Table of Content

10 July 2013, Volume 35 Issue 7

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The clinical characteristics anti-tuberculosis drug-induced liver injury

XIAO He-ping，GU Jin

Chinese Journal of Antituberculosis. 2013, 35(7):  485-487. 

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Annual report on clinical diagnosis and treatment progress of tuberculosis(2012)(Part 2  clinical treatment)

Clinic Society of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2013, 35(7):  488-510. 

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In the recent one year,much progress has been made on the clinical treatment of tuberculosis(TB)and many new drugs,regimens,therapies have already been tested and verified in clinical practice. In 2012,the most encouraging event was that Bedaquiline(TMC207)has been approved by USFDA to be used in multi-drug resistant TB treatment. Immunotherapy and therapeutic vaccines have also made some progress in clinical TB research. An international multi-center randomized,double-blinded,placebo-controlled study on heat inactivated Mycobacterium indicus pranii(M.w or MIP)plus glucocorticoids-contained chemotherapy to treat tuberculous exudative pericarditis is worthy of attention. This report presents the results of a randomized,double-blinded,placebo-controlled phase Ⅱb clinical trial by using the therapeutic vaccine V5 for hepatitis on the treatment of TB. For the respiratory endoscopic treatment,we mainly focused on assessing the value of the various methods in the treatment of tuberculosis,and systematically introduced the interventional treatment extracted from Guidelines for diagnosis and treatment of tracheal endobronchial TB(trail version).  The progress made by bone TB surgeon specially the new surgical treatment and application for spine TB has been added.  New approaches in the treatment of drug-resistant TB have been thoroughly researched. The treatment for Mtb/HIV co-infection has also made great progress,including 7 parts:prophylaxis for latent TB infection,treatment of TB,antiretroviral therapy,the interaction of anti-TB and antiretroviral drugs,the clinical efficacy,adverse events and immune reconstitution inflammatory syndrome.

Tuberculosis drug resistance surveillance report in Fujian province

CHEN Qiu-yang,LIN Shu-fang, LIANG Qing-fu,WEI Shu-zhen,ZHAO Yong, LIN Jian, ZHENG Jin-feng

Chinese Journal of Antituberculosis. 2013, 35(7):  511-515. 

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Objective To understand the drug resistant status of tuberculosis in Fujian province,evaluate the effect of TB control，and provide evidence base for TB control policy development.  Methods 30 counties were selected for TB survey sites by stratified cluster sampling method，all the newly registered smear positive cases during investigation received sputum culture examination,we plan to enroll a total of 1230 new cases of smear positive, 41 new cases in each site and all retreatment patients. The drug susceptibility testing of H，R，S，E，Ofx and Km were performed by proportion method. Results We enrolled a total of 1579 patients(1223 new cases and 356 retreatment cases)，of which，2.3%(36/1579)was contaminated, the culture negative rate of smear positive patients was 3.9%(61/1579)；1452 cases were performed DST，and 1389 cases were identified as MTBC,new and retreatment cases accounting for 79.8%(1109/1389)and 20.2%(280/1389)，respectively. The total drug resistant rate was 24.0%(333/1389),the rate of multi-drug resistance(MDR)was 5.7%(79/1389), the extensively drug resistant(XDR)rate was 0.1%(1/1389). The primary drug resistant rate was 20.7%(230/1109)，the primary MDR rate was 3.2%(35/1109)，the acquired drug resistant rate was 36.8%(103/280)，the acquired MDR rate was 15.7%(44/280)，the acquired XDR rate was 0.4%(1/280). We found 41 patterns of drug resistant MTBC spectrum，including 6 patterns of mono-drug resistance，24 patterns of resistance to 2 or more drugs but not MDR，and 11 MDR(comprising 1 patter of XDR)patterns.  Conclusion The drug resistant tuberculosis in Fujian province is in a low level,but the resistance spectrum is diverse and complex,therefore,we need to further strengthen the drug resistant TB control work.

Analysis of awareness rate of tuberculosis control and prevention among students in four universities in Shandong province

WEI Qian，WANG Shi-chang，LOU Lei，WANG Qian，ZHANG Cui

Chinese Journal of Antituberculosis. 2013, 35(7):  516-520. 

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Objective To understand the awareness of tuberculosis(TB)control and prevention in 4 universities in Shandong province and to provide evidence for the direction and priority of health education. Methods 815 students were selected through the cluster random sampling method,and they were interviewed face-to-face with a standard questionnaire. 800 valid questionnaires were collected eventually(among whom 610 were from Shandong and 190 were from other provinces),and the effective rate was 98.2%(800/815). The EpiData 3.1 software was used to set up the database and double entry of the data,Excel 2003 and SPSS 13.0 were used for data analysis. Chi-square test was used for comparing difference of rates,α=0.05. Results The total awareness rate of 5 core information was 51.8%(2072/4000). In 5 core information,one specified as “People who cough,expectorating more than 2 weeks,or blood stained sputum,should be suspected of suffering from TB” had the lowest awareness rate(27.6%,221/800),followed by the awareness rate of 33.7%(270/800)for the core information that specified as “people who receive the TB examination and treatment in the TB control institute at county(district)level can enjoy the free policy”. 89.9%(719/800)college students knew that TB was a serious or very serious disease,and 55.5%(444/800)thought that TB has a great influence on learning. 33.1%(265/800)students had taken the initiative to learn tuberculosis knowledge,and 25.6%(205/800)had actively disseminated tuberculosis knowledge. The main sources of TB knowledge were “mentioned by others”(65.4%,523/800),“network”(51.5%,412/800),“explained by the medical staff”(44.3%,354/800), and “community activities”(36.5%,292/800). Poster was the most favorite materials in college students(51.0%,408/800). The total awareness rare to 5 core information of students from Shandong was 52.8%(1610/3050),which was higher than that in respondents from other provinces(48.6%,462/950)(χ²=5.009，P<0.05). Conclusion The awareness rate of TB in the 4 universities in Shandong is still low. Tuberculosis health education in university should be paid sufficient attention to.

Study on impacts of treatment effect with medication management system for pulmonary tuberculosis

SONG Tao, LIANG Zhi-qiang, HE Kai-li, LUO Yan-ming, JIANG Li-ying, BAO Wan-ling, LI Xiao-Yan, FAN Rui-lan

Chinese Journal of Antituberculosis. 2013, 35(7):  521-524. 

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Objective To explore the impacts on treatment effect with medication management system for pulmonary tuberculosis. Methods Three hundred cases with pulmonary tuberculosis notified in Yuexiu district from January to June 2011,were selected and randomly divided into study group and control group,with 150 cases in each group. The study group was managed with medication management system and the control group was managed with routine treatment supervision. The regular treatment rate and cure rate were evaluated at the end of treatment. Results The regular treatment rate of the study group was 99.3%（149/150）,while that of the control group was 84.0%（126/150）,and there was significant difference（χ²=23.084, P<0.05）. The cure rate of the study group（97.3%（146/150））was significantly higher than the control group（83.3%（125/150））（χ²=16.834, P<0.05）. Conclusion The medication management system can improve the regular treatment rate and the cure rate of pulmonary tuberculosis cases.

Observation of therapeutic effect of rifabutin on retreatment smear-positive pulmonary tuberculosis

ZHAO Yong，LIU Xin

Chinese Journal of Antituberculosis. 2013, 35(7):  525-528. 

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Objective To learn the therapeutic effect of rifabutin on retreatment smearpositive pulmonary tuberculosis. Methods This was a prospective cohort study. One hundred and twenty retreatment pulmonary tuberculosis（PTB）inpatients registered from September 15, 2009 to June 30, 2010 in Shangqiu Research Institute for Tuberculosis Control and Prevention were selected and divided into 2 groups randomly. One group（60 cases）were treated with the regimen 2HBZES/6HBE（B:rifabutin）,and the other group（60 cases）were treated with the regimen 2HRZES/6HRE. The sputum conversion rates,changes of lesion absorption and cavity closure rates were compared between the two groups. SPSS 13.0 software was used for data sorting and analysis.Chi-square test was applied for comparison. A Pvalue of 0.05 was used to signify statistical significance. Results At the end of 2 months of treatment,the sputum conversion rate was 48.33%（29/60）for rifabutin group and 30.0%（18/60）for rifampicin group,and the difference was statistical significant（χ²=4.23，P<0.05）. According to the results of chest X-ray,the efficiency rate of rifabutin group（21.67%（13/60））was significantly higher than rifampicin group 8.33%（5/60）（χ²=4.18，P<0.05）,and the effective rates were 36.67%（22/60）and 18.33%（11/60）respectively,with significant difference（χ²=5.06，P<0.05）. The sputum conversion rates at the end of treatment in the 2 groups were 81.67%（49/60）and 61.67%（37/60）respectively,and the difference was significant（χ²=5.91，P<0.05）. The radiographic outcomes showed that the cavity closure rate of Rifabutin group 47.92%（23/48））was significantly higher than rifampicin group（27.45%（14/51））（χ²=4.43，P<0.05）. For the changes of lesion absorption,the efficiency rates were 53.33%（32/60）and 35.00%（21/60）,respectively,with significant difference（χ²=4.09，P<0.05）. The effective rate of rifabutin group（68.33%（41/60））was significantly higher than rifampicin group（48.33%（29/60））（χ²=4.94，P<0.05）. Conclusion The regimen with rifabutin has better clinical therapeutic effect on retreatment pulmonary tuberculosis.

Correlation between CD4⁺ T lymphocyte count of HIV-infected individual or AIDS patients and clinical symptoms and signs of TB patients

LAN Ru-shu, ZHAO Jin-ming, CHENG Shi-ming, ZHOU Lin, ZHAO Yan-lin, LIN Mei, LUO Dan, LIU Fei-ying

Chinese Journal of Antituberculosis. 2013, 35(7):  529-532. 

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Objective To investigate the correlation of CD4⁺ T lymphocyte count of HIV-infected individual or AIDS patients and clinical symptoms and signs of TB patients. Methods Seven hundred and thirty-three HIV-infected or AIDS cases registered during July 2010 to June 2012 were selected in Guangxi CDC, Guangxi Longtan Hospital and the Fourth People’s Hospital of Nanning city. Liquid culture and improving neutral roche method were used for mycobacterium culture. The flow cytometry test was used for detecting CD4⁺ T lymphocyte count. The correlation between their CD4⁺ T cell count and TB clinical signs and symptoms was analyzed. Results The positive rate of sputum mycobacterium culture in HIV-infected individual or AIDS patients was 16.1% (118/733). The positive rates of sputum culture in class 1, 2, 3 and 4 of CD4⁺ T lymphocyte count were 12.3% (9/73), 10.3%（6/58）, 17.0%（15/88）and 17.1%（88/514）, respectively. There were no statistically significant difference between different classes of CD4⁺ T lymphocyte count (χ² Linear-by-Linear=2.004, P=0.157).There was a correlation between mycobacterium culture result and CD4⁺ T lymphocyte count in different classes (r=-0.048, P=0.035). The CD4⁺ T lymphocyte count was lower in the cases with cough more than 2 weeks（1.54±0.65）lg than those without cough more than 2 weeks（1.68±0.70）lg (t=-2.621，P=0.009). Conclusion The CD4⁺ T lymphocyte count of HIV-infected individual or AIDS patients has a correlation with the results of sputum mycobacterium culture. The cough in HIV-infected individual or AIDS patients for more than 2 weeks should be paid more attention on the combination of pulmonary tuberculosis.

Curative effect of ginseng polysaccharide on adjuvant therapy of diabetes combined with pulmonary tuberculosis

CAI Qing-he，LIN Jian-xiong，HUANG Song-wu,CHEN Huai-yi

Chinese Journal of Antituberculosis. 2013, 35(7):  533-537. 

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Objective To investigate the curative effect of ginseng polysaccharide on adjuvant therapy of type 2 diabetes combined with pulmonary tuberculosis(PTB). Methods One hundred and twenty outpatients with diabetes combined with PTB notified in Shantou Institute of Tuberculosis Control and Prevention from January to December,2011 were the study targets. The diagnosis of TB was accord with the standard of Clinical Practice Guidelines for Tuberculosis, and the diagnosis of type 2 diabetes was accord with the standard of China Guideline for Diabetes issued in 2009 by Chinese Diabetes Society. One hundred and twenty patients were randomly divided into experimental group(62 cases)and control group(58 cases)based on oddeven notified number. Routine antiTB and glucoselowering treatment were applied in control group(180days),while ginseng polysaccharide was given(12mg intramuscular injection every other day for 180days)to experimental group besides the routine treatment. The short term effect and the change of T cell subset of the two groups were compared. SPSS 13.0 software was used for data analysis,ttest was used for quantitative data andχ² test was applied for rate comparison. P<0.05 was set as the standard of statistical significance. Results The sputum conversion rate of experimental group was 95.2%(59/62), which was significantly higher than that of the control group(79.3%,46/58)(χ²=6.88, P<0.01). The effective rate of experimental group(96.8%,60/62)was also significantly higher than control group(75.9%, 44/58)(χ²=11.34, P<0.01). From peripheral blood testing,the proportions of CD3⁺ T cells in patients in experimental group was(50.0±10.42)% after treatment and(34.89±7.26)%before treatment,and the proportion in patients in control group was(37.46±8.96)%before treatment, tvalues were 9.36 and 7.04 respectively compared with the latter two,and both P value were less than 0.01. The proportions of CD4⁺ T cell in experimental group were(34.88±9.96)% after treatment and(25.89±8.68)% before treatment,while that in control group after treatment was(25.64±9.68)% after treatment, tvalues were 5.38 and 5.11 compared with the latter two with P<0.01. The ratios of CD4/CD8 were 1.58±0.78,1.15±0.45 and 1.20±0.62 respectively,and the tvalues were 3.76 and 2.94 compared with the latter two with  P<0.01. The proportions of CD8⁺T cell were(18.50±7.22)%,(24.76±9.85)%and(23.86±8.92)%respectively,and the tvalues were 4.03 and 3.63 compared with the latter two with P<0.01. Conclusion The sputum conversion rate,effective rate and cellular immune function were clearly improved by ginseng polysaccharide on diabetes combined with PTB.

Advances in laboratory diagnosis of nontuberculosis mycobacterial disease

HUANG Ming-xiang

Chinese Journal of Antituberculosis. 2013, 35(7):  538-51. 

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At present,the incidence of non-tuberculosis mycobacterial(NTM)disease increased year by year in the world. NTM and M. tuberculosis all can cause the lesions in the lung and other organs, they have similar clinical symptoms,and their diagnoses were more difficult. Therefore,the identification of Mycobacterium species had important significance for the diagnosis,treatment and prognostic of disease. Traditional method of biochemical identification is time-consuming,can not satisfy the clinical need. In recent years,MPB64 antigen colloidal gold assay based on immune chromatography technology,the gas phase chromatography and high performance liquid chromatography based on chromatographic technique,the molecular biology technology including gene probe,PCR-RFLP,and PCR-gene sequencing method as the representative,and other new techniques were used for the identification of NTM species,which provided more scientific methods. In this paper,the principle,application and performance of 3 kinds of techniques above mentioned were introduced,and the advantages and limitations of these methods were evaluated. After new techniques continue to be improved,we believe that a fast,reliable,cheap and standardized NTM identification system would be gradually developed.

Analysis of MDR-TB information management system design and function

WANG Qian，CHEN Cheng，FANG Qun，LI Ren-zhong，CHEN Ming-ting，WANG Li-xia

Chinese Journal of Antituberculosis. 2013, 35(7):  542-544. 

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MDR-TB information management system was designed for Hospital and Prevention Cooperation Program of China-Gates Foundation TB Project. The object of the system is to meet the requirements of multi-drug resistant tuberculosis(MDR-TB)treatment and management through the cooperation between general hospital and tuberculosis dispensary.This information system is designed to automatically collect MDR-TB patients’ data and improve the quality and efficiency of data analysis,and to provide reference for the national information system development of MDR-TB control and prevention.