Table of Content

10 March 2006, Volume 28 Issue 3

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Survey and analysis on the compliance of fixed-dose combination on TB treatment

He Yonghong¹,Cheng Shiming,Chen Cheng

. 2006, 28(3):  129-132. 

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Objective To survey and analyse the treatment compliance of fixed-dose combination(FDC),so as to provide evidences for expending use FDC nationwide. Methods Nine hundred and sixty-six primary smear positive pulmonary tuberculosis cases registered in 17 counties TB institutions from 4 provinces were randomly divided into experiment and control groups.Compared compliance difference with uniform questionnaires,and analysed compliance changes with time throughout the treatment. Results Nine hundred and sixty-one cases were surveyed at the beginning,899(93.5%)preferred receiving treatment.There was significant difference on the percentage who prefer had drugs per day between experiment(86.8%)and control group(42.1%)(P<0.01).At the end of intensive phase,261(28.3%)cases perceived difficulty with the treatment;213(23.1%)cases thought that were the doctors who lead to the insist of treatment.At the end of treatment,only 138 cases(15.5%)thought that were the doctors who lead to the insist of treatment. Conclusion The compliance of FDC was better than contro1 group.It might increase the compliance when decreasing the number of tablets and should expend used on TB control.The effect of TB doctors decreased through the treatment.More intention should be paid in intense phase.

Analysis of psychological character of 70 pulmonary tuberculosis cases

Ren Yanwei,Xu Hui,Song Xiaodong,et al

. 2006, 28(3):  133-135. 

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Objective To study psychological status of the pulmonary tuberculosis and provide social-psychological base for perfect the comprehensive support for tuberculosis treatment. Methods Symptom Check List 90(SCL-90)questionnaire,were used to investigate 70 case of tuberculosis patient. Results Positive factors(SCL-90)of the pulmonary tuberculosis patients were significantly higher than standard modle(0.05>P>0.01),especially somatization,depression and anxiety(PP<0.05).The degree of depression in middle aged group is higher than that in the young and ones(P<0.05).The disturbances among the educated were more setious than these with little education(P<0.05).There was much different in the state of mind in the length of sickness(P<0.05). Conclusion The scope of the mental disturbances of TB patient is serious and wide.The psychosocial intervention is necessary alone with the chemical treatment.

Analysis on case-finding and treatment outcome of pulmonary tuberculososis in Jiangsu province(2001—2004)

Fan Benda,Xu Weiguo,Chen Zonglan

. 2006, 28(3):  136-138. 

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Objective To analyze case-finding and treatment outcome of pulmonary tuberculosis in Jiangsu province,and provid the base for policy maker of TB control. Methods Analyze registered cases and their treatment outcome of tuberculois from 2001 to 2004. Results From 2001 to 2004 total new smear positive cases were 57 253,the proportion of smear positive cases in activity cases raised from 25.1%in 2001 to 55%in 2004,the new registration rate of smear positive cases were raised from 9.75/100000 in 2001 to 34.09/100000 in 2004.Cure rate was raised 89.9%. Conclusion The level of case-finding and cure management of pulmonary tuberculosis improved in Jiangsu province during near 4 years,and achieved significant achievements,due to the modern tuberculosis control strategy.

Evaluating the quality of life of patients with multi-drug resistant pulmonary tuberculosis

Yuan Baodong¹,Wag Weihua,Duan Qionghong,et al

. 2006, 28(3):  139-142. 

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Objective To evaluate health and curative effect of patients with multi-drug resistant pulmonary tuberculosis(MDR-TB) from the angle of the quality of life(Qol). Methods To measure and evaluate Qol for 100 patients with MDR-TB and 100 natural persons using SF-36 instrument.To state and accomplish 92 patients Qol.The investigation time was before,3 months after treatment and 1 year after treatment.The changes of Qol scores were evaluated in total and many domains To evaluate curative effect using paired t test and analysis of variance.Single and multiple stepwise regression analysis were made to evaluate factors affecting Qol. Results Between the patients with MDR-TB and the control in the total Qol scores and eight domains,there were significant differences(P<0.01),total Qol scores and eight domains in 3 months or 1 year after treatment were higher than before therapy,there were significant differences(P<0.01).Between 1 year after therapy in the total Qol scores and PF、 PR、GH、 VT、 SF、 ER、 MH’s domains were lower than control groups,there were significant differences(P<0.05).The main factors affecting the Qol of patients with MDR-TB were cultural level,kinds of drug resistant and reduction of counts of white blood cell. Conclusion There were comprehensive reduces in the quality of life of patients with MDR-TB. The quality of life of patients with MDR-TB had increased significantly but hadn’t recovered completely 1 year after therapy.Early intensive therapy could increase the quality of life of patients with MDR-TB.The main factors affecting the Qol of patients with MDR-TB are cultural level,kinds of drug resistant and reduction of counts of white blood cell.

Analysis on impact of TB suspects referring from general hospital to TB dispensary on case-finding

Chen Rong,Peng Dongdong,Wang Dongmin

. 2006, 28(3):  143-144. 

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Objective To explore the impact of TB suspects referring from general hospital to TB dispensary on TB case-finding. Methods To enhance administrative interventions,standardize TB suspects referring process and patient-traced system,to implement patient incentive system and health education. Results Five hundred and fifty-six TB patients with smear-positive were notified while the project was implemented.Comparing with last year,139 more patients were notified,the increased rate was 33.3%.There were 391 cases referred from general hospital,accounting for 70.3% in all patients.The number of referral from general hospital and cases arrived in TB dispensary for examination was clearly increasing.The sputum-examination rate and positive rate were improving too. Conclusion Enhancing the collaboration with general hospital and establishing perfect TB suspects referring system are the important routes for improving TB case-finding.

The analysis of misdiagnosis pulmonary eosinophilia as tuberculosis:14 cases report

Jiang Ruihua

. 2006, 28(3):  145-147. 

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Objective To improve differential diagnosis ability of pulmonary eosinophilia and pulmonary tu-berculosis through analyzing the reason of misdiagnosis between pulmonary eosinophilia and pulmonary tuberculosis.Methods 14 pulmonary eosinophilia cases which were confirmed by clinical and lab test and were misdiagnosed as pulmonary tuberculosis were analyzed retrospectively. Results The symptoms of pulmonary eosinophilia misdiagnoses as pulmonary tuberculosis including coughing, mild phlegm, chest pain, breathlessness, dyspnea, low-grade fever, hypodynamia and night sweat. The duration of the disease was more than three weeks. The thoracic X-ray and CT manifestations were multifarious: the special manifestations were“Y”or botryoidalis shadows, pul- monary atelectasis and obstructive pneumonia changes in the distal obstructive location. Conclusion The reason of misdiagonosis is lack of knowledge of pulmonary eosinophilia. We should be alert to pulmonary eosinophilia that sputum examination is negative, clinical symptom and chest X-ray examination is similar as tuberculosis, but relapses or has no effect after regular therapy.

Analysis on treatment outcome of drug-resistant pulmonary tuberculosis patients in Anyang of Henan province

Chang Baozhen,Zhu Lixia

. 2006, 28(3):  148-151. 

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Objective To determine the treatment outcome of drug-resistant pulmonary tuberculosis patients in Anyang of Henan province,so as to provide reference evidences for policy making for management of drug-resistant pulmonary patients in the future. Methods Retrospective analysis the information of drug-resistant pulmonary patients registered in Anyang Tuberculosis Dispensary from June 1994 to June 2004. Results Two hundred and twenty-one drug-resistant pulmonary tuberculosis patients registered in ten years.One hundred and fifteen cases were initial drug-resistance.One hundred and six cases were acquired drug-resistance;87 cases were resist to one drug,57 cases were resist to two drugs,77 cases were resist to three and more drugs.Sixty cases were multi-drug resistance cases.The treatment management of the cases are as followings: 177 cases with full-course management;44 cases with self-management.One hundred and twenty-two cases were prescribed with standardized regimens and 99 cases were prescribed with individual regimen.165 cases completed the treatment with regular drugs taking. 56 cases were default.The cure rate of 221 drug-resistance cases was 52.5%.The default rate was 25.3%.The cure rate of inital drug-resistant caseswas 67.0%.The cure rate of 1 drug resistance cases with standardized treatment regimen was 88.1%.The cure rate of acquired drug-resistance cases was 36.8%.Thecure rate of 1 drug resistance cases with standardized treatment regimen was 37.5%.The cure rate of multi-drug resistance cases was 30%.The cure rate of the patients who took medicine regularly was 70.3%. Conclusion The standardized treatment regimen have a higher effect to the initial drug-resistant patients,a lower effects to the acquired drug-resistant patients and MDR patients.The higher default rate is important impact factor for treatment outcome.We should be careful of selecting the individual regiment for the drug-resistance patients.We suggest that drug-resistance pulmonary tuberculosis patients should be registered separately and strengthen management to prevent treatment default so as to reduce the occurrence of hard to be treated cases.

Therapeutic effect and safety of three different regimens to 103 eldly new pulmonary tuberculosis inpatients with smear-positive

Ge Qiping,Gao Weiwei,Kong Zhongshun,et al.

. 2006, 28(3):  152-155. 

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Objective To observe and analyse the therapeutic effects and safety of different regiments to new pulmonary tuberculosis patients with smear-positive.To evaluate the validity and security of levofloxacin in elderly patients. Methods One hundred and three elderly new pulmonary tuberculosis patients with smearpositive were allocated into the treatment group（Ⅰ group,2HL₂EV/10HL₂E)）、control group（Ⅱ group,2HL₂EZ/10 HL₂E）and individualized group（Ⅲ group,18HL2E or 18HVE or 18HL2V）.The sputum conversion rates,chest X-ray improvement rates, one-year relapse rates and the side-effects of anti-tuberculosis drugs were observed. Result The sputum conversion rates at the end of therapeutic course in group Ⅰ,Ⅱ,Ⅲ were 97.4%,93.1%,95.0%,respectively（P>0.05）.The improving rates of chest X-ray were 87.2%,89.7%,80.0%,respectively（P>0.05）.The cavity closure rate was 35.3% in group Ⅰ,33.3% in group Ⅱ and 31.3% in group Ⅲ,（P>0.05）.One-year bacteriological relapse rate were 7.9%, 3.7%, 5.3%, respectively（P>0.05）.The side-effect rate was 24.5% in group I and 54.8% in group Ⅱ（P<0.01）. Conclusion The treatment effects of regimen including cravit was the same as that of regiment including pyrazimide.The cravit was safe to elderly patients.The side-effect rate caused by pyrazinamide was significant higher than that of cravit.The individualized regiment also has satisfied theraputic effect.

Explore on increasing detection rate of new smear positive tuberculosis cases in rural areas

Wan Jian¹,Cai Yan,Gu Xinrong,et al.

. 2006, 28(3):  156-159. 

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Objective To explore the approach of increasing detection rate of new smear positive tuberculosis cases in rural areas.Methods To utilize randomized control study,we selected randomly 6 townships in Hai’an county and divided randomly into 2 groups.Different intervention approach was carried out in the 2 groups.The other 8 townships were composed to control group.Results The new smear positive rate was 40/100000 in intervention group 1 that carried out referral management at countryside community health service station.The rate was 29.1/100000 in intervention group 2 that carried out sputum examinatioqn in township village smear clinic.The rate was 16.3/100000 in control group（χ²=38.6,P<0.0001）.Conclusion Strengthening referral management at countryside community health service station and carrying out sputum examination in township smear exemination sites could all increase the detection rate of new smear positive.But the staffs training,laboratory building and examination quality control of sputum examination sites in township village need to be enhanced.

Intervention before initial consulting: effect of sputum examination rate in pulmonary tuberculosis suspects in floating population

Gao Cuinan,Tan Qingyun,Luo Shaoxia,et al

. 2006, 28(3):  160-161. 

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Objective Through taking intervention to pulmonary tuberculosis suspects in floating population before initial consulting,to improve the rate of sputum-examination. Methods Suspects were divided into two group.Suspects in control group were examined according to national tuberculosis control implementaion guidelines.Health education was done before examination for the suspects in study group. Results The sputum examination rate in study group was 95.7%,the rate in control group was 80.3%.Both were different in statistic(P<0.01). Conclusion Intervention before initial consulting can improve the sputum examination rate and case-finding rate accordigly.

Clinical effects of Bi-level positive airway pressure ventilation in pulmonary tuberculosis patients with respiratory failure

Zhu Qi

. 2006, 28(3):  162-163. 

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Objective To observe Bi-level positive airway pressure ventilation（BiPAP ventilation）the treatment effects in pulmonary tuberculosis patients with respiratory failure. Methods Thirty-one patients treated by BiPAP on the basis of routine treatment were enrolled in the treatment group.The efficacy was evaluated and compared with 20 similar patients is the control group. Results After BiPAP ventitalion the PaO2 and PaCO2 were greatly improved in treatment group（P<0.01）.PaO2 was also increased in control group.There was no significantly difference after routine therapy. Conclusion BiPAP ventitalion can improve the PaO2 and PaCO2 and relieve symptom especially to respiratory muscle fatigue.It is a supplementary measure to treat pulmonary tuberculosis patients with respiratory failure and it can prevent the incidence of pulmonary encephatopathy.

Clinical study on the diagnostic value of interferon-γ and vascular endothelial growth factor in differentiating tuberculous pleural effusion from malignant pleural effusion

Lv Wei,Xue Keying,Xiong Shengdao,et al.

. 2006, 28(3):  164-166. 

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Objective To evaluate the significance of interferon-γ(IFN-γ) and vascular endothelial growth factor(VEGF) in differentiating tuberculous pleural effusion from malignant pleural effusion.Methods forty-five patients with tuberculous pleural effusion and 42 patients with malignant pleural effusion in Wuhan Antituberculosis Institute,from March 2004 to May 2005,were the study subject.The adenosine deaminase(ADA),IFN-γ,carcinoembryonic antigen(CEA) and VEGF levels of pleural effusion were detected.The sensitivity,specificity and accuracy of ADA,IFN-γ,CEA,VEGF and VEGF/IFN-γ ratio were obtained through ROC.Results The ADA and IFN-γ levels of tuberculous group were significantly higher than that of malignant group(P<0.01),while its CEA,VEGF levels and VEGF/IFN-γ ratio were significantly lower than that of malignant group(P<0.01).The sensitivity and specificity of IFN-γ were higher than that of ADA.The sensitivity and specificity of VEGF/IFN-γ ratio were higher than that of CEA and VEGF.Conclusion IFN-γ and VEGF/IFN-γ ratio could be used as valuable parameters for the differentiation of tuberculous pleural effusion from malignant pleural effusion.

Antibody response against recombinant EIS protein of Mycobacterium tuberculosis in patients with pulmonary tuberculosis:possible application for screening the active tuberculosis

Xiao Songsheng,Li Meizhong,Wang Huosheng,et al.

. 2006, 28(3):  167-169. 

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Objective To study the immunogenecity of recombinant EIS protein,a novel antigen encoded by enhanced intracellular survival gene of Mycobacterium tuberculosis,and its possible application to screen the active tuberculosis. Methods The purified recombinant EIS protein was used as antigen to detect the antibody responses in the sera from the patients with pulmonary tuberculosis,healthy donors and patients with lung disease other than tuberculosis by ELISA.Results:The level of antibody responses was significant higher in the sera from patients with pulmonary tuberculosis than that from healthy donors and patients with non-tuberculosis lung disease.The titer of anti-EIS antibody in the sera from patients with pulmonary tuberculosis had not significant changed during the anti-tuberculosis chemotherapy. Conclusion EIS antigen may be a useful antigen for screening the active tuberculosis.

Identification of mycobacterium species and analysis of drug susceptibility of mycobacteria isolated from 2001 to 2004 in Guangzhou

Wu Longzhang,Huang Jieling,Zhang Yuanliang,et al.

. 2006, 28(3):  170-173. 

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Objective To study mycobacterium species and drug susceptibility of mycobacteria isolated from 2001 to 2004 in Guangzhou,and to provide reliable scientific support for clinical diagnosis and therapy of tuberculosis.Methods 2154 mycobacterial strains isolated from 1459 patients from Sep 2001 to Mar 2004 were identified the species and the susceptibilities to 4 antituberculosis drugs by absolute concentration methods.Results The positive ratio of nontuberculous mycobacterium increased from 16.5% during Jul 1998 to Sep 2001 to 20.5%.The Results of drug susceptibilities of 1703 Mycobacterium tuberculosis isolates showed that the primary drug resistance rate increased from 14.4% during Jul 1998 to Sep 2001 to 20.1% and the secondary drug resistance rate decreased from 35.4% to 32.6%.However,non-tuberculous mycobacteria showed high primary resistance to antituberculosis drugs.Conclusions It is necessary that mycobacteria isolated from clinical samples should be identified the species and performed drug susceptibility tests.

Study on the hepatoxicity induced by antitubercular medicines in rat models

Zha Yuefang,Zeng Wen,Hu Jianjun,et al.

. 2006, 28(3):  174-177. 

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Objective To study the correlation of lipid peroxidation,P450 drug-metabolizing enzyme of liver tissue and hepatotoxicity. Methods Fifty-six healthy adult rats were divided randomly into 7 groups: INH(H),RFP(R),PZA(Z),HR,RZ,HRZ,the control group.The rats took different drugs and same foods for 10 days,and then were taken the livers.The livers were cut into slices and watched pathologic changes of hepatic cells under electronic microscope,were homogenized and measured MDA,GSH,SOD,P450. Results MDA and P450 increased,while GSH and SOD decreased in each drug group.In the groups contained RFP,level of P450 increased significantly.The degree of liver damage and the change of index of lipid peroxidation were more severe in the combined antituberculous drug groups than that in the single antituberculous drug groups.The hepatic pathologic damage was related with the degree of lipid peroxidation. Conclusion INH,RFP,PZA all could induce the lipid peroxidation and hepatic damage