Table of Content

10 April 2005, Volume 27 Issue 4

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Feasible evaluation of fixed-dose combination (FDC) in anti-tuberculosis therapy: a community-controlled study

Tan Weiguo, Yang Yingzhou, Chen Jinquan,et al.

. 2005, 27(4):  209-214. 

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Objective To assess the advantages and disadvantages of FDC in chemotherapy and management in anti-tuberculosis therapy. MethodsSix districts in Shenzhen city were allocated into two groups: FDC treatment group and controlled group according to the distribution of patients and economic-culture level. From Aug. 1, 2003 to Dec. 31, 2003, 373 new smear positive pulmonary tuberculosis patients were enrolled and allocated to two groups according to their treatment convenience. Results(1) Compared with controlled group, less patients in treatment group complained about the manner of taking medicine, the size and quantity of pills (P＜0.05).(2)The rates of complement treatment were nearly similar in two groups, but the cure rate in treatment group was higher than that of controlled group. (3)There was no significant difference of adverse reactions between two groups . Stopping treatment rates because of liver damage in two groups were similar (8.9% and 5.4% respectively, P＞0.05)；(4) More supervision doctors in treatment group felt inconvenience in pills distribution, quantity management of pills and patients supervision. In their viewpoint, there was almost no advantage in increasing patients’ adherence (P＜0.05). (5) The cost-effective of the controlled group showed a remarkable advantage over FDC. ConclusionsFDC can improve the patients’ compliance and cure rate of chemotherapy. but acceptability of doctors and cost-effective analysis are inferior to controlled group due to manufacture technique, market and some other factors.

Gender difference in health seeking behavior among patients with smear-positive pulmonary tuberculosis in rural area of Hunan Province of China

Bai Liqiong, Xiao Shuiyuan.

. 2005, 27(4):  215-218. 

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Objective To explore the gender difference in health seeking pattern of smear-positive pulmonary tuberculosis patients attending county tuberculosis dispensaries in rural area Hunan Province of China. MethodsA cross-sectional descriptive survey was conducted in 4 counties randomly stratified by economic status from 122 counties, Hunan, China. After obtaining informed consent, a consecutive sample of patients, aged 15 years and over, with smear-positive pulmonary tuberculosis was interviewed. A pre-tested questionnaires were used in this study. ResultsA total of 318 patients with smear-positive pulmonary tuberculosis was interviewed and completed questionnaire during the study period. Among the participants, 229 were male and the rest were female, with the average age of 38.2 years old. Only 5.4% of the respondents visited the local county tuberculosis dispensaries firstly at the onset of tuberculosis, while 33.3% of them initially chose to visit general hospitals and 54.8% to township clinics, village clinics or private practitioners. The typical health-seeking pattern of men tended to go to general hospitals while women, on the other hand, initial visited to a private practitioner or an attempt to practice self-medication. 24.8% of the respondents had visited temples and asked the Bodhisattva to cure their disease or visited traditional healers, as well as 34.9% had visited folk herbalists before they went to tuberculosis dispensaries, and women are more likely to believe folk healing than men. ConclusionsThere is a great need for better understanding of behavioral factors and gender aspects of tuberculosis control, particularly aspects that influence the likelihood for achieving equity in health services. The priority target population for TB health promotion should be the people who can not access TB information like female,low level of education and low social-economic status.

The clinical observation on adjunctive immunotherapy with recombinant human IL-2 in adults with retreatment pulmonary tuberculosis

Zhang Hongmei, Wu Weihua, Han Zhirong, et al.

. 2005, 27(4):  219-223. 

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Objective To study and evaluate the clinical effects of adjunctive immunotherapy with recombinant human IL-2 in adults with retreatment pulmonary tuberculosis. MethodForty-three sputum smear positive retreatment TB patients were enrolled into this study. There are 22 cases in intervention group and 21 cases in control group. The chemotherapeutic regime which was 2HL2AK(E)Z(TH)V+IL-2/1HL2(TH)V+IL-2/5HL2V in intervention group and 2HL2AK(E)Z(TH)V/1H L2(TH)/5HL2V in control group. ResultForty patients completed the treatment course, their outcome were evaluated. Among of them, 20 patients from intervention group and 20 patients from control group. The sputum smear-conversion, lesion absorbed, cavity shrunk and immune test Results in intervention group were better than that of control group. There were no severe side-effects among patients received IL-2 for treatment. ConclusionThe study suggest that the recombinant IL-2 would be not only a safe biological agent, but also an adjunctive immunotherapy for retreatment pulmonary tuberculosis, which can facilitate smear , lesion absorbed, immunity of patients with pulmonary tuberculosis.

The mensuration and clinical values of the soluble Fas in tuberculosis patitents

Liu Jiahong, Wang Yingnian, Gong Xitao, et al.

. 2005, 27(4):  224-226. 

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Objective To determine the values and clinical significance of level of soluble Fas(sFas) in tuberculosis patitents . Methods The content of the sFas in the plasmas and the supernatant of peripheral blood mononuclear cells (PBMC) cultures of 63 tuberculosis patients were examined with enzyme-linked immuno- sorbent assay (ELISA) . ResultsThe levels of the sFas in both the plasmas and supernatant of PBMC cultures in tuberculosis patients were significantly higher than in controls (6.672.05/2.210.54;P＜0.01;46.6412.44/15.973.51,P＜0.001);The levels of the sFas in the plasmas and supernatant of PBMC cultures in patients with cavity were significantly higher than that in patients without cavity (7.981.41/5.131.25,P＜0.01;55.9418.52/35.7311.44,P＜0.01). The levels of the sFas in patients who had been treated more than one month were significatively higher than that in the patients who had not been treated (6.831.39/5.681.23 P＜0.01;52.3714.55/39.436.97,P＜0.01). ConclusionsThe disregulation of the sFas maybe a attribution factor to the occur of tuberculosis. The variety of the sFas in the patients with tuberculosis could be used to forecast the status and prognosis.

Bronchoscpic cryotherapy for endobronchial tuberculosis

Yang Hongzhong,Hu Chengping,Yang Huaping,et al.

. 2005, 27(4):  227-229. 

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Objective To evaluate the effects of bronchoscpic cryotherapy on endobronchial tuberculosis(EBTB).MethodsTwenty-one EBTB patients, cryotherapy and cather intervention compined with chemotherapy were performed through bronchofibroscope. Efficacy was assessed and followed up after treatment. ResultsTwenty-one patients with EBTB were treated 52 times by bronchoscpic cryotherapy. In 18 patients with granulomatous and ulcerative EBTB, intraluminal lesions disappeared thoroughly and the chinical symptoms improved completely and atelectasis or obstructive pneumonia disappeared.Only 3 patients leaved some intraluminal cicatrices. The significant improvement rate was 83.3%(15/18 patients), clinical effective rate was 16.7%(3/18 patients).The overall effective rate was 100%(18/18 patients).But,there were not significantly efficacy in 3 patients with cicatricial EBTB by bronchoscpic cryotherapy. ConclusionsBronchoscpic cryotherapy for granulomatous and ulcerative EBTB, could disappeared thoroughly the intraluminal lesions,and rapidly relieve chinical symptoms.Bronchoscpic cryotherapy is an effective and safe method of treatment in patients with EBTB.

The research on the relationship between the therapeutic effect and the mutations of the drug-resistant genes in multi-drug resistant pulmonary tuberculosis

Lin Minggui, Li Hongmin, Wu Xueqiong, et al.

. 2005, 27(4):  229-232. 

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Objective To investigate the relationship between the therapeutic effect and the mutations of the drug-resistant genes in multi-drug resistant pulmonary tuberculosis, and to provide the theoretical evidence for treating the multi-drug resistant pulmonary tuberculosis. Methods108 M. tuberculosis clinical isolates from sputum specimens were detected by PCR-SSCP and the traditional drug susceptibility testing. The therapeutic effect of the patients with multi-drug resistant tuberculosis was evaluated. ResultsThe rates of mutations of katG gene for Isoniazid resistance, rpoB gene for Rifampin resistance, rpsL gene for Streptomycin resistance, pncA gene for Pyrizinaride resistance and embB gene for Ethambutol resistance were 70.4%, 72.2%, 71.9%, 53.4% and 31.7%, respectively. The rate of gene mutation was higher in the isolate with high concentration of drug resistance than that with low concentration of drug resistance. According to the Results of PCR-SSCP and drug susceptibility testing, the patients were treated with 1 to 2 kinds of anti-TB drugs never used before combined with a regimen of KAOP (kanamycin, ofloxacin, sodium aminosalicylate) for average 1.4 years. The sputum bacterial negative conversion rate was 74.1%, the sputum culture-negative conversion rate was 67.5%, the absorption rate of lesion was 83.3%, 65.3% of the cavities closed up. There wasn’t any serious side effect to be found. ConclusionThe detection of drug-resistant genes might be helpful for the clinical treatment of multi-drug resistant pulmonary tuberculosis.

A study on treatment effects of effusion levels of sIL-2R in tuberculous pleural effusion patients by using polysaccharide-nucleic acid of BCG

Jiang Xiufeng,Ma Hui,Cai Xiguang,et al.

. 2005, 27(4):  233-235. 

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Objective To observe the treatment effects of polysaccharide-nucleic acid of BCG (BCG-PSN) as immune regulation preparation in patients with tuberculous pleural effusion. MethodThirty-eight tuberculous pleural effusion patients were divided into trial group and control group randomly. All patients were treated by pleurocentesis and the same chemotherapy regime, but the trial group was treated by pleurae cavum injection BCG-PSN. Before and after treatment, the effusion levels of Sil-2R were measured. ResultThe effusion levels of Sil-2R in two groups have no significant difference (P＜0.05) before treatment. After treatment 30 days, the effusion levels of Sil-2R in trial group decrease significantly (P＜0.05). At the end of the course, the fluid absorbed rates of the trial group and the control group were 95.5% and 68.7% respectively. The information above was significant in statistics (P＜0.05). ConclusionBCG-PSN can inhibit the extreme secretion of Sil-2R in tuberculous pleural fluid. By injection BCG-PSN in pleurae cavum, it can improve the fluid absorbed rate. There was no side effect observed during applying BCG-PSN in pleurae carum.

Antithetical analysis on nutrition status in patients with pulmonary tuberculosis and diabetes

Yan Zhongfang, Sun Feng.

. 2005, 27(4):  236-238. 

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Objective To investigate the nutrition status in the patients with pulmonary tuberculosis (PTB) and diabetes mellitus (DM), and to explore the nutrition improvement advice for these patients. Methods patients were divided into 3 groups: PTB and DM group, PTB group, and normal public group. Four parameters were chosen to analyze the nutrition status, including body mass index (BMI), hemoglobin (Hb), total lymphocyte count (TLC), and serum albumin. ResultsThe incidence of malnutrition according of PTB and DM group was 45%～78.3%, PTB group was 38.3%～75%, normal public group was 1.8%. Significant difference was found in these four parameters in the PTB and DM group and normal public group, similarly PTB group and normal public group have significant difference. The incidence of malnutrition according to HB, ALB of the PTB and DM group was higher than that in the PTB group. ConclusionsThe incidence of malnutrition is higher in the patients with PTB and DM, and also in the patients of PTB,and put forward the nutrition improvement advice for these patients.

Study on treatment effects of bronchofiberscope and catheter Intervention on retreated pulmonary tuberculosis

Gao Weihong, Yuan Dongyun, Xu Lijiang.

. 2005, 27(4):  239-241. 

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Objective To explore the clinical value of bronchofiberscope and catheter intervention on previously retreated pulmonary tuberculosis. Methods158 previously retreated pulmonary tuberculosis were treated by injecting isoniazid and streptomycin through bronchofiberscope plus routine chemotherapy treatment, 156 controls were on treated by chemotherapy only. ResultsAt the end of the treatment, the sputum conversion rate was 97%, radiographic improvement rate was 90% and cavity closing rate was 48% in the treatment group, all of which were higher than that in the controls (62%,58% and 10% respectively)(P＜0.01～0.05). No complication and obvious side effects were observed. ConclusionThe effect of bronchofiberscope and catheter intervention plus chemotherapy is better than only chemotherapy on retreated pulmonary buberculosis.

Clinical ananlysis on 72 cases of nasopharyngeal tuberculosis

Zhou Lin¹, Yun Jingping, Zhang Guangli, et al.

. 2005, 27(4):  241-243. 

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Objective To investigate diagnosis and therapy of nasopharyngeal tuberculosis. MethodsSeventy-two cases of nasopharyngeal tuberculosis confirmed pathologically were analyzed retrospectively. Results Seventy-two cases of nasopharyngeal tuberculosis were clinicopathologically confirmed, of which the ratio of male to female was 1:1.32(3141), the average ages of these cases were 30.7. The local symptoms of these cases were the main clinical feature. The incidence of lymph node swelling in cervix was 79.2%(57/72). The diseases were usually misdiagnosed. These cases were cured by anti-tuberculosis therapy for 9 to 12 months. There were no recurrence based the Results of 15 years follow-up. ConclusionThe incidence of the disease increase recently, especially primary cases in majorities. The disease can be diagnosed by nasopharyngoscope and clinicopathologic examination and cured by standardized anti-tuberculosis therapy.

Analyse on characters of 216 smear-positive pulmonary tuberculosis patients

Wang Zhigang, Liu Shike.

. 2005, 27(4):  244-246. 

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Objective To determine the characters of smear-positive pulmonary tuberculosis patients for providing scientific basis on selecting efficient the control measures. MethodsThe data of 216 patients during 2003 to September 2004 were analyzed. ResultsThe cases with following characters: (1)most of patients had the education background below junior high school and most of them were farmer. (2)the ratio of male to female was 2.13. (3)the peak ages in male were 25 and 35 , and the peak ages in female was 25 and 15. (4) 44.9% of patients confirmed that they have contact history with TB patients. (5)76.4% patients had X-ray shadows in more than two fields of lungs. 21.3% of patients had cavities in their X-ray film. 12.5% and 12.04% patients complicated with heart disease. (6)216 smear positive cases treated according to the targets of sputum conversion and cure rates. ConclusionIt is helpful for accelerate the space of tuberculosis control if strengthen TB control in rural areas and among young adults.

Analysis on situation of drug-resistant tuberculosis among outpatients in primary urban districts of Guangzhou from 1994-2003

Luo Yilu, Liu Zhihui, Luo Chunming.

. 2005, 27(4):  247-250. 

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Objective To analyze current situation and trend of drug-resistant tuberculosis in primary urban districts of Guangzhou during the recent ten years and provide the evidences for TB control policy makers in Guangzhou. MethodsTesting records of tuberculosis drug susceptibility test from laboratory department of TB and Pulmonary Tumor Control Institute were analyzed retrospectively during the period 1994-2003. Analyzed anti-TB drugs included isoniazid (H), rifampin ?, streptomycin (S) and ethambutol (E). ResultsThe total, initial and acquired drug resistance rate of 9044 strains of Mycobacterium tuberculosis from clinical isolation were 23.7%, 20.7% and 34.6% respectively. The total and initial drug resistance rate presented slowly descended trend, and the acquired drug resistance rate was on the contrary during the ten years. The order of drug resistance of 2145 drug resistance strains according to from high level to low level was H (20.3%), R (10.2%), S (9.5%) and E (5.0%).The order of initial drug resistance rate was H (17.7%), R (8.3%), S (8.1%) and E (4.1%), and that of acquired resistance rate was H (29.8%), R (16.7%), S (14.3%) and E (8.3%). The drug resistant rates of single drug, 2 drugs and multi-drugs were 10.8%, 3.4% and 9.0% respectively. Their initial drug resistance rates were 9.8%, 3.0% and 7.6%, and their acquired resistance rates were 14.4%, 4.6% and 14.0%. Their acquired resistance rates of H, R, S and multi-drugs showed generally rising trend while the initial drug resistance rate was a decreasing trend during the ten years. ConclusionsAccording to the above results, we should pay great attention to high level of drug resistance rate of H, R and the initial drug resistance rate, generally rising trend of the acquired resistance rates and acquired multi-drugs resistance rates and a decreasing trend of the initial drug resistance rate that predicts producing more Mycobacterium tuberculosis strains of multi-drugs resistance in a specific number of strains in future. We must take initiative in TB control to prevent the prevalence and spread of drug resistance tuberculosis, especially of multi-drugs resistance tuberculosis.

The evaluation the effects of of tuberculosis control project in Zhejiang Province

Li Qun, Yang Shibo, Xu Xuqing, et al.

. 2005, 27(4):  251-254. 

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Objective To analyze the social benefit and economic benefit of Zhejiang TB Control Project. MethodCollect and analyze the project quarterly and annual reports in the period during 2001-2004. Result In the whole Zhejiang province, 100% of counties (districts) have been covered by DOTS strategy. Case detection rate of new smear-positive was 73.5%. And 87.0% of them were cured. Zhejiang province had reached WHO 2005 targets in advance. ConclusionZhejiang TB Control Project made a great progress, including the social benefit and economic benefit during the last three years. DOTS strategy was familiar to doctors in all levels hospitals and CDC. The technical strategy of TB Control Project was successful, and it promoted sustainable development of TB control in Zhejiang Province.

Study on tuberculosis control model in yantai City of Shandong Province

Chi Desi¹, Xu Jishan,Gao Jisheng, et al.

. 2005, 27(4):  255-257. 

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Objective To summarize and analyse the set of intervenient measures on tuberculosis control in past 10 years. MethodTo review and analyse the intervenient measures namely "consciousness-medicine-action" taken in tuberculosis control from 1992 to 2001 in Yantai City. And the data of case detection, treatment and management was analyzed retrospectively. ResultsFrom 1992 to 2001, 14995 cases of active pulmonary TB were detected. 7581 were smear positive cases. The percentage of smear positive rate was increased from 35.7% in 1992 to 59.0% in 2001(χ²=19.07,P＜0.001), which has a remarkable difference and clearly displays the effectiveness of detection, control and measures. ConclusionThere was a good result of the carried intervenient measures. It has provided scientific basis for the governments’ policy-making and the establishment of a good prevention and control system.

The investigation of tuberculosis infection situation in the middle and primary school in Huairou District of Beijing

Liu Donglai.

. 2005, 27(4):  258-260. 

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Objective To investigate the TB infection situation in the middle and primary school in Huairou District of Beijing .MethodTuberculin (PPD) skin test had been done in students of middle and primary school. The characteristics of the infection were analyzed. ResultThe rates of PPD results5 mm of the students in the senior,junior middle school and the primary school was57.7%,44.4%, and 21.6% respectively .And the rate of PPD Results 15 mm was 16.8%,13.5%,and 2.8%. The difference of 5 mm and 15 mm between the different grades was significant. The rate of PPD Results 15 mm in the students who have TB contact was 45.2% , while the opposite was 10.6%, which was 34.6% less than the former. ConclusionTo put the students of the middle and primary school as the objects of preventive TB treatment is an essential measure to control TB .

Analysis on the treatment outcome at the end of initial phase of new smear-positive pulmonary tuberculosis patients hospitalized in the first 2 months supervised by health personnal

Wu Chenghui,Xu Feifei

. 2005, 27(4):  261-263. 

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Objective To observe the treatment outcome of new smear-positive pulmonary tuberculosis patients who received the initial phase treatment in hospital. Method168 new smear-positive pulmonary tuberculoses patients were divided randomly into hospitalization group (88cases) and outpatient (80 cases group). Result The sputum negative conversion rates at the 2nd month in the treatment and the control group were 81.8%/88.6% and 63.8%/75.0% respectively.Chest radiograghy showed remarkable improvement, the resolution of pulmonary lesions in hospitalization group and outpatient group was 80.7% and 67.5% respectively. ConclusionThere were significant satisfied treatment Results in the hospitalized patients. Initial treatment in hospital could be a option for the outpatient patients who could not ensure their regular treatment.

Analysis on treatment outcomes of pulmonary tuberculosis in floating population in Dongguan

Zhang Xiping

. 2005, 27(4):  264-266. 

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Objective To determine the treatment outcome of pulmonary tuberculosis in floating population. MethodTo provide free diagnosis and treatment to the patients in floating population Donggduan, as the same policy applied to resident population. And DOTS was implemented. ResultThere are 1171cases registered and treated from August 2001 to June.2004. The cure rate of initial treatment cases with smear-positive was 98.5%. The treatment outcome was close to the outcome of the patient of resident population. ConclusionThe DOTS strategy was implemented in floating population was feasible and effective.