Table of Content

10 February 2008, Volume 30 Issue 2

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Combined application of factor analysis and cluster analysis in CT images classification of secondary active pulmonary tuberculosis

Lu Xiwei¹ Wu Jianlin,Liu Jinghua1,et al.

. 2008, 30(2):  80-84. 

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Objective To explore the significance of combination of factor analysis and cluster a- nalysis in CT images classification of pulmonary tuberculosis and to provide a scientific basis for the criterion of classification.Methods The CT appearance images of 243 active pulmonary tuberculo- sis(PTB)cases were divided into 13 sorts,and analyzed by combination factor analysis(varimax) with cluster analysis.The value in diagnose smear positive and smear negative PTB was compared. Results CT findings of 243 cases can be induced into 5 common factors according to factor analysis, including air spreading factor,consolidation factor,centrilobular nodule positive factor,centrilobu- lar nodules negative factor and cavity factor.The images of the secondary PTB can be subdivided to 5 groups by K-mean cluster analysis,viz.cavity-air spread type 59 cases(24.3%),cavity type 34 cases(14.0%),air spread type 32 cases(13.2%),consolidation type 54 cases(22.2%)and centri- lobule nodule type 64 cases(26.3%).There was significant statistical difference in composition of classification between smear positive and negative cases(P<0.05).Among the total,cavity-air spread type and consolidation type in the smear positive cases were obviously more than those of negative cases,and while centrilobular nodule type in smear negative groups was vividly less than one of positive groups.Conclusions Combination between factor analysis and clustering analysis can reveal the characteristics and regularity of multiplex CT images of PTB,perform scientific clas-sification and improve the diagnosis of active PTB,especially smear negative cases.

Comprehensive analysis of the status of drug resistance of Mycobacterium tuberculosis among different age group in China

Fan Yongde¹,He Guangxue,Cheng Shiming,et al

. 2008, 30(2):  85-89. 

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Objective To analyze drug resistance of Mycobacterium tuberculosis in different age group in recent years,and to provide scientific evidence for further development of TB control poli-cy.Methods Systematic Review was applied to comprehensively analyze the status of drug resist- ance of Mycobacteriurn tuberculosis in different age group from 1996 to 2007.Results According to the systematic analysis of the literature in the past 10 years,the primary drug resistance rates were 28.0%,31.8% and 28.9% respectively in young group,middle age group and old group.There was significant difference between young group and middle age group(P<0.05),and there were no significant differences between young group and old group,middle age group and old group (P>0.05);the rates of acquired drug resistance were 70.1%,66.1% and 57.0% respectively in young group,middle age group and old group.There were significant differences among them(P<0.05). The frequency of primary drug resistance from high to low in order were S,R,H and E in young group and middle age group,and H,S,R and E in old group;the acquired drug resistance frequen- cy were H,R,S and E in all groups,the acquired resistance rate to H in young group was 71.0%, which was the highest among three groups.The rate of primary multi-drug resistance in middle age group was 4.2 %,higher than that in young group and old group,there were significant differences between young group and middle age group,middle age group and old group(P<0.05);the rate of acquired multi-drug resistance in young group was 45.2%,much higher than that in middle age group(35.2%)and old group(19.7%),there were significant differences among them(P<0.05).The rate that the drug resistance happens along with duration of medication is different a-mong different age group(P<0.05);the drug resistance rates in the group with 1～3 month of medication,the group with 4～6 month of medication and the group with more than 6 month of medication were 44.5%,66.8% and 83.1% respectively.There were significant differences among them(P<0.05),and the drug resistance happens fastest in the young group.Conclusions Prima- ry drug resistance or acquired drug resistance varies in different age groups with special characteris-tics,which is of important meaning to clarify the reason of drug resistance.It is suggested that great attention should be paid to tuberculosis cases in age group of high drug resistance.

Effect of different pathways and doses of inoculation on establishment of experimental tuberculosis in SD rats

Yuan Xiaoliang Lei Jianping Li Guangming,et al.

. 2008, 30(2):  90-95. 

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Objective To investigate the effect of pathway and dose of inoculation on establish-ment of experimental tuberculosis in SD rats.Methods Eighty male SD rats were randomized into eight groups.The rats in group C,group D and group E were injected intravenously with 0.1 mg, 1 mg,10mg of Mycobacterium tuberculosis standard strain H37Rv,respectively.The rats of group F,group G and group H were injected intraperitoneally with 0.1mg,1mg,10mg of Mycobacterium tuberculosis standard strain H37Rv,respectively.The rats of group A and group B were injected in- travenously and intraperitoneally with the normal saline,respectively.All rats were sacrificed at six weeks postinfection.Their lungs,livers,and spleens were observed pathologic changes,weighed to compare weight index of organs.The lung,liver,spleen homogenates were cultured for mycobacte- rial growth,smeared and stained to find acid-fast bacilli.Results The histopathological changes in the lungs,livers and spleens showed that macrophages and epithelioid cells aggregated within the tubercle lesion whose periphery are surrounded by lymphocytes.With increasement of dose of inoc- ulation,tubercle lesion change and positive rate of mycobacterial culture of lung,liver and spleen tissues from experimental groups were increasing.Lung,liver,spleen sections with Ziehl-Neelsen staining showed that red,small and short acid-fast bacilli arrayed disorderly within macrophages and inflammatory tubercle.Tubercle lesion change and positive rate of mycobacterial culture of lung,liver,spleen in rats from the groups infected by caudal vein were higher than that from the groups infected by abdominal cavity with the same doses of inoculation.Conclusions Caudal vein pathway is better than abdominal cavity pathway in establishing experimental tuberculosis in SD rat.SD rats can be infected by Mycobacterium tuberculosis and can be used as animal model of ex- perimental tuberculosis.

The evaluation on the tuberculosis control project in Wenzhou from 1996 to 2005

Zhao Xiaochun

. 2008, 30(2):  96-98. 

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Objective To evaluate the effect of the tuberculosis control project in Wenzhou and provide technique and policy foundation for the sustainable development of the control on pulmonary tuberculosis.Methods The registrations and treatment outcome of the cases were analysed accord- ing to the annual registration list of pulmonary tuberculosis cases from 1996 to 2005 in Wenzhou. Results From 1996 to 2005,there were 12491 new smear positive cases.The case detection,cure rate,registration rate of smear positive were increased annually from 1996 (22.2%,73.7% and 7.54 per 100,000)to 2005 (95.6%,85.4% and 32.5 1per 100,000).The death rate was reduced from 6.4% to 1.1 %.Conclusions The modern pulmonary tuberculosis control strategy carried out by Wenzhou has gained the expected effect,and contagious source of pulmonary tuberculosis has been under control.

Clinical analysis of severe pulmonary tuberculosis with multiple organ dysfunction syndromes

Wang Wei,Wang Zhongyuan,Wang Ansheng,et al.

. 2008, 30(2):  99-100. 

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Objective To study the clinical feature and the cause of death in pulmonary tubercu- losis with multiple organ dysfunction syndromes.Methods To review and analyze of 45 cases of pulmonary tuberculosis with multiple organ dysfunction syndrome in research institute in the last 7 years.Results Damage of lungs(100%)was the most common feature;followed by damage in liver(68.8%),kidney (40.0%),brain(35.5%),heart(31.1%)and gastrointestinal(22.2%). Thirty-four patients were died.The main inducement was infection.The death cases mostly were respiratory failure,infectious shock and ARDS.Conclusions The early prevention and diagnosis, and integrated therapy are helpful in reducing mortality of severe pulmonary tuberculosis with mul- tiple organ dysfunction syndromes.

Evaluation on quality control modes of sputum smear in Urumqi

Liu Hong

. 2008, 30(2):  101-103. 

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Objective To evaluate two quality control modes of sputum smear in Urumqi. Methods The sputum smears from the laboratories of seven districts and one county were selective- ly examined by different quality control modes with same content once a quarter.Results The pos- itive rate and the accordant rate of quality control in double grade quality control mode were signifi- cantly lower than those in single grade quality control mode.Conclusions The communication and study were increased among laboratories,the objectivity and authenticity were improved by double grade quality control mode.The untrue sputum smear could be reduced by single grade quality con- trol mode.

Mid-term evaluation on TB Control Program in 3 countries at Nanning

Zhao Yaling，Lin Xinqin，Ge Lihui,et al.

. 2008, 30(2):  104-106. 

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Objective To analyze TB Control Program effect from 2002 to 2005 after implemen- ting World Bank Loan Project and Japan-assisted China TB control project in 3 countries in Nan- ning.Methods Analyze the data of the work on TB control project from 2002 to 2005 in 3 coun- tries in Nanning.Results The work of TB control in 3 countries in Nanning had been strengthened and the detection of source of infection and cure rate of TB increased year after year.18513 suspec- ted TB cases were registered in the 4 years,among whom 7354 cases were with active pulmonary TB and 2674 were smear-positive pulmonary tuberculosis cases.The registration rate of smear-posi- tive case had increased from 11.37/106 to 32.97/106 and the cure rate of current smear-positive case had increased from 76.7 % to 89.9 % from 2002 to 2005.Conclusions The work on TB control in the 3 countries in Nanning was effective.Only high quality of implementing DOTS can the high detection rate and cure rate be ensured.

Analysis on the cases detection of new smear positive pulmonary tuberculosis in 2005,China

Zhang Hui,Liu Jianjun,Du Xin,

. 2008, 30(2):  107-108. 

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Objective To understand the situation on national case detection of tuberculosis (TB)in 2005.Methods National tuberculosis control quarterly report forms in 2005 were used to to analyze the registration of new smear positive pulmonary TB cases.Results Total 471 732 TB cases were registered,the notification rate was 36.06/100 000 pop,the case detection rate was 78.67%.Of all the new smear positive TB cases,the number and rate of notification in male were higher than those in female,the notification rates in old people were higher than those in young people,the notification rates in 31 provinces were varied from 4.22/100 000 pop to 72.43//100 000 pop.The notification rate of new smear positive was associated with the initial consulting rate(R=0.705).Conclusions Though national case detection rate has achieved the target which has been developed in 2005,TB prevention and control should be further improved.

Comparison of the therapeutic effect of tranexamic acid and para-aminomethylbenzoic acid for tuberculosis hemoptysis

hang Lixing¹,Tu Dehua, Xiao Heping,et al.

. 2008, 30(2):  109-113. 

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Objective To compare the efficacy and safety of TXA and PAMBA in the treatment of tuberculosis with hemoptysis.Methods A prospective randomized multicenter study was con- ducted from 2002 to 2003.Tuberculosis patients with mild to moderate hemoptysis were assigned to the TXA group(n=60)and the PAMBA group(n=58).The patients were similar with respect to sex and age distribution,history and severity of hemoptysis,and bronchiectasis.Results The cure rates were 55% for the TXA group and 41.4% for the PAMBA group after 3 days of treatment (P>0.05),and 95% and 81% respectively after 7 days of treatment(P<0.01).Either TXA or PAMBA was more effective for patients with new-onset hemoptysis than for those with repeated he- moptysis,without obvious side-effect.Conclusions The therapeutic effect of TXA for tuberculosis hemoptysis was similar to that of PAMBA after 3 days of treatment,but was superior to PAMBA after 7 days of treatment.

Clinical analysis of 104 multi-drug resistance pulmonary tuberculosis of different patterns

Gao Weiwei Zhao Yanlin Liu Yuhong,et al.

. 2008, 30(2):  114-117. 

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Objective To analyze the factors of MDR-TB from clinical point of view and the out- come of individualized regimen for different patterns of drug resistance(MDR,XDR and TDR). Methods Retrospective study was adopted to analyze the risk of multi-drug resistance and clinical response for 104 MDR-TB cases,which had both laboratory DST Results and 24-month follow-up outcome.Chi-square test was used for statistic analysis between each group.Results (1)The cau- ses of MDR were mainly focused on irregular use of anti-TB drugs and primary drug resistance and resistance after regular treatment,which respectively contribute 31.7%,27.9% and 20.2% of all the MDR reasons analyzed(with the total of 79.8%).(2)The sputum conversion rate at the end of therapeutic course in the group of MDR-TB,XDR-TB and TDR-TB were 52.20%,40.9% and 0% respectively.The treatment outcome did not show statistically difference between MDR and XDR (P>0.05).However,there was significant differences between TDR and MDR(P<0.01),TDR and XDR for MDR(P<0.05).Conclusions Guideline should be developed to completely cure the new PTB cases and to prevent MDR,XDR and TDR gradually.Early diagnosis and timely treat- ment to MDR-TB patients is essential to increase the cure rate of MDR.

Surgical treatment of spinal tuberculosis in lumbosacral region

Chen Xing Guo Lixin Ma Yuanzheng,et al.

. 2008, 30(2):  118-121. 

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Objective To evaluate the effect of surgery and its clinical outcome in treating pa- tients with lumbosacral spine tuberculosis.Methods Retrospective analysis was conducted to ana- lyze the treatment outcome of 53 patients with lumbosacral spine tuberculosis.Among them,37 pa- tients received surgical treatment(with 21 patients had anterior debridement and auto-grafting;16 patients had posterior debridement and auto-grafting.All patients had standard anti-tuberculosis chemotherapy for 9-12 months.Results Low-back pain in the 37 patients was relived substantially or disappeared 4 weeks after the operation.Weight was gained in 34 patients and ESR in majority of patients became normal 6 weeks after the operation.Focus was absorbed in 36 patients 12 months after operation.Focus was not absorbed in 1 patient with the internal auto-grafting becoming loose Average fusion duration was 4 months for one-segment and 6 months for two-segment.Focus was absorbed in 36 patients.Conclusions Surgical strategy of spinal tuberculosis in lumbosacral region is based on focus character.Anterior approach is appropriate for lesions debridement and bone graft,and posterior is essential for stabilization because anterior internal fixation is difficult.Poste- rior debridement is indicated for lesions localized in vertebral body and disc,and simultaneously the bone graft and internal fixation are operated.

The analysis of factors that causing fever of the patients with anti-tuberculosis treatment

Fan Lin,Xiao Heping,

. 2008, 30(2):  122-125. 

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Objective To analyse the factors that causing fever of the patients with anti-tuber- culosis treatment.Methods The 112 hospitalized pulmonary tuberculosis(PTB)patients from 2003 to 2006 occuring fever during anti-tuberculosis treatment were analysed respectively.Results The 112 PTB patients occured fever for 140 times.There are six factors causing fever including infection other than TB,fever due to TB,drug reaction,fever after bronchoscopy,combined with extrapulmonary TB and other complications.The infection acquired in hospital accounts for 98% of the infection other than TB.There is correlation between fever due to TB and hypo-albumin level of serum.Conclusions Hospital acquired infection other than TB was the top factor that causes fe- ver,followed by drug reaction and combination with extrapulmonary TB.