Table of Content

10 April 2007, Volume 29 Issue 4

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Economic and geographic factor analysis for cases with limit access to health service in Hubei FIDELIS area

Chen Cheng,Liu Jianjun,Yao Hongyan.

. 2007, 29(4):  293-297. 

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Objective To analyze the economic and geographic factors,which affect the rate of cases with limited access(LA) among the new smear positive(NSP) cases,and design relevant interventions to reduce the rate of cases with LA among the NSP cases.Methods The rate of cases with LA among the NSP cases in 36 counties of Hubei FIDELIS project area during Oct.2003-Sept.2004 was obtained by questionnaire survey.Chi-square test was conducted in analyzing the relationship among the rate of cases with LA among the NSP cases,GDP per capita,service semi-diameter of TB dispensary,and landform characteristics(plain,mountain,and hill).Results There is no difference of the rate of cases with LA among the NSP cases among different GDP pre capita groups(χ²=1,P＞0.2);there is difference of the rate of cases with LA among the NSP cases among the three groups of service semi-diameter of TB dispensary(χ²=8.236,P＜0.002);the rate of cases with LA among the NSP cases is higher in the group beyond 30km than the group of 25～30km(χ²=7.063,P＜0.05);the rate of cases with LA among the NSP cases is higher in the group beyond 30km than the group less than 25km group(χ²=7.469,P＜0.05);there is difference of the rate of cases with LA among the NSP cases among landform characteristics groups(χ²=8.800,P＜0.001);the rate of cases with LA among the NSP cases is higher in mountain area than in hill area(χ²=6.085,P＜0.05),the rate of cases with LA among the NSP cases is higher in mountain area than in plain area(χ²=4.5,P＜0.05).Conclusion More funds should be invested to the counties with larger geographic area and mountainous area to facilitate patients receiving health service and reduce the rate of cases with LA among the NSP cases.Geographic area and mountainous area should be the priority consideration as criteria for project support with economy and population in the next place.

Discussion on the effect of the detection and management of TB patients by setting up anti-tuberculosis spots in hospitals

Li Bo¹,Li Chunju,Tu Dehua.

. 2007, 29(4):  298-301. 

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Objective To investigate the effect of detection and management of tuberculosis patients in anti-tuberculosis spots setting up in the hospitals.Methods The data of pulmonary TB patients which have been centrally registered in Fengtai District Anti-tuberculosis Institute from 1996 to 2002 were collected,and the data including the personnel,equipment conditions and their working status of anti-tuberculosis spots in the 1st and 2nd hospitals were also collected.Results In the nine anti-tuberculosis spots,there are altogether ten full-time or part-time anti-TB doctors.Seven spots can do the sputum smear examination,five can do the sputum culture.From 1996 to 2002,2253 active pulmonary TB patients were detected,in which 1493 cases(532 cases were culture positive) were urban,760 cases were floating population(262 cases were culture positive).1204 cases were detected and registered in the Anti-TB Institute of Fengtai District,which accounted for 53.4% of the total,and 1049 cases were detected in anti-TB spots,which accounted for 46.6%.During the 7 years,794 smear or culture positive cases were detected in Fengtai district,in which 38.4% were detected in the anti-TB spots.727 cases were treated under DOTs(Directly Observed Treatment,short-course),in which 37% were done in the anti-TB spots.The anti-TB spots had almost the same effect as the Anti-TB Institute of Fengtai district.Conclusion In the area where people live spread around and are not easy to get to see a doctor,setting up anti-TB spots in hospitals will be convenient for the tuberculosis patients,and will be helpful to detect and treat the patients under DOTs.Nevertheless,we must reinforce the DOTs and put more fund to the anti-TB spots,and make it as the most part of the work of tuberculosis control.

Exploration on tracing method of tuberculosis cases by an internet-based surveillance system

Wang Zhaowei¹,Wu Jianlin,Tang Xinghua,et al.

. 2007, 29(4):  302-305. 

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Objective To explore the Methods of recruiting tuberculosis cases that reported by an internet-based surveillance system,and to enhance the case detection rate of tuberculosis cases.Methods With the fund from FIDELIS project(Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB),a tracing system composed of county-town-village network in 50 project counties was set up,township smear-sputum-sites were established for patient’s convenience,and incentive mechanism was developed.5014 cases were traced by the surveillance system.The outcome of the tracing was compared between the project counties and other 50 non-project counties which traced 2746 cases.Results The following indicators were significantly higher in project counties than the non-project counties,including the tracing rate of cases(smear positive,smear negative or non-smear sputum) from surveillance system(P＜0.05),the arrival rate of the traced cases(smear positive,non-smear sputum)(P＜0.05).The smear positive rate of cases that retrieved by tracing was not significantly different between the two groups(P＞0.05).Conclusion A systemic tracing system of county-town-village network,township smear-sputum-sites and incentive mechanism can enhance the case detection rate of cases from internet-based surveillance system.

Investigation of mental health state and effectiveness of nursing intervention in pulmonary tuberculosis cases

Lin Yi,Li Jing,Xu Yan,et al.

. 2007, 29(4):  306-309. 

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Objective To study the mental health of patients with pulmonary tuberculosis(PTB) and the effectiveness of nursing intervention in PTB.Methods 200 PTBs were examined by self-rating depression scale(SDS),self-rating anxiety scale(SAS).They were randomly divided into observation group(added complete health education,psychological intervention)and control group(only conventional therapy and nursing care).All the patients in the two groups were evaluated by using SDS,SAS respectively.Results The scores of SDS and SAS in PTBs were significantly higher than that of standard model,and the scores in observation group were significantly lower than those of control group(P＜0.01).Conclusion PTBs are frequently with psychological.Complete nursing intervention can obviously reduce the psychological disorders of PTBs improve their ability of self-care and clinical treatment effectiveness.

The clinical analysis on 412 primary smear and culture negative pulmonary tuberculosis cases

Zhang Fengchi,Liu Chengyong,Shi Xiangkui.

. 2007, 29(4):  309-311. 

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Objective To discuss the clinical characters and diagnosis Methods of primary smear and culture negative pulmonary tuberculosis cases.Methods The clinical characters of 412 cases primary smear and culture negative pulmonary tuberculosis cases from Jun.2004 to Feb.2006 were reviewed and analyzed,and the clinical showings and X-rays features of the 2 years were dynamically observed.Sputum were checked for three times,namely before the treatment and at treatment of 2nd,5th,6th month.Sputum culture was made before the treatment.Meanwhile,the patients received anti-tuberculosis antibody test and PPD test.Results The clinical symptoms of primary smear and culture negative pulmonary tuberculosis cases are mainly slight coughing,flaccid and night sweating.Nothing was found on another 11.4% cases in physical examinations.Through the whole procedure of anti-tuberculosis treatment with common dosage,the rate of symptom improvement,assimilation of cavity and function recovery shown by X-rays was 98.3%.Conclusion Sputum negative pulmonary tuberculosis can be diagnosed in a comprehensive way.Coughing,flaccid,emptysis,low fever and night sweating are the clues combined with X-rays and laboratory examination.X-rays is one of the important Methods to diagnose sputum negative pulmonary tuberculosis.After treatment,the most ideal outcome is tuberculosis assimilated wholly,followed by tuberculosis assimilated with cavity,and tuberculosis assimilated with scobination.The 6-month regimen is available in treating the primary smear and culture negative pulmonary tuberculosis patients.

The importance of referring suspects from hospital system to TB dispensary in the case-finding of pulmonary tuberculosis

Li Jianwei,Zhong Qiu,Wang Guiqing,et al.

. 2007, 29(4):  312-314. 

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Objective To evaluate the role of referring suspects from hospital system to TB dispensary in pulmonary tuberculosis case-finding.Methods The ratio of cases and the detection rate of tuberculosis in the cases from different sources that were registered in the TB dispensaries were calculated and analyzed.Results Of the suspects consulted initially in TB dispensary,46.9% are referred cases. Of the diagnosed tuberculosis with smear-positive,54.3% are referred cases.In the referred cases with smear-positive,the percentage from county-level or above hospital is 47.1% and from town-level hospital is 45.8%.The detection rate of pulmonary tuberculosis with smear-positive in the referred cases from county-level or above hospital is 33.9%,and from town-level hospital is 23.1%.Conclusion Referring suspects from hospital system to TB dispensary is an important channel for pulmonary tuberculosis case-finding.Implementation of tuberculosis referral management is the key to insure the referral of hospital system.

Clinical analysis of 54 HIV/AIDS cases co-infected with pulmonary tuberculosis

Lu Ruichao,Xu Cailing,Li Qi.

. 2007, 29(4):  314-316. 

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Objective To analyse the causes of death of HIV/AIDS cases co-infected with pulmonary tuberculosis(PTB) and to improve the level of clinical diagnosis and treatment.Methods The causes of death of 54 HIV/AIDS cases co-infected with PTB in all of 308 patients were analyzed retrospectively.Results There were 62 cases with CD₄≥200/mm³,and 2 cases died;70 cases with CD₄ 100～199/mm³,and 8 cases died;82 cases with CD₄ among 55～99/mm³,and 17 cases died;94 cases with CD₄<50/mm³,and 27 cases died.There were 268 cases treated with anti-tuberculosis drugs,while 35 cases died;40 cases treated without anti-tuberculosis drugs,while 19 cases died.The main causes of death were fungus infection(28 cases),bacterial infection(10 cases),tubercle bacillus infection(6 cases),pneumocystis carinii infection(5 cases),viral infection(2 cases) and other causes(3 cases).Respiratory tract infection was the main cause.Conclusion The treatment of anti-tuberculosis may decrease the morality of these patients. When the level of CD₄ is lower,the fatality is higher compared with CD₄＞100/mm³(P＜0.05),fungus infection is the main cause of death of HIV/AIDS cases co-infected with pulmonary tuberculosis(PTB).Thus,the main Methods are anti-tuberculosis treatment at early stage,HAARTM,promoting immunity,and controlling other pathogenic infection,specially the fungus infection.

Change of NF-kappa B,transforming growth factor beta-1 in the development of rat hepatic fibrosis and the effect of Liver-aid Tablets on them

Wu Yichun¹,Wu Qiang,Yang Yan,et al

. 2007, 29(4):  317-320. 

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Objective To study the dynamic changes in the expression of nuclear factor kappa B(NF-κB)and transforming growth factor beta-1(TGF-β₁)in the development of middle and late stage of rat hepatic fibrosis,and the effect of liver-aid tablets on them.Methods SD rats were divided into three groups:normal control,model control and group of liver-aid tablets.CCl₄(12.5%,4ml·kg^-1)was injected sub-cutaneously in model rat twice a week for 8 and 13 weeks.The drug(921mg·kg^-1 in the group of liver-aid tablets,but 0.5% CMC-Na in control groups)was taken orally once a day for 8 and 13 weeks.The rats were killed at the end of 8th and 13th week,respectively.The left liver tissue was then used to make tissue microarrays(TMA).The TMA sections were used for Immunohistochemistry(IHC)to detect the protein expression of NF-κB p65 and TGF-β₁.The NF-κB p65 and TGF-β₁ Results of IHC were quantified by MetaMorph imaging analysis system.Results (1)During 8 and 13 weeks,the degrees of liver injury and fibrosis grades in the model group were higher than those in the normal group(P＜0.01),which was amelionated remarkably by liver-aid tablets treatment.(2)The protein expression of NF-κB p65 and TGF-β₁ in the model group was stronger than that in the normal group during 8 and 13 weeks(P＜0.01),the protein expression of NF-κB p65 and TGF-β₁ were correlated to each other during 8 and 13 weeks(P＜0.01).(3)Liver-aid tablets inhibited the protein expression of NF-κB p65 and TGF-β₁ of fibrotic liver tissue in rats during 8 and 13 weeks(P＜0.01).Conclusion Liver-aid tablets have anti-fibrosis effects on CCl₄-induced rat liver fibrosis,which might be performed through the pathway of inhibiting the expression of NF-κB and TGF-β₁.

The diagnosis value of protein electrophoresis and adenosine deaminase in tuberculosis and malignant pleural effusion

Qin Hui,Xu Xiaoping,Zou Jing

. 2007, 29(4):  321-323. 

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Objective To study the diagnostic value of pleural effusions protein electrophoresis and Adenosine Deaminase(ADA) in differentiating tuberculosis from malignant pleural effusion.Methods Thirty-six patients with tuberculous pleuritis and thirty-eight patients with malignant pleural effusion were examined.Protein electrophoresis and ADA of pleural fluid were measured by SEBIA HYDRASYS and colorimetry respectively.Results In tuberculosis and malignant pleural effusion,the level of α₁ global protein were4.32±1.35 and 3.41±0.97(P＜0.05),α₂ global protein were 8.98±1.50 and 6.01±1.53(P＜0.000),the ratio of α₂ global protein and album were 0.15±0.03 and 0.09±0.03(P＜0.000),and ADA were 71.35±24.00 and 31.21±11.90(P＜0.000).According to receiver operating characteristic curve(ROC),the sensitivity,specificity and accuracy of the ratio of α₂ global protein and album for diagnosing tuberculosis pleural effusion were 76%,89%,and 83% respectively.And the sensitivity,specificity and accuracy of ADA were 82%,78% and 80% respectively.The sensitivity,specificity and accuracy were 88%,100% and 94% when the two Methods were combined.Conclusion (1) The levels of α₁ global protein,α₂ global protein,the ratio of α₂ global protein and album,and ADA in tuberculosis pleural effusion were higher than that in malignant pleural effusion(P＜0.05).(2) Combining the ratio of α₂ global protein and album with ADA can raise the sensitivity,specificity and accuracy for diagnosing tuberculosis pleural effusion.

Diagnostic values and clinical significance of detecting soluble FasL of pleural effusions in differentiating tuberculous and malignant pleural effusions

Liu Yufeng¹,Che Wenhua,Shi Yugui,et al.

. 2007, 29(4):  324-327. 

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Objective To explore the diagnostic values and clinical significance of detecting soluble FasL of pleural effusions in differentiating tuberculous and malignant pleural effusions.Methods Using enzyme-linked immunosorbent assay(ELISA) method to detect the soluble FasL in 43 tuberculous pleural effusions and 32 malignant pleural effusions.Results The mean of soluble FasL of tuberculous pleural effussions(13.56±5.38ng/ml)was markedly higher than that of malignant pleural effusions(5.72±2.59ng/ml)(P＜0.001).If 10ng/ml of soluble FasL was regarded as cutoff value,the sensitivity,the specificity and accordance of diagnosing tuberculous pleural effusions were 81.4%,81.3% and 81.4%,respectively.Conclusion Soluble FasL might be a effective laboratory marks of differentiating tuberculous and malignant pleural effusions.

Association of polymorphisms of HLA-DRB gene and ACE gene with pulmonary tuberculosis

Shi Guangli,Hu Xiuling,Rong Changli,et al.

. 2007, 29(4):  327-329. 

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Objective To analyze the relation of polymorphisms of HLA-DRB gene and ACE gene with pulmonary tuberculosis.Methods PCR/SSP was used to identify the HLA-DRB and ACE genotype in pulmonary tuberculosis group and control group.Results The frequency of HLA-DRB₁^*15 allele in pulmonary tuberculosis group was significantly higher than that in control group(P＜0.05).The frequency of ACE I/D genotype in retreatment and drug-resistant pulmonary tuberculosis group was significantly higher than that in initial and drug-sensitive group(P＜0.05).Conclusion The HLA-DRB₁^*15 allele and the I/D genotype of ACE gene were evidently associated with pulmonary tuberculosis.

Clinical evaluation of diagnosing pleural tuberculosis

Fan Lin¹,Xiao Heping¹

. 2007, 29(4):  330-333. 

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Objective To evaluate the clinical factors of diagnosing pleural tuberculosis(PT).Methods 70 cases with PT and 70 pleurisy cases with Non-PT were analysed retrospectively.The LR,sensitivity,specificity,positive predictive value,and negative predictive value of pleural ADA,protein,lymphocyte ratio,TB-antibody in blood and pleural fluid,fever and age were calculated respectively.Results The variable with the highest LR+ was ADA,followed by TB-antibody,age,lymphocyte ratio,protein in pleural fluid and fever.If all six variables are positive,the probabilities of PT will be above 99%.If all variables are negative,the probabilities of PT will go down to be less than 1%.If four or above four variables are positive,the probabilities of pleural tuberculosis will be 97%.Conclusion The combination of these six variables can be used to evaluate the PT and to help to conduct the clinical treatment.

The analysis of the perioperative management of 32 pulmonary tuberculosis cases with diabetes mellitus.

Tang Jifu,Xu Jianrong,Wei Ming,Liao Yong,fen chen gang,chai qin

. 2007, 29(4):  333-335. 

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Objective To evaluate the perioperative management of pulmonary tuberculosis patients with diabetes mellitus.Methods The surgical treatment was performed on 32 pulmonary tuberculosis cases with diabetes mellitus and the retrospective analysis was made.Results The blood glucose level of 32 cases was controlled to a reasonable level.All the patients underwent operation.There were no serious complications during perioperative period.Conclusion Although diabetes mellitus was an unfavorable factor for pulmonary tuberculosis patients who underwent operation,the important factors related to the successful operation are emphasizing the examination of the levels of blood glucose and the levels of glucose in urine,and adjusting the dose of insulin.

Analysis of the outcome of surgery combined with chemotherapy treating multidrug-resistant pulmonary tuberculosis

Dou Xuejun,Gong Changfan,Yan Dongjie,et al.

. 2007, 29(4):  336-338. 

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Objective The outcome of chemotherapy treatment in treating multidrug-resistant pulmonary tuberculosis(MDR-TB) is not satisfied,thus the study is to explore the feasibility of surgery combined with chemotherapy in treating MDR-TB.Methods A retrospective review was performed in 48 MDR-TB patients who had surgery combined with chemotherapy from April,1995 to March,2005.36 patients(75%) had cavitary lesions,16 patients(33.3%)had bilateral lesions.All patients received pulmonary resection,consisting of lobectomy(n=28),pneumonectomy(n=15),pleuropneumonectomy(n=3),segmentectomy(n=1),wedge resection(1).Results Mortality was 2.1%(n=1) after surgery.Postoperative complications occurred in 8 patients(16.7%).The follow up was ranged from 6 to 90 months.Sputum conversion rate was 83.3%.Conclusion Pulmonary resection combined with chemotherapy achieves high cure rates with acceptable morbidity and mortality.

Research on preventing pulmonary fibrosis of pulmonary tuberculosis patient with Huang Qi and salvia miltiorrhiza

Du Debing,Luo Shizhen,Yu Pin,et al.

. 2007, 29(4):  339-342. 

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Objective To discusses the change of ECM in the pulmonary tuberculosis patient and the effect of Huang Qi and salvia miltiorrhiza in its prevention.Methods 106 pulmonary tuberculosis patients were divided into group A with 55 cases and group B with 51 cases.Based on the anti-tuberculosis treatment,group A added Huang Qi and salvia miltiorrhiza.Simultaneously,50 healthy persons were recruited in the control group.HA,LN,PⅢP and C-Ⅳ were examined before and after the treatment.The blood serum HA,LN,PⅢP and C-Ⅳ,sputum conversion rate and the absorption of the focus in the lung were compared between the two groups.Results Before the treatment,the HA,LN and C-Ⅳ were significantly higher in the 106 pulmonary tuberculosis patients than the control group(P＜0.05).After the treatment,the HA,LN and C-Ⅳ were lower in group A than those in group B(P＜0.05).The following indicators were better in group A than those in group B,including sputum conversion rate at early stage,the absorption rate of the focus in the lung,the improvement of the lung function changes and the improvement of the main symptoms(P＜0.05 or P＜0.01).Conclusion ECM plays an important role in the progress of pulmonary tuberculosis,Huang Qi and salvia miltiorrhiza have active effect on preventing and reversing the pulmonary fibrosis.

The relationship between HBsAg carrier state and hepatotoxicity during anti-tuberculosis chemotherapy

Chen Zhifei,Han Dan,Sun Xuezhi

. 2007, 29(4):  343-346. 

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Objective To determine whether inactive hepatitis B surface antigen(HBsAg) carriers are at a higher risk of drug-induced hepatotoxicity than control subjects during anti-tuberculosis treatment.Methods One hundred fifty-six inactive HBsAg carriers with newly diagnosed active tuberculosis who received standard anti-tuberculosis treatment were included in the study population.One hundred forty-one HBsAg negative patients who received standard anti-tuberculosis treatment were selected as control subjects.Results More severe hepatotoxicities were observed in cases than controls.After the hepatotoxicity was cured,HBsAg carriers can be treated with isoniazid,rifampin,ethambutol,and/or pyrazinamide again.Conclusion With monthly liver function examination,it is effective and safe for TB and non-active HBV co-infected patients to be treated with standard short-course regimens.