Table of Content

10 October 2013, Volume 35 Issue 10

Previous Issue    Next Issue

Development and expectation of the tuberculosis designated hospital

JIANG Shi-wen, ZHANG Hui, LIU Xiao-qiu, WANG Li-xia

Chinese Journal of Antituberculosis. 2013, 35(10):  765-767. 

Abstract ( 1114 )   PDF (879KB) ( 1110 )   Save

References | Related Articles | Metrics

Effect evaluation on tuberculosis control in floating population in global fund China tuberculosis control project

LIU Xiao-qiu, LI Jun, JIANG Shi-wen

Chinese Journal of Antituberculosis. 2013, 35(10):  768-772. 

Abstract ( 1177 )   PDF (751KB) ( 530 )   Save

References | Related Articles | Metrics

Objective To identify the status of case finding and treatment of tuberculosis (TB) cases in the floating population in global fund China TB control project, and to make an effect evaluation on the project. Methods Data was collected from the quarterly reports of the global fund of TB control project, and the case finding and treatment outcomes of cases in floating population were analyzed. Compared with the nationwide data of patients who were detected from floating population in 2010 the case finding and treatment outcomes in the project areas were evaluated. In the past 6 years since the project was implemented, 165529 active TB cases in floating population were registered in the project areas. The total number of floating population in 2010 was 0.213 billion, and 73963 pulmonary TB cases were registered. Results The notification rate was increased from 25.34/100000 (4166/16440400) to 71.43/100000 (41439/58011500) after 6 years’ implementation. Among those who were treated in the registered place, the cure rates of new sputum smear positive (SS+) cases and retreatment SS+ cases were 90.87% (43442/47809) and 78.63% (4847/6164) respectively, and the treatment completion rate of new smear negative cases and patients without results of sputum examination was 92.26% (59088/65405). Meanwhile, among those who were transferred to the origin residence for treatment, the cure rates of new SS+ cases and retreatment SS+ cases were 48.85% (1444/2956) and 37.99% (106/279) respectively, and the treatment completion rate of new smear negative cases and patients without results of sputum examination was 47.06% (1335/2837). The notification rates of both active TB cases and smear positive patients in the project areas were significantly higher than those nationwide in 2010 (active TB cases: 74.26/100000 (41615/56040600), 34.72/100000 (73963/21300000), U=127.08, P=0.000; SS+ cases: 32.20/100000 (18047/56040600), 15.16/100000 (32298/21300000), U=183.83, P=0.000). The treatment success rate of patients who were transferred to the origin residence for treatment (48.45%, (1550+1392)/6072) was higher than the national rate in 2010 (8.89%, (279+177)/5127) (χ²=2058.10, P=0.000), and the default rate (28.69%, 1742/6072) was significantly lower (90.83%, 4657/5127) (χ²=4383.45, P=0.000). Conclusion The Globe Fund China TB control project for floating population has shown satisfactory effect, which increases the case finding and treatment outcomes.

Satisfaction degree of tuberculosis patients on designated hospitals

XIE Hai-bo, CHEN Sen, LIU Ying-juan, LIU Xiao-qiu, LI Jun, JIANG Shi-wen, ZHANG Hui, WANG Li-xia, ZHAN Si-yan

Chinese Journal of Antituberculosis. 2013, 35(10):  773-777. 

Abstract ( 1150 )   PDF (696KB) ( 189 )   Save

References | Related Articles | Metrics

Objective To understand the satisfaction degree of tuberculosis (TB) patients on designated hospitals, and to provide reference for designated hospital model improvement.  Methods Forty designated hospitals in which designated hospital model launched in October 2009 in Global Fund TB program area were enrolled in this study. 907 questionnaires were sent to TB patients and 795 effective questionnaires were retrieved, and the effective rate of questionnaire was 99.38%. TB patients’ information of diagnosis and treatment were attained through medical record and satisfaction degree on designated hospitals through questionnaires. The satisfaction degree of different types of patients was compared by chi-square test, 0.05 was set as the criteria of statistically significant difference. Results Of 795 TB patients, 94.65% (752/795) of the patients wanted to recommend designated hospital to their relatives with TB. The diminishing sequence of satisfaction degree on all aspects of designated hospitals was medical technology (86.79%, 690/795), service attitude (86.79%, 690/795), health promotion (83.02%, 660/795), treatment process (76.60%, 609/795), outpatient environment (73.84%, 587/795), effect of health promotion (73.21%, 582/795) and expenses (41.89%, 333/795). The satisfaction degree of sputum smear positive TB patients on medical technology, effect of health promotion and expenses (82.76%, 264/319; 69.59%, 222/319; 36.99%, 118/319) were all lower than those of sputum smear negative TB patients (89.43%, 423/473; 75.90%, 359/473; 45.45%, 215/473) (χ² values were 7.371, 4.673 and 5.436 respectively, and all P values were lower than 0.05). TB patients supervised taking medicine had higher satisfaction degree on health promotion (84.16%, 558/663) than those without supervision (75.76%, 100/132) (χ²=4.195, P<0.05). The proportion of affordable expenses of TB patients supervised taking medicine (39.06%, 259/663) was lower than those without supervision (55.30%, 73/132) (χ²=12.944, P<0.001). Conclusion Although the designated hospital model obtains the approval of most of TB patients, it still needs to improve the outpatient environment and treatment process, and to carry out the free diagnosis and treatment policy for TB patients, in order to further improve the TB patients’ satisfaction.

Evaluation of the implementation of tuberculosis designated hospitals mode of Global Fund project in China

LI Jun, LIU Xiao-qiu, LI Xue, LI Xin-xu, ZHANG Hui, WANG Li-xia, JIANG Shi-wen

Chinese Journal of Antituberculosis. 2013, 35(10):  778-782. 

Abstract ( 1327 )   PDF (697KB) ( 408 )   Save

References | Related Articles | Metrics

Objective To evaluate the implementation status of tuberculosis designated hospitals mode supported by Global Fund project in China. Methods Quantitative research method was adopted. The overview of implementation status, and the information of patient detection and treatment management before and after the implementation (through Oct 01, 2008 to Sep 30, 2011) in 40 counties of 16 provinces was collected through the questionnaire and Tuberculosis Information Management System. Meanwhile, it was analyzed comparing with the situation nationwide and in control counties. SPSS 17.0 was utilized for data analysis. The Chi-square test was used to identify the differences of implementing status before and during project implementing, between the project areas and the whole country or control counties, with a P-value less than 0.05 considered statistically significant differences. Results The registration rates of active tuberculosis(TB) patients in project areas in 3 years before and during the project implementing were 74.5/100 000 (16 242/21 800 000), 69.4/100 000 (15 106/21 770 000) and 70.0/100 000 (15 421/22 040 000), while smear-positive TB patients were 30.2/100 000 (6572/21 800 000)、31.2/100 000 (6787/21 770 000) and 29.4/100 000 (6469/22 040 000), with significant statistic difference during 3 years(χ²=48.3，P<0.01；χ²=12.0，P<0.05). It had the same decline trend with the registration rates nationwide from 2008—2010(The registration rates of active TB patients was 76.2/100 000,71.9/100 000 and 67.9/100 000，χ²=6297.5，P<0.01, while smear-positive TB patients was 40.3/100 000,38.6/100 000 and 36.3/100 000，χ²=2790.0，P<0.01). The total arrival rate in project areas in 3 years before and during the project implementing were 88.2%（9339/10 589）,95.9%（10 069/10 496）and 96.9%（10 547/10 881）, with significant statistic increase（χ²=825.6，P<0.01）,more than control counties(92.9%,93.8% and 94.6%，χ²=20.6，P<0.01). The completion treatment rates of smear-positive TB patients in project areas in 3 years before and during the project implementing were 94.0%（6817/7252）,95.0%（6241/6572） and 94.2%（3082/3272）; while initial smear negative were 91.8%（6011/6547）,94.0%（6114/6502） and 92.8%（3087/3328）,with significant statistic increase(χ²=6.4，P<0.05；χ²=24.4，P<0.01). The completion treatment rates in control counties had no significant statistic difference (The completion treatment rates of smear-positive TB patients during 3 years was 95.0%,95.3% and 94.2%，χ²=4.9，P>0.05, while initial smear negative was 95.5%,95.2% and 96.4%，χ²=5.8，P>0.05). Conclusion Remarkable achivements were observed as a result of the TB designated hospital mode supported by Global Fund project in China. The level of patient detection and treatment management was improved. It also provided experiences to improve health service system of TB control.

Analysis on implementation effect of new tuberculosis control model of designated hospital

LU Wei, YU Hao, CHEN Cheng, ZHOU Yang, LIU Qiao, DING Xiao-yan, ZHU Li-mei

Chinese Journal of Antituberculosis. 2013, 35(10):  783-787. 

Abstract ( 1277 )   PDF (702KB) ( 190 )   Save

References | Related Articles | Metrics

Objective To analyze the implementation effect of new tuberculosis (TB) control model of designated hospital in Jiangsu province, and to provide scientific evidence for TB control and prevention strategy development. Methods Ten counties which conducted TB control by designated hospitals (Designated Hospital Model) and 10 counties which conducted TB control by county centers for disease control and prevention (CDC) (CDC Model) were selected. Data of diagnosis delay, referral and tracing, systematic management, treatment outcome and data quality of 10 578 TB cases registered from January 2012 to December 2012 were collected. SPSS 17.0 was used for data analysis to evaluate the effects of two models. Results The registration rates were 55.60/100 000 (4768/8 575 823) and 55.93/100 000 (5810/10 388 634) respectively (χ²=0.091, P=0.763), the overall arrival rates were 99.1% (4939/4985) and 99.2%(6064/6111) respectively (χ²=0.780, P=0.3771), durations from diagnosis to registration were (0.021±0.009) day and (0.025±0.010) day respectively (t=0.419, P>0.05), systematic management rates were 99.0% (5048/5097) and 98.7% (5645/5719) respectively (χ²=2.65, P=0.103), and treatment completion rates of smear negative TB cases were 96.6% (3182/3295) and 97.4% (3661/3760) respectively (χ²=3.82, P>0.05) for Designated Hospital Model and CDC Model, which were no statistical significance. The average duration from getting sick to TB diagnosis was (11.117±6.109) day for Designated Hospital Model, less than (15.399±6.866) day for CDC Model (t=12.42, P<0.001). The consulting rates with symptoms and signs were 52.0% (2479/4768) and 33.8% (1966/5810) respectively (χ²=352.468, P<0.0001), referral rates were 99.1% (4941/4985) and 98.5% (6017/6111) respectively (χ²=9.606, P=0.0019), tracing arrival rates were 99.6% (1320/1325) and 97.9% (1559/1593) respectively (χ²=16.993, P=0.000 04) for Designated Hospital Model and CDC Model, which were all higher in Designated Hospital Model than CDC Model. The cure rates of new smear positive cases were 89.8% (1172/1305) and 94.7% (1293/1366) respectively (χ²=22.03, P<0.0001), cure rates of retreated smear positive cases were 80.8% (274/339) and 88.9% (335/377) respectively (χ²=9.06, P<0.01), timely rates of information entry were 98.9% (23 571/23 840) and 99.0% (28 773/29 050) respectively (χ²=4.088, P=0.043), and completion rates of information entry were 98.8% (28 272/28 608) and 99.4% (34 646/34 860) respectively (χ²=60.113, P<0.0001) for Designated Hospital Model and CDC Model, which were all lower in Designated Hospital Model than CDC Model, while the rates still meet the requirements of national TB control. Conclusion The implementation of Designated Hospital Model at county level in Jiangsu province has achieved great effect. Designated Hospital Model of TB control is the inexorable trend which accords with the demands of the medical institutions reform, and can adapt to the needs of TB control and be implemented according to the local conditions.

Analysis on factors influencing the therapeutic outcome of the first-time retreated smear-positive pulmonary tuberculosis patients in Wuhan city

DUNA Qiong-hong，CHEN Cong，ZHANG Zheng-bin，TIAN Dan，NAN Jing，CHEN Jun，YANG Wei，PENG Peng，WANG Wei-hua

Chinese Journal of Antituberculosis. 2013, 35(10):  788-792. 

Abstract ( 1433 )   PDF (688KB) ( 193 )   Save

References | Related Articles | Metrics

Objective To investigate factors influencing the therapeutic outcome of the first-time retreated smear-positive pulmonary tuberculosis (TB) patients and to improve the cure rate of retreated smear positive TB patients.  Methods A cluster sampling was used to select all of the first-time retreated smear-positive pulmonary TB patients registered in Wuhan TB center from July 2011 to March 2012, which had a total of 232 subjects. Face to face questionnaire survey and 9 months follow-up were conducted. A total of 232 TB patients were interviewed，and 219 questionnaires were eligible, the qualification rate was 94.4%.χ² test and stepwise logistic regression were used to analyze the influencing factors.  Results Among 219 first-time retreated smear-positive pulmonary TB patients, 156 cases were treated successfully, and the treatment success rate was 71.2%. The treatment success rates of patients with diabetes mellitus and without diabetes mellitus were 51.2% (21/41) and 75.8% (135/178) respectively (χ²=9.860, P=0.002). The treatment success rates of drug resistant TB (DR-TB) patients and those without drug resistance were 55.0% (33/60) and 73.7% (87/118) respectively (χ²=6.351, P=0.012). The treatment success rates of multi-drug resistant TB (MDR-TB) patients and non MDR-TB patients were 26.1% (6/23) and 73.5% (114/155) respectively (χ²=20.538, P=0.000). The stepwise logistic regression revealed that MDR-TB (OR=10.758, 95%CI=3.481-33.247) was the risk factor for treatment success, the difference was highly significant (P<0.01). With diabetes mellitus (OR=2.838, 95%CI=1.187-6.788) and treatment without supervision by doctors (OR=1.678, 95%CI=1.087-2.588) were also the risk factors for treatment success, the diffe-rence were significant (P<0.05). Conclusion The treatment success rate of the first-time retreated smear-positive pulmonary TB patients was low in Wuhan. MDR-TB, with diabetes mellitus and treatment without supervision by doctors were the main influential factors on therapeutic effect of first-time retreated smear-positive pulmonary TB.

Cost-effectiveness study of different strategies for pulmonary tuberculosis case finding in elderly people

ZHANG Can-you, WANG Li-xia, ZHANG Hui, CHENG Jun

Chinese Journal of Antituberculosis. 2013, 35(10):  793-798. 

Abstract ( 1313 )   PDF (1564KB) ( 570 )   Save

References | Related Articles | Metrics

Objective To optimize strategies for pulmonary tuberculosis (PTB) case finding in elderly people through cost-effectinveness analyses, and provide scientific evidences of such cases finding strategies for policy maker in China. Methods Using decision tree to conduct cost-effectiveness analysis of different straregies which are used for finding PTB patients, then to get an optimal strategy. It is assumed that there is a crowd of 500000 people, and the elderly people(≥60 years old) of it are the target group in this study. Using sofeware TreeAge ProSuite 2011 to build decision tree models, including 3 strategies: (1) For the elderly people who have PTB symptoms and can see a doctor actively: chest X-ray and sputum smear microscopy should be taken. (2)Firstly, clue investigation should be taken to the target groups. And then, chest X-ray and sputum smear microscopy may be given to those who are symptomatic candidates going to clinic actively and from clue investigation. (3) For all the elderly people: firstly, symptom screening and chest X-ray should be taken. And then, sputum smear microscopy may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray. To collect parameters and scopes of the parameters, carry out cost-effectiveness analyses to confirm the optimal strategy, and carry out sensitivity analyses to check out the stability of the models. Results Strategy 3 (For all the elderly people: firstly, symptom screening and chest X-ray should be taken. And then, sputum smear microscopy may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray) was the most productive one for PTB case finding, which could find 713 PTB patients; strategy 1(For the elderly people who have PTB symptoms and can see a doctor: chest X-ray and sputum smear microscopy should be taken) was the most efficient one, which would cost 551 Yuan for one PTB patient. The sensitivity analyses showed that the results of the model analyses were not affected by the scopes of the parameters. Conclusion To find more PTB patients, case finding in elderly people should strategy 3. To be most efficient, case finding should take strategy 1 in elderly people. By now, it is not fit to the cost-effectiveness principle to finding PTB patients in elderly people all alone. It may be considered to do research in groups with multiple risks in future.

Effect analysis of global fund multi-drug resistant tuberculosis project in Guangdong province

WU Hui-zhong, YIN Jian-jun, ZHONG Nai-rong, JIANG Li, LI Jian-wei, ZHOU Lin, ZHONG Qiu

Chinese Journal of Antituberculosis. 2013, 35(10):  799-802. 

Abstract ( 1161 )   PDF (833KB) ( 462 )   Save

References | Related Articles | Metrics

Objective To analyze and evaluate the implementation effect of global fund multi-drug resistant tuberculosis (MDR-TB) project, in order to provide reference for MDR-TB control work in Guangdong province. Methods Monthly and quarterly reports are all collected for retrospective analysis from Oct.2006 to Dec.2010. Results By the end of Nov.2012, a total of 12 165 MDR-TB suspects were screened, among which 12 125 cases received sputum culture, 8633 suspect cases performed drug susceptibility test (DST). 1170 MDR-TB patients were confirmed and 488 cases were recruited for treatment. A total of 221 MDR-TB cases included in treatment for 2 years, 99 cases were cured, and 5 cases completed treatment. The treatment success rate was 47.06%（104/221）. Conclusion With the implementation of the MDR-TB project, we established the MDR-TB diagnosis, treatment and management model. The standard treatment regimen as the main strategy is feasible.

Analysis on tuberculosis epidemic characteristics and treatment outcomes in Rizhao city in 2002 to 2011

LU Ji-xu

Chinese Journal of Antituberculosis. 2013, 35(10):  803-807. 

Abstract ( 1076 )   PDF (751KB) ( 290 )   Save

References | Related Articles | Metrics

Objective To learn the implementation effect of Notice on Issuing Rizhao Tuberculosis Control Program(2001—2010) (RTCP in short), and to analyze tuberculosis (TB) epidemic characteristics and treatment outcomes. Methods The total population of Rizhao city was 28189894 during 2002-2011. Data came from TB Information Management System and relevant statistic reports. TB prevalence, characteristic and treatment outcomes in Rizhao city were analyzed. Results During 2002-2011, the registration rates of active and new sputum smear positive (SS+) pulmonary TB cases were 44.34/100000 (12499/28189894) and 24.28/100000 (6844/28189894). The ratio of male to female was 2.51∶1. The age group of 15- years old accounted for 18.11% (2263/12499), 55- age group accounted for 16.84% (2105/12499), and 45- age group accounted for 16.55% (2069/12499). The occupational of farmer accounted for 78.92% (9864/12499). The registration rates were different among counties, Donggang was 43.84/100000 (5270/12021948)，Juxian was 7.21/100000 (4118/11067974)，and Wulian was 61.00/100000 (3111/5099972). Sputum conversion rates of new and retreatment SS+TB cases were 96.27% (6589/6844) and 92.74% (830/895) at the end of initial phase. The average cure rate of SS+TB cases was 95.54% (7394/7739). Conclusion Since the implementation of RTCP, TB prevalence has been controlled effectively, TB registration rate has increased significantly and the cure rate of SS+TB cases has achieved and exceeded the requirement of RTCP.

The analysis of current situation on the detection and treatment of MDR-TB patients in six districts and counties of Chongqing city

LIU Ying,CAO Yi,ZHANG Wen,CHENG Jun

Chinese Journal of Antituberculosis. 2013, 35(10):  808-811. 

Abstract ( 1050 )   PDF (685KB) ( 336 )   Save

References | Related Articles | Metrics

Objective For the purpose of providing scientific evidence for the prevention and treatment model of drug-resistant TB,we analyzed the current situation on the detection and treatment of MDR-TB patients of 6 districts and counties in Chongqing. Methods All 1189 smear-positive patients were collected from the 6 districts and counties of the 3 Gorges reservoir region,1015 cases were new smear-positive TB patients and 174 cases were from high risk patients of MDR-TB. The drug-susceptibility test results, transporting situation and the causes who were not included in the treatment were analyzed. Results Among 1189 smear-positive patients,84 cases(7.1%)were diagnosed as MDR-TB. Comparing multidrug-resistant detection rate in different gender，the male was 6.9% (61/883), the female was 7.5% (23/306); there was no statistical differences between genders with the detection rate of multidrug-resistant(χ²=0.07,P＞0.05).Comparing different age groups，≤20 years, >20 years-,41 years- and 61-80 years old were 6.9% (7/102), 8.7% (25/286), 7.8% (39/499), 4.3% (13/302) respectively; there was no statistical differences between different age groups with the detection rate of multidrug-resistant(χ²=2.15,P＞0.05). From the point of patient classification, new smear-positive pulmonary tuberculosis patients with multidrug-resistant detection rate was 3.6%(37/1015),the detection rate from high risk population was 27.0%(47/174), the difference was statistically significant (χ²=123.5,P＜0.01). The overall time interval (d) for suspected multi-drug resistant patients between leave phlegm to carry out drug sensitive test was an average of 90.9 d (66.0-118.9 d). In 84 cases of multi-drug resistant TB diagnosis, 22 cases received treatment, the treatment rate was 26.2% (22/84); and 62 cases were out of treatment and economic difficulties was the priority reason accounting for 41.9%(26/62). Conclusion The screening for MDR-TB should target at the high risk population in Chongqing city, we should set up standardized diagnosis and treatment management points of MDR-TB nearby designated TB hospitals, and carry out medical insurance policy, addressing patient clinic costs, in order to ensure patients’s standardized treatment.

Analysis of the sputum negative conversion rate and risk factors for primary pulmonary tuberculosis with tracheobronchial tuberculosis

KUANG Hao-bin, LIANG Min-qing, FANG Qiong, HE Qiao, CHENG Wu, KUANG Xiao-jia，LIAO Jin-liang，TAN Shou-yong

Chinese Journal of Antituberculosis. 2013, 35(10):  812-815. 

Abstract ( 1382 )   PDF (680KB) ( 216 )   Save

References | Related Articles | Metrics

Objective To explore the sputum negative conversion rate and risk factors of curative effect for pulmonary tuberculosis (PTB) with tracheobronchial tuberculosis (TBTB).  Methods Two hundred and five primary PTB cases with TBTB were confirmed by bronchoscopy in Guangzhou Chest Hospital from Jul 2011 to Feb 2012, all of whom received chemotherapy of 2-3HRZE/9-10HR and different transbronchoscopic interventional therapy according to TBTB types. After more than 6 months’ following-up, the sputum negative conversion rates after 2 months treatment and 6 months treatment were analyzed, and risk factors were also analyzed by backward logistic regression analysis. Results After the treatment of 2 months and 6 months, the sputum negative conversion rate were 59.0% (121/205) and 90.2% (185/205) respectively. Multiple-factor logistic regression analysis showed that age (OR=1.013, P=0.061, 95%CI＝0.992-1.035), lesion range (OR=2.012, P=0.022, 95%CI＝0.948-4.273), number of cavity (OR=1.655, P=0.031, 95%CI＝1.116-2.453) and drug resistance (OR=1.298, P=0.047, 95%CI＝0.7962-2.117) were risk factors of sputum non-negative conversion after 2 months’ treatment. The drug resistance (OR=1.452, P=0.022,95%CI＝0.818-2.575) and sputum positive after 2 months’ treatment (OR=18241.990, P=0.008, 95%CI＝0.000-6.4×10⁸) were the risk factors of sputum positive after 6 months’ treatment. Conclusion The sputum negative conversion rate is relatively low for PTB with TBTB after 2 months’ treatment. It needs to intensify treatment and management and improve treatment compliance. The risk factors of sputum non-negative conversion after 2 months’ treatment were age, lesion range, number of cavity and drug resistance, while those after 6 months’ treatment were drug resistance and sputum positive after 2 months’ treatment.

Analysis of the relation between symptoms related to liver injuries induced by anti-tuberculosis drugs and liver injury in tuberculosis patients during treatment

FANG Hong-xia, WU Shan-shan, LV Xiao-zhen, XIA Yin-yin, ZHAN Si-yan

Chinese Journal of Antituberculosis. 2013, 35(10):  816-822. 

Abstract ( 1703 )   PDF (781KB) ( 428 )   Save

References | Related Articles | Metrics

Objective To analyze the symptoms related to liver injuries induced by anti-tuberculosis drugs and liver injury in tuberculosis (TB) patients during treatment, and to evaluate the risk of anti-tuberculosis drugs induced liver injury (ATLI) in patients with these symptoms. Methods Relevant data in the database of “Anti-tuberculosis Drugs induced Adverse Reactions in China National Tuberculosis Control and Prevention Scheme Study” (ADACS), including information of follow-up calendars and outcome, were used to analyze the distribution of symptoms related to liver injury in 4065 new smear positive TB patients during treatment with first-line anti-tuberculosis drug and evaluate the risk of ATLI on patients with these symptoms. Results The proportion of TB patients had symptoms related to liver injury during treatment was 33.9% (1377/4065). Among whom 91.1% (1255/1377) experienced 1 to 3 symptoms, and 92.2% (1269/1377) developed symptoms in intensive phase. In patients with symptoms related to liver injury, the risk of liver injury and moderate or severe liver injury increased. The rates of liver injury in patients with fever, nausea, weakness, skin rash, abdominal discomfort, anorexia and other symptoms of ATLI were 7.4% (14/190), 13.3% (130/975), 10.1% (51/505), 10.8% (47/434), 14.5% (56/387), 77.4% (41/53) and 55.6% (15/27) respectively, while the rates of moderate or severe liver injury were 6.3% (12/190), 5.8% (57/975), 5.0% (25/505), 5.3% (23/434), 7.2% (28/387), 60.4% (32/53) and 48.1% (13/27) respectively. Patients with each symptom of above (except fever) had higher risk of liver injury and moderate or severe liver injury than those without the symptom. The relative risk of liver injury in patients with anorexia or other symptoms of ATLI was 13.4 (95%CI: 10.5-17.1) and 8.7 (95%CI: 5.7-13.2) respectively in comparison with patients without the symptom, and the relative risk of moderate or severe liver injury was 27.5 (95%CI: 21.2-35.7) and 18.2 (95%CI: 12.1-27.3) respectively. The relative risk of moderate or severe liver injury in patients with fever was 2.3 (95%CI: 1.3-4.0) compared with patients without fever. Conclusion One third of TB patients experience symptoms related with liver injury during treatment, and the symptoms mainly appear in intensive phase. Patients with nausea, weakness, skin rash, abdominal discomfort, anorexia and other symptoms of ATLI have a higher risk of liver injury. Fever may be the indicative symptom of moderate or severe liver injury, which needs to be further confirmed.

An analysis of the drug resistance situation of 223 inpatient coal workers of pneumoconiosis-tuberculosis

KONG Dong-qing, CHEN Dong-jin, ZHANG Man-gang, LI Wei, LI Mei-ling

Chinese Journal of Antituberculosis. 2013, 35(10):  823-826. 

Abstract ( 1058 )   PDF (682KB) ( 249 )   Save

References | Related Articles | Metrics

Objective To understand the drug resistance situation of coal workers of pneumoconiosis-tuberculosis, and to explore the control strategy. Methods The clinical data of 223 coal workers lived in the General Hospital of Beijing Jingmei Group and diagnosed with pneumoconiosis-tuberculosis from January 2009 to December 2012 were collected and the drug resistance situation was analyzed. Descriptive statistics was employed andχ² test was applied to categorical data. P<0.05 was set to be the criteria of statistical significance. Results The overall drug resistance rate was 42.60% (95/223), among whom 26.32% (25/95) were new cases and 73.68% (70/95) were retreatment cases, and the difference was significant between the two types (χ²=58.436, P<0.01). The poly-resistance rate was 50.53% (48/95), the multidrug-resistance rate was 34.74% (33/95) and the extremely drug resistance rate was 7.37% (7/95). The mono-resistance rates of first-line drugs were 73.68% (70/95) for H, 70.53% (67/95) for S, 64.21% (61/95) for R, 50.53% (48/95) for E, and those of second-line drugs were 44.21% (42/95) for Km, 36.84% (35/95) for PAS, 35.79% (34/95) for Ofx and 24.21% (23/95) for Pto. The order of drug resistance rate of new cases to first-line drugs in descending order was S>H>R>E, and the drug resistance rates were 76.00% (19/25), 56.00% (14/25), 52.00% (13/25) and 44.00% (11/25) respectively. Km (48.00%, 12/25) and Ofx (44.00%, 11/25) were the main second-line drugs to which that new cases were resistant. The order of drug resistance rate of retreatment cases to first-line drugs in descending order was H>S>R>E>Z, and the drug resistance rates were 80.00% (56/70), 68.57% (48/70), 67.14% (47/70), 52.86% (37/70) and 7.14%(5/70) respectively. The order to second-line drugs were Km>PAS>Ofx>Pto>Lfx, and the rates were 42.86% (30/70), 40.00% (28/70), 32.86% (23/70), 25.71% (18/70) and 15.71% (11/70), and the number of resistant drugs was significantly higher than new cases. Conclusion The drug resistance of inpatient coal workers of pneumoconiosis-tuberculosis is serious. The study on management and treatment methods should be strengthened to improve the situation.

The exploration of the diagnosis and surgical therapy of intestinal  tuberculosis——based on 23 clinical cases

LI Peng-fei, CHEN Yan, SUO Jian

Chinese Journal of Antituberculosis. 2013, 35(10):  827-830. 

Abstract ( 917 )   PDF (675KB) ( 470 )   Save

References | Related Articles | Metrics

Objective To explore clinical diagnosis and surgical treatment of intestinal tuberculosis based on 23 clinincal cases. Methods The clinical data of 23 patients with intestinal tuberculosis were collected in our hospital from 2008.1 to 2010.12. Results Twenty-three patients, 4 intestinal tuberculosis cases were diagnosed by colonoscopy pathology,combining with the medicial history, radiographic and laboratory examination, 12 of them were suspected cases, the rest 7 which couldn’t be distinguished with abdominal tumor or needed emergency surgery failed to make a definite diagnosis before operation. All cases were treated with anti-tuberculosis drugs postoperatively, 20 of them were cured or improved except 3 couldn’t be followed up.   Conclusion Early diagnosis, standard antituberculous therapy, and optimal surgical operation are benefit to the intestinal tuberculosis treatment.

Analysis of drug susceptibility profiles of multidrug-resistant M. tuberculosis isolated from China

ZHAO Bing, SONG Yuan-yuan, PANG Yu, LI Qiang, OU Xi-chao, XIA Hui, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2013, 35(10):  831-834. 

Abstract ( 1465 )   PDF (690KB) ( 264 )   Save

References | Related Articles | Metrics

Objective To analyze drug susceptibility profiles of multi-drug resistant (MDR) M. tuberculosis isolated from China, and provide the scientific evidence for MDR-tuberculosis (MDR-TB) control and prevention. Methods One hundred and twenty-six MDR isolates were selected from the first drug resistant survey in China between April 2008 and July 2008. The conventional drug susceptibility testing was used to detect the drug-resistant profiles against 2 first-line (streptomycin and ethambuol) and 7 second-line anti-tuberculosis drugs (ofloxacin, kanamycin, capreomycin, ethionamide, protionamide，cycloserine and 4-Amino-2-hydroxybenzoicacid). The drug-resistant proportion and cross resistance were analyzed. Results For first-line drugs, the drug-resistant proportions against streptomycin and ethambuol were 73.0% (92/126) and 58.7% (74/126), respectively. For second-line drugs, the percentages of the resistance to ofloxacin and ethionamide were the highest, accounting for 25.4% (32/126) and 23.0% (29/126), respectively. Then, 17.5% (22/126) and 13.5% (17/126) of MDR strains were resistant to kanamycin and cycloserine, respectively. In addition, the drug-resistant rates of capreomycin, protionamide and 4-Amino-2-hydroxybenzoicacid were all 3.2% (4/126). The drug-resistant proportions of kanamycin (χ²=20.025，P<0.01) and cysloserine (χ²=6.558，P=0.017) in new case group were significantly higher than that in re-treated case group. In addition, there were the cross-resistances between kanamycin and capreomycin, or ethionamide and protionamide. Three of four capreomycin-resistant isolates were resistant to kanamycin, and all four protionamide-resistant strains were resistant to ethionamide meanwhile. Conclusion The high prevalence of M. tuberculosis strains with the resistance to second-line anti-tuberculosis drugs, especially to ofloxacin and ethionamide in MDR-TB patients was the major challenge on the prevention and control of TB and MDR-TB in China.

National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

CHENG Jun, HE Guang-xue, CHENG Shi-ming, JIANG Shi-wen, WANG Li-xia

Chinese Journal of Antituberculosis. 2013, 35(10):  835-839. 

Abstract ( 1251 )   PDF (754KB) ( 869 )   Save

References | Related Articles | Metrics

Tuberculosis (TB) is one of the major public health problems worldwide. China has the second highest TB burden globally. In view of the current technical strategies employed in TB control and prevention in China, the implementation status was described from immunization, case detection, treatment and management and care, the problems existed in BCG protection efficiency, tuberculosis case finding strategy, diagnostic methods and capacity, treatment course and anti-tuberculosis drug, patient compliance, case management tools, the complemen-tation quality of conducting Directly Observed Treatment (DOT), policy on free tuberculosis diagnosis and treatment, health insurance level and patient care were analyzed, and practical solutions were provided as well.