Table of Content

10 January 2005, Volume 27 Issue 1

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The functions of hospitals in grass roots to find out infectious tuberculosis cases

Zhang Zhipeng.

. 2005, 27(1):  2-4. 

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Objective In order to investigate the functions of hospitals in grass roots to find out the infectious tuberculosis cases in Yinzhou Block.Methods To analyse the numbers of bacteriological positive tuberculosis cases from the tuberculosis registration book from 1994 to 2003 and broke by the sources of different level hospitals.Results There were 3574 tuberculosis cases reported in 10 years.Of them, 1458 cases were bacteriological positive cases.436(29.9%) positive cases were reported from hospitals at county level or above,1022(70.1%) were reported from hospitals in grass roots (central township hosipitals and townships hosipitals).The notification rate of smear-positive cases increased form 12.61/100000 to 27.63/100000 in the duration of 1994 to 2003.The sampling checking of sputum smear examination in 2000 showed that the quality of sputum examination had reached the standard set by Ministry of Health in hospitals at county level or above,while it slightly lower than the standard in grass roots.Conclusion The sputum smear examination should be one of the routine clinical examination works in grass roots hospitals.And the hospitals in grass roots has been a main strength to find out the infectious tuberculosis cases.

The clinical outcome of 6-month short-course chemotherapy on pure effusive tuberculous pleurisy

Luo Ping,Pan Xin,Tu Dehua.

. 2005, 27(1):  5-7. 

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Objective To determine the therapeutic effect of 6-month short-course chemotherapy of pure effusive tuberculous pleurisy,and to evaluate the period of treatment.Methods 256 cases of new pure effusive tuberculous pleurisy diagnosed and treated from 1996 to 2000 in 9 counties (distriats) TB Dispensaries in Beijing were reviewed and analyzed retrospectively.Results The rate of pleural effusion absorbed completely was 73.0% (187/256) at the end of 6-month.The cases were followed up 48 months and the relapse rate was 1.4%(2/139).The cases of pleural effusion not absorbed entirely continue received their treatment to 9～12 months,the relapse rate of following up 48 months was 2.2% (2/92).The patients with the duration between illness and clinical consultation ≤28 days or＞28 days,the rate of pleural effusion absorbed evidently were 87.1%(196/225)、67.7%(21/31) respectively at the end of 6-month.The rate of pleural not thickening were 54.7%(123/225)、32.3%(10/31) respectively,both rates were statistically significantly different.Conclusion The outcome of pure effusive tuberculous pleurisy used 6-month,the patients of pleural effusion not absorbed entirely could take their chemotherapy to 9～12 months.The early diagnosis and treatment were of benefit to the absorbing of pleural effusion and the reduction of pleural thickening.

The predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection in diagnosis of adult pulmonary tuberculosis:a Bayesian analysis

Li Dexian,Lv Jiangqing,Kuang Haobing,et al.

. 2005, 27(1):  8-12. 

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Objective To evaluate the predictive value of tuberculin test and serum anti-Mycobacterium tuberculosis antibody detection for diagnosis of adult pulmonary tuberculosis.Methods Two hundred and ninety-four bacteriologically,patholgic histologically or cytologically proved adult patients received tuberculin skin test and detection of serum IgG antibody to a recombinant 38-kDa antigen from Mycobacterium tuberculosis,134 with TB,109 with chest tumors and 51 with pulmonary infections.The eligible non-TB patients were excluded those complicated with TB.The tuberculin test and the serum anti-Mycobacterium tuberculosis antibody detection were combined to form different positive results.To compare the diagnostic value of different combinations.The predictive value of a positive test and the predictive value of a negative test were estimated by Bayes’s formula.Results The sensitivity of tuberculin test was higher than that of serum anti-Mycobacterium tuberculosis antibody detection.Whereas,the specificity of serum anti-Mycobacterium tuberculosis antibody detection was higher than that of tuberculin test.It can improve the diagnostic value while combined the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection.If a positive result was defined as the diameter of PPD skin test ≥15mm or a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria one),the predictive value of a negative test was the highest.If a positive result was defined as the diameter of PPD skin test≥20mm and a positive of the serum anti-Mycobacterium tuberculosis antibody (criteria two),the predictive value of a positive test was the highest.When the prevalence of tuberculosis was 0.5%,5%,10%,30%,60% respectively.The predictive value of a negative test for criteria one was 0.999,0.987,0.972,0.901,0.723 respectively.And the predictive value of a positive test for criteria two was 1.000.Conclusion In regions with a high prevalence of TB,combination the tuberculin test with the serum anti-Mycobacterium tuberculosis antibody detection might still be useful for diagnosis of adult TB.It might exclude TB if one’s diameter of PPD skin test＜15mm and a negative of the serum anti-Mycobacterium tuberculosis antibody.It might be TB if one’s diameter of PPD skin test≥20 mm and a positive of the serum anti-Mycobacterium tuberculosis antibody.

Evaluation on the effect of tuberculosis control project for full-population supported by world bank laon in Bao’an district of Shenzhen city

Qiu Guilian,Lu Tanwang,Peng Shiqian,et al.

. 2005, 27(1):  13-17. 

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Objective To evaluate the effect of tuberculosis control project supported by World Bank loan in Bao’an area of Shenzhen City.Methods To collect and analyse the quarterly reports and related information from 1993 to 2001.Results: In the pasted 9 years,17500 suspect tuberculosis cases had been received and diagnosed (containing 3625 cases of permanent residents,and 13875 cases of temporary residents).2704 infectious patients were detected (containing 716 cases of permanent residents,and 1991 cases of temporary residents).The treatment coverage rate of new smear positive cases of permanent and temporary residents was 100%.The regulation treatment rate of permanent resident paitnets was 98.4%,and temporary resident patients was 91.3%.The sputum conversion rates at the end of 2 months of treatment was 91.75 and 91.3% of permanent resident and temporary resident patients respectively.The cure rate of permanent resident and temporary resident patients was 98.0% and 96.7% respectively.There was no statistical significant differences on the treatment outcome of permanent and temporary resident patients the (P＞0.05).Conclusion If implement the correct the technical strategy, the effect of tuberculosis control can reach the high level not only for the temporary resident pouplation but also for the temporary resident population.

Comparison of phage-amplified biologically assay and conventional proportion method for the drug susceptibility testing in Mycobacterium tuberculosis

Peng Li,Chen Baowen,Shen Xiabing,et al.

. 2005, 27(1):  18-22. 

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Objective To evaluate the value of phage-amplified biologically assay (PhaB),to set up a fast,sensitive,specific and inexpensive method for testing the drug susceptibility in Mycobacterium tuberculosis.Methods Fifty-two M.tuberculosis isolates were tested the susceptibility to rifampicin and isoniazid by using the PhaB assay and the conventional proportion method.Results Using the conventional proportion method as control,the sensitivity of testing using the PhaB assay were 94.1% (32/34) on rifampicin-resistant isolates,and 92.1% (35/38) on isoniazid-resistant isolates,the specificity were 94.4% (17/18) on rifampicin-sensitive isolates,and 78.6% (11/14) on isoniazid-sensitive isolates.The two susceptibility Methods for rifampicin and isoniazid were 94.2% and 88.5% agreement respectively.Conclusion The PhaB assay could test correctly the drug susceptibility on the majority of M.tuberculosis isolates in 2 to 4 days.It might become a drug susceptibility testing with simplicity,high sensitivity,high specificity and low cost.

The analysis of characteristics of DNA fingerprint patterns of Mycobacterium tuberculosis strains in Yanyi City

Li Shulin,Jin Defu,Han Zhongbo,et al.

. 2005, 27(1):  23-25. 

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Objective To establish IS6110 RFLP fingerprint patterns of Mycobacterium tuberculosis isolated from Yanji City and analyze the national characteristics of Han and Korean nationalities.Methods To abstract the DNA from 97 mycobacterium tuberculosis strains,using endonuclease,southern blot,probe hybridization and chemiluminescence to get IS6110 RFLP fingerprint patterns,analyze the characteristics according to their homology of IS6110 RFLP fingerprint.Results The characteristics of IS6110 RFLP patterns of mycobacterium tuberculosis strains isolated from Yanji City showed:(1)The average of the copies of IS6110 is 13.(2)The clustering rate of strains was 57.7%,they had the characteristics of “Beijing genotype strains".(3)The characteristics of IS6110 RFLP fingerprint patterns were not related to the geographic and ethnic distribution of the patterns.Conclusion The isolated strains of Mycobacterium tuberculosis from Yanji City was closely relative to “Beijing genotype strains”,but there was a feature specially,that was the high polymorphism.

The clinical study on treatment of multi-drug resistance pulmonary tuberculosis with containing drug gelatin by bronchofiberscoope

Wang Anseng,Wang wei,Ling Minggui,et al.

. 2005, 27(1):  26-28. 

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Objective To evaluate the clinical treatment outcome and safety of the treatment approaches for multi-drug resistance pulmonary tuberculosis with containing drug gelatin by fiberbronchoscope.Methods The matients were treated with containing drug gelatin by bronchofiberscope and antituberculosis treatment in experiment group;the patients were treated only by antituberculosis treatment in control group.The clinical treatment outcome were observed.Results At the end of six months therapy,the sputum conversion rate was 73.1%,foci marked absorption rate was 85.4%,and cavity curative effect rate was 81% in experiment group,all of which were higher than that of the controls (51.3%, 56.7% and 51.4%)(P＜0.05).The duration of sputum conversion time was 36.3d in experiment group,it was shorter than that of the controls (61.8 d),(P＜0.01).There were not severe adverse reaction observed in experiment group.Conclusion The efficiency of the containing drug gelatin by fiberbronchoscoope combined with routine antituberculosis treatment is better than the routine antituberculosis treatment only.The treatment approaches were effective and safe in treatment of multi-drug resistance pulmonary tuberculosis.

Interventional therapy on cavitary pulmonary MDR-TB

Chen Weisheng,Zheng Yanping,Xin Lihong.

. 2005, 27(1):  29-32. 

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Objective To determine the significance of interventional therapy on cavitary pulmonary MDR-TB.Methods Study the inhibitory effects on 36 cultured drug-resistant TB strains using increased concentration of anti-tuberculosis drugs,and compare the clinical effect of treaditional anti-TB treatment vs.bronchoscope-assisted interventional therapy on cavitary pulmonary MDR-TB.Randomly selected 180 adult hospitalized patients with cavitary pulmonary MDR-TB and received 3DLOZA/18DLOZ treatment.The therapeutic group consists of 86 patients treated with both traditional and the bronchoscope-assisted interventional antituberculosis drug therapy and had completed.Results Increased concentration of antituberculosis can effectively control growth of drug-resistant tuberculosis.However,the dosage needed could be far more less than the concentration of the antituberculosis jelly interventional therapy.For the sputum negative rate,the therapy group (88.4%) was higher than the controlled group (70.0%).The cavitive closing rate was higher in therapy group (43.0%) than the controlled group (20.0%) too.In addition,more clinically improvement had been shown in the therapy group than the controlled group.Upon observation,the therapeutic effect was much better on single,caseous cavity than on multiple,fibrous cavity.There had not been any observed adverse reaction in the process of interventional therapy.Conclusion Super-drug-resistant TB can be more effectively controlled by higher dose of antituberculosis drugs.Bronchoscope-assisted interventional antiphthisic therapy is an safe and effective way to treat refractory cavitary pulmonary MDR-TB,provided the significant effect on cleaning,closing of the cavity as well as turning sputum negative.Worthwhile,the clinical application should be approached extensively.

Observation of supplementary treatment effect of spirin and transfer factor for treating reteated pulmonary tuberculosis

He Lianfu, Cha Jianyuan,Wu Shilin.

. 2005, 27(1):  33-35. 

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Objective To observe the supplementary treatment effect for pulmonary tuberculosis treated of spirin and transfer factor.Methods One hundred and ninety two patients were divided into two groups: therapy group with 100 cases, control group with 92 cases. The therapy group received chemical therapy and three spirin capsules, three times a day, transfer factor 3mg, imjection(H) twice a week.Results At the end of 9 months, the sputum conversion rate was 92%(in therapy group), 73.9%(in control group), P＜0.01. The foci absorption was 88%(therapy group) and 76%(control group), Cavity cloce up was 73.9% (ther-apy group), 59.8%(control group),P＜0.05. The therapy group’s side effect rate (6%) was lower than that of control group(26%), P＜0.01. Conclusion The supplementary treatment effect of spirin and transfer factor for treating retreated pulmonary tuberculosis was obvious. Especially for reducing side effect of antituberculosis.

The investigation of the tuberculosis infectious source in Qiannan prefecture state

Chen Zufu,Lei Chengde,Zhang Yongge,et al.

. 2005, 27(1):  36-38. 

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Objective To seek for the Methods for detecting the tuberculosis infectious source and determine its distribution for providing the scientific evidences for developing measures for tuberculosis control.Methods Selecting 8 out of 12 counties as the investigated areas,while the others are taken as the control ones.The tuberculosis control teams were established in county CDC that were responsible for providing smear examination for the TB suspects.The township hospitals were responsible for health education,sputum collection.The working approaches in investigation areas and control areas were the same except free smear examination and free treatment policy in investigation areas.Results The rate of the sputum smear examination in the investigated areas was 51.1%.The notification rate of smear positive cases was 25.99/Objective To seek for the Methods for detecting the tuberculosis infectious source and determine its distribution for providing the scientific evidences for developing measures for tuberculosis control.Methods Selecting 8 out of 12 counties as the investigated areas,while the others are taken as the control ones.The tuberculosis control teams were established in county CDC that were responsible for providing smear examination for the TB suspects.The township hospitals were responsible for health education,sputum collection.The working approaches in investigation areas and control areas were the same except free smear examination and free treatment policy in investigation areas.Results The rate of the sputum smear examination in the investigated areas was 51.1%.The notification rate of smear positive cases was 25.99/100000.It was 18.3% and 0.26/100000 accordingly in the control areas.The smear positive detected rate in the patients that diagnosed as bronchitis,lung infection,and others was 12.4%,11.8%,8.2% respectively.There was no difference in the location distribution and seasons distribution of cases.There was a higher infection rate among peasants and youth.Conclusion The situation of TB infection in rural area was serious.The governments should provide more funds for TB control and to implement free smear examination and free treatment for smear positive cases.In order to find infectious TB sources as soon as possible,smear examination should be one of the routine test in hospitals for respiratory diseases..It was 18.3% and 0.26/100000 accordingly in the control areas.The smear positive detected rate in the patients that diagnosed as bronchitis,lung infection,and others was 12.4%,11.8%,8.2% respectively.There was no difference in the location distribution and seasons distribution of cases.There was a higher infection rate among peasants and youth.Conclusion The situation of TB infection in rural area was serious.The governments should provide more funds for TB control and to implement free smear examination and free treatment for smear positive cases.In order to find infectious TB sources as soon as possible,smear examination should be one of the routine test in hospitals for respiratory diseases.

Mid-term evaluation on the 2001—2010 Henan provincial tuberculosis control programme conducted in 2003

Zhen Xinan,Du Changmei,Wang Guobin,et al.

. 2005, 27(1):  39-41. 

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Objective To evaluate the implementation of 2001—2010 Henan provincial tuberculosis control programm.Methods To analysis the data from the evaluation of 2001—2010 Henan provincial tuberculosis control programm conducted in 2003.Results The arrive rate of the funds was 31%.The success show up rate of the patients who referred by the hospitals to tuberculosis dispensaries was 47%.The case finding rate of smear positive cases was 12.4%.The rate of smear positive tuberculosis cases received DOTS management was 51.4%.The treatment completing rate of the smear positive tuberculosis cases was 72%.There were far way to achieve the targets of the programme.Conclusion There are still may constraints for achieving programming targets.Lacking of funds,low case finding and poor DOTS management are the key constraints.

CT manifestations of splenic tuberculosis

Duan Hongfei,Zhou Xinhua,He Wei.

. 2005, 27(1):  42-43. 

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Objective To assess CT manifestations and diagnostic value in splenic tuberculosis.Methods To analysis CT findings in 25 cases with splenic tuberculosis proved by clinical examinations retrospectively.There were 15 men and 10 women with ages ranging from 16 to 52 years old,and the median age was 25 years old.Results 25 cases with splenic tuberculosis can be divided as apostematic,miliary,incorporated and calcified types.The outlines of these lesions were vague when plain scanning.After enhancement,these lesions were clear with irregular rims.Conclusion When patients have typical manifestations mentioned above,and they are younger and diagnosed as pulmonary or/and extrapulmonary tuberculosis,splenic tuberculosis should be considered.

HRCT manifestation of military pulmonary tuberculosis

Guo Xingquan,Zhou Xinhua,He Wei.

. 2005, 27(1):  44-46. 

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Objective To analysis the HRCT appearance of military pulmonary tuberculosis.Methods To review conventional CT and HRCT of 28 cases with military pulmonary tuberculosis.The findings of CT and HRCT in chest were compared.Results 12 cases (42.9%) showed “three ehonogenous" characrestic,16 cases (57.1%) showed no “three ehonogenous" characrestic.The distribution of military focuses were in random,mostly distributed in interlobular center,interlobular septum and subpleural of pulmonary interstitium and peribronchovascular interstitium were fewer.Only the zone between of pulmonary lobular center and lobular edge were distrbuted in pulmonary parenchyma.Conclusion The distribution characteristics of military pulmonary tuberculosis can be better showed in HRCT.

The clinic study of the immune functions in AIDS complicated with pulmonary tuberculosis

Liu Yan,Yu Weiye,Wang Xiaoyan,et al.

. 2005, 27(1):  47-50. 

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Objective To investigate the damage of immune functions in AIDS complicated with pulmonary tuberculosis and to analysis the relationship between AIDS and tuberculosis to treat and prognosis.Methods Retrospective analysis was performed in 11 cases AIDS complicated with pulmonary tuberculosis patients hospitalized from May 1997 to March 2004 cases were tested T-lymphocyte subpopulation, PPD test and HIV-RNA. These tests Results were compared with 27 AIDS cases and tuberculosis 31 cases in the same time hospitalized.Results The CD4 and CD8 cell level in peripheral blood was statistical significance difference (P＜0.01) in the AIDS with tuberculosis, and AIDS than tuberculosis.The CD3 cell level was no statistical significance (P＞0.05). 6 cases HIV-RNA viral content in AIDS with tuberculosis was＞3.0×10⁶ copy/ml,5 cases HIV-RNA viral content＜3.0×10⁶ copy/ml.It was statistical significance (P＜0.01)that it was compared with AIDS 27 cases (3cases＞3.0×10⁶ copy/ml,24cases＜3.0×10⁶ copy/ml). ALL patients alive expect for two patients dead of blood distribution of pulmonary tuberculosis.Conclusion The immune functions of AIDS complicated with tuberculosis were severe destroyed.The mortality was high in ADIS complicated blood distribution of pulmonary tuberculosis and terminal AIDS complicated with pulmonary tuberculosis. The study found AIDS complicated diffusion by blood of pulmonary tuberculosis and terminal AIDS complicated with pulmonary tuberculosis viral content was high, infective was serious, harm was verse. Treatment effect of anti-tuberculous was poor.

Clinical analysis of 129 cases suffer from AIDS with pulmonary tuberculosis

Jin Kequn.

. 2005, 27(1):  51-53. 

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Objective To improve the awareness of AIDS with pulmonary tuberculosis.Methods 129 cases suffered from AIDS with pulmonary tuberculosis from 1998 to 2003 were analyzed.Results Infection means of in 80 cases infected by narcotic taking by blood vein.25 cases by sexual,18 cases by both ways.Common clinical presentations were fever (86.8%),weight loss (76%),pantalgia and asthenia (74.4%),lymphnodes tumour (30.2%),diarrhea (21.7%),skin itching (20%) and so on.Chest X-ray showed military tuberculosis,lung infiltration,pulmonary hilar or mediastinal lymphnodes tumour and pleuritis.37.2% with HCV antibody positive,5.4% with syphilis serum antibody positive.The clinical symptoms,signs and chest X-rays were improved after anti-tuberculosis therapy in most of the patients.Conclusion Physician should be alert of the occurrence of AIDS with pulmonary tuberculosis.HIV antibody and HCV antibody should be detected routinely for tuberculosis cases with atypical radiographic complicated fever.The short course anti-tuberculosis chemotherapy is effective for AIDS with pulmonary tuberculosis.

Analysis on misdiagnosis of 14 cases with cardiac pleural effusion

Fu Tieli,Liu Weiping,Zhang Jian.

. 2005, 27(1):  54-56. 

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Objective To analyse the misdiagnosis reason of cardiac pleural effusion.Methods To analyse clinical symptoms of 14 cases with cardiac pleural effusion retrospectively.Results (1)The patients over 45 years old were 86%,whose average age was 59.4 years.(2)71% of cases had paroxysmal dyspnea at night, enlarged heart, enlarged liver with tenderness, edema with legs and feet.57% of cases had heart failure symptoms and signs such as vena jugular enlargement.(3)All of cases had ST-T change and showed lack of blood and cardiac muscles hurt in electrocardiogram,71% of cases had cardiac arrhythmia.(4)All of cases showed different edema image of lung interstitial or/and alveolar in chest X-ray and CT.71% of cases had cardiac image enlargement,93% of cases had two lateral pleural effusion. 92% of cases of cell members were not typical pleural effusion.(5)Clinical diagnosis: 8 of 14 cases were coronary atherosclerotic heart disease.One case with pericarditis,three cases with hypertension.), two of cardiomyopathy disease, two of pulmonary heart disease,one of hyperthyroidism heart disease,one of hypertension heart disease. There were 14 cases of pneumonia and congestive heart failure.Conclusion Cardiac pleural effusion was found in the middle age and old age patients commonly. All of them combined with some basic diseases which could lead to heart failure. Many diseases consist at the same time, impact each other, cover or lead to more serious heart symptoms and signs, effect the examination result of pleural effusion, which make the diagnosis more difficult. Serious clinical observation and analysis of the disease history and clinical imformation could prevent from misdiagnosis.