Table of Content

10 October 2011, Volume 33 Issue 10

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Study on the indicators associated with the delay of new smear positive tuberculosis before initiation of standard TB treatment

CHENG Shi-ming，WANG Ni，ZHOU Lin，YANG Hua-lin，XU Wei-guo，HE Jin-ge

Chinese Journal of Antituberculosis. 2011, 33(10):  633-636. 

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Objective To validate the indicators used in evaluation of delay of TB patients before initiation of standard TB treatment and related data collection methods and their feasibility in order to provide evidence base for the development of relevant TB control and prevention strategies. Methods Indicators including total delay, health seeking delay, diagnostic delay, treatment delay were defined according to the critical nodes (onset of symptoms, first visit to doctor, TB diagnosis and treatment initiation) during the health seeking process. The typical survey methods were adopted and three counties were selected from the eastern, middle and western provinces each. New smear positive TB patients registered during May 2010 to September 2010 were administered face-to-face self-designed questionnaire survey. A total of 329 smear positive TB patients were enrolled in this study. Results  In this study, male accounted for 81.5%（268/329）, the average age was 51.8 (95% CI:49.9－53.8) years old, farmers accounted for 71.1%(234/329), junior high school education or less were 86.6% (285/329), an annual income of less than 5000 yuan accounted for 81.2% (267/329); The total delay was 36d(0－597d), health seeking delay was 15d(0－594d) and diagnostic delay was 10d(0－429d), between the two there is no significant difference (t=1.596, P=0.111); According to causes of delay, health system induced diagnostic delay was 7d (0－428d), patient induced diagnostic delay was 1d (0－45d), the difference between the two is statistically significant (t=8.609, P=0.000); According to the key nodes in health seeking process, delay in detection of TB suspects was 0d(0－428d), in referral of TB suspects was 4d (0－267d), the difference between the two is statistically significant (t=3.235, P=0.001). Conclusion The indicators designed in this study could give a more in-depth understanding of the causes of the delay.

Observation of effect and safty on Mycobacterium vaccae for prevention pulmonary tuberculosis

MA Fu-bao，XU Wei-Guo，CHEN yong，LU Jing-zhong，DING Xiao-Zhu，WANG Ya-Long，FAN Gang

Chinese Journal of Antituberculosis. 2011, 33(10):  637-640. 

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Objective To observe the epidemiological effect and safety on Mycobacterium vaccae (M. vaccae)for prevention pulmonary tuberculosis. Methods According to the PPD skin test results, double-blind controlled prospective study were conducted in the new students of primary school, middle school and college. All students were randomly divided into experimental group(21 684 cases vaccinated with M. vaccae) and control group(21 421 cases vaccinated with hepatitis B vaccine)。The morbidity of pulmonary tuberculosis and allergic diseases were followed up for 3 years approved by the Ethics Committee of our centre. Results The incidence rate of pulmonary tuberculosis in experimental group and in control group were 0.14‰ and 0.51‰, respectively (χ²=4.671，P=0.031）.The incidence rate of allergic asthma in experimental group and in control group were 0.46‰ and 1.31‰, respectively.(χ²=8.755，P=0.003). The incidence rate of allergic skin diseases in experimental group and in control group were 3.04 ‰ and 4.29‰, respectively. (χ²=4.619，P=0.032). All differences above were significant statistically. However, the incidence of fever were not significant statistically (u=1.71,P<0.05) in experimental group with 6.69‰ (151/21684) and in control group with 2.75‰ (59/21 421). Conclusion M. vaccae has good epidemiological effect on the prevention of pulmonary tuberculosis, allergic asthma and allergic skin diseases M. vaccae is also safe for injection.

Analysis of the current situation of TB control and prevention in Gansu Province

YANG Shu-min，WANG Bo，CHEN Wei-tao，GAO Qiao-fen，SI Hong-yan

Chinese Journal of Antituberculosis. 2011, 33(10):  641-645. 

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Objective To understand the current situation of TB control and prevention in Gansu Province. Methods A retrospective epidemiological survey was conducted through questionnaires for provincial, prefecture and county level, making use of the TB surveillance information from 2001 to 2009. Epidata is used to establish the database, and Excel and SPSS 17.0 is used for data analysis. Results By the end of 2009,DOTS coverage rate reached 100% and the DOTS quality continued to increase. From 2001 to 2009, a total of 70804 cases of smear positive TB cases were detected in the whole province with the task completion rate of 93.49%（70 804/75 738）. In 2009, the cure rate of new and re-treatment smear positive TB cases reaches 91.68%（56 592/61 731） and 87.33%（9983/11 431）respectively, the cure success rate reaches 91.63%（67 039/73 162） for the infectious pulmonary TB cases. From 2005 to 2009, the referral rate of TB cases and the suspected TB cases had reached 65.08%（61 511/94 510）, the arrival rate of referral TB cases and the suspected TB cases reached 48.35%（29 741/61 511）, tracing rate reached 77.35%（50 100/64 769）,tracing arrival rate reached 58.16% （29 139/50 100）,the total arrival rate reaches 62.30% （58 880/94 510）. The training rate of village doctor reaches 90.07%（17 922/19 898）.Conclusion Our province has established a government-led, multi-sectoral cooperation and full social participation mechanisms for sustainable development of TB control work. The human resources improved both in quantity and in quality. Laboratory building and financial input strengthened gradually.

Comparison between the effects of interventions of telephone supervision and traditional supervision to the pulmonary TB patients in Hunan rural areas

YANG Hua-lin, BAO Chang-lin, BAI Li-qiong, LI Yan-hong, GONG De-hua, TANG Yi, WAN Yan-ping, XIAO Tao, FAN Jiang-jing, CHEN You-fang

Chinese Journal of Antituberculosis. 2011, 33(10):  646-650. 

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Objective To investigate the feasibility of telephone supervision in Hunan TB control by the comparison of the effects between telephone supervision and traditional supervision to smear positive pulmonary TB.  Objective Four counties, which were obtained by a cluster random sampling method, were random divided into three experimental groups and a control group. Three experimental groups were treated with telephone supervision by the county and village physicians (Group 1), the county physician alone (Group 2), or the village physicians alone (Group 3), respectively. The control group was treated with traditional supervision. 546 cases were enrolled in this study. 173 124 and 160 cases were in three experimental groups, respectively; while 89 in the control group. Of all patients enrolled were followed up for one year. Sample radio and composing analysis of the main parameters of four groups were tested by χ² test. Results Compared to the control group 82.0%（73/89） the cure rate of Group 1 (94.2%，163/173) increased significantly (χ²=10.052, P<0.05); the non-regular medicine-taking rate of Group 1 (1.2%,2/173) was obviously lower than the control group (11.2%,10/89) (χ²=16.120, P<0.05); and compared to the control group (18.0%，16/89), the non-regular reexamination rate of Group 2 (5.6%，7/124) decreased markedly (χ²=9.153, P<0.05). Conclusion Telephone supervision of pulmonary TB patients are urged to improve TB medication compliance, so it could be widely used in Hunan TB control.

Comparison between the effects of interventions of telephone supervision and traditional supervision to the pulmonary TB patients in Hunan rural areas

YAN Xue-min，WANG Hai-yan，WANG Chun-mei，QIAO Jun-xia，GAO Ye，YIN Rui-hua，WANG Xiu-lian

Chinese Journal of Antituberculosis. 2011, 33(10):  651-654. 

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Objective To evaluate the effect of supervision chemotherapy of smear positive tuberculosis patients in Baotou and analyze factors affecting the chemotherapy effect. Methods 1993 cases of tuberculosis patients with positive sputum smear examined in the Disease Prevention and Control Center of Baotou from January 2005 till December 2009 were selected and subjected to regression analysis in the following 13 categories including sex, age, vocation, household registration, hospital visit style, diagnosis classification, severe tuberculosis, treatment grouping, treatment plan, with or without cavity, with or without miliary tuberculosis, administrating manner, prognosis. P<0.05 is considered statistically significant. Results Through single factor analysis, it has been found that the Odd Ratio (OR) and 95% Confidence Intervals (95% CI) for age factor are 0.981 and 0.972～0.990 respectively (with P value equal to 0.000), the OR and 95% CI for vocation factor are 0.385 and 0.190～0.777 respectively (with P value equal to 0.008), the OR and 95% CI for household registration factor are 0.235 and 0.144～0.384 respectively (with P value equal to 0.000), the OR and 95% CI for administrating manner factor are 0.019 and 0.008～0.047 respectively (with P value equal to 0.000), indicating that these four factors of age, vocation, household registration and administrating manner are factors affecting the effect of supervision chemotherapy of smear positive tuberculosis patients. Through multiple factor analysis, our data indicate that age, vocation, household registration, administrating manner, treatment plan, and miliary tuberculosis are factors affecting the effect of supervision chemotherapy. Among these factors, age (with OR of 0.989 and P of 0.037), vocation (with OR of 2.250 and P of 0.014) and miliary tuberculosis (with OR of 0.332 and P of 0.004) are risk factors while household registration (with OR of 0.276 and P of 0.003), administrating manner (with OR of 0.010 and P of 0.000), and treatment plan (with OR of 10.719 and P of 0.036) are protective factors. Conclusion Our analysis indicates that extra attention ought to be paid to the following pulmonary tuberculosis patients including medium-elderly men, migrant workers, and miliary tuberculosis patients. Administrating mode of whole course supervision system and highly effective chemotherapy plan ought to be adopted to raise cure rate and lessen recurrence rate.

Comparison of efficacy between fixed-dose combination and assembled drugs in new smear positive pulmonary tuberculosis

ZHANG Si-yu, BAI Li-qiong, TAN Hong-zhuan, TANG Yi, TAN Zhen, XIAO Tao, FAN Jiang-jing, GONG De-hua, WAN Yan-ping

Chinese Journal of Antituberculosis. 2011, 33(10):  655-658. 

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 Objective To compare the efficacy of fixed-dose combination (FDC) with assembled drugs in patients with new smear positive pulmonary tuberculosis. Methods Patients were assigned to a FDC group (FG) or a control group (CG) by random digits table, while 269 cases in FG and 265 cases in CG. Patients were managed according to the Directly-Observed Treatment Strategy, and the efficacy of the two therapies was compared. Firstly traditional significance test was used, then superiority test was used if the difference between two groups was significant, or non inferiority test used if not, and set α=0.05. Results  Non-inferiority test indicated that the negative conversion rates of sputum at the 2nd month, the cure rates and the absorption rates of infection focus in FG were not inferior to those in CG. The negative conversion rates of sputum at the 2nd month in FG and CG was 95.54% (257/269) and 92.83% (246/265) respectively (u=3.809, P<0.001), the cure rates were 96.28% (259/269) and 93.21% (247/265) respectively (u=4.187, P<0.001) and the absorption rates of infection focus were 86.62% (233/269) and 83.40% (221/265) respectively (u=2.662, P<0.01). Superiority test showed that the cavity closure rates in FG (87.27%, 48/55) was superior to CG (63.64%, 28/44) (u=2.770, P<0.01).  Conclusion  The efficacy of FDC in new smear-positive pulmonary tuberculosis was equal to assembled drugs.

Analysis of the effect of integrated measures on Increasing case detection rate of pulmonary TB patient in Chengde city of Hebei province

LIN Sen，LIU Wei-jun，YANG Yin，MA Ying-zi，WANG Cui-hua，LI Jun-juan，WANG Ying-zi，ZHANG Gui-yun，ZHANG Gui-xiu

Chinese Journal of Antituberculosis. 2011, 33(10):  659-662. 

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Objective To analyze the effect of integrated measures on case detection rate of pulmonary TB patients. Methods The total population in Chengde city were 3 509 600 in 1999 and 3 719 100 in 2010;The registered patients of active pulmonary TB was 4917 during 1999—2002 and 19772 during 2003—2010.The situation of TB case referring, reporting and finding in general hospital were compared and analyzed before and after integrated measures performed in Chengde city. Results After all the measures performed, the yearly average number of referred patients in general hospital increased 218.81%（154625/485×100%-100%）. The total yearly average referral arrival rate raised from 53.25% to 86.89%. The yearly average contribution of active pulmonary TB from referral arrival patients increased from 6.26% to 25.21% in all diagnosed active pulmonary TB patients; The total attendance rate increased from 138.81/100 000 to 296.31/100 000, the yearly average active pulmonary TB registration rate rose from 34.78/100 000 to 67.90/100 000. The yearly average case detection rate of new smear-positive rose from 40.11% （2892/7210）to 7694%（11 426/14 851）.Conclusion The integrated measures such as the collaboration between general hospital and TB dispensary has a remarkable effect on improving the TB case detection in Chengde.

Analysis on the management status of diagnosis and treatment  for patients with pulmonary tuberculosis in Kashi prefecture of Xinjiang

YANG Tai-hua, Wahafu·Shali, YANG Jin-min

Chinese Journal of Antituberculosis. 2011, 33(10):  663-665. 

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Objective To evaluate the status of tuberculosis prevention and control in Kashi prefecture and to analyze the main problems, affecting factors and trends in the management of patients with pulmonary tuberculosis. Methods Twenty patients with active pulmonary tuberculosis who were registered as cure or treatment completed in 2010 were randomly selected by digital table and analyzed with report forms in each county. Results Of 244 cases with treatment completed, 64(26.23%) cases were classified with mistake and 172(70.49%) cases were treatment completed. The rate of sputum smear was 77.87%(190/244) at the beginning of diagnosis and was 20.90%(51/244) at the end of treatment. Of 151 cases with smear positive pulmonary tuberculosis, the rate of taking medicine observed by health worker or by themselves were 28.48%(43/151) and 71.52%(108/151), respectively. 109 cases were inspected by county level supervisor and 147 cases were inspected by township level supervisor among all patients.  Conclusion Case classification concepts unclear, lack of understanding on sputum bacteria finding, diagnosis and treatment of tuberculosis, and low DOTS are important causes which result to epidemic situation of tuberculosis seriously in Kashi prefecture.

Effects of case based payment for TB outpatient auxiliary diagnosis and treatment on TB patients’ detection and treatment

ZHANG Yi-rui，BAI Li-qiong，GONG De-hua，PENG Guo-qing，XU Bo，TANG Yi，TAN Zhen，ZHANG Chuan-fang

Chinese Journal of Antituberculosis. 2011, 33(10):  666-670. 

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Objective To analyze the effects of case based payment for TB outpatient auxiliary diagnosis and treatment on TB patients’ detection and treatment. Methods According to selection criteria of the study site, Miluo county and Linxiang county were selected as the pilot counties, Huarong county as the control county, three counties’ population respectively were 660 000, 502 000 and 729 000 at the end of 2008. Main intervention was case based payment for TB outpatient auxiliary diagnosis and treatment by the new rural cooperative medical scheme (NCMS) in pilot counties. The effect of the pilot on TB case detection and treatment was evaluated through comparison of the consultation rate of TB suspects, case detection rate, the rate of patients delay and the loss-rate of patients before and after the pilot and between pilot and control counties. Description, χ² test and Wilcoxon rank sum test were used for statistical analysis, and the level of test was 0.05. Results The consultation rate of TB suspects in Miluo county was 332.0/100000 during the pilot period which was compared with 209.8/100 000 during the same period last year, increasing by 58.2%, and the difference was statistically significant (χ²=182.852，P<0.001). The consultation rate of TB suspects in Linxiang county was 491.0/100 000 in the pilot period which was compared with 407.2/100 000 last year, increasing by 20.6%, and the difference was statistically significant (χ²=39.921，P<0.001). During the pilot period, 478 and 533 cases of active TB patients were registered in Miluo and Linxiang respectively which corresponded with 416 and 409 cases last year, increasing by 14.9% and 30.3%, respectively. The rate of patients delay in Miluo county was 40.2% during the pilot corresponding with 57.2% last year, decreasing by 29.8%, and the difference was statistically significant (χ²=25.884，P<0.001). The rate of patients delay in Linxiang county was 41.8% during the pilot corresponding with 49.4% last year, decreasing by 15.3%, and the difference was statistically significant (χ²=5.328，P<0.05). The consultation rate of TB suspects in Miluo and Linxiang during the pilot period respectively was 332.0/100 000, 491.0/100 000, while which was 359.0/100 000 in the control county, the differences were statistically significant between Miluo and the control county (χ²=7.253，P<0.01）,and Linxiang and the control county (χ²=127.685，P<0.001）. The rate of patients delay in Miluo and Linxiang county respectively was 40.2%and 41.8%, while which was 48.9% in the control county, and the differences were statistically significant between Miluo and the control county (χ²=7.881，P<0.01), and Linxiang and the control county (χ²=5.443，P<0.05). The case-loss rate of active pulmonary TB patients registered in two pilot counties respectively was 0.2% and 0%, while which was 1.8% in the control county, the differences were statistically significant between Miluo and the control county (χ²=6.283， P<0.05), and Linxiang and the control county (Fisher’s Exact P<0.01). Conclusion Case based payment for outpatient TB auxiliary diagnosis and treatment had improved the case detection level, reduced the number of case-loss and facilitated the standard treatment and management of TB patients.


The diagnostic value of MDCT TLC scanning for active tuberculosis

ZHAO Guang-cheng，ZHANG Jian，HE Yan

Chinese Journal of Antituberculosis. 2011, 33(10):  671-674. 

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Objective To evaluate the diagnostic value of Multi-slice Spiral CT (MDCT) TLC scanning for active pulmonary tuberculosis. Methods The data from two hundred patients with pulmonary tuberculosis including 132 new cases and 68 relapsed cases were analyzed. Results There were centrilobular lesions (93.0%, 186/200), tree-in-bud sign (76.0%,152/200) and bronchial wall thickening(70.0%,140/200) showed in MDCT imaging among patients with pulmonary tuberculosis. Conclusion MDCT TLC scanning is a useful tool to diagnose active pulmonary tuberculosis.

A comparative study of the correlation between sputum smears positive and the chest X-ray features of 119 cases with pulmonary tubercolosis

WANG Zhong-sheng, ZHU Tao, HU Yu-hong, WANG Mei-zhen

Chinese Journal of Antituberculosis. 2011, 33(10):  675-679. 

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Objective To explore the correlation between sputum smear-positive and chest X-ray features of patients with pulmonary tuberculosis (PTB) in order to provide the reference for management of PTB. Methods Chest X -ray features of 119 cases of smear-positive pulmonary tuberculosis who were divided into two groups according to sputum-smear 1+ to 2+ or 3+ to 4+ were reviewed and analyzed by Chi square and multivariate non-conditional logistic regression analysis with P<0.05 being considered statistically significant. Results There were no correlation between sputum mycobacteria condition and lesion distribution and range in patients with PTB. In sputum-smear 1+ to 2+ group and 3+ to 4+ group, there were 90 and 88 lesions（χ²=0.208，P=0.649）, 2.37 and 2.33 lung fields in each case（χ²=0.006，P=0.936）.There were also no correlation between sputum mycobacteria condition and cavity size(χ²=3.300，P=0.069) with or without draining bronchi （χ²=0.092，P=0.761）.Sputum condition were related to X -ray features of the type(type Ⅲ 110 cases, 92.4%)，stage(advanced stage 79 cases，66.4%；resolving stage 33 cases，27.7%；stable stage 7 cases，5.9%)，the cavities’ distribution （χ²=13.553，P=0.000）, the cavity number(χ²=15.427，P=0.000）, and the cavity wall condition（χ²=11.166，P=0.001）. Conclusion There was a closed correlation between sputum smear-positive condition and chest X-ray features in patients with PTB.

Application of gene knock-out technology in the research of tuberculosis

TIAN Xi-ze，ZHANG Wan-jiang

Chinese Journal of Antituberculosis. 2011, 33(10):  686-688. 

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