Table of Content

10 March 2004, Volume 26 Issue 3

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Study on gyrA mutation in Mycobacterium tuberculosis quinolone-resistant isolates

An Huiru,Wang Wei,Li Hongmin,et al.

. 2004, 26(3):  129-132. 

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Objective To observe the mutations of gyrA gene in M.Tuberculosis quinolones-resistant isolates,and to evaluate their clinical value.Methods 77 clinical isolates were identified for their mycobacteria species,and were analyzed M.tuberculosis gyrA genes by PCR-SSCP and PCR-direct sequencing.Results Seventy-five isolates were identified as M.tuberculosis.Of 30 quinolones-sensitive isolates,11 isolates had same gyrA SSCP profiles as H₃₇R_v,19 had same profiles as M.bovis BCG.The drug-sensitive isolates whose gyrA SSCP profiles was identical to H₃₇R_v were AGC at condon 95,the others were ACC at condon 95.Of 45 quinolones-resistant isolates,34 (75.6%) displayed abnormal gyrA SSCP profiles.25 clinicals of 2 kinds of gyrA SSCP profiles which appeared at a high frequency were sequenced.15 isolates had GAC→GGC mutation at condon 94;10 isolates had GCG→GTG mutation at condon 90.Conclusion Quinolones resistances in some M.tuberculosis isolates were due to mutation on gyrA genes.PCR-SSCP method might become a simple and rapid diagnostic test for identification of genotypes of M.tuberculosis quinolones-resistance.

Cytokine expression of lipopolysaccharide-stimulated macrophage infected by M.bovis BCG

Li Chuanyou,Liu Zhongquan,Li Weimin,et al.

. 2004, 26(3):  133-135. 

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Objective To study whether lipopolysaccharide (LPS) can influence cytokine expression of macrophage infected by M.bovis BCG.Methods ELISA method was used to measure the cytokine expression of the different groups including macrophage group, macrophage +BCG+LPS group,macrophage +BCG group, macrophage +LPS group, and thus to compare the differences.Results Little IL-12 and TNF-α was produced in single macrophage group,LPS can stimulate macrophage group especially macrophage group infected by M.bovis BCG to produce significant amount of IL-12 and TNF-α.Compared with single macrophage group,LPS also can’t stimulate macrophage group including macrophage group infected by M.bovis BCG to produce more IL-1,IL-2,IL-18 and IFN-γ.Conclusion LPS can stimulate macrophage to produce more IL-12,TNF-α.That is conducive to the host immune response.It is suggested that LPS and its analogues may have potential for anti-TB drugs,vaccines or their adjuvants.

Cost-effectiveness analysis on identification of pulmonary tuberculosis from different population

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

. 2004, 26(3):  136-138. 

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Objective To evaluate the effectiveness of identification of pulmonary tuberculosis from different population.Methods Target population was classified into pulmonary tuberculosis suspect group and other three groups. Identification rate of pulmonary tuberculosis and its cost-effectiveness were analyzed.Results In the suspect group, the identification rate of active pulmonary tuberculosis is 3590.09/10000, and the rate of pulmonary tuberculosis with smear positive is 1159.1/10000. Both are more than the identification rates of other three groups (P＜0.001).The cost for identification 1 active pulmonary tuberculosis case and 1 smear positive case was 103.3 yuan and 319.2 yuan Respectively.Both of the cost was less than that of other three groups.Conclusion In the case of limited resources,the best way for detecting tuberculosis case is that identify the cases from the suspects who making clinical consultation.

Study on the effect of bronchofiberscope and catheter intervention in the treatment of endobronchial tuberculosis

Zhou Zhongzhi,Tao Yanhong,Chen Zhonghong.

. 2004, 26(3):  139-141. 

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Objective To determine the effect of bronchofiberscope and catheter intervention combined with chemotherapy in the treatment of endobronchial tuberculosis.Methods To divide the patients with endobronchial tuberculosis diagnosed by bronchoscope.Sputum smere and clinical manifestation into two groups.One group was treated by bronchofiberscope and catheter intervention combined with chemotherapy,the other was treated simply by chemotherapy.Results The improvement rate of clinical symptoms.Radiographic and bronchoscopic manifestations and bacilli negative convertion rate in combined therapy group were significantly higher than that in simple therapy group (P＜0.01,P＜0.05).And after 6 months’ therapy,bronchoscopic improvement and negative convertion rate in the combined therapy group were significantly higher than that in simple therapy group (P＜0.05).In granulomatous and ulcerative subtypes of tuberculosis,the efficacy rate in comlined therapy group was higher than in simple therapy group.But in exudative and cicatricial subtypes,there was no significant difference in two groups.Conclusion Bronchofiberscope and catheter intervention combined chemotherapy could be applied in granulomatous and ulcerative endobronchial tuberculosis,for the therapy could not only rapidly relieve clinical symptoms,but also auelerate lesion absorbtion and improve treatment effect.

Effect of traditional Chinese medicine (snakes and scorpions) on immune function of patients with neck tuberculous lymphnoditis

Sun Yanzhi,Yu Weiye,Fu Xiangdong,et al.

. 2004, 26(3):  142-144. 

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Objective To observe the regulatory effect of traditional Chinese medicine on immune function of patients with neck tuberculous lymphnoditis after receiving regular anti-tuberculous treatment to explore its therapeutic mechanism.Methods Sixty relapse patients with neck tuberculous lymphnoditis after regular treatment with anti-tuberculous drugs were randomly divided into two groups,30 patients in each group.The treatment group were treated with traditional Chinese medicione (snakes and scorpions) only.The control group were treated with routine anti-tuberculous drugs (2DRtZE/7DRtE).T lymphocyte subsets of peripheral blood were determined before treatment and 1～6 months after treatment to compare the therapeutical effect in the two groups.Results The parameters of T lymphocyte subsets were improved in 20 patients within treatment group.After 6 months treatment,the parameters of T lymphocyte subsets were improved only in 5 patients within control group.There is a significant difference between two groups (P＜0.01).In the treated group,the total effective rate were 90%(27/30),clinical cure rate 53.3%(16/30).As compared with those in the control group,36.7%(11/30),10%(3/30) respectively,the difference was significant (P＜0.01).Conclusion Snakes and scorpions shows the regulatory effect on cellular immune function in patiens with neck tuberculous lymphnoditis failed after regular anti-tuberculous treatment.It could be increased the healing rate.Detumescence of lymphnoditis,healing of ulceration and the improvement of lesion on B-ultrasound in the treated group were better than that of the control group (P＜0.01).

The clinical analysis of senile pulmonary tuberculosis received surgical treatment

Wei Li,Zhu Changgeng,Wang Guobin.

. 2004, 26(3):  145-147. 

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Objective To determine the clinical features of senile pulmonary tuberculosis cases received surgical treatment.Methods The treatment outcome of 56 cases of senile pulmonary tuberculosis received surgical treatment from 1998 to 2003 were analyzed retrospectively.Results Among 56 cases 55 were clinical cured,the cure rate was 98.2%.Thirty-one cases of sputum positive were negative after operation,the sputum negative conversion rate was 100%.Conclusion Surgical treatment could be selected for senile pulmonary tuberculosis if complications were corrected before,wound was reduced in operating and complications were corrected after operation.

The differential diagnosis value of Interleukin-6 and Transferrin in pleural effusion

Hu Yunliang,Chen Xinyu,Lin Jie,et al.

. 2004, 26(3):  148-150. 

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Objective To determine the differential diagnosis value of the levels of Interleukin-6 (IL-6)、Transferrin (TRF) in pleural effusion in patients with pleural effusion.Methods Ninety-three cases with differential diagnostic pleural effusion were divided into transudatory pleural,tuberculous exudative and malignant exudative groups.IL-6、TRF were simultaneously determined in three groups,and the value of two indices was evaluated by receiver operating characteristic curve (ROC).Results The levels of IL-6 were significant difference among three groups.The level of IL-6 in tuberculous exudative group was the highest,and that in transudatory pleural group was the lowest.The level of TRF in exudative pleural group was higher than that in transudatory pleural group (P＜0.01);Regarding 95pg/ml as the cut off value of IL-6 and 70mg/dl as that of TRF to distinguish exudative pleural effusion from transudatory pleural effusion,the sensitivities in diagnosis exudative pleural effusion was 95.2%,85.7% respectively and the specialities was 93.3%,70% respectively.Conclusion The speciality and sensitivity of IL-6 were higher.There are diagnostic values in IL-6、TRF for identifying the property of pleural effusion.

Clinical study on 101 extrapulmonary tuberculosis cases in general hospital

Xu Bin,Sun Jiayuan,Huang Yan.

. 2004, 26(3):  151-154. 

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Objective To improve the diagnosis and treatment of extrapulmonary tuberculosis (EPT) through clinical analysis on 101 EPT cases.Methods The diagnosis and treatment situation of EPT patients treated in Shanghai Fifth People’s Hospital,from January,1994 to January,2001 were studied retrospectively.Results The total number of EPT patients were 101,the most patients were old people (33.7%).The proportion of EPT overo all tuberculosis (TB) was 8.3%～20.2% and the mean rate was 12.8%±4.6%.The sites of TB primarily affected were the lymphadenitis of the neck (42.6%),abdominal cavity (13.9%) and kidney (12.9%).The final diagnosis confirmed by pathological findings,bacteriology test and diagnostic treatment and follow up was 69.3% (70),15.8% (16) and 14.9% (15) respectively.The number of patients with delayed diagnosis were 45 (44.6%).62 (61.4%) of the cases received standard chemotherapy and 39 (38.6%) received unstandard treatment.The cure rate of patients who receive standard chemotherapy was 100%.The rate of patients who need to receive treatment again was 25.6%.Conclusion The diagnose and treatment of EPT in general hospital should be paid attentions to ensure the patients be diagnosed and treated timely and by standardized treatment.

Comparison on the smear negative conversion rates of new smear positive TB cases through 2 sputum smear tests and 3 sputum tests

Hou Shuangyi,Xiao Aiqing,Jian Guilan,et al.

. 2004, 26(3):  155-157. 

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Objective To determine the difference on smear negative conversion rates of new smear positive TB patients by 2 smear tests and 3 smear tests.Methods Testswith 2 smear and 3 smear are conducted once a month in the six months of treatment of the new smear positive TB patient 1047.Results During the six months of treatment,the smear negative conversion rates by 2 smear and 3 smear tests at the end of 4th～6th months of treatment are almost the same.The difference was found at the end of 1th and 2nd months.The differences was 4.4% and 3.1% respectively.The relapse rates within two years was 2.4% in cases with negative Results and with intensive treatment for another month,and 9.4% in cases of negative result of 2 smear test at end of the 2nd month but still of positive result of 3 smear test and nit out extended intensive treatment.There was significant difference.Conclusion It is better to conduct follow up sputum tests at the end of month 1 and 2 of tre atment of TB patients by 3 smear tests.

Study on treatment effect of intrapleural urokinase for tuberculous pleurisy

Huang Ziqing,Huang Jie.

. 2004, 26(3):  158-160. 

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Objective To observe the curative effect intrapleural urokinase for tuberculous pleurisy.Methods One hardred and twenty patients with tuberculous pleurisy were randomly divided into 2 groups:treatment group and control group.The patients in the treatment group were injected with urokinase 100000IU intrapleurally each time after 1,2,3 thoracocentesis,and the patients in the control group were injected with 20ml physiological saline each time.The other therapies in both groups were the same.Results The duration of pleural effusion absorption in treatment group was (20.2±3.1) days,while it was (19.6±4.2) days in control group (P＞0.05).The mean volume of fluid drained in treatment group was (3648±512)ml,while it was (2934±478)ml in control group (P＜0.01).The mean number of fluid drained in treatment group was (5.2±1.6),while it was (4.8±1.6) in control group (P＞0.05).There were two patients with pleural adhesion and loculation in treatment group,but there were 9 cases in control group (P＜0.01).After two months,the mean thickness of pleura in treatment group was (1.22±0.19)mm by B ultrasonic wave test,but it was (1.48±0.32)mm in control group (P＜ 0.01).The lung function (FEV1%) examined was (89.2±1.6%) in treatment group,while it was (82.3±2.1%) in control group (P＜0.01).FVC% was (94.3±2.2%) in treatment group,while it was 90.2±2.4% (P＜0.01) in the control group.Conclusion Intrapleural urokinase can not only reduce pleural adhesion,loculation and thickening of the pleura but also improve lung function.

Social and economic effects of World Bank loaned TB Control Project in Linyi

Zhou Fujia,Liu Quanfu,Zhao Shanliang.

. 2004, 26(3):  161-164. 

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Objective To analyze the cost-effects of World Bank Loaned TB Control Project in Linyi in the past 10 years.Methods The uterlization of loans,the counterpart funds and data of case detection and treatment between 1992 and 2001 were analyzed.Results 21440 cases of pulmonary tuberculosis were cured by using of the World Bank loans of RMB 5.5 million Yuan and counterpart funds of 7.7 million Yuan in the past ten years.21.44～32.16 thousands people are avoided from infection with tuberculosis and 1.072～1.608 thousands people avoid suffering from it.The treatment costs were saved for 2.8 million Yuan.19 million Yuan were saved for avoiding missing work.19～44 million Yuan were saved for reducing TB cases.Conclusion Good preventive and curative effects were got in the implementation of World Bank Loaned TB Control Project in the past ten years.21.44～32.16 thousands people are made free from tuberculosis and 10.72～16.08 thousands people avoid suffering from it.13276100 Yuan was invested but 77158211～91898131.1 Yuan was saved.Although the investment is low,good social and economic benefits have been achieved of World Bank Loaned TB Control Project.

The short-term treatment effect of regimen which contains the Amikacin Sulfate and the Levofloxacin for multi-drug resistant pulmonary tuberculosis cases (MDR-TB)

Gao Chunrong,Yuan Dongyun,Xu Lijiang.

. 2004, 26(3):  165-167. 

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Objective To observe and evaluate the treatment effect of the regimen which contains the Amikacin (AK) Sulfate and the Lexofloxacin (LVFX) for MDR-TB cases.Methods 97 MDR-TB patients were randomly divided into two groups.48 cases in the observation group (treated with AK,LVFX,DL-473,Pa,PZA,Pt),49 cases in the control group (treated with AK,DL-473,Pa,PZA,Pt).The duration of treatment was 21 months.Results 93 cases completed their treatment.The sputum smear negative conversion rate was 87% and 59% in the observation group (46 cases) and control group (47 cases).The rate in observation group was significantly higher than that of the control group (P＜ 0.01).Conclusion The regimen which contains Amikacin Sulfate and Levofloxacin was helpful to the sputum smear negative conversion and the absorption of the athology and with lower side reaction,this regimen deserve to be popularized in the practice.

Analysis on the reasons for misdiagnosis of 60 bacteriological negative tuberculosis cases confirmed by fibrebroachoscope of which are at lower part lung diagnosed using

Zhu Yuyin.

. 2004, 26(3):  168-169. 

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Objective To determine the diagnostic value of fibrebronchoscope on diagnosis bacteriological negative tuberculosis at lower part lung.Methods Retrospective analysis on the clinical information of 60 bacteriological negative tuberculosis cases confirmed by fibrebronchoscope who were misdiagnosed.Results Most of the cases suffered with catarrh at middle and lower part of bronchuswhich was 25 cases (41.7%) and 20 cases (33.3%) respectively.7 cases suffered with nozzle stricture (11.7%).37 cases (61.7%) with positive bacteriological result confirmed by merely brush examining.46 cases (76.7%) with positive result through brush examining and bronchus alveolus lavage.Fifty-two cases were diagnosed as tuberculosis through BAL and phlegm test after fibrebronchoscope and tissue live test.Sixty cases were diagnosed as tuberculosis by combination of the 4 mehtods (100%).Conclusion Fibrebronchoscope could improve the accurate diagnosis rate of tuberculosis at lower part of lung.Brush examining,bronchus alveolus lavage (BAL),tissue live test and phlegm test after fibrebronchoscope are supplementary for improving the diagnosis rate and avoiding misdiagnose.

Surveillance results of pulmonary tuberculosis cases in immigrants in ZheJiang Province

Yang Shibo,Li Qun,Miao Zhiping.

. 2004, 26(3):  170-172. 

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Objective To determine the current tuberculosis epidemic situation in immigrants and explore the concerned control strategy in Zhejiang.Methods To analysis the surveillance reports of tuberculosis cases in immigrants of every counties during 2001-2002.Results Pulmonary tuberculosis cases in immigrants accounted for 16.3% and 21.6% of the total number of cases in 2001 and 2002 respectively.Smear positive case rate was 31.16/100000 and 31.27/100000 respectively.It was 2.03 and 1.62 times of the rates of permanent residents.The cure rate was only 63.9% based on the cohort analysis.It’s obviously lower than that of cases of permanent residents (85.2%).The rate of transfer rate was 27.5%.Conclusion The treatment and management for tuberculosis cases in immigrants have become one of the constraints of tuberculosis control in Zhejiang.According to the characteristics of the immigrants,to apply appropriate approaches to ensure high cure rate and increasing case finding is the key for reaching the targets of tuberculosis control.