Table of Content

10 December 2012, Volume 34 Issue 12

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Development and progress of tuberculosis surveillance in China

DU Xin，HUANG Fei，CHEN Wei，CHENG Shi-ming

Chinese Journal of Antituberculosis. 2012, 34(12):  757-759. 

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The application of spatial interpolation method in the epidemiological studies

LI Jian-tao, HUANG Fei, CHEN Wei, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2012, 34(12):  760-763. 

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The fact that the provincial level prevalence data were not obtained through the recent two national TB epidemiological surveys, brings difficulties for prevalence and disease burden estimation for each province. The spatial interpolation method can be used to predict the data of notsampled areas by data of sampled areas. The author summarized the characteristics and principles of several common used spatial interpolation methods, and their applications in TB and other fields. The author also prospected the application of spatial interpolation method in TB prevalence calculation.

Spatial analysis on the active pulmonary tuberculosis patients registered between 2003 and 2011 in Hunan province

TANG Yi, GONG De-hua, BAI Li-qiong, WAN Yan-ping, FAN Jiang-jing, ZHANG Chuan-fang

Chinese Journal of Antituberculosis. 2012, 34(12):  764-767. 

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Objective  To analyze the spatial distribution pattern of the active TB patients registered in Hunan province, and find out the gathered area, to provide theoretical basis for further study of the tuberculosis risk factors and prevention and control strategies.  Methods  There are a total of 475 125 cases of active TB registered between 2003 and 2011 in Hunan province, with the prefecture annual average registration rate of 80.1/100 000 (61.3/100 000-122.8/100 000). We collected the active TB registration number and average annual population in each prefecture between 2003 and 2011, analyzed the spatial distribution of average annual registration rate by SPSS 13.0 clustering analysis (hierarchical cluster), the aggregation characteristic of spatial, time and time-space distribution by SaTScan (Version 9.1.1) Possion distribution probability model, and mapping by MAPGIS 67 software.  Results  There was a descending trend of the spatial distribution of active TB patients registration from northwest to southeast in Hunan province between 2003 and 2011. Purely spacial analysis identified 4 clusters, the first cluster included Xiangxi, Zhangjiajie and Huaihua, and 85 065 patients were registered actually, while the expectation number of registration patients were 62 095，RR=1.45 (P<0.001), the second cluster was Loudi, 31 381 patients were registered actually, while the expectation number of registration patients were 27 043，RR=1.17 (P<0.001), the third cluster was Changde, and 47 831 patients were registered actually, while the expectation number of registration patients were 43 366，RR=1.11 (P<0.001), the fourth cluster was Yongzhou, and 41 837 patients were registered actually, while the expectation number of registration patients were 37 656，RR=1.12 (P <0.001). Purely temporal analysis identified there was a cluster between 2004 and 2006 in terms of notification on active tuberculosis patients, and 162 067 patients were registered actually, while the expectation number of registration patients were 151 859，RR=1.10 (P=0.001). The spatial analysis identified 4 clusters, the first cluster included Xiangxi, Zhangjiajie and Huaihua, and 41 695 patients were registered actually, while the expected registration number were 25 306，RR=1.71 (P<0.001), the second cluster was Yongzhou, 9518 patients were registered actually, while the expected number of 6334，RR=1.51 (P<0.001), the third was Loudi, 7223 patients were registered and the expected of 4589，RR=1.58 (P<0.001), the fourth was Changde, 23 058 patients were registered while expected of 19 149，RR=1.21 (P<0.001). Conclusion  There was a descending trend of the spatial distribution of active TB patients registration from northwest to southeast in Hunan province between 2003 and 2011. The notifications are not randomly distributed in space, time and timespace, and clusters did exist in Hunan. The cluster most likely existed in Xiangxi, Zhangjiajie and Huaihua, and gathered between 2004 and 2006.

The analysis of anti-TB treatment outcome of different institutional sources of HIV-positive TB patients

LAI Yu-ji，CHENG Shi-ming，ZHOU Lin，LIU Er-yong，WANG Dong-mei，Li Tao

Chinese Journal of Antituberculosis. 2012, 34(12):  768-772. 

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Objective  To compare the characteristices and anti-TB treatment outcome of HIV-positive TB patients from TB programme and AIDS programme. Methods  We collected the TB-related information from TB information management system and HIV-related information from HIV institutions. In the selected fouteen counties within six provinces, a total of 925 TB/HIV cases were registered between Spe.2007 and Aug.2009, 673(72.8%) were known to be HIV positive and referred by HIV institutions and 252(27.2%) were newly detected HIV positive cased by TB institutions.  Results  In areas where HIV transmited mainly through illegal blood donation, the treatment success rate was 90.6%（328/362）and 82.4%（70/85）（χ²=4.806，P =0.034）and the death rate was 7.5%（27/362）and 16.5%（14/85）（χ²=6.711，P=0.010）repsectively for TB/HIV patients from HIV institutions and TB institutions. In areas where HIV transmited mainly through drug use and sex, the treatment success rate was 60.1%（187/311）and 68.9%（115/167）（χ²=3.563，P =0.059）and the incidence of adverse drug response was 24.1%（75/311） and 13.8%（23/167）（χ²=7.132，P =0.009）repsectively for TB/HIV patients from HIV institutions and TB institutions.  Conclusion  We should intensify TB case finding in people living with HIV/AIDS. Meanwhile, HIV testing in TB patient is also an important measure.

The economic status and treatment cost of MDR-TB patients compared to nonMDR-TB patients in Henan province

SUN Yan-ni, WANG Guo-jie, ZHEN Xin-an, LIU Zhan-feng, Harley David, Hall Gillian, Vally Hassan, Sleigh Adrian.

Chinese Journal of Antituberculosis. 2012, 34(12):  773-779. 

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Objective  To investigate the socioeconomic status and treatment cost of MDR-TB patients compared to non-MDR-TB in Henan province in 2010 to provide evidence for comprehensive TB control strategies.  Methods  Participants were randomly selected by using Excel generated random digits table from an anti-TB drug resistance surveillance survey dataset collected by the Institute for Tuberculosis Control and Prevention, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Interviews were carried out using a questionnaire to collect information on the socioeconomic status including wealth and impacts and treatment costs between MDR-TB and non-MDR-TB patients. Bivariate analysis was performed for data analysis. Altogether 234 TB cases were interviewed. Among the interviewed cases, 86 were MDR-TB cases and 148 were non-MDR-TB cases based on their anti-TB drug resistance status. In order to compare,  t-test was applied in continuous variables and Chi square test was used for categorical variables.  Results  Compared to non-MDR-TB household, the proportion of annual household income less than 5000 Yuan for MDR-TB patient’s household was much higher. The difference between the two groups was statistically significant (55.3%,47/85 vs 38.1%,56/147, χ²=6.9，P=0.031). 47.1%(40/85)of MDR-TB patients’ households were in lower 1/3 in term of economic status compared to other households in the community, while 32.9% (48/146)non-MDR-TB patients’ household ranked in lower 1/3(χ²=4.6, P=0.032). Compared to households with non-MDR-TB patients, higher proportion of MDR-TB patients’households had bedrooms less than 3 (37.8%,31/82 vs 17.9%,26/145). The difference between the two study groups was statistically significant(χ²=11.0，P=0.004). More proportion of households with MDR-TB patients reported loan for TB treatment and can not pay back in time(19.0%,15/79 vs 4.5%,6/134χ²=13.4，P=0.001). Much higher MDR-TB households paid treatment costs more than 10000 Yuan compared to non-MDR-TB households (30.2%, 26/86 vs 9.5%,14/148). The difference between two groups was statistically significant(χ²=19.7, P=0.001).  Conclusion  Economic burden on TB patients, especially on MDR-TB patients is serious. Compared to households with non-MDR-TB patients, the MDR-TB patients’ households is poorer. MDR-TB patients’ households tend to pay more on TB treatment costs as well.

Feasibility study of case-based payment for outpatient tuberculosis auxiliary diagnosis and treatment in Hunan province

XU Zu-hui, BAI Li-qiong, GONG De-hua, TANG Yi, ZHANG Yi-rui

Chinese Journal of Antituberculosis. 2012, 34(12):  780-783. 

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Objective  To explore the feasibility of implementing case-based payment for outpatient tuberculosis auxillary diagnosis and treatment in Hunan province. Methods  All 131 counties of Hunan province were investigated to obtain the current situation for medical insurance of tuberculosis patients by questionnaire survey and telephone interview. Forty staffs of 10 counties from the new rural cooperative medical system (NRCMS) sectors and centers for disease control and prevention (CDC) were interviewed on the pros and cons of pilot case-based payment for outpatient tuberculosis.  Results  Outpatient TB treatment fee was covered by NRCMS in 118 counties. Reimbursement approaches consist of proportional reimbursement, fixed amount reimbursement and case-based reimbursement. However, the fixed amount reimbursement varies from 200 to 1500 Yuan per case and the proportional reimbursement has a range of 30%-80%. According to the provincial guidance of basic service package, at least 10.14 million Yuan per year need to be input to NRCMS for non-pilot counties to implement the case-based payment policy. Among 6 investigated pilot counties, NRCMS’ fund burden did not show obvious change(increasing by -5%～5%)in 2 counties, slight increase（by 5%-10%） in 3 counties, but significant increase（over 10%）in 1 county after pilot carrying out. Conclusion  The policy of case-based payment for outpatient TB auxiliary diagnosis and treatment can be adapted to local conditions, and gradually expanded and promoted in Hunan province.

Death and risk factors of new registered aged pulmonary tuberculosis patients in Shanghai

CHEN Yong，SHEN Xin, PAN Qi-chao, SHEN Mei, XIA Zhen, GUI Xiao-hong, WANG Li-li, ZHUANG Yu, MEI Jian

Chinese Journal of Antituberculosis. 2012, 34(12):  784-789. 

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Factors associated with patients’ delay and diagnosis delay for patients with smear positive pulmonary tuberculosis

WANG Ni，ZHOU Lin，BAI Li-qiong，XU Wei-guo，HE Jin-ge，CHENG Shi-ming

Chinese Journal of Antituberculosis. 2012, 34(12):  790-794. 

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Objective  To analyze the factors associated with patients’ delay and diagnosis delay for patients with smear positive pulmonary tuberculosis in order to provide evidence base for the formulation of relevant TB control and prevention strategies. Methods  The typical survey methods were adopted and 3 counties were selected from the eastern, middle and western provinces each. New smear positive TB patients registered during May 2010 to September 2010 were administered face-to-face self-designed questionnaire survey, 329 effective questionnaires were collected. t test was used for comparing the difference between patients’ delay and diagnosis delay, Cox proportional hazards regression model was used for analyzing the factors associated with health seeking delay, and rank sum test was used for comparing the diagnosis delay between different facilities. Results  Health seeking delay was 15 d(0－594 d) and diagnosis delay was 10 d(0－429 d), there is no statistically significant difference between these two indicators(t=1596, P=0.111). Patients who had medical insurance(except for the new rural cooperative medical care) （β=0.701，Waldχ²=6.223，P=0.013，RR=2.015） or suffering from fever（β=0.430，Waldχ²=11.556，P=0.001，RR=1.537） are more likely to go hospitals quickly, but patients with symptom of cough（β=-0.711，Waldχ²=9.314，P=0.002，RR=0.491） or sputum（β=-0.429，Waldχ²=8.549，P=0.003，RR=0.651） are more likely to have a longer delay. For TB case detection, the delays vary caused by different medical institutions（χ²=115.134，P=0.000）,shortest in county hospital or above (0 d, Q 0 d), township hospital (0 d, Q 6 d) and TB facilities (0 d, Q 0 d), longest in pharmacy (26 d, Q 66.5 d). And there are difference between medical institutions on TB patients’ referral（χ²=55.476，P=0.000）, shortest in TB facilities (0 d, Q 1 d), longest in individual private clinics (9 d, Q 19.5 d).  Conclusion  The factors of delay for patients with smear positive pulmonary tuberculosis will be considered from patients and medical institution. The main factors related to patients were lack of the knowledge of TB suspected symptoms or attaching no importance on it. Delay in TB suspects’ detection and referral in primary care facilities are the main factors affecting medical institutions delay.

Effect evaluation of liquid medium culture for Mycobacterium detection in HIV/AIDS patients

LI Tao, WANG Dong-mei, LIU Er-yong, LIU Fei-ying, YAO Song, XU Lin, XU Ji-ying, WU Wei-dong, ZHOU Lin

Chinese Journal of Antituberculosis. 2012, 34(12):  795-798. 

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Objective  To explore the feasibility of the application of liquid culture in the early diagnosis of TB in patients living with HIV/AIDS, and provide a reference for Chinese Mtb/HIV co-infection prevention and treatment.   Methods  We selected 10 cities (8 enrolled eventually) from 5 provinces of Global Fund Mtb/HIV control Program, provided liquid culture screening for 2162 eligible cases within 15 199 new findings and previous follow-up of HIV/AIDS patients, recorded the results and compared the TB diagnosis rate with the whole 15 199 patients in the same place and national 67 186 cases of HIV/AIDS patients during the same period screened by routine tuberculosis screening methods.  Results  The positive TB diagnosis rate of experimental group’s samples was 14.2%(306/2162), which is significantly higher than the overall rate (5.2%,793/15 199) of the same area over the same period, the difference was statistically significant (χ²=254.9，P<0.0001）; also, the positive TB diagnosis rate of the experimental group （14.2%）and overall TB diagnosis rate of the same area （5.2%,793/15 199）were both higher than the tuberculosis diagnosis rate in HIV/AIDS patients of whole country (2.3%, 1525/67 186), the difference was statistically significant(χ²=1150.7,393.8; P both<0.0001）.   Conclusion  Compared with tuberculosis symptomatic screening, sputum smear, chest X-ray examination and other routine tuberculosis screening methods, liquid culture can significantly improve the TB detection rate in HIV/AIDS patients, which is very important for early  TB diagnosis in HIV/AIDS patients and is of great significance to be promoted nationwide.

Relationship between PPD reaction extent and tuberculosis risk among senior high school students

CHEN Shu-lin, SUN De-quan, SHI Jun-feng, ZHANG Ai-hong, XIA Jian-hua

Chinese Journal of Antituberculosis. 2012, 34(12):  799-802. 

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Objective  To explore the relationship between the extent of PPD reaction and risk of tuberculosis (TB) among senior high school students,  and to provide scientific evidence for prophylactic treatment object selection.  Methods  1664 students from 2 senior high schools were the target of prospective cohort study. At the beginning of cohort study, the intracutaneous test of PPD and chest fluoroscopy were applied. Chest X-ray was conducted for those with abnormal chest fluoroscopy. People with PPD negative reaction were control group and with PPD positive reaction (diameter of induration in PPD skin test≥5 mm) were exposure group. The exposure group were divided into 5 subgroups according to the extent of PPD positive reaction (5-, 10-, 15-, ≥20 mm and with blister). The Mantel-Haenszel chi-square statistics and Cox regression were applied to analyze the difference of incidence rates between exposure group and control group.  Results  Coxregression model multivariate analysis showed the incidence rates of three subgroups (15-, ≥20 mm and with blister) were 10.14％(14/138), 21.21％(7/33) and 52.00％(26/50),so the diameter of induration ≥15 mm and <20 mm, ≥20 mm and with blaster were risk factors of tuberculosis（Wald χ²=53.366，54.851，124.829，P values were 0.000）, RR(relative risk)  values were 35.55, 63.43 and 161.84, respectively.  Conclusion  The senior high school students of whom diameter of induration in PPD skin test ≥15 mm and with blister were high risk population of tuberculosis and should be the target of prophylactic treatment.

Pulmonary tuberculosis prevalence among different regions in China in 2010

XIA Yin-yin，DU Xin，CHEN Wei，ZHANG Hui，LIU Xiao-qiu，LI Xue，JIANG Shi-wen，WANG Li-xia，CHENG Shi-ming

Chinese Journal of Antituberculosis. 2012, 34(12):  803-807. 

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Objective  To investigate prevalences of pulmonary tuberculosis among different regions in China.  Methods  Multi-stage stratified clustered sampling method was adopted, 176 clusters were selected. All 252 940 residents over 15 years old received investigation and took chest X-ray films. Sputum smear and culture were conducted for 9825 patients with abnormal X-ray film or tuberculosis related symptoms. Strains isolated via culture were taken an identification test to identify M. tuberculosis complex and non-tuberculosis mycobacteria for 380 patients. A weighted adjustment method accounting for complex sampling was used to calculate prevalence and 95% confidence intervals.Second-order Rao-Scott adjusted chi-square test was used to compare prevalences among different groups.  Reporting incidences were abstracted from Chinese Infectious Disease Detection Report Information System to compare with prevalences in different regions.  Results  The weighted prevalence of active, and bacteriological positive pulmonary tuberculosis was 832/100 000(497/51 333), 241/100 000(145/51 333) respectively in rural areas in western provinces, significantly higher than those in urban areas of western provinces［286/100 000(70/18 563), 70/100 000(16/18 563)］，χ²=148.16（P<0.01）and 13.82（P<0.01）respectively. While for the prevalence of smear positive pulmonary tuberculosis in western provinces, there were no difference found between rural and urban areas（χ²=3.16，P=0.08）. In eastern rural areas, the weighted prevalence of active, smear positive and bacteriological positive pulmonary tuberculosis（364/100 000（190/41 763），62/100 000（31/41 763），91/100 000（47/41 763）） were all significantly higher than those in urban areas（228/100 000（150/60 355），28/100 000（18/60 355），44/100 000（28/60 355））, χ²=17.61（P<0.01）,5.19(P=0.03) and 6.90(P=0.01) separately. In middle provinces, no difference was found between rural and urban areas（χ²=0.35，P=0.56；χ²=1.18，P=0.28；χ²=0.01，P=0.91）respectively for comparison of weighted prevalence of active, smear positive and bacteriological positive pulmonary tuberculosis. Ratio of prevalence and reporting incidence of smear positive pulmonary tuberculosis in western provinces was 284：1, which was higher than that in eastern provinces(1.47：1) and in middle provinces(1.50：1).  Survey sites with the highest number of active pulmonary tuberculosis patients detection were all located in remote areas.  Conclusion  The prevalences of tuberculosis are still high in western, rural or remote areas, which should be regarded as key areas for enhanced tuberculosis control.

Study on the usage verification for rational use of anti-TB drugs

WAN Li-ya，ZHOU Lin，CHENG Shi-ming，WANG Ni，MA Yan

Chinese Journal of Antituberculosis. 2012, 34(12):  808-812. 

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Objective  To discuss the method of drug use verification to evaluate the rational use of drug indirectly.  Methods  The typical survey methods were adopted and six counties were selected from Henan, Chongqing and Jilin. The information of TB case detection and treatment outcome was collected from national control quarterly report. And the information related to in- and out- store, damage or expired, out of stock was collected from account book and medical record. Out of stock rate, damage/expired rate, correct prescription rate and drug use verification difference degree were calculated according to the definitions. Totally 2122 new smear positive TB, 202 retreatment smear positive TB, and 1596 smear negative TB were involved from 2007.1－12.  The smear negative conversion rates at the end of two months’ treatment was 6.03% (128/2122) for new smear positive cases and 7.92% (16/202) for retreatment smear positive cases. Results  Out of stock rate was 1.78% (234/(36×365)) and damage/expired rate was 0.57% (2159/(125 544+250 440)). 1200 TB cases, selected by cluster sampling method, were all given the correct prescriptions in accordance with “Guidelines for Implementing the National Tuberculosis Control Program in China”. The drug use verification difference degree of HRZE was －41.93%((84 378－119 760)/84 378), with the maximum－12.1% ((13 140－14 730)/13 140) and the minimum －86.36% ((10 673－19 890)/10 673)), there were 3 counties below －25%. The difference degree of HR was －28.60%((173 475－223 080)/173 475), with the maximum－14.05% ((34 470－39 600)/34 470) and the minimum －114.51%((17 761－38 100)/17 761)), there were 2 counties below －25%. The difference degree of HRE was 31.22% ((26 434－18 180)/26 434), with the maximum 90.91% ((3960－360)/3960) and the minimum 3.52% ((2985－2880)/2985)), there were 3 counties above 25%.  Conclusion  As it’s possible that evaluating the rational drug use roughly through comparing the difference between theoretical and actual consumptions, we suggest implement drug use verification every six months or one year.

Analysis of public awareness rate of tuberculosis control and prevention in Guangdong province

JIANG Li, ZHONG Qiu, LI Jian-wei, ZHOU Lin, LIAN Yong-e

Chinese Journal of Antituberculosis. 2012, 34(12):  813-816. 

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Objective  To understand the public awareness of tuberculosis (TB) control and prevention in Guangdong province and to provide scientific evidence for effective TB health promotion.  Methods  49 514 people were selected through a proportional stratified cluster random sampling method, and they were interviewed face to face with a standard questionnaire. 49 514 questionnaires were collected and the qualified rate was 100%.  Results  The public total awareness rate to key messages on TB prevention and control was 78.4% (194 183/247 570). The group of aged over 60 years old had lower awareness rate (67.5%, 32 265/47 765). The total awareness rate of the local residents was 80.8% (166 838/206 505）, which was significantly higher than the floating population (Z=63.96，P<0.05). The majority of the study subjects knew that pulmonary TB, with cough as main symptom, was an infectious disease as a major threat to health and impeding human productivity but curable. By contrast, 28.9% people did not know about TB control institutes which providing professional TB services.  Conclusion  The public awareness rate of TB knowledge in Guangdong province is relatively high. New policies for health promotion should be developed and more comprehensive activities should be carried out in the future to improve the public awareness of TB.

Establishment and analysis of a mouse model for low-dose Mycobacterium tuberculosis infection

LIN Shu-zhu, DONG Na, XIANG Zhi-guang, XU Yan-feng, ZHAN Ling-jun, MA Chun-mei, QIN Chuan

Chinese Journal of Antituberculosis. 2012, 34(12):  817-820. 

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Objective  To establish a mouse model for low-dose Mycobacterium tuberculosis infection, and analyse the bacterial load and histopathological changes in the mouse tissues. Methods  Forty C57BL/6J mice were infected intravenously with approximately 100 colony forming units (CFU) of M. tuberculosis H37Rv. Groups of five mice were euthanatized at 1, 3, 5, 8, 12, 16, 20 and 24 weeks after infection. The lungs and spleens were homogenized and plated to determine the bacterial load. Lungs, spleens and livers were fixed in buffered formalin and embedded in paraffin, and sections were prepared with haematoxylin and eosin to observe histopathological changes.  Results  Bacterial loads in spleens reached high level (4.97±0.19) lg CFU at 3 weeks after infection, then dropped to (3.64±0.22) lg CFU at 5 weeks after infection, and were minimized to (2.75±0.23) lg CFU at 8 weeks after infection. Pathological changes in the lungs, spleens and livers occurred at 3 weeks after infection, and aggravated at 5 weeks after infection, and were lessened naturally at 8 weeks after infection.  Conclusion  A  mouse model infected with low-dose Mycobacterium tuberculosis was established successfully, and it might provide a base for the study of slow and persistence or latent M. tuberculosis infection.

The results of drug susceptibility test in 1819 non-tuberculosis mycobacterial strains

WU Long-zhang,TAN Shou-yong,TAN Yao-ju,YANG Jian-liang, PAN Mei-yu,CHEN Jian-feng,ZENG Shao-fang,LIU Yan-wen

Chinese Journal of Antituberculosis. 2012, 34(12):  821-824. 

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Objective  To analyze drug sensitivity of non-tuberculosis mycobacteria (NTM) in Guangzhou, to provide reliable scientific basis for the clinical treatment.  Methods  14 095 mycobacterial isolates were identified by traditional mycobacterial species identification method. 1819 NTM isolates were determined their sensitivity to 13 first-line and second-line anti-tuberculosis drugs (including INH, RFP, S, EMB, Am, Clr, Lfx, Mfx, CIP, Depasic, Rfb, Pto, Cm).  Results  Of 1819 NTM isolates, the INH and depasic resistant rates reached 96.15%（1749/1819）and 95.41%（1248/1308）, other drug-resistant rates were 76.25% (1387/1819) (S), 73.94% (817/1105) (Pto), 72.94% (954/1308) (Lfx),72.51% (1319/1819) (RFP),70.42% (1281/1819) (EMB),65.29% (854/1308) (Mfx),60.13% (543/903) (CIP),56.87% (236/415) (Rfb)and 50.50% (102/202) (Cm), respectively. While Clr- and Am-sensitive rates were 88.17%（1163/1319）and 67.73%（892/1317）, respectively.   Conclusion  NTM showed natural resistance to the first-line anti-tuberculosis drugs. The macrolide Clr and Amino sugar glycoside have stronger bacteriostatic effect on NTM. NTM isolates need perform the drug sensitivity testing.

The application of thoracoscopy and proteomic fingerprinting technique in the diagnosis of pleural effusion

CHEN Li-zhou, WANG Gang-ling, WANG Hong-xiang, YANG Guo-yu, LI Tian-lin，LIU Tan-ye

Chinese Journal of Antituberculosis. 2012, 34(12):  825-829. 

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Objective  To study the clinical value of thoracoscopy and protein fingerprinting technique（PFT）in improving the early diagnosis of cancer and tuberculous pleural effusions.  Methods  Of 121 cases with pleural effusions confirmed by imaging examination, thoracoscopy, pathological or bacteriological examination, 30 cases with malignant pleural effusion and 50 cases with tuberculous pleural effusion were detected simultaneously pleural fluid protein fingerprint peaks, and the data were statistically analyzed.  Results  There were 7 different protein peaks between two groups（m/z 5335, 8048, 11 700, 11 670, 15 982, 11 683 and 7700）. The protein peaks m/z 11 670 and m/z 11 700 were selected to establish the diagnosis model of malignant effusion, which was statistically significant between two groups (χ²=26.55, P<0.01). Its sensitivity and specificity for the malignant effusion were 83.3%（25/30）and 76.0%（38/50）, respectively. The protein peaks m/z 5335 and m/z 8048 were used to establish the diagnosis model of tuberculous pleural effusion, which was significantly different between two groups (χ²=9.86, P<0.01). The sensitivity and specificity for the tuberculous effusion were 52.0%（26/50）and 83.3%（25/30）, respectively.  Conclusion  The pleural fluid protein fingerprint technique is a simple, fast and effective means for the differential diagnosis of tuberculous and malignant effusions, but need be further studied in the interpretation of protein maps.

Identification of  Mycobacterium tuberculosis complex using the morphological characteristic with colloidal gold method

HUANG Ming-xiang, ZHANG Li-shui, CHEN Xin-chao, MAO Wen-jie

Chinese Journal of Antituberculosis. 2012, 34(12):  830-834. 

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Objective  To study the value of the morphological characteristic with colloidal gold method in rapid identification of mycobacterial species.  Methods  A total of 853 clinical isolates of Mycobacteria were identified using morphological characteristic and colloidal gold method, and the results were compared with traditional experimental methods.  Results  The sensitivity and specificity of mycobacterial species identification by morphological characteristic were respectively 98.4%(750/762) and 96.7%(88/91). The sensitivity and specificity of identification by colloidal gold method were respectively 99.0%(754/762) and 98.9%(90/91). When the smears of culture-positive samples showed serpentine cord morphology and the colliodal gold test was positive, the culture would be reported to contain  Mycobacterium tuberculosis complex, and it’s PPV was 100.0%(741/741). When the cord morphology and the colloidal gold method test were all negative, the culture would be reported to contain non-tuberculous mycobacteria, and it’s NPV is 100.0% (87/87).  Conclusion  The morphological characteristic with colloidal gold method for the dentification of Mycobacterium tuberculosis complex could improve detection accuracy,  was a fast, easy method and suitable for all levels of laboratory.

A study on tuberculosis epidemic status in Panyu district of Guangzhou

CHEN Yu-hui，ZHONG Qiu, ZHOU Lin, HE Chao-wen, LAO Wei-min

Chinese Journal of Antituberculosis. 2012, 34(12):  835-839. 

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Objective  To explore the tuberculosis epidemic status in Panyu district of Guangdong province in order to provide evidence for tuberculosis control strategies development.  Methods  By using household clue method, a survey was conducted in all resident population of Donghuan street and Shilou township in Panyu district, 86 212 persons were investigated. The tuberculosis epidemic status was analyzed.  Results   (1)There were 89 active pulmonary tuberculosis cases among 86 212 persons investigated, among whom 33 smear positive cases and 29 new smear positive cases. (2) The prevalence rate of active pulmonary tuberculosis and smear positive tuberculosis were 103.23/100 000 and 38.28/100 000 respectively, with no significant difference of that with the 5th tuberculosis epidemiological sampling survey of Guangdong province. (3) The prevalence of active pulmonary tuberculosis in male and female were 123.11/100 000 and 85.53/100 000 respectively, there was no statistical significance. The prevalence  was higher in young and middle-aged people, and the prevalence of smear positive was higher in urban area with 67.94/100 000 than rural area（χ²=4.585，P=0.032）, although there was no significant difference of the prevalence rate of active pulmonary tuberculosis （142.06/100 000 and 94.26/100 000）. Conclusion  Panyu district still have high tuberculosis burden. National tuberculosis control strategy should be implemented thoroughly. The young people are still the key population in tuberculosis control in future.