant differences among them（P<0.005）. Injected urokinase into pleural cavity：the rate of pleural thickening was 33.3% in type Ⅱand 69.4% inno injected urokinase, showing that a significant difference was found between them（P<0.05）. The incidence rates ofpleural thickening were 100% in type Ⅲ both after injected urokinase and no injected urokinase.  Conclusions There ar e evaluation of therapeutic effect after injected urokinase.

Analysis of influencing factors for culture results during sputum collection,storage and transport

Song Honghuan,Meng Erwang,Shi Jinyan,Peng Hong,Xu Weiguo

Chinese Journal of Antituberculosis. 2011, 33(6):  372-376. 

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Objective To analyze the influencing factors for sputum culture during sputum collection, storage and transport.  Methods The data of sputum culture from a municipal TB lab in Jiangsu province from April to October in 2010 were analyzed.  Results The process including sputum specimen collection, storage, transportation and culture in 475 smear-positive patients were analyzed, and found that the sputum specimens from different counties (P=0.007), different specimen quantity (P=0.008), different specimen storage time（P=0.037）and different positive class （P=0.001）all had statistic significance for culture quality.  Conclusions The procedure of specimen collection, storage, transportation and culture influence the result of culture. Their standard procedure required by the NTP should be strictly followed, and the training for health workers in county laboratory should be strengthened to improve sputum culture quality.

Analysis on effect of clinical nursing pathway for health education in patients with new smear positive pulmonary tuberculosis

Li Aizhen,Li Yamei,Li Yuzhuo,Liu Junping

Chinese Journal of Antituberculosis. 2011, 33(6):  377-379. 

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Objective To investigate the effect of the clinical nursing pathway（clinical pathway for short） for health education in patients with new smear positive pulmonary tuberculosis.  Methods 400 patients with new smear positive pulmonary tuberculosis were assigned equally to a clinical pathway group and a control. The clinical pathway group included 94 male and 106 female and average age was (54±15.9). The control group included 99 male and 101 female and average age was （56±14.2）. Patients received health education with clinical nursing pathway in clinical pathway group and received health education with conventional care programmes in the control. Change of life behavior, nursing satisfaction and compliance of taking anti-tuberculosis drugs were compared between the clinical pathway group and the control. Data were analyzed with chi-square test. P-value<0.05 was considered to be statistically significant. Results The score of treatment compliance in the clinical pathway group were 4 scores in 140 cases, 3 scores in 20 cases, and 2 scores in 10 cases. In the control group, the scores of treatment compliance were 4 scores in 170 cases, 3 scores in 30 cases, 2 scores in 21 cases and 1 scores in nine case. Cognitive behavior change in the clinical pathway group were basic apprehension in 144 cases, partial apprehension in 51 cases and inapprehension in 5 cases. In the control group, basic apprehension in 78 cases, partial apprehension in 71 cases and inapprehension in 51 cases.Nursing satisfaction in the clinical pathway group were satisfactory in 170 cases, partial satisfactory in 20 cases, basic satisfactory in 10 cases and unsatisfactory in 0 cases. In the control group,satifactory in 130 cases,partial satifactory in 40 cases, basic satifactory in 20 cases,and unsatifactory in 10 cases.Three above assessment indicators between the clinical pathway group and the control were significantly different. The chi-square value were 17.806, 60.686 and 35.33 respectively, P values were less than 0.01. The indicator in the clinical pathway group was higher than those in the control (P＜0.01). Conclusions Management of clinical pathway can improves treatment compliance, nursing care satisfaction and cognitive behavior change in patients with pulmonary tuberculosis.