Table of Content

10 June 2003, Volume 25 Issue 6

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A five-year study on the outcome of initial smear-p ositive pulmona ry tuberculosis cases treated under DOTS in rural areas of Beijing

LI Bo ¹,TU De-hua,LIANG Wan-nian.

. 2003, 25(6):  343-346. 

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Objective To evaluate the long-term efficacy of DOTS strategy which implemented in rural areas (include 10 rural districts and co unties) of Beijing in 1995,and to analyze the possible influence factors which w ould lead to relapse and the failure of treatment.Methods To analyze the treatment outcome Results of all new reg istered initial smear positive cases in rural areas of Beijing in 1995 for five -years with cohort analysis.Results Under the strict standards of DOTS,the number of case w ho had been treated under DOTS were 272,which occupied 72.8% of total cases.The cure rates of DOTS group and self-administered group in the cohort analysis at the end of the treatment course were 95.2% and 88.2% respectively.And the differ ence between th e two groups was statistically significant (P<0.05).The relapse rate over 5 years was 1.4% and 9.1% respectively in DOTS and self-administered group,the d ifference between the two groups was significant (P<0.01).Among the 372 cas es who were treated,6 cases failed in the treatment,11 cases relapsed,but only o ne became the chronic infectious case after the retreament.The possible inf luence factors which led to relapse and the failure of treatment might be incomp liance with the treatment.Conclusion The short and the long-term efficacy of DOTS strate gy implemented in rural areas of Beijing is wonderful as expected.The top priori ty of tuberculosis control should be focus on supervision of chemotherapy treatm ent by input of human sources and investment.

Study on causes that result in retreatment in different tuberculosis management area

WAN Li-ya,WU Gui-ying,GONG You-long,et al.

. 2003, 25(6):  347-350. 

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Objective To study the impact factors that resul t in retreatment of different management area.Methods Re-treatment TB patients had been investigated by face to face interview survey with questionnaire.Result Re-treatment cases had dropped from 1993 to 1997.The re gions used ITP(World Bank Loaned Project,described as international tuberculosi s program,ITP) had greatly declined, but the regions used NTP (national tubercu losis program, NTP) and CTT(convention tuberculosis therapy,CTT)had gently dr opped. The reasons of re-treatment were the p atients who did not insist on treatment, or did not approprite treamtnet regimen used,or irregularly treated. The main reason was incomplete treatment that occ upied 70% of the total retreament cases in CTT area.Conclusion We should strengthen treatment management for new sm ear positive tuberculosis patients to reduce occurrence of re-treatment TB patients.

Varying tendency analysis on the proprotion of initially treated and retreated smear positive pulmonary tuberculosis

LI Jian-ming,LI Jia-hong.

. 2003, 25(6):  351-352. 

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Objective To determine the influential fa ct ors and variation regularity of the proprotion of smear positive pulmonary tuber culosis cases initially treated and retreated.Methods By means of linear correlation to an alyse the data of smear positive pulmonary tuberculosis cases from 1993 to 2000. Results The cure rate of initially treated smear positive cases increase yearly comparing with a downward tendency of retreated ones from 1993 to 2000,which shows a significant difference (r=-0.7156,P<0.05).Conclusion To strengthen phasize DOTS strategy for ensuring,the cure rate of intial smear positive pulmonary tuberculosis will be one key appro ach for prevention and to reduce the occurrence of retreated cases.

Analysis of the situation of tuberculosis control in Henan

XU Ji-ying,WANG Guo-jie,SONG Huai-zhou

. 2003, 25(6):  353-355. 

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Objective To analyze the situation of tuberculos is control in Henan province.Methods To analyze the case-finding and treatment outcome of smear positive cases noticified in Henan from 1993 to 2000 based on annual report from counties. Results DOTS population coverage rate in Henan in 2000 was 67.7 %. The notification rate and detection rate for new smear positive cases, and th e percentage of smear positive cases to new active pulmonary cases in DOTS area were 15.4/105, 33.5% and 40.0% respectively.And those indicators were 1.73,1.74 and 1.40 times of that in non-DOTS are.Conclusion It is the top priority to increase case-finding fur ther of tuberculosis control in Henan.

Pilot in sustainability of TB control in rural area in Fujian

CHEN Qiu-yang,ZHENG Jin-feng,LIN Rong,et al.

. 2003, 25(6):  356-359. 

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Objective To explore the sustainability of TB co ntrol in the 4 rural areas in Fujian from 1999 to 2002.Methods To implement DOTS strategy,standardize the managements and technical performances.Results During the four years,the overall investment on TB control was 0.98 million Yuan RMB.The DOTS cover rate o f was 100%. The consultation rate of TB suspects was only 0.1%.The sputum examin ation rate was 87.7%, and the positive rate was 32.4%.Smear positive cases occup ied 58.2% of TB cases. The rates of new smear positive cases and smear posit ive patients were 22.1/100000 and 28.9/100000 respectively.The rate of treatment management under direct observation was 89%.The regular treatment rate reached 98.6%, the cure rates of initially tr eated cases and retreated smear positive cases were 92.7% and 87.9% respectively .Conclusion Government committment,strengthened capacity buildi ng of TB control staff,standardizing technical,performance,improved referral sys tem and health promotion were the important approaches to maintain the sustainab ility of TB control in the rural area.

Study on the effect for initial smear positive pulmon ary tuberculosis cases treated with three short course(6 months)intermittent ch emotherapy regimens

LI Jun-juan,ZHANG Lian-ying,ZHANG Hui-min,et al.

. 2003, 25(6):  360-362. 

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Objective In order to find a good regimen to tre at tuberculosis patient,the study was carried out to treat initial smear positive TB cases with 2H₂R₂Z₂S₂(E₂)/4H₂R₂,2H₃R₃Z₃S₃(E₃)/4H₂R₂,compairedwith the result that TB cases treated with the regimen in TB contro l program in our country. Methods Twenty TB dispansaries were randomly selected as the st udy fields. Initial smear positive TB cases were chosen as study subjects and were divided into three groups(groupⅠ, groupⅡand group Ⅲ) randomly and were treated with different kinds of short course intermittent regimens of chemothera py.Results The smear negative conversion rates of the three g roups at the end of the sixth month during the treatment courses were 95.96%, 97 .98%, 97.37% respectively. There were not significant differences among them (P>0.05). Side effect rates of three groups after treatment were 22.73%, 33.88% and 40.00% respectively. The re were significant defferents between groupⅠand other two groups(P<0.01).B ut there was no significant difference between groupⅡ and group Ⅲ(P>0.05). The relapse rates of the three groups were 4.86%, 3.70% and 2.76% respectively and there were no significant differences among them(P>0.05). Average times of each cases of three groups ta king drugs in full treatment courses were 60, 70.48 and 90 times respectively. Conclusion The two experimental chemotherapy regimens have got almost the same Results with control group. The side effect rate of cases in group Ⅰ was less than th at in other two groups. The costs of the TB patients were reduced in the experim ent groups.

Report on tuberculosis epidemiology survey in 2001 of Changch un city

ZOU Zhi-yan,YANG Guang-xu,ZHANG Yue-mei,et al.

. 2003, 25(6):  363-367. 

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Objective To determine tuberculosis epide miologica l situation,evaluate the effects of tuberculosis control in the past and provide scientific bases for developing the Tuberculosis Control Programme from 2001 to 2010.Methods 52 investigative clusters were selected by multi -stratified grouping random sampling Methods that with proportional sampling.Fl uoroscopy and smear examinations were provided to known active TB patients,TB sy mptomatic and close contacts of TB cases.X-ray film was taken for that with abn ormal shadows Results of fluoroscopy and TB symptomatic with cough and expectora tion more than 3 weeks and/or haemoptysis.Results The prevalence rate of active pulmonary tuberculosis ra te was 250.71/100,000.The prevalence rate of smear positive cases was 99.5/100,0 00.The tuberculosis mortality was 22.6/100,000 in Changchun City.Conclusion The prevalence rate declined slowly in Changchun cit y.Tuberculosis remaining the disease that impact on the developments of the soci al-economic and the health of the public.The problem should be paid great atten tion by governments at different levels,the referral system should be strengthen ed and DOTS strategy should be implemented fully.

Invesigation on the actual DOTS management situation of cases with smear positive pulmonary tuberculosis cases in rural area in Ji’ nan

LI Ren-zhong,MA Yan-hui,TANG Shi-qing,et al.

. 2003, 25(6):  368-370. 

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Objective To determine the actual implementation s ituation and problem DOTS management of the smear positive pulmonary tuberculosi s cases.Methods To investigate the financial income and expenditure of four county dispensaries in 1996,1997.County,town and village doctors and 126 sm ear positive cases were investigated.Results The proportion of patients who were directly observed b y village doctor during all the course of treatment and intensive page of treat ment were 19.0%,74.6% respectively.The proportion of patients who didn’t miss dr ug was 95.2%.The number of patients treated by DOTS were 59.6% of the number of patients estimated by World Bank Loan Project.Conclusion The majority of patients were managed by village doc tors during intensive page of treatment and a few patients who missed drug.Few p atients who directly observed by village doctor during the whole course of treat ment.

The clinical observation on the effects of Wu-Zhi Capsules in preventing and treating liver damage caused by anti-tuberculosis drugs

XIAO Jiang-qiang,DENG Xiao-mei.

. 2003, 25(6):  371-373. 

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Objective To determine the effect of Wu-Zhi Cap su les in preventing and treating liver damage caused by anti-tuberculosis drugs.Methods 179 initially-treated pulmonary tuberculosis patients who received the regimen of 2HRZS(E)/4～10HR were randomly separated into 2 grou ps:Observe group,96 cases,supplemented with Wu-Zhi Capsules for six mouths and Control group,83 cases,received glucurolactone.Results There were 7 cases who had liver damage in observe grou p (7.3%),5 cases with HBsAg positive (11.4%);There were 32 cases who had liver damage in control group (38.6%),20 cases with HBsAg positive (52.6%).There wa s signific ant difference between the 2 groups (P<0.01).HBsAg,HBeAg positive patients were more likely to have liver damage in anti-tuberculosis treatment.Conclusion Wu-Zhi capsules is effective in preventing and trea ting liver damage caused by anti-tuberculosis drugs,HBsAg,HBeAg positive patien ts’ liver function should be monitored in the early period of anti-tuberculosis treatment.

The diagnostic value of CT in pulmonary tuberculosis

CHEN Yan-qin,YANG Jun,CHEN Xiao-you,et al.

. 2003, 25(6):  374-376. 

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Objective To determine the diagnostic value of C T in pu lmonary tuberculosis.Methods An retrospective analysis were don e through comparing the clinical information,X-ray film and CT film of 98 patie nts with pulmonary tuberculosis.Results (1)Most of intrapulmonary lesions located in superior lobe apicoposterior segmen t and lower lobe dorsal segment, superior lobe anterior segment and lower lobe b asal segment.(2)The show rate of the lesions on chest CT films was significant h igher than that of X-ray films.(3)The show rates of focal calcification,inner- mediastinum lymph node enlargement,inner-mediastinum lymph node calcification, bullae of lung,pulmonary barotrama,pneumathorax in chest CT films were significa nt higher than that of X-films (P<0.05).(4)There was no significant differe nce on show rates for various shadows in CT films and X-ray films.Conclusion The value of chest CT for providing evidences for di agnosis of TB is very higher.

Analysis on Tuberculosis cases who received renal transplantion

LIN Cun-zhi,ZHU Xin-hong,NIU Juan-juan,et al.

. 2003, 25(6):  377-378. 

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Objective To determine the possibility of illnes s with tuberculosis after receiving renal transplantion Methods Retrospective analyze 16 tuberculosis patients rece iving after occured renal transplantation in recent 3 years.Results Fifteen cases were pulmonary tuberculosis cases and thr ee of them combied with extrapulmonary tuberculosis and one combied with endobro nchial tuberculosis.Conclusion The patients who received renal transplantation are easily to get tuberculosis.

Evaluation of the application for fast cultivation an d drug susceptibility tests by BACTEC-MGIT960 in diagnosis and treatment of patients with pulmonary tuberculosis

WANG Wei,LI Hong-ming,WANG An-sheng,et al.

. 2003, 25(6):  379-381. 

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Objective To evaluate the application for fast cultivation and susceptibility tests by BACTEC-MGIT960 in diagnosis and treatment of patients with pulmonary tuberculosis.Methods Fast cultivation of mycobactria tuberculous and suscept ibility tests by BACTEC-MGIT960 and compared with improved 7H9 drug medium and improved L-J medium.Results Average report time of cultivation and drug susceptibil ity tests by BACTEC-MGIT960 was only 8.5 d and 6.5 d,it was shorter than that o f improved 7H9 medium (20.6 d and 17 d) and improved L-J medium.(30.8 d and 26. 5 d).Indentical proportion of drug susceptibility tests was higher than 90%.Conclusion The fast cultivation and drug susceptibility tests b y BACTEC-MGIT960 is helpful to diagnosis and treatment of patients with pulmona ry tuberculosis,and it is a quick,efficient and relieble method.

Effects of glucocorticoids on apoptosis of lymphocyte in tuberculous effusion

ZHOU Xiang-dong,LAN Jian,ZHANG Tin.

. 2003, 25(6):  382-384. 

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Objective To evaluate the celluar basis of glucocorticoids accelerating the resolution of tuberculous pleural effusion. Methods In situ-endlabeling te chnique of fragmental DNA was used to detect the apoptosis dynamic features of t he lymphocytes in pleural effusion from patients with tuberculous pleurisy befor e anti-tuberculous therapy (group T),after sole anti-tuberculous therapy(group A),anti-tuberculosis in company with glucocorticoids therapy(group G) respecti vely.Results The lymphocytes of group T showed signs of apoptosis spontaneousl y and no signs of surviving cells was 91.4h and 147.6h respectively .The above times were shorten gradually by anti-tuberculous therapy.There were obvious difference between group T and group A after 9 days of therapy(P<0. 05).The above time of group A and group G were 85.3h/143.6h and 72.8h/121.3h res pectively(P<0.05) after 3 days of therapy, were 84.9h/137.1h and 65.4h/118.6 h respectively(P<0.01) after 6 days of therapy,were 81.2h/130.3h and 62.1h/1 13.4h respectively(P<0.05) after 9 days of therapy.Conclusion The lymphocyte apoptosis of tuberculous pleural effusion was in inhibitory st ate.The inhibitory state could be relieved by anti-tuberculous therapy graduall y,and the relieving process could be shor ted obviously by glucocorticoids.This effects of glucocorticoids may be the impo rtant celluar basis for accelarating the resolution of pleural effusion.

Analysis on gene of strains of drug-resistance of Mycobacterium tuberculosis isolated from coal worker’s pneumoconiosis with tuberculosis

CHEN Dong-jin,LI Hong-min,JIANG Ping,et al.

. 2003, 25(6):  385-387. 

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Objective To realize the gene mutation of Mycobacterium tuberculosis strains resisted with isoniazid,rifampicin,ethambutol an d streptomycin isolated from coal workers’ pneumoconiosis with tuberculosis in order to find more effective therapy and prevention methods.Methods 64 strains of isoniazid, rifampicin,streptomycin or eth ambutol resistant Mycobacterium tuberculosis were separa ted from 96 coal workers’ pneumoconiosis with tuberculosis. Then we amplified t heir katG, rpoB or rpsL fragments of genome with PCR and compared their SSCP pro files with standard strains.Results Out of 64 drug-resistant strains,42 rpsL,47 rpoB and 42 katG SSCP profiles appe ared abnormal separately.Conclusion Most of the resistant strai ns in our analyse showed evidences on gene mutation.The mutation rate was lower than that of rutinc test.

Study on the correlation between serum immunosuppres sive acidic proteins and Tlymphocyte subsets of patients with pulmonary tuberculosis

FEI Xiao-feng,WU Jian-hong.

. 2003, 25(6):  388-390. 

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Objective To study the correlation between serum immunosuppressive acidic proteins (IAP) and T lymphocyte subsets in patie nts with pulmonary tuberculosis(TB).Methods The levels of IAP were detected by agar diffusion assay, and T lymphocyte subsets detected by the technique of alkaline phosphatase and anti-alkaline pho sphatase (APAAP) in 122 patients suffered from pulmonary TB and 45 healthy indiv iduals.Results The level of IAP was higher,and the expression of CD₃,CD₄ and the ratio of CD₄/CD₈ were lower in patien t group and both of those two indicators showed a siginificant difference with t hat control group(P<0.05).The changes of them were more obvious in progressi ve stage than that in stable and improving stages, respectively (P<0.05).The re was a negative correlation between IAP level and the expression of CD₃,CD₄ and the ratio of CD₄/CD₈(P<0.05).There was a positive correlation betw een CD₈ expression (P<0.05).Conclusion The Results indicate the change of IAP level and T lymphocyte subset may be rela ted with the severity and prognosis of pulmonary TB patient.

Species identification of Mycobacteria with multiprimer PCR

WANG Zhong-yuan,KUANG Tie-ji,JIN Guan-fu,et al.

. 2003, 25(6):  391-393. 

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Objective To find a new rapid and easy method of species identification of Mycobacteria for improving diagnosis level on tube rculosis.Methods Use three sets primers for mycobacteria togeth er to amplify the genome DNA of Mycobacteria including reference and some cl inical isolates.Results This method can distinguish M.tuberculosis complex from Nontuberculous Mycobacteria or does M.tuberculosis from M.bovis in a single step.Its specificity was 100%,and its sensitivity i s 10ng /response. Conclusion It showed that multiprimer PCR is a effective specie s identification method for Mycobacteria.So it can be used for initial diffe rentiational diagnosis between M.tuberculosis complex and Nontuberculous Mycobacteria or Mycobacteria and non-mycobacteria.

The effect of health education on registered PTB cases

DUAN Qiong-hong¹, HU Jial-ian ,Dick Chamla, Nieshaofa¹

. 2003, 25(6):  394-396. 

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ObjectiveTo determine the general knowledge and attitude(KA)of Tub erculosis (TB) and its associated factors among the PTB patients in Wuhan city, and explore the efficient ways to improve health education on this disease. Methods102 patients admitted between November 2001 and April 2002 and they were consecu t ively interviewed, followed up and provided with the health education. The KA of TB was assessed before and after the education. Single factors like age, sex, l evel of formal educa tion, residence, occupation were analysised by T test and F analysis to determi ne if it had an association with the score of TB KA. Results Prior to education, the score was 3.79±1.67 and that a fter education was 5.97±1.56 (P<0.001). Those with high level of formal ed ucation were more likely to have higher score (P<0.05). Age, sex, occupatio n,residential area did not have association with the score (P>0.05).ConclusionThe health education conducted in this study was efficient.Strengthening freguen cies and improving the methodoloyies of education should be one of effective ways for improving the knowledge and attitude of TB.Future health education intervention strategies shoula target those peope who w ith low-level of formal education.