Table of Content

10 May 2013, Volume 35 Issue 5

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Pay more attention to spinal tuberculosis,to improve its diagnosis and treatment

MA Yuan-zheng

Chinese Journal of Antituberculosis. 2013, 35(5):  297-298. 

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Clinical analysis on drug-resistant tuberculosis in 128 patients with spinal tuberculosis

QIN Shi-bing, DONG Wei-jie, LAN Ting-long, FAN Jun, XU Shuang-zheng

Chinese Journal of Antituberculosis. 2013, 35(5):  299-304. 

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Objective  To analyze the drug-resistance, cause of drug-resistance and principle of management. Methods  1057 patients admitted and diagnosed definitely as spinal tuberculosis in our hospital from Jan. 2005 to Jan. 2012 were enrolled. The samples of pus and caseous matter collected by puncture or operation were culture and drug susceptible testing(DST). Results  Of 1057 cases, 128 cases were culture positive(128/1057,12.1%). Among 128 patients with drug-resistance tuberculosis, the cases of drug-resistant to isoniazid, rifampicin and streptomycin were 22, 16 and 27, respectively. The rates of drug-resistance were 17.2%, 12.5%and 21.1%, respectively. High concentration drug-resistance was serious and common in rifampicin, rifapentine and streptomycin which accounted for 100.0%(16/16), 75.0%(12/16) and 92.6%(25/27) among drug-resistant strains. The rate of cases with multi-drug resistant tuberculosis(MDR-TB) which all belonged to retreatment were 16.4%(21/128). All patients were given standardized or individual treatment plus selective operation according to the result of DST. All patients were cured. Conclusion  Mycobacterium tuberculosis from focus of spinal tuberculosis was mainly resistant to first-line drugs such as isoniazid, rifampicin, rifapentine and streptomycin. All patients with MDR-TB were retreatment and were mainly secondary tuberculosis. It is key step for efficacy that rational treatment according to DST result earlier is performed. It is also useful to prevent MDR-TB.

The retrospective study of surgical treatment of multi-segmental thoracolumbar  tuberculosis

ZHANG Jia-li, LI Da-wei, MA Yuan-zheng, YANG Da-yu, WANG Tian-tian

Chinese Journal of Antituberculosis. 2013, 35(5):  305-308. 

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Objective  To investigate the surgical treatment effect of multi-segmental thoracolumbar tuberculosis in patients who underwent debridement, bone grafting and internal fixation combined with anti-tuberculosis chemotherapy. Methods  Fifty adult patients with multi-segmental thoracolumbar tuberculosis,admitted in the 309th hospital of the PLA from October 2009 to September 2011, undergone different surgical procedures were reviewed retrospectively. All patients were divided 4 groups as follows according to site and extent of the lesion, Frankel level, the kyphosis Cobb angle, surgical treatment and clinical outcome. Group A included 10 cases who underwent anterior radical debridement, bone grafting and internal fixation. Group B included 6 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage. Group C included 22 cases who underwent front side radical debridment，strut graft and posterior instrumentation in thoracic or thoracolumbar spine. Group D included 12 cases who underwent single-stage posterior debridement and instrumentation. Eighteen patients suffered neurological deficit including 12 cases for Frankel D, 4 cases for Frankel C, 2 cases for Frankel B，32 cases for Frankel E. The kyphosis Cobb angle ranged from 10°to 20°in 16 cases，over 20°in 18 cases. Frankel level and the Cobb angle were compared before and after operation in follow-up patients. Results  The average operation time and blood loss were （3.6±0.6）h and （455±54）ml in group A，（4.7±0.8）h and （670±58）ml in group B，（4.8±0.9）h and （630±62）ml in group C, （4.1±0.7）h and （420±46）ml in group D. ESR restored to normal value about 8-12 weeks after operation,and the patient’s symptoms were significantly improved about 1-3 weeks after operation. At the last time of follow-up，14 cases had improved 1 grade, and 4 cases improved with 2 grades in Frankel level. Kyphosis Cobb angle was corrected by 45.6%±12.3%, with loss of correction about 23.7%±20.4% at last time of follow-up in 50 patients. Conclusion  The radical debridement and bone grafting can improve satisfactorily the efficacy in patients with multi-segmental thoracolumbar tuberculosis based on the scope of vertebrae damage,the site and size of abscess, and different surgical procedure and internal fixation.

Preparation and evaluation of  poly(lactic-co-glycolic acid)/β-tricalcium phosphate/isoniazid slow-release material in animal model

LI Da-wei, MA Yuan-zheng, YANG Fei, CUI Xu, LI Li-tao, AN Jin-yu, ZHANG Jia-li

Chinese Journal of Antituberculosis. 2013, 35(5):  309-313. 

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Objective To prepare poly(lactic-co-glycolic acid)/β-tricalcium phosphate material loaded with isoniazid and to evaluate its function in vitro and in vivo. Methods The lactic acid/glycolic acid copolymer was dissolved in 1,4-dioxane mixed with β-tricalcium phosphate and isoniazid powder to prepare a liquid slurry. The liquid slurry was mixed well-distributed under ultrasound, and then was put into a cylindrical artificial bone carrier to form the artificial bone materials. The morphology of the material was observed by electron microscopy scanning and the pharmacokinetics was analyzed with HPLC. Thirty-six New Zealand rabbits made femora condyle defects model were divided randomly into three groups(12 rabbits in each group). Group Ⅰ: loaded in active artificial bone without isoniazid. Group Ⅱ: loaded in active artificial bone with isoniazid. Group Ⅲ: non-loaded any materials as blank control. The repair of bone defects were observed and evaluated by imaging, histological scoring, bone growth rate after 4,8 and 12 weeks of operation. Results The artificial material can release INH constantly for 12 weeks. At the 12th week, all bone defects in the experimental groups(groupⅠand group Ⅱ) were radiographically repaired. The histological scoring and bone growth rate were 7.3±0.6,7.1±0.8,2.0±0.4 and 83.0%±7.0%, 84.0%±6.0%, 10.0%±1.1% in three groups, respectively. There were significant differences between groupⅠand group Ⅲ, also in group Ⅱ and group Ⅲ among histological scoring and bone growth rate（t values of histological scoring were 14.700,11.404，P＜0.01. t values of bone growth rate were 20.604 and 24.262, P<0.01). But the parameters were similar in groupⅠand group Ⅱ（t values of histological scoring were 0.400，P＞0.05. t values of bone growth rate －0.217, P>0.05）. Conclusion Poly(lactic-co-glycolicacid)/β-tricalcium phosphate/isoniazid slow-release material can effectively repair bone defects in rabbits, its degradation rate well matches the bone formation rate and maintains INH release.

The analysis of posterior transpedicular fixation combined with anterior thoracotomy debridement to treat 35 children with thoracic spinal tuberculosis

LAN Ting-long，QIN Shi-bing，DONG Wei-jie，XU Shuang-zheng，FAN Jun

Chinese Journal of Antituberculosis. 2013, 35(5):  314-316. 

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Objective  To evaluate efficacy of posterior transpedicular fixation combined with anterior thoracotomy debridement to treat thoracic spinal tuberculosis in children.  Methods  Thirty-five cases admitted in our hospital from Jan. 2004 to Dec. 2010 were taken posterior transpedicular fixation combined with anterior thoracotomy debridement. Among the 35 cases, there were 13 cases with varying degrees of paralysis and one case with urinary retention. All cases were postoperatively followed up for 1 to 7 years, average 3.5 years, and to be analyzed the local lesions recurrence or not, symptom improvement and correction of kyphosis in the short-term and long-term variation. Results  Thirty-five patients were all cured and found no recurrence. Of the 13 patients with varying degrees of paralysis, lower extremity muscle strength was increased by 1 to 3 levels. The patient with urinary retention postoperatively recovered at 5th month later. Of all cases, the preoperative average kyphosis cobb’s angle was 42°(20°to 55°), and postoperative average cobb’s angle was 22°(5°to 38°) in the short-term and still 22°(5° to 40°) in the long-term. Among the 35 cases, 17 cases were removed the implants after 2 to 3 years. Conclusion  Posterior transpedicular fixation combined with anterior thoracotomy debridement taken to treat thoracic spinal tuberculosis in children can complete debridement, decompress spinal cord thoroughly, provide rib bone to be grafted, reconstruct spinal stability, correct kyphosis deformity effectively and prevent kyphosis increased.

Retrospective study of surgery combined with individualized chemotherapy for patients with multi-drug resistant spinal tuberculosis

LI Li-tao, MA Yuan-zheng,LI Da-wei,CUI Xu, HU Ming, LUO Xiao-bo

Chinese Journal of Antituberculosis. 2013, 35(5):  317-321. 

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Objective  To investigate the clinical outcomes of the management with combination of surgery and individualized chemotherapy for the multi-drug resistant tuberculosis spondylitis. Methods  From February 2006 to June 2010, we retrospectively analyzed 21 cases of multi-drug resistant tuberculosis spondylitis admitted in the General Hospital of the General Staff Department of PLA. Among them, 6 were initial treatment cases, and 15 were retreatment cases. After admission, 21 patients received open operation or CT guided percutaneous drainage according to characteristics of the focus. Individualized chemotherapy regimens were tailored for each patient according to the drug resistance spectrum and previous history of anti-tuberculosis treatment after surgery and drug susceptibility testing. All patients were followed up clinically and radiologically for at least 18 months.  Results  Retreatment cases had undergone previous chemotherapy for an average of（19.30±15.80）(7-49) months. 19 cases received open operation and the other 2 received CT guided percutaneous drainage. Instrumentation failure was observed in one case and local recurrence was observed in 4 patients. Patients received individualized chemotherapy with an average of 18.3(18-20) months postoperatively. At the final follow-up, all of the 11 patients with paraplegia had a slight or remarkable recovery, and 9 patients with kyphosis had significant correction. 18 patients had treatment cure and the other 3 cases were still undergoing chemotherapy.  Conclusion  Management with combination of surgery and individualized chemotherapy is feasible in the treatment of severe complications and prevention dissemination of multi-drug resistant strains and development of acquired drug resistant spinal tuberculosis.

Diagnosis and treatment for early sacroiliac joint tuberculosis

CHEN Jing，ZHANG Jun，WU Xiao-e，HUANG Nan，ZUO Zhen-hua，HAN Guang，FAN Shui-ping

Chinese Journal of Antituberculosis. 2013, 35(5):  322-325. 

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Objective  To discuss diagnosis methods and curative effect for the early sacroiliac joint tuberculosis. Methods  Twenty patients with early sacroiliac joint tuberculosis from February 2005 to June 2011 in the Second Hospital of Peking Armed Police were enrolled. Diagnosis was primarily identified by clinical manifestations,imaging features and biopsy, with the kim type Ⅱ8 cases, type Ⅲ12 cases. Patients received intralesional curettage and autologous bone grafting.To observe the effect of the treatment, Majeed rating system was used, in which score was evaluated from five aspects including the pain (30 points), work (36 points), seating (10 points), sex (4 points) and stand (20 points).The total score is 100 points and clinical classification is evaluted by calculating the total points: optimal（>85 points）, good(70-84 points), medium(55-69 points), poor（<55 points）. For all the cases’ preoperative Majeed score, no patients reached optimal, 2 got good level, 14 cases got medium level, and 4 cases was poor. Results  Twenty patients were followed up for 12 to 36 months. No patients developed recurrence, infection and dislocation of sacroiliac joint complications such as dislocation, all patients resumed normal training and attendance after 3－6 months. Preoperative Majeed scoring average was(61.75±6.54) points, the final follow-up average of (92.75±3.70) points with significantly difference（t=3.481，P<0.001）. Conclusion  Early sacroiliac joint tuberculosis can be diagnosed early by clinical manifestations, imaging features and biopsy. Patients can obtain satisfactory curative effect by receiving system standard antituberculosis drugs and operation treatment.

The application of negative pressure wound therapy for retreatment spine tuberculosis and sinus in the elderly

LUO Xiao-bo，MA Yuan-zheng，LI Hong-wei，BAO Da，CUI Xu

Chinese Journal of Antituberculosis. 2013, 35(5):  326-330. 

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Objective  To observe the application of negative pressure wound therapy(NPWT) by filling PVA foam for retreatment spine tuberculosis and sinus, and to evaluate the therapeutic effect in the elderly. Methods  From March 2008 to March 2011, 13 cases of elderly retreatment spine tuberculosis and sinus were treated by sinus debridement and NPWT. Mycobacterium tuberculosis isolated strains and its drug susceptible testing(DST) were identified by Lowenstein-Jensen(L-J) absolute concentration method. Individual anti-tuberculosis drug regimens were established according to the DST results. The regimen of 3HRZE/6HR for 9 months was given to patients with culture negative and the regimen of 3SHRZE/9HRE for 12 months was given to patients with mono-drug resistance. Some sensitive agents from first-line and second-line anti-tuberculosis drugs were selected to compose regimen to MDR-TB for 18 months. Follow-up plan was done in 1, 3, 6, 9 and 12 months after operation. Since then, follow-up was performed every 6 months. The clinical symptoms and signs, imaging of CT and three-dimensional reconstruction were collected during follow-up. According to Bridwell standard (divided into class Ⅰ, Ⅱ, Ⅲ and Ⅳ), the situation of bone graft fusion and wound healing were evaluated.  Results  Thirteen cases of elderly retreatment spine tuberculosis and sinus applied NPWT were healing well(according to Bridwell standard the fusions of bone graft were Ⅰ~Ⅱ level). It took about 12 to 28 days for wound completely healing. The average was 17.5 days. No relapse cases were found during the follow-up for 12 to 36 months.  Conclusion  NPWT is an important healing tool for retreatment spine tuberculosis and sinus in the elderly. The good clinical efficacy can be got using NPWT combination with individual anti-tuberculosis drug regimen.

Immune response induced by Micrococcus luteus Rpf domain and its mutants in mice

QIU Yi, ZHAO Shan-min, SHI Chang-hong, SHI Jie-ran

Chinese Journal of Antituberculosis. 2013, 35(5):  331-336. 

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Objective  To study the immunogenicity of three recombinant proteins (Rpfd, Rpfd1, Rpfd2) of Micrococcus luteus resuscitation-promoting factor (Rpf) domain and its mutants in mice.  Methods  Seventy male-BALB/c mice were divided randomly into 5 groups as follow: Rpfd（A）, Rpfd1（A1）, Rpfd2（A2）, BCG（B）and Saline（C）．The mice were immunized subcutaneously at weeks 0, 2 and 4. At 1 week after the final immunization, 7 mice each group were collected and separated sera to detect levels of IFN-γ, IL-2 and antibodies against Rpfd, Rpfd1, Rpfd2 proteins in sera by ELISA. At 4 weeks after the final immunization, the other 7 mice were infected with 1×10⁵CFU Mycobacterium tuberculosis H37Rv by the tail vein injection. At 1 week after infection, the levels of IFN-γ and IL-2 were detected by ELISA.  Results  （1）Antibody levels: ①Rpfd specific antibody levels in mice：group A1（0.990±0.272）were higher than group B（0.631±0.180; t=4.635, P<0.05）; group A2（1.470±0.455）were higher than group B（ t=6.634, P<0.05）. ②Rpfd1 specific antibody levels：group A （1.030±0.304）were higher than group B（0.573±0.004; t=5.276, P<0.05）; group A1（1.368±0.171）were higher than group B（t=17.20, P<0.05）; group A2 （2.766±0.245）were higher than group B（t=31.643, P<0.05）. ③Rpfd2 specific antibody levels：group A1（1.055±0.202）were higher than group B（0.538±0.100; t=8.009, P<0.05）; group A2（1.605±0.544）were higher than group B（t=8.192,P<0.05）. （2）Levels of IFN-γ: Before infection, IFN-γ levels in mice of group A（553.47±132.00) pg/ml were higher than that of group B（385.28±129.07) pg/ml（t=3.150,P<0.05）.After infection, IFN-γ levels in mice of group A1（492.41±211.74）pg/ml were higher than that of group B（335.36±207.72) pg/ml（ t=2.874, P<0.05）; group A2（543.09±223.07）pg/ml were higher than group B（t=3.15, P<0.05）. （3） Levels of IL-2: Before infection, IL-2 levels in mice of group A（1490.05±215.35) pg/ml were higher than that of group B（718.70±269.29) pg/ml（t=7.763,P<0.05）; group A1（1738.91±358.40） pg/ml were higher than group B（t=7.903, P<0.05）; group A2（2270.74±193.40) pg/ml were higher than that of group B（t=16.308,P<0.05）. After infection, IL-2 levels in mice of group A（806.81±306.39) pg/ml were higher than that of group B（335.26±176.81） pg/ml（t=4.627, P<0.05）; group A1（1373.22±143.75） pg/ml were higher than that of group B（t=15.90, P<0.05）. Conclusion  Vaccination with Rpfd、Rpfd1 and Rpfd2 proteins could induce humoral and cellular immune responses in BALB/c mice. They could be used as candidate vaccines.

Trend analysis of the pulmonary tuberculosis registration rate nationwide from 2010 to 2012

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

Chinese Journal of Antituberculosis. 2013, 35(5):  337-342. 

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Objective  To analyze the trend of the registration of patients with new smear-positive pulmonary tuberculosis（NSP）and active pulmonary tuberculosis(AP) nationwide from 2010 to 2012, and to provide reference for the evaluation of case detection.  Methods  The numbers of NSP and AP from the National Tuberculosis Information Management System were used for analysis. The number of population was originated from the National Bureau of Statistics. The annual registration rate of AP and the proportion of NSP in AP were calculated and compared both nationwide and by provinces.  Results  In 2010 and 2012, NSP registered accounted for 46.2% (429 899/931 465)  and 35.4% (316 332/894 199) of AP registered respectively. The registration rates of AP were 69.8/100 000 and 66.4/100 000 respectively in 2010 and 2012, while those of NSP were 32.2/100 000 and 23.5/100 000 respectively. The number of AP decreased by 3.3% from 2010 to 2011 and 1.7% from 2011 to 2012, so did that of NSP (by 12.7% from 2010 to 2011 and 16.5% from 2011 to 2012). The proportions of NSP in AP of 31 provinces ranged from 26.4% to 66.7% in 2010, from 24.1% to 66.3% in 2011,and from 20.7% to 63.1% in 2012.Compared with the data in 2010, 7 provinces had a rise in the yearly registration rate of AP in 2012 with an average annual increase from 0.74% to 6.97%, and 24 provinces had a decline with an average annual decrease from 0.12% to 12.26%. While 30 provinces had a significant decline in the yearly registration rate of NSP with an average annual decrease from 1.38% to 46.33%, and only one province increased by 2.94% annually. Conclusion  There was a slight decline in the registration rate of AP but a significant decline in that of NSP nationwide, especially in some provinces, which is worthy of further investigation.

Spatial epidemiology study on tuberculosis based on geographical weighted regression model

LIU Yun-xia, LIU Yan-xun, ZHANG Bing-bing, ZHANG Hong-mei, XUE Fu-zhong

Chinese Journal of Antituberculosis. 2013, 35(5):  343-346. 

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Objective  To explore the local relationship between tuberculosis and influencing factors in Shandong Province, and to provide evidence for appropriate regional TB prevention and control strategy development. Methods  The data of TB notification and related influencing factors during 2005 to 2008 in Shandong province were collected. The spatial autocorrelation of tuberculosis was analyzed by Moran’I. Geographical weighted regression (GWR) model was constructed to analyze the local relationship between tuberculosis notification rate and various influencing factors, and mapped by ArcGIS9.0. The notification rates of active tuberculosis of each county during 2005 to 2008 in Shandong were 12.79/100 000～107.35/1 000 000, 16.01/1 000 000～86.52/1 000 000, 17.36/1 000 000～92.10/1 000 000 and 17.86/1 000 000～114.86/1 000 000 respectively. Results  The spatial autocorrelation analysis showed that the spatial distribution of tuberculosis notification rate had significant spatial positive correlation (Moran’s  I were 0.3517, 0.3505, 0.3337 and 0.3116 respectively, and P value were all less than 0.05) in Shandong between 2005 and 2008. GWR model displayed better fitting effect than global OLS model (the declines of akaike information criterion(AIC) were all higher than 3, and R² all increased, eg. the AIC and R² were 1168.8380 and 0.3537 for GWR model, and 1173.5410 and 0.1350 for OLS model). The local R² appeared significant spatial variability (eg. the local R² was 0.1162~0.1798 in 2008). Conclusion  GWR model can reveal the spatial heterogeneity of the effect of influencing factors on tuberculosis notification rate, and regional tuberculosis prevention and control programme and strategy should be developed based on the spatial characteristic of the impact factors and the local relationship with tuberculosis notification rate.

Effect analysis on standard regimens of retreatment pulmonary tuberculosis in 177 cases

LUO Ping, TU De-hua, HONG Feng, WANG Jing, WANG Su-min, ZHANG Tian-hao

Chinese Journal of Antituberculosis. 2013, 35(5):  347-351. 

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Objective  To explore the status and effect of standard treatment regimens of retreatment pulmonary tuberculosis patients in Beijing. Methods  This was a retrospective study. The bacteriologically confirmed retreated pulmonary tuberculosis cases registered from 2009 to 2010 in Beijing were enrolled and divided into rifampin-sensitive (138 cases) and rifampin-resistant (39 cases)groups, according to the results of drug susceptibility test. The cases in each group were divided into isoniazid-sensitive and isoniazid-resistant groups. There were 114 cases sensitive to both isoniazid and rifampin, 24 resistant to isoniazid and sensitive to rifampin, 12 sensitive to isoniazid and resistant to rifampin, and 27 resistant to both isoniazid and rifampin. Standard treatment regimens（2HRZES/6HRE）were applied, and the effect was retrospectively analyzed. Results  In isoniazid-sensitive and resistant groups, the sputum conversion rates were 92.9%（117/126）and 66.7%（34/51）,and the treatment success rates were 87.3%（110/126）and 60.8%（31/51）respectively. There was no statistical significant difference in the sputum conversion and the treatment success between two groups(χ²_MH value were 2.183 and 1.974, both P_MH value >0.05).In rifampin-sensitive and resistant groups, the sputum conversion rates were 94.2%（130/138） and 53.8%（21/39）,and the treatment success rates were 88.4%（122/138） and 48.7%（19/39） respectively. The differences in the sputum conversion and the treatment success between two groups were statistical significant (χ²_MH values were 16.199 and 12.686, both P_MH value ＜0.001). Conclusion  The effect of standard regimens of rifampin-sensitive pulmonary tuberculosis has been approved, while the rationality of applying standard regimens to those rifampin-resistant cases needs to be discussed.

Medical service package and expenditure analysis of multi-drug resistant tuberculosis

CHEN Cheng, LI Ren-zhong, RUAN Yun-zhou, ZHU Li-zhen, TU De-hua, ZHAO Jin, CHEN Ming-ting, WANG Li-xia

Chinese Journal of Antituberculosis. 2013, 35(5):  352-356. 

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Objective  To develop standardized medical service package of multi-drug resistant tuberculosis (MDR-TB) so as to provide evidence for the promotion of free health care policy for MDR-TB. Methods  Experts meetings were organized to establish the MDR-TB medical services package. The MDR-TB medical services package includes seven categories: diagnosis, pre-admission examination, hospitalization, follow-up, psychological support, treatment of complications, adverse reaction and DOT. To analyze the expenses of medical services package based on the actual price of medical services in the four prefecture level designated hospitals. Results  The average expenses of services package for the whole course of MDR-TB treatment is 32 617 yuan. Of all service categories, the highest incurs in drug expenses with an average of 13 722 yuan, accounting for 42.07％(13 722/32 617) of the average total cost. Of the agencies, the largest is spent in the prefecture level hospital with an average of 26 527 yuan, accounting for 81.33％(26 527/32 617) of the average total. In 24-month treatment of MDR-TB patients, the highest expenses is incurred in the first and second month of hospitalization. The expenses of the first and second month is 5879 yuan and 2651 yuan, accounting for 18.02％（5879/32 617）and 8.13％（2651/32 617） of the total respectively. Conclusion  MDR-TB medical service package is mainly used to standardize medical service behaviors, limits medical expenses, and provides reference for the promotion of standardized MDR-TB treatment.

Risk factors analysis on anti-TB treatment outcomes of 757 primary pulmonary tuberculosis cases

CHEN Hong-guang, WANG Chun-xia, LIU Hai-tao, LIU Min

Chinese Journal of Antituberculosis. 2013, 35(5):  357-360. 

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Objective  To explore the treatment dynamics and risk factors on treatment outcomes of pulmonary tuberculosis. Methods  Seven hundred and fifty-seven cases of primary pulmonary tuberculosis registered and followed up in Xiangshui county from 2009 to 2011 was analyzed by univariate and multivariate based on survival analysis model. Results  Of 757 patients, 720 cases were successfully treated. Median healing time of pulmonary tuberculosis was 182 days estimated by Kaplan-Meier survival curves. Univariate analysis on risk factor showed that the proportion of the observed numbers under successful treatment from detection were 24.17% (174/720)，66.53% (479/720)，9.31% (67/720) respectively. Compared to the proportion of the expected numbers under successful treatment (29.86%, 59.72%, 10.42%), the distribution difference was statistically significant (χ²=23.19, P=0.000). The proportion of the observed numbers under successful treatment from delayed diagnosis status were 26.67% (192/720) and 73.33% (528/720). Compared to the proportion of the expected numbers under successful treatment(31.25%，68.75%), the distribution difference was statistically significant (χ²=11.33, P=0.001). Cox multivariate analysis showed that factors with age under 30，（45－＜60，OR=1.213, 95%CI=1.014-1.452; ≥60（OR=1.323, 95%CI=1.069-1.636), being farmers(OR=0.787, 95%CI=0.650-0.953) and others (OR=0.755, 95%CI=0.591-0.966), with case detection by referring way(OR=1.498，95%CI=1.275-1.760), delayed diagnosis(OR=0.782，95%CI=0.658-0.929) affected the cure rate of pulmonary tuberculosis.  Conclusion  More attention should be paid to TB cases being farmers, with age under 30, detected by referring way and having delayed diagnosis.

The effects of anti-TB treatment on the growth and development of infants born by maternal active TB cases during terminal stage of pregnancy

HAN Dan, CHEN Zhi-fei, LIU Yan-li, LIANG Jun, DUAN Qiong-hong, RUAN Han-li

Chinese Journal of Antituberculosis. 2013, 35(5):  361-364. 

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Objective  To explore the effects of anti-TB treatment on the growth and development of infants born by mothers who were diagnosed with active TB during terminal stage of pregnancy. Methods  The clinical records, treatment and follow-up materials of 7 maternal active TB cases during terminal stage of pregnancy who were hospitalized in Wuhan TB Center from May 2005 to August 2011 were analyzed. Among them, 6 patients were newly diagnosed TB cases (intensive regimen for 3 of these cases was HRE, for the remaining cases were HRZE, HRZ and HZE respectively), 1 patient was retreatment TB case (intensive regimen for the sole retreatment TB case was INH, PAS, PZA, Lfx, Pto).  Results  The actual treatment duration of these 7 cases ranged from 3 to 12 months, with all cases had experienced obvious relief to the clinical symptoms and all had achieved smear and culture conversion as well, all these improvements were further proven by the marked absorption on the diseased parts shown by their chest X-ray. All 7 patients had given birth to healthy infants without deformities (with 1 premature birth), non infants had infected with utero TB. The results of follow-up observation showed that non of these infants had experienced hearing lose and visual impairment, their language, motor and mental developments were found to be normal. Conclusion  Appropriate and timely anti-TB treatment not only cures maternal active TB cases during terminal stage of pregnancy, but also causes neglectable adverse effects on early childhood growth and development.

Detection of Mycobacterium in the air of wards for tuberculosis patients from tuberculosis hospital in Shanghai

JIANG Yuan, LIU Zhi-bin, GUI Xiao-hong, SHEN Xin, ZHANG Zhong-shun, XIAO He-ping, MEI Jian

Chinese Journal of Antituberculosis. 2013, 35(5):  365-369. 

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Objective  To assess the risk of aerosol transmission of Mycobacterium in the air of the wards of tuberculosis (TB) inpatient in TB hospital. Methods  134 air samples were collected from the air of 22 wards housing sputum smear-positive patients in TB hospital by using the microbial aerosols liquid percussive sampler (FA-1 type air sampler). The air samples were digested and depolluted by NALC-NaOH, then inoculated in L-J culture medium and BacT/ALERT 3D culture system, respectively. The culture-recovery samples were identified by Ziehl-Neelsen staining and DNA sequencing. The Mycobacterium culture-recovery rates of L-J culture and BacT/ALERT 3D culture were compared and statistically analyzed using chi-square test of paired comparison (significance level α=0.05). Results  Of 134 air samples, 3 samples were culture-recovery, and identified respectively as M. tuberculosis, M. intracellulare and M. gordonae by gene sequencing. For BacT/ALERT 3D culture, 2 samples were conta-minated, and its culture-recovery rate was 2.3% (3/132). For L-J culture, 1 sample was contaminated, and its culture-recovery rate was 1.5% (2/133). There was no significant difference between these two methods (χ²=0.00，P>0.05).  Conclusion  Mycobacterium existed in the wards of sputum smear-positive TB inpatient in TB hospital. Surveying termly the air of TB hospital is an important measure to prevent and control the nosocomial infection.

Analysis of the need of psychological support for MDR-TB patients

YU Lan, WANG Jing, SU Wei, CHI Jun-ying, CHENG Jun, Lv Qing, CHEN Ming-ting

Chinese Journal of Antituberculosis. 2013, 35(5):  370-372. 

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Objective  To explore the psychological state and need of psychological support of multi-drug resistant tuberculosis (MDR-TB) patients. Methods  Face-to-face questionnaire interview was conducted to 51 MDR-TB patients who finished 3 questionnaires of all 100 MDR-TB patients enrolled in Kaifeng TB Control Institute in Henan and the Second Hospital of Yongchuan in Chongqing during Mar. 1 2011 to Feb. 29 2012. Out of the 51 subjects, there are 86.3%（44/51） male, 66.7%（34/51） farmers, and 39.2%（20/51） with primary education and below, whose average age are（46.9±12.8）years. Results  The psychological state of MDR-TB patients were statistically improved during their treatment. Patients’ psychological pressure decreased along with the treatment. The percentage of patients without pressure increased from 21.6%（11/51） at the entry of hospitalization to 35.3%（18/51） as discharging from hospital and finally to 70.6%（36/51） after 6 months of treatment（χ²=39.9，P<0.01）.   Conclusion  Effective medical treatment can improve MDR-TB patients’psychological state.

The awareness of tuberculosis infection control knowledge in 670 rural doctors in Bayan Nur in Inner Mongolia

SONG Yu-dan,GENG Meng-jie,HE Guang-xue,GUO Hui,HOU Yue-yun,XIONG Yong-chao，GAO Fang-fang，REN Li-ping，WANG Ya-li，HU Dong-mei，ZHAO Fei，CHENG Jun，LI Meng

Chinese Journal of Antituberculosis. 2013, 35(5):  373-375. 

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Objective  To understand the awareness status of tuberculosis infection control (TBIC) knowledge in rural doctors in Bayan Nur City of Inner Mongolia. Methods  The rural doctors of Linhe district and Hangjin Rear Banner in Bayan Nur were investigated with questions chosen from those in China’s rural doctors tuberculosis and tuberculosis incidence investigation of China-U.S. Collaborative Program on Emerging and Reemerging Infectious Diseases(EID). 670 questionnaires were issued, and the overall response rate was 100.0%.  Results  Only 29.9%（200/670）rural doctors gave correct answers to all questions. For the questions which related to administrative control, environmental and engineering controls, as well as personal protective measures, the accuracy rate ranged from 47.2%（316/670）to 99.3%（665/670）.   Conclusion  The awareness of TBIC knowledge in rural doctors needs further improvement. Relevant training should be provided to rural doctors to improve their cognitive and practical skills on TBIC.

Research progresses of drug delivery material in the treatment of osteoarticular tuberculosis

LI Da-wei, MA Yuan-zheng

Chinese Journal of Antituberculosis. 2013, 35(5):  376-378. 

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Antituberculosis drug delivery material is a new focus in the field of osteoarticular tuberculosis treatment.The material implanted in osteoarticular tuberculosis lesions can repair the bone defect and release antituberculosis drug in a long time. In this article, the recent progresses in research on drug delivery material in the treatment of osteoarticular tuberculosis have been reviewed.

Recent advances in the research on biological characteristics of interleukin-22 in tuberculous pleurisy and malignant pleural effusion

YUAN Yan-ming,WANG Zhong-yuan,CHENG Xiao-xing

Chinese Journal of Antituberculosis. 2013, 35(5):  379-383. 

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Interleukin-22 (IL-22)is a member of IL-10 cytokine family, and its biological activity is initiated by binding to a cell surface complex composed IL-22R1 and IL-10R2 receptor chains. IL-22 is expressed by most notably T-helper 22 (Th22),Th17 and Th1 cells, partly γδT cells, natural killer cells (NK cells) and lymphoid tissue inducer cells (LTi-like cells). Both of the concentration of IL-22 in tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) were increased. CD4⁺T cells recruitment from peripheral blood which induced by chemokine/CCR interaction and the differentiation of Th22 cells promoted by IL-1b, IL-6 or tumor necrosis factor-α(TNF-α) from native CD4⁺T cells contribute to the increase. IL-22 was involved in the immunopathology by promoting the expression of matrix metalloproteinases (MMPs) in pleural cavity, and IL-22 could mediate NK cells to produce soluble factors to reduce bacillary growth in M. tuberculosis infected monocyte-derived macrophages. In MPE pleural Th22 cells might be involved in the proliferation and migration of cancer cells,and promote intercellular adhesion of cancer cells to pleural mesothelial cells（PMCs） by upregulating the expression of cellular adhesion molecules. To explore the mechanism of IL-22 in these two diseases will provide new methods for immunodiagnosis and immunotherapy.