Table of Content

10 September 2011, Volume 33 Issue 9

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Tuberculosis research general situation in China

CHENG Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(9):  525-526. 

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Comparative analysis of the transference and treatment outcome of the smear positive TB patients in the floating and resident population in 2010

DU Xin, LIU Er-yong, CHEN Wei, HUANG Fei, XUE Xiao, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(9):  527-530. 

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Objective To analyze the transference and treatment outcome of the floating and resident population in 2010. Methods Through TB-specific reporting system in 2010, the transference information and treatment outcome of 31 771 floating and 477 121 resident smear-positive pulmonary TB patients were analyzed. SPSS 17.0 was used to analyze the rate of transferring out, arrival rate, and taking over rate and cure rate. P＜0.05 is considered to be statistical difference. Results In 2010, 1784 cases of floating Pulmonary TB patients were transferred out with the transference rate of 5.6% (1784/31 771), among them, 1253 arrived the receiving institution with an arrival rate of 70.2% (1253/1784), 596 of them were taken over by the receiving institution. The taking over rate was 47.6%（596/1253）.The cure rate of the patients been taken over was 71.6% (427/596). In resident population, 897 smear positive pulmonary TB patients were transferred nationally with the transference rate of 0.2%（897/47712）, 743 arrived the receiving institution with an arrival rate of 82.8%（743/897）, among them, 483 patients were taken over by the receiving institution. The taking over rate was 65.0%(483/743).The cure rate of the patients been taken over was 74.7%（361/483）.The arrival rate of the floating population is lower than that of  the resident population（χ²=88.325, P<0.001）. The cure rate of the patients been taken over by receiving institution in the floating population was lower than that in the resident population（χ²=162.393,  P<0.001）.The cure rate of the re-registered patients in the floating population was lower than that in the resident population（χ²=17.719,  P<0.001）.The differences are all statistically different. In floating population, 1784 patients were transferred,753 patients were cured with a cure rate of 42.2%（753/1784）.In 29987 patients without transfering,27142 patients were cured with a cure rate of 90.5%（27 142/29 987）.The cure rate of the transferred patients was significantly lower than that of the patients who were not transferred （χ²=17 911.166，P<0.001）.In resident population, 897 patients were transferred, 556 patients were cured with a cure rate of 62.0%（556/897）.In 476224 patients without transfering, 443015 patients were cured with a cure rate of 93.0%（443015/476224）. The cure rate of the transferred patients was lower than that of the patients who were not transferred（χ²=180637.032，P<0.001）.Conclusion The arrival rate and the cure rate of the floating population are lower than that of the resident population, therefore we should strength the management of tuberculosis in the floating population.

Application of birth cohort analysis in the distribution of tuberculosis in China

KANG Wan-li, DUANMU Hong-jin, ZHENG Su-hua

Chinese Journal of Antituberculosis. 2011, 33(9):  531-534. 

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Objective Application of birth cohort analysis to explore the distribution of the bacteriological positive pulmonary TB and to provide the evidence for high-risk groups. Methods Data were collected from the third and the fourth national TB epidemiological surveys, relevant database was set up. A total of 1 461 190 people were investigated in the third survey. 2389 bacteriological positive pulmonary TB patients were found, among which 1537 of male and 852 of female patients. In the fourth survey, a total of 365 097 people were investigated. 584 bacteriological positive pulmonary TB patients were found, including 411 of male 173 of female patients. The distribution of the bacteriological positive pulmonary TB was analyzed by negative binomial regression and correspondence analysis. Results (1) The correspondence analysis graph showed that the earlier-birth cohort, male were correlated with high prevalence of bacteriological positive pulmonary TB. (2)Negative binomial regression analysis showed that the risk of bacteriological positive pulmonary TB was associated with sex and birth cohort. The risk of TB in earlier-birth group was 1.557 (95% CI:1.443-1.692) times of the adjacent later group. The prevalence of bacteriological positive pulmonary TB was related to sex, higher in male, the risk was 1.992 (95%CI:1.415-2.807) times in male than female. Conclusion The birth cohort analysis could be used to explore the distribution of the bacteriological positive pulmonary TB and to provide the evidence for high-risk groups. The results of analysis indicated that male and earlier-birth cohort group was high-risk groups of bacteriological positive pulmonary TB.

The health care workers’awareness level of TB infection control in Inner Mongolia

ZHANG Wei-min, HE Guang-xue, REN Yu-lin, GAO Fei, REN Li-ping

Chinese Journal of Antituberculosis. 2011, 33(9):  535-538. 

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Objective To understand the health care workers’awareness level of TB infection control knowledge in Inner Mongolia. Methods This is a cross-sectional study. A total of 1345 health care workers in twelve TB institutions and general hospitals were investigated by self-designed questionnaires which include following related knowledge: triage, isolation, disinfection, ventilation, wearing masks and personal protection. 1337 valid questionnaires were collected for analysis, among them 540(40.4%) were from doctors and 797(59.6%) were from nurses.  Results On isolation and ventilation, the proportion of accurate answers by health care workers both reached 99.0% (1324/1337, 1324/1337). However, for the type of mask should be worn when contact with suspected or confirmed TB, and disinfection, the accurate answers were only 22.6 % (302/1337) and 54.3% (726/1337) respectively. The highest proportion of accurate answers by health care workers was about how to wear the masks which was 81.7%(1092/1337).  Conclusion The awareness level of TB infection control knowledge needs to be improved among health care workers in Inner Mongolia. There is a need to strengthen the training of relevant knowledge and skills, with the focus on the content of disinfection and personal protection related mask wearing.

Factors impacting on not arriving at TB dispensaries of TB cases reported and referred by non-TB control institutions

LI Xin-xu, YANG Tian-chi, JIANG Shi-wen, HE Xiao-xin, ZHOU Lin, LI Yang, WU Wei-dong, LIU Xiao-qiu, ZHANG Hui, WANG Li-xia

Chinese Journal of Antituberculosis. 2011, 33(9):  539-543. 

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Objective To identify the factors impacting on not arriving at TB dispensaries (TD) of TB cases (cases) reported and referred by non-TB control institutions (NTI), and provide the reference for developing policies to strengthen PPM.  Methods During May to July 2010, total 8 counties were sampled in Beijing, Guangdong, Guizhou and Xinjiang, and 235 cases who arrived at TD and 226 cases who didn’t arrive at TD were recruited to receive questionnaire interviews as control and case groups, respectively.  Results Multiple logistic regressions demonstrated that cases being female (OR=1.63; 95%CI:1.06-2.51), cases living less than one year in the place they were notified (OR=3.05; 95%CI:1.36-6.86), cases’ total expense from their pockets during in NTI exceeding their families’ annual income per capita by 60% (OR=1.94; 95%CI:1.25-3.02), physician in NTI not issuing referral sheets to cases (OR=2.61; 95%CI:1.69-4.04), cases suspecting or not knowing curative effect of TB drugs provided by TD (OR=2.00; 95%CI:1.29-3.11), cases not knowing the place of TD (OR=3.04; 95%CI:1.64-5.63) and cases needing more than eighty minutes from NTI to TD (OR=2.71; 95%CI:1.63-4.51) were significantly associated with cases not arriving at TD.  Conclusion In order to improve the arrival rate of referral, NTI should pay more attention to cases in female and floating population, and reduce cases’ economic burden, and TD should enhance health promotion, and provide convenient service measures.

The comparative study of the effect of TB control before and after adjusting the cooperation model between medical agencies and TB dispensaries in Yantai city

GAO Shao-bo, WANG Mao-bo, GUO Pei-jun, FENG Xue-ying, ZHOU Zheng-quan, DING Rui

Chinese Journal of Antituberculosis. 2011, 33(9):  544-547. 

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Objective To evaluate the effect of TB control before and after adjusting the cooperation model between medical agencies and TB dispensaries in Yantai city. Methods By using the TB control monitoring reports from thirteen county-level units with different cooperation model between medical agencies and TB dispensaries (special hospital model, general hospital model, TB institution model, CDC model) from 2004 to 2009, the referral rate, the tracing rate, the tracing arrival rate, the overall arrival rate and the impact of case-finding and treatment (ICT) before and after adjusting the city-level cooperation model were analyzed with chi-square test and LSD-t test. There was a significant difference if P<0.05. Results From 2004 to 2009, the referral rate increased from 3226% (549/1702) to 100.00% (992/992), the tracing rate increased from 68.37% (575/841) to 100.00% (474/474), the tracing arrival rate increased from 5026% (289/575) to 89.90% (605/673), and the overall arrival rate increased from 30.55% (520/1702) to 95.87% (951/992), χ² test showed there were significant differences ( χ² values were 2432.82, 550.97, 212.07, 1839.08 respectively, P<0.05)；the ICT of specialt hospital model was 51.13%［(1244×1161×1122)/(2048×1244×1244)］, TB institution model was 68.07% ［(4168×4055×3990)/(5703×4168×4168)］, general hospital model was 51.89%［(310×296×288)/(530×310×310)］ and CDC model was 71.09%［(903×895×875)/(1220×903×903)］, there were significant differences( χ² =158.25, P<0.05) among the ICT of the four kinds of cooperation model. Conclusion The effect of TB control has been improved significantly after adjusting the coopeartion model between medical agencies and TB dispensaries in Yantai.

Survey of the TB control work status of floating population in Bao’an district of Shenzhen city

CHEN Wei, LI Jian-wei, ZHONG Qiu, YANG Ying-zhou, LIU Jin-hong, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(9):  548-553. 

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Objective To understand the TB control work status of floating population in Bao’an district of Shenzhen. Methods We collected the case-based database of pulmonary TB cases registered from 2004 to 2007 in Bao’an chronic disease hospital. A total of 3027 cases were registered, among which 796 cases were of resident population, and 2231 were of floating population. We analyzed the features of TB epidemic in floating population. We also interviewed nine cases of TB patients, six TB doctors, and ten health administration leaders responsible for floating population TB management. Through the interview, we analyzed the health demand of floating population TB patients, their health seeking behavior and current status in their TB diagnosis, treatment, management and control policy.  Results The number of pulmonary TB cases registered in floating population was 2.8 times（2231/796） of that in resident population. 6.05%（135/2231）of TB patients were detected by passive case identification in floating population, the referral rate was 93.32％(2082/2231). Patients aged between 15 to 45 years old predominated in new smear positive patients was 93.80％(1739/1854). Case management was mainly through full course management, 97.93%(663/677)  for new smear positive pulmonary TB patients in 2007, the accumulative smear conversion rate at the end of third month was 92.99%(1724/1854). The cure rate was 46.33%（859/1854）because high proportion of patients missed treatment outcome information in the end.  Conclusion The number of TB registration in floating population is higher than in resident population, however, a large proportion of patients were loss to follow-up at the end of treatment. Therefore, we should strengthen the treatment management of TB patients and information connection and sharing.

Analysis of electronic healthcare record（EHR）related information of residents in Baoan district of Shenzhen

CHEN Liang，LI Jian-wei，YIN Jian-jun，JIANG Li，ZHAO Mei-gui，ZHOU Lin，ZHONG Qiu

Chinese Journal of Antituberculosis. 2011, 33(9):  554-557. 

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Objective To analyze the EHR-related information of Bao’an residents in order to understand the present records status and provide basis for improvement of EHRs. Methods We aggregated EHR databases of each community health service centers, ruling out records with serious loss of registration information, or with logical errors, or waste records which had been unused for long. The eligible 1 088 773 records information in 2009—2010 was analyzed.Results Among the 1 088 773 cases of records, 491 324 were male and 597 449 were female with the ratio of 1∶1.22. Age group:<15 group of 37 902 cases, 15－ group of 587 039 cases, 30－ group of 386 980 cases, 45－ group of 53 938 cases, ＞60 group of 22 914 cases. The majority came from 15－45 age groups; the floating and temporary population accounted for 97.25%（1 058 854/1 088 773）；The medical expenses dominated by medical insurance for workers （680 053 cases， 62.46%）or at their own expenses(312 097cases，28.67%).As for disease spectrum, 4176, 16 588 and 3217 cases had diabetes, hypertension, tuberculosis respectively. Conclusion The structure of EHR is complete and large number of patients have built the records. However, there is some missing or incomplete information. Therefore, the accuracy and completeness of EHRs needs to be further improved.

Study on the pulmonary tuberculosis (TB) case detection model in universities, Shanghai

CHEN Jing, SHEN Xin, XIA Zhen, GUO Jun-tao, ZHANG Jia-qi, HONG Jian-jun, SHEN Mei, MEI Jian

Chinese Journal of Antituberculosis. 2011, 33(9):  558-561. 

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Objective To explore the current situation of TB case detection in universities in shanghai, and implement interventions in order to improve the TB case detection in universities.  Methods Secondary data review method was used to investigate the situation of pulmonary TB case detection in Yangpu and Songjiang districts in 2006—2007, Excel 2007 is used to sort the data. Qualitative interviews was carried out to student with TB, CDC TB staff, teachers and health care workers (HCWs) in universities to explore the current situation of TB case detection and existing problems, MAXQDA software was used to sort, tag and categorize the data. The interventions were taken in 17 universities in two districts. The effects of the intervention were evaluated through indicators including case detection methods and corresponding proportion, registration rate of student TB, cavity detection rate, median days from symptoms onset to visiting the clinics,  awareness rate of core TB knowledge.   Results Before the implementation of the intervention, case detection rates of active and smear positive pulmonary TB patients were 11.0/100000 and 3.8/100000, respectively. 97.8% (45/46)of the student with TB were detected via passive case identification. 32.6% (15/46)of the patients visited doctors within 14 days after symptom onset. The awareness rate of core TB knowledge was 57.6%. After the interventions, case detection rates of active and smear positive pulmonary TB patients increased to 22.1/100000 (χ²=15.89,P<0.0001) and 6.0/100000, respectively. The awareness rate of core TB knowledge increased to 65.4%(6319/9660)（χ²=126.9,P<0.0001）. The proportion of the patients visited doctors within 14 days after symptom onset increased to 54.8%(51/93).  Conclusion The model greatly improved the TB case detection in universities in Shanghai.

The tendency of delay between onset of clinical symptoms to initiation of standard TB treatment for new smear positive TB patients in different regions of China

WANG Ni，ZHOU Lin，CHENG Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(9):  562-565. 

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Objective To describe the tendency of delay between onset of clinical symptoms to initiation of standard TB treatment for new smear positive tuberculosis patients in different regions of China in order to provide evidence base for development of relevant TB control and prevention strategies. Methods Typical survey methods were adopted in this research. Three provinces were selected from the eastern, middle and western regions of China respectively. A total of three counties, one in each selected provinces, were selected as study sites. 5066 casebased information of TB patients reported from 2005 to 2009 in the study sites were obtained through national TBspecific report system, meanwhile the information was validated by review of patients’ medical records. Rank sum test was used for to compare the delay between each study site and the tendency of delay from 2005 to 2009 in each site. Results Among the patients, male accounted for 74.7%(3783/5066) and female accounted for 25.3%(1283/5066). The average age was 48.1 years old (95% CI:47.6－48.6), 85.5%(4331/5066) were farmers. The overall delay from 2005—2009 in eastern, middle and western regions were 24 d(0－404 d),42 d(0－730 d)and 62 d(0－587 d) respectively，which was significantly different between regions (χ²=1095.981，P=0.000).The delay from 2005 to 2009 in eastern region were 28 d(0－398 d)，19 d(0－387 d)，22 d(1－404 d)，22 d(0－219 d) and 22 d(0－96 d) respectively, and the differences are significant between years (χ²=117.840，P=0000). For middle region, the corresponding delay by year were 54 d (0－712 d)，40 d(1－730 d)，38 d(1－471 d)，44 d(1－709 d) and 44 d (1－711 d),the differences are not significant (χ²=6.310，P=0.177). For western region, the delay by year were 91 d(5－501 d)，67 d(0－521 d)，42 d(4－435 d)，51 d(3－587 d) and 59 d(4－268 d), the differences are not significant (χ²=166.120，P=0.000). Conclusion There was a downward trend of the delay from 2005 to 2009 in each site, however, for middle and western regions of China, there are still rooms for improvement.

Clinical use of antituberculosis drugs in Beijing Haidian Hospital in 2010

XU Yu

Chinese Journal of Antituberculosis. 2011, 33(9):  566-569. 

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Objective To understand clinical use of anti-tuberculosis drugs in Beijing Haidian Hospital and provide evidence for rationale use of anti-tuberculosis drugs in general hospitals. Methods Medication rationality was evaluated by DDDs, DDC and DUI calculated based on total use, money and days using drugs of first-line anti-tuberculosis drugs in 2010 using computer information system. Sixty-two patients were detected from 17321 in-hospital patients, and their reasons for medication, regimen, and dosage were analyzed. Results The first-line drugs which can be used in Beijing Haidian Hospital were rifampicin(RFP), isoniazid(INH), ethambutol(EMB),pyrazinamide(PZA), and streptomycin(SM) The whole year’s expense on all first-line anti-tuberculosis drugs was 1988.05 RMB. The DUI value of RFP, EMB and PZA were 0.85, 0.86 and 0.96, respectively. Forty-eight patients were treated with anti-tuberculosis drugs as treatment aim among 62 patients who received the first-line anti-tuberculosis drugs. Among 32 confirmed and clinical diagnosed patients, only 43.8%（14/32）received HRZE regimen. Addition of levofloxacin(Lfx) to the regimen in patients who received second-line anti-tuberculosis drug accounted for 79.2%（38/48）.Conclusion The dosage of antituberculosis drugs was less in Haidian hospital. The rate of standardized clinical use of antituberculosis drugs is low and some agent dosage isn’t enough.  Standard  treatment of tuberculosis should be strengthened in the future.

Analysis on correlative factors of tuberculous destroyed lung

CAI Bao-yun，ZHANG Jin-fu，CHU Nai-hui，KANG Wan-li，ZHENG Su-hua，LIANG Qing-tao，LI Qi

Chinese Journal of Antituberculosis. 2011, 33(9):  570-574. 

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Objective To analyze correlative factors of tuberculous destroyed lung in order to reduce occurrence of the disease.  Methods The data from 100 pulmonary tuberculosis patients with destroyed lung and 100 pulmonary tuberculosis patients without destroyed lung, who were admitted from May, 2005 to May, 2010，were investigated. Several factors including demographic data, duration of the disease, regular therapy, drug resistance, lung infection, the number of lesions, complications, hemoptysis, empyema, respiratory failure were analyzed. Results By using single factor analysis, several factors had a significant difference between two groups, including duration of the disease（χ²=84.040，P<0.001）, drug resistance(χ²=53.107,P<0.001), respiratory failure(χ²=11.753, P=0.001), concentration of hemoglobin(χ²=12.106, P=0.001), lung infection(χ²=8.036,P=0.005)、hemoptysis(χ²=11.293, P=0.001), positive sputum AFB (χ²=8.413, P=0.035), empyema(χ²=13.211,P<0.001) and the number of lesions(χ²=22.917,P<0.001). In addition, factors such as regular therapy(χ²=25.149,P<0.001), complicated with COPD(χ²=5.647, P=0.017) and concentration of albumin(χ²=6.650,P=0.010) showed significant difference between two groups. By using multivariate analysis, factors such as duration of disease［Wald χ²=24.47, P<0.01, OR=3.81(2.24-6.64)］, drug resistance［Wald χ²=20.09, P<0.01, OR=27.11 (6.40-114.79)］, complications ［Wald χ²=9.76,P<0.01, OR=4.88 (1.81-13.20)］, concentration of hemoglobin［Wald χ²=3.95,P=0.050, OR=0.38 (0.14-0.99)］, positive sputum AFB ［Wald χ²=4.68, P=0.030, OR=0.61(0.39-0.95)］ and the number of lesions ［Wald χ²=5.08, P=0.020,OR=26.53 (1.54-458.52)］were risk factors for the occurrence of destroyed lung. Conclusion Various factors contribute to the occurrence of tuberculous destroyed lung. Early and comprehensive therapy can reduce the occurrence of tuberculous destroyed lung.

Analysis of TB case-finding in Dongfang Hospital Affiliated to Beijing University of Chinese Medicine

LI An-de, WANG Xiao-cai, SUN Li-hong, LI Jing-yu, WANG Ling-pu, WANG Tong， HUANG Xiang-an

Chinese Journal of Antituberculosis. 2011, 33(9):  575-577. 

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Objective To analyse the situation of tuberculosis case-finding and accuracy of clinical diagnosis in a general hospital. Methods Ninety-six patients clinically diagnosed with tuberculosis in Dongfang hospital from January 2010 to March 2011were transferred to other hospitals and reported via network were followed up for their diagnosis and treatment in other hospitals by phone. Results Among 96 cases, 27 were transferred to Beijing Chest Hospital,while 65 to other tuberculosis dispensaries, 4 went back home and 10 cases lost contact. Sixty-two cases of the 86 tracked patients were exactly diagnosed（62/86,72.09%）,18 cases misdiagnosed, 6 cases without identified diagnosis. Conclusion General hospitals are important parts in tuberculosis detection. They should further close their contact with TB Specialist agencies and improve their staff to increase the accuracy of TB diagnosis.

Clinical research of different regimens in patients with pulmonary tuberculosis combined with type B hepatitis

ZHANG Xi-lin, HUANG Dan, WU Yan-ting, CHEN Xiao-yan

Chinese Journal of Antituberculosis. 2011, 33(9):  578-581. 

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Objective To observe the efficacy and hepatic function in patients with pulmonary tuberculosis combined with type B hepatitis treated by three regimens and to provide the evidence for the treatment option. Methods 128 patient with pulmonary tuberculosis combined with type B hepatitis were randomly assigned to three groups including A group received the standard regimen with 2HREZ/7HRE(n=44), B group received 9HL2E in which levofloxacin was used in intensive(n=42) stage and C group received 2HREZ/7HRE and lamivudine(n=42). The X-ray resorption rate, the sputum negative conversion rate, Hepatic function and HBV DNA were observed over the course of treatment. Results The withdrawl rates of A, B and C goups were 40.9%（18/44）,11.9%（5/42）and 8.9%（5/56）（χ²=18.22，P<0.01）, the sputum negative conversion rate were 53.8%（14/26）,81.1%（30/37）and 90.0%（36/40）, the X-ray resorption rates were 38.5%（10/26）,62.2%（23/37）and 70.0%（28/40）（χ²=7.04-4.46，P<0.01 or P<0.05）. When the course of treatment was over, alanine transaminase(ALT)were （0.73±0.37）μmol·s^－1·L^－1, （0.68±0.30）μmol·s^－1·L^－1 and （0.47±0.14）μmol·s^－1·L^－1（t=4.39，P<0001）,Aspartate transaminase(AST) were （0.68±0.33）μmol·s^－1·L^－1, （0.65±0.32）μmol·s^－1·L^－1 and （0.42±0.13）μmol·s^－1·L^－1（t=4.63，P<0.001） in A, B and C group, respectively.  Total bilirubin(TB) were （17±4.38）μmol/L, （16±4.01）μmol/L and （13±4.21）μmol/L（t=9.97，P<0.001），HBV DNA were （6.3±0.6）log copy/ml, （6.1±0.8）log copy/ml and （3.1±0.4） log copy/ml（t=378.65，P<0.001）in A, B and C group, respectively. There were statistical significance between group A, B and group C. Conclusion In patients with pulmonary tuberculosis combined with type B hepatitis, B group and C group had better efficacy and was safety with lower rate of hepatic lesion and tolerable.

Potential reasons for delayed diagnosis of 83 pulmonary tuberculosis cases

KONG Wen，CHEN Cheng，XU Wei-guo，DING Xiao-yan

Chinese Journal of Antituberculosis. 2011, 33(9):  582-584. 

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Objective To analyze the potential reasons for delayed diagnosis of pulmonary tuberculosis. Methods Consecutive pulmonary tuberculosis cases with delayed diagnosis were  collected from 2006 to 2009 in department of tuberculosis, Henan hospital of infectious disease. Results Forty five males and 38 females were included in this study, age ranged from 16 to 87 years old, and the median age was 46 years old. Thirtyfive cases were delayed to visit to hospitals, and 48 cases were delayed diagnosis. Average delayed time for 60 tuberculosis patients aged less than 60 years old were 2.43 months, and was 4.13 months in 23 tuberculosis case aged more than 60 years old with  significant difference(t=2.13, P=0.036).The average delayed time was 3.59 months for 35 tuberculosis cases (42.17%) who were delayed to see a doctor; and 2.40 months for 48 tuberculosis cases (57.83%) who were delayed to be diagnosed which showed no significant difference between two groups (t=1.63, P=0.145).Among 48 delayed to be diagnosed subjects, 11 cases (22.92%) were misdiagnosed as upper respiratory tract infection, 9 cases (18.75%) as pneumonia, and 4 cases (8.33%) as obsolete pulmonary tuberculosis. Fortyone of 48 delayed to be diagnosed tuberculosis patients (85.42%) firstly saw a doctor in non-tuberculosis hospitals, 17 of 41 cases (35.42%) firstly went to private clinics and community hospitals. Twenty-three delayed diagnosed cases (47.92%) were not given an X-ray examination befor diagnosed. Meanwhile, 29 patients (60.42%) did not receive PPD test, and 33 tuberculosis cases (68.75%) were not tested for sputum smear. Conclusion Misdiagnosis may be the main reason for delayed diagnosis, and delay of visiting a doctor should not be disregarded.

Efficiency of fluorescence microscopy with light emitting diodes in detecting Mycobacterium tuberculosis

CHEN Yan-mei, QIAN Ming, JIANG Yong, CHEN Tao, LI Hai-cheng, ZHONG Qiu

Chinese Journal of Antituberculosis. 2011, 33(9):  585-587. 

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Objective To evaluate the efficiency of fluorescence microscopy with  light emitting diodes (LED-FM) in screening Mycobacterium tuberculosis. Methods Sputum samples of 232 suspected patients were collected and there were totally 696 samples including 3 samples from each patient. All samples were detected by Ziehl-Neelsen (Z-N) stain microscopy and LED-FM respectively. Results The positive rates of LED-FM and Z-N were 37.9%（88/232）and 26.7%（62/232） with significant difference (χ²=6.66, P＜0.01). Conclusion LED-FM in detecting Mycobacterium tuberculosis is superior to the conventional method.

Clinical evaluation of fluorescence microscopy with lightemitting diodes in detecting tuberculosis

SHAO Yan, ZHU Yong-dong, TAO You-ai, PENG Hong, LI Guo-li, CHEN Cheng, XU Wei-guo

Chinese Journal of Antituberculosis. 2011, 33(9):  588-591. 

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Objective To assess the efficacy of fluorescence microscopy with light-emitting diodes (LED) in clinical tuberculosis detection. Methods With 3881 sputum smears from TB lab in Huaiyin district, Huaian city, the positive rate of the smears by Ziehl-Neelsen(Z-N), conventional fluorescence microscopy(FM) and LED were compared respectively. Moreover, the relevance between the clinical diagnosis and Z-N or LED was analyzed through retrospective study. 
Results All 3881 smears were rechecked by provincial reference Lab (PRL). Of Z-N smears 284 were positive, with positive rate 14.6% (284/1941), 4 were low-false-positive, and 9 low-false-negative; of fluorescent smears, LED detected 498 positive and there were 464 positive after rechecking by FM, 39 were low-false-positive and 6 were low-false-negative. The positive rate of fluorescent smears was 23.9% (464/1940). With McNemar-Bowker test analysis, there were significant differences among the results of LED and the other two methods (P<0.001). The consistency of LED vs FM (Kappa=0.903) was much higher than LED vs Z-N (Kappa=0.409). For 78 new smear-positive patients, there was no difference between Z-N and LED. But LED detected 14 positive patients out of Z-N-negative. During follow-up patients, the positive of LED and Z-N was 228 and 195 respectively. Conclusion LED had a high consistency with FM and was obviously better than Z-N in detecting Mycobacterium tuberculosis and monitoring the follow-up.

Multicenter study of application of fluorescent-staining light-emitting diodes fluorescence microscope at county level in China

XIA Hui, ZHAO Bing, LI Qiang, OU Xi-chao, WANG Sheng-fen, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2011, 33(9):  592-595. 

Abstract ( 2169 )   PDF (708KB) ( 700 )   Save

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Objective To assess the application status of fluorescent-staining light-emitting diodes fluorescence microscope (LED) in laboratories at county level in China. Methods Two smears were prepared for each sputum from 11288 specimens coming from 3691 pulmonary tuberculosis suspects, 2509 follow-up patients and 8 cases without record of diagnosis or follow-up. Each of smears were followed with Zeihl-Neelsen (Z-N) and LED respectively. The comparison of smear positive detection rate and reading time between two methods were made. Results The smear positive detection rate using LED were 11.20% (1264/11288), 2.61% higher than that of Z-N (8.59%, 970/11288) (χ²=8086.74, P=0.000). The mean reading time with LED (120.03±38.88)s was significantly shorter than that with Z-N (206.31±75.86)s (t=28.12, P=0.00).Conclusion LED method could increase smear positive detection rate and shorten reading time compared with Z-N, so application of LED at county level laboratories is in prospect.

The value of particle colorimetric technique in rapid detection of Mycobacterium tuberculosis  resistance to pyrazinamide

WANG Dong-min, LIN Jian-xiong, PENG Dong-dong, LI Jin-zhan, LI Geng-cong, LI Hong-bing, CHEN Rui-ming

Chinese Journal of Antituberculosis. 2011, 33(9):  596-599. 

Abstract ( 2020 )   PDF (998KB) ( 457 )   Save

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Objective To explore the clinical application value of particle colorimetric  technique in rapid detection of Mycobacterium tuberculosis （Mtb） resistance to pyrazinamide (PZA).  Methods 102 strains of Mtb resistance to PZA was measured by particle colorimetric technique, and was compared with the results of BACTEC MGIT-960 Mycobacterium detection system by American BD Corporation. Results Through particle colorimetric technique, in 102 strains of Mtb, 70 of them were PZA sensitive, 32 were PZA resistant. While under the method of BACTEC MGIT-960, 69 of them were PZA sensitive, 33 were PZA resistant. The two methods are consistent in 67 sensitive strains and 30 resistant strains. If we treat the susceptibility results of BACTEC MGIT-960 as the standard, for particle colorimetric technique, the sensitivity of PZA resistance was 90.9% (30/33), specificity was 97.1% (67/69), positive predictive value of 93.8% (30/32), negative predictive value of 95.7% (67/70), accuracy was 95.1% (97/102).  Conclusion Particle colorimetric technique is rapid and convenient in Mtb-PZA-resistance measurement. This method does not need any special apparatus and instrument and has high clinical application value.

Diagnostic value of quantitative diagnostic kit for Mycobacterium tuberculosis-IFN-γ release assay

LIU Jia-wen, KANG Li-jun, WENG Sheng-feng, ZHU Xin-ying

Chinese Journal of Antituberculosis. 2011, 33(9):  600-603. 

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Objective To analyze the clinical value of Mycobacterium tuberculosis IFN-γ release assay (TB-IGRA) in diagnosis of tuberculosis. Methods The serum specimens of 249 patients with tuberculosis and 140 healthy people  were detected by Mycobacterium tuberculosis-IFN-γ release assay with Wantai quantitative diagnostic kit (WT-IGRA, Beijing Wantai Biological Pharmacy Corporation Ltd.) and QuantiFERON^®-TB GOLD in tube (QFT^®-GIT, Cellestis Limited, Australia), respectively. The results of TB-IGRA with WT-IGRA and QFT-GIT were compared with BCG-PPD skin test, Sputum smear and mycobacterial culture. Results Among 249 patients with tuberculosis, the positive rate of TB-IGRA with WT-IGRA and QFT-GIT were 76.3%（190/249）and 67.1%（167/249),respectively,and the specificity with two methods were all  83.3%（100/120). There were no statistical significant differences on positive rates of TB-IGRA and QFT-GIT between smear-positive patients and smear-negative patients which were 74.1%（43/58）,76.1%（83/109）with WT-IGRA（χ²=0.082，P＞0.05） and  67.2%（39/58），65.1%（71/109）with QFT-GIT(χ²=0.075，P＞0.05). The coincidence rate of the two kits is 84.3%. Conclusion TB-IGRA has certain diagnostic value in tuberculosis.

Analysis on the model of tuberculosis control and management and its’ control effectiveness in Hunan jail system

JIAN Xue-wu, ZHAO Hui, BAI Li-qiong, YANG Hua-lin, XIE Ying, ZHANG Zhi-ping

Chinese Journal of Antituberculosis. 2011, 33(9):  604-607. 

Abstract ( 2143 )   PDF (700KB) ( 746 )   Save

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Objective To analyze the management model of TB prevention and control and the effect of the management model in Hunan prison system, and to provide scientific basis for case detection and treatment. Methods All detainees in all of Hunan jails were enrolled in this study, the survey began in January 2006, and ended in December 2009. By the establishment of the intersectoral department coordinating mechanism and pilot hospitals, and adopted multiple methods to detect cases, such as, made census on the people who were newly sent into prison, passive case identification, and screening those ones who have been in close contact with smear-positive patients. According to the results of the survey, TB patients newly discovered were centralized to the pilot hospital to accept “Multiple cohorts, face-to-face, people-to-people” unified management and treatment. Results In the cross-sectional investigation of Hunan custody TB epidemic from 2006 to 2009, 2015 pulmonary TB patients were detected, including 237(11.26%) smear-positive patients, and 1808 (85.89%) patients were mainly found out by passive case identification. The detection rate of custody smear-positive patients was increased year by year from 9.06%（57/629）in 2006 to 12.90%（53/411）in 2009. The cure rate of smear-positive patients was 97.05% (230/237), and the treatment success rate of the smear-negative patients was 84.74% (1583/1868). Conclusion Through establishment of a multi-department cooperative mechanism, and the combination between the jail and pilot hospital, the TB control work has achieved good results. The model proves to be a viable model for TB prevention and control in Hunan jails.

Development of molecular diagnosis of drug resistance tuberculosis

ZHANG Jun

Chinese Journal of Antituberculosis. 2011, 33(9):  608-610. 

Abstract ( 2326 )   PDF (713KB) ( 1402 )   Save

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Research progress of several tuberculosis related issues

CHENG Shi-ming，ZHUANG Yu-hui

Chinese Journal of Antituberculosis. 2011, 33(9):  611-614. 

Abstract ( 1687 )   PDF (733KB) ( 723 )   Save

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The progress of the application of case based payment in New Rural Cooperative Medical Schema

BAI Li-qiong, LI Yan-hong, ZHANG Yi-rui

Chinese Journal of Antituberculosis. 2011, 33(9):  615-618. 

Abstract ( 2073 )   PDF (703KB) ( 647 )   Save

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