Table of Content

10 January 2009, Volume 31 Issue 1

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Clinical observation of the therapeutic effect with capreomycin ultrasonic aerosol inhalation combined with antitubercular agents in the treatment of retreated sputum positive pulmonary tuberculosis

Zeng Dan,Yu Delu,Tian Jingfang

. 2009, 31(1):  3-5. 

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ObjectiveTo evaluate the therapeutic effect of capreomycin(CPM) ultrasound aerosol inhalation spray combined with antitubercular agents in the treatment of retreated sputum positive pulmonary tuberculosis. Methods126 retreated patients with sputum positive for AFB were randomly divided into two groups: CPM aerosolization combined with rational chemotherapy was given in the treatment group, and chemotherapy only for the control group. ResultsAfter 3 months of treatment,the rate of sputum negative conversion and radiological improvement of patients in the treatment group were 82.5% and 93.7% respectively,much higher than those of the control group (73.0% and 80.9% respectively).There are statistically significant differences between two groups respectively (P<0.01). ConclusionsOur study showed that antitubercular agents combined with CPM ultrasonic aerosolization had higher efficacy than chemotherapy alone. It needs to be studied further.

The relation of TNF-α and pleural pachynsis and the therapeutic effect of garlic moxibustion and herb fumigate on it

Lin Cunzhi, Zhu Xinhong, Qi Yan, Wang Jian, Zhang Haiyan, Pang Jinzhi, Ge Yuxiang.

. 2009, 31(1):  6-9. 

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ObjectiveTo explore the expression of tumor necrosis factor-alpha(TNF-α) in pleural effusion and the relation of TNF-α with pleural pachynsis, and the clinical effect of pleural pachynsis treated by garlic moxibustion and herb fumigation. MethodsSenventy-six cases of tuberculous pleurisy with pleural effusion were selected. The expression of TNF-α in pleural effusions and peripheral blood were measured by ELISA. To analyze the relation between TNF-α and pleural pachynsis, 62 cases with pleural pachynsis were divided into two groups. Thirty-two cases in therapeutic group were received garlic moxibustion and herb fumigation for 30 min for five times a week. A course of treatment was four weeks. Control group contained 30 cases. These two groups were given same routine anti-tuberculosis drug treatment regiments. The therapeutic effects were evaluated by chest spiral CT check. 30 healthy individuals were as control. ResultsThe expression of TNF-α was significantly higher in pleural effusion than that in the peripheral blood (P<0.01). There was a positive correlation between the expression of TNF-α in tuberculous pleural effusion and the degree of pleural pachynsis (r=0.613,P<0.001). The degree of pleural pachynsis was obviously improved by giving garlic moxibustion and herb fumigation after four weeks (P<0.05) in therapeutic group, while it was not improved in the control group (P>0.05). ConclusionsThe expression of TNF-α was positive correlation to the degree of residual pleural thickening. Garlic moxibustion and herb fumigation therapy could decrease the pleural pachynsis.

A controlled clinical study of long course chemotherapy regimens combined with immunopotentiator in the treatment of multi-drug resistant pulmonary tuberculosis

Chu Naihui¹, Luo Yongai, Zhu Lizhen, Fu Yu, Ye Zhizhong, Xiao Heping, Wang Wei, Yuan Songlin, Zhang Xia, Lu Shuihua, Ma Liping, Nie Yusheng, Chen Wei, Chen Xiaohong, Liu Zhicheng, Li Fujian, Wang Lihua,Shang Haozhen.

. 2009, 31(1):  10-14. 

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ObjectiveTo evaluate the efficacy and safety of long course chemotherapy regimens combined with immunopotentiator in the treatment of multi-drug resistant pulmonary tuberculosis. MethodsDuring 18 months treatment, 203 patients with multi-drug resistant pulmonary tuberculosis were randomized 1∶1 to a treatment group (rifapentine,pasiniazide,levofloxacin,ethambutol,ethionamide,amikacin, clarithromycin and M. vaccae for 3 months, followed by rifapentine, pasiniazide, levofloxacin, ethambutol, ethionamide, clarithromycin and M. vaccae for 6 months, and rifapentine, pasiniazide, levofloxacin, ethambutol, clarithromycin for 9 months), and a control group (the same chemotherapy regimen alone,without M. vaccae). ResultsAt the end of the treatment, the sputum negative conversion rate (smear negative, culture negative) was 74.5% (73/98) in the treatment group, and was 72.5% (66/91) in the control group.There was no statistically significant difference between groups(χ²＝0.09, P=0.759 9). The marked effective rates of chest X-ray in the treatment group and the control group were 72.4% (71/98) and 47.3% (43/91) with statistically significant difference(χ²＝12.52, P=0.000 4),and the effective rates were 90.8% (89/98) and 82.4% (75/91) without statistically significant difference(χ²＝2.90, P=0.088 6, P>0.05) between two groups. The cavity closure rates were 33.3% (27/81) and 22.1% (17/77) without statistically significant difference(F=1.52，P=0.1294, P>0.05). CD3 count was improved statistically significant difference after 3 months and 6 months treatment in the treatment group, and the difference of CD8 in treatment group was also higher than that of control group after 6 months treatment. CD4, CD8, CD4/CD8, NK, IL-2R were similar in two groups at any stage of treatment without statistically significant difference. The symptom of cough, expectoration, chest pain, hypodynamia were improved in the treatment group better than those in control group. ConclusionsOur study showed regimens combined with immunopotentiator were very effective in bactericidal activity and bacteriostatic activity for the treatment of multi-drug resistant pulmonary tuberculosis. It had also an activity to lesion absorption and the improvement in symptoms.

Diagnostic value combined detection of ADA IFN-γ and TB-Ab-IgG in tuberculous pleurisy

Li Tongxia, Wang Jun, Pan Wei, Hua Yuzhong

. 2009, 31(1):  15-18. 

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ObjectiveTo explore the diagnostic value of adenosine deaminase (ADA) activity, IFN-γ level and Tb-Ab-IgG expression in tuberculous pleurisy. MethodsFifty-six patients with tubercular pleural effusion, 20 patients with malignant pleural effusion and 12 patients with other pleural effusion were recruited. ADA activity, IFN-γ level and TB-Ab-IgG were detected from pleural effusion and peripheral blood among these patients.ResultsThe mean levels of ADA, IFN-γ in tubercular pleural effusion were (50.98±13.07)U/L and (139.46±70.43)pg/ml.They were significantly higher than those in malignant effusion which were (10.88±9.22)U/L and (12.15±9.31)pg/ml respectively (P<0.001),and significantly higher than those in the other pleural effusion too(P<0.001). The positive rate of TB-Ab-IgG in tubercular pleural effusion were 60.7%, it was significantly higher than that in other two groups(P<0.05). When 45U/L was regarded as cut off value for ADA,the sensitivity and specificity for ADA in the diagnosis of tuberculous pleurisy were 80.4% and 96.9% respectively. The coincidence rate of clinical diagnosis was 86.4%. If 100 pg/ml was regarded as cut off value for IFN-γ in tubercular pleural effusion, the sensitivity and specificity were 83.9% and 93.8% respectively. The coincidence rate of clinical diagnosis was 87.5%. The sensitivity and specificity for TB-Ab-IgG were 60.7% and 87.5%. The coincidence rate of clinical diagnosis was 70.5%. The combined detection of the three markers for diagnosis of tuberculous pleurisy had a sensitivity of 92.9% and a specificity of 100%. The coincidence rate of clinical diagnosis was 95.5%. ConclusionThe accuracy of diagnosis for tuberculous pleurisy was significantly improved with combined detection of ADA, IFN-γ and TB-Ab-IgG.

Evaluate the application value of tuberculosis antibody and enzyme-linked immuno-spot assay used for tuberculosis.

Zhao Jing¹，Jiang Caihua，Wang Yunshan, Wang Haiying.

. 2009, 31(1):  19-21. 

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ObjectiveTo evaluate the application value of tuberculosis antibody and enzyme-linked immuno-spot assay used for Clinical diagnosis of TB.MethodsThe two Methods were used individually and in combination respectively to 83 active tuberculosis patients (43 Mycobacterial tuberculosis positive patients, 40 Mycobacterial tuberculosis negative patients), 50 nontuberculosis in control group.ResultsMycobacterium positive rate were 79％detected with 38kD-IgG and 93.0％ with T SPOT-TB． The combined detection positive rate was 97.7％． The TB culture negative patient’s Mycobacterium positive rate were both 72.5％ tested with the two single method． And the combined tested positive rate was 92.5％． To Non-TB control group, the specificity rate of the 2 Methods were 70.0％ and 94.0％ respectively. Combined tested specificity rate was 66％． ConclusionsTo TB positive patients， T Spot-TB is more sensitivity than 38kD-IgG (93％)． But there was no significantly statistical difference (χ²=3.49， P>0.05) between them． T SPOT-TB test specificity was significantly higher than 38kD-IgG test (χ²=9.76，P<0.01)． Joint detection of the two Methods can significantly improve the tuberculosis positive rate in culture negative patients． Compared with the single detection method， the difference was statistically significant (χ²=5.54，P<0.05)， As a result， the joint testing for TB-negative patients have more practical value.

Analysis on the status of DOT management in poor and remote area in Gansu province

Gao Qiaofen, Gan Peishang, Zhang Lan, Si Hongyan, Yang Shumin, Feng Juying

. 2009, 31(1):  22-25. 

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ObjectiveTo investigate the status of DOT management in poor and remote area, and to identify the existing problems and the influencial factors of it. MethodsTwo counties with the population at 400000 or above were randomly selected in the remote and poverty counties in Gansu province. The quarterly and annual data in 2005 and 2006 were collected and analyzed. Twelve townships whose distance to county center was more than l0 km were selected to conduct questionnaire interview and follow-up survey among the smear positive PTB cases that have completed the treatment before 2005, which was designed to understand the DOTS management status and its influencial factors and to evalaute the quality of DOTS in poor and remote area. ResultsThe DOTS coverage of the 109 smear positive cases was 19.3%, and 75.2% patients was not covered by DOTS and took drugs by themselves; the cure rate was 41.3% and the completion rate was 38.5%, 18.4% of the total cases did not regularly take medicine. The low coverage of DOTS was mainly due to the insufficiency in human resource, time and financial support at county, township and village levels. The factors related with the drug intake and frequency of sputum examiniation included age, TB awareness, quality and frequency of DOTS, and side-effect. ConclusionsThe quality of DOTS management in poor and remote area is low. It is urgent to develop DOTS management Methods adaptable to the local situation in poor and remote area and to improve the TB awareness among various group in the poor and remote area.

Discussions on strengthening the cooperation between the general hospitals and TB dispensaries to improve the case-detection of pulmonary tuberculosis in Fujian province

Lin Shufang, Chen Qiuyang, Du Yongcheng, Lin Yongming, Dai Zhisong

. 2009, 31(1):  26-28. 

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ObjectiveTo evaluate the effectiveness of TB case referring and tracing in the cooperation between general hospitals and TB dispensaries, and to improve the case detection of pulmonary tuberculosis. MethodsResponsibilities and take of health administration, general hospitals and TB dispensaries, the department of health administration, general hospitals reported and referred tuberculosis patients. TB dispensaries developed tracing tuberculosis patients and collected the report forms. The data was analyzed by SPSS11.0. Results55.5% new infectious pulmonary tuberculosis were reported by general hospitals which was significantly higher than other sources (P<0.01). The detection rate of infectious pulmonary tuberculosis by the TB dispensaries was significantly higher than general hospitals. From 2004 to 2007, the referring arrival rate was descended from 42.8% to 36.3% in general hospitals. The tracing rate increased from 53.3% to 95.2%, the tracing arrival rate increased from 53.4% to 67.3%, and the overall arrival rate rose from 59.1% to 77.1% in TB dispensaries. The indexes have been increasing each year except for the referring arrival rate (Current chi-square test, P<0.01). ConclusionsIt was an important methed to impove the case detection by the cooperation between general hospitals and TB dispensaries, but the cooperation mechanism would be strengthened.

The study on survey of knowledge, attitude and practice of tuberculosis control among general public in Shandong province

Wang Shichang¹, Liu Zhimin¹, Zheng Jianli¹, Gao Honglian¹, Wei Qian¹, Zhuang Jijin², Li Fang³, Bo Tao⁴, Li Cunchuan⁵, Wan Dejun⁶.

. 2009, 31(1):  29-32. 

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ObjectiveTo investigate the status of knowledge, attitude and practice of tuberculosis control among common people in Shandong province, to offer evidence for relevant policy-making of tuberculosis control, measures for health education and health promotion and baseline survey data for the future effectiveness evaluation. MethodsMultistage sampling was adopted and inquired questionnaire survey was conducted among all selected samples. ResultsTotally, 9891 people were admitted. The total understanding rate of core messages on tuberculosis control among general public was 50.1%. ConclusionsThe total understanding rate of core messages on tuberculosis control among common people is very low, and comprehensively measures should be taken in health education and health promotion, so as to improve the understanding rate of core messages on tuberculosis control.