Table of Content

10 January 2014, Volume 36 Issue 1

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The molecular mechanism of antituberculosis drug induced live injury

ZHANG Jun-xian，WU Xue-qiong

Chinese Journal of Antituberculosis. 2014, 36(1):  3-8.  doi:10.3969/j.issn.1000-6621.2014.01.002

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直接面视下督导化疗(DOTS)是目前结核病控制的有效策略，它主要应用4个一线抗结核药物异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）和吡嗪酰胺（PZA）联合治疗6个月或更长时间。然而，抗结核药物不良反应尤其是INH、RFP和PZA引发的肝损伤是化疗中最常见的，联合用药时肝毒性的发生率和严重程度明显增加，给结核病的化疗带来了难题。约1.00％～30.18％的患者因为严重的肝损伤而不得不更换药物或终止治疗，少数患者甚至发生肝衰竭。抗结核药物引起肝损伤（antituberculosis drug induced live injury，ATDILI）的高发生率、严重程度和可能导致的医疗纠纷引起了广大防痨工作者对该问题的重视，但其发生的机制尚未完全阐明。因此，了解抗结核药物引起肝损伤的机制，建立快速检测方法，减少ATDILI的发生势在必行。ATDILI的发生率随着人群特点、用药方案、肝毒性诊断标准、监测和报告机制不同而有很大变化，笔者着重探讨患者遗传因素与ATDILI的相关性。

Impact of other liver diseases against TB drugs-induced liver injury and its prevention

LEI Jian-ping, DENG Guo-fang, LIU Zhou

Chinese Journal of Antituberculosis. 2014, 36(1):  9-13.  doi:10.3969/j.issn.1000-6621.2014.01.003

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Objective  Study on the relationship between some foundation diseases in liver and antituberculosis drug-induced liver injury to approach the controlling and preventing measures.   Methods  For patients with other liver disease before anti-TB treatment, records the patient’s medical history and laboratory test results, development of appropriate anti-TB treatment regime to take measures to protect the liver. Assess effect of these measures in the treatment process of 1337 cases from January 2011 to December 2012. The data uses the card side examination; the measurement uses the t-test, carries on statistics analysis. P<0.05 means significance differences.   Results  Incidence of liver injury in patients with underlying disease of the liver (40.4%,116/287), was higher than patients without underlying disease (12.3%,129/1050);Merged incidence of liver injury in patients with hepatitis b (58.5%,83/142), above all of the cases (18.3%,245/1337), the differences were statistically significant respectively (χ²=16.2320, and 119.7547,P<0.01).The liver harm group B₁ group alanine aminotransferase (ALT) ≥8 times the upper limit of normal value (ULN) or (and) total bilirubin (TBIL) ≥ 4 times ULN is higher than the B₂ Group, the differences are statistically significant (χ²=7.9344, χ²=4.3033, P<0.01 or P<0.05).Group B₂ ALT, aspartate aminotransferase (AST), transformation of l-glutamine peptide enzyme (GGT), TBIL, direct bilirubin (DBIL) and indirect bilirubin (IBIL) ((173.8±197.0) IU/L,(113.3±208.6) IU/L,(74.5±73.4) IU/L,(22.3±84.9) μmol/L,(11.3±36.9) μmol/L,(10.7±25.4) μmol/L) are below B₁ ((343.4±235.4) IU/L,(270.7±246.6) IU/L,(115.5±83.5) IU/L,(84.6±102.6) μmol/L,(34.7±42.8) μmol/L,(30.5±30.7) μmol/L), and albumin (Alb) ((35.5±3.8) g/L) is higher than the B₁ Group ((32.5±3.7) g/L), the differences are statistically significant (t=3.9805,3.5226,2.6990,3.2093,3.8648,3.4089 and t′=4.0968, P-value <0.01 or <0.05).Treatment of group B₂ group interrupt rate is lower than B₁ (2/34,211/211) and the difference was statistically significant (χ²=220.2098, P<0.01).  Conclusion  The study suggests the some liver diseases can significantly increase the liver injury induced by anti-tuberculosis drugs, implementation of anti-TB treatment liver damage control measures can reduce the incidence of liver damage and reduce the rates of treatment interruption.

The relationship between genetic polymorphism of NAT2, GSTM1, and antituberculosis drug-induced liver injury

AN Hui-ru, WU Xue-qiong, WANG Zhong-yuan

Chinese Journal of Antituberculosis. 2014, 36(1):  14-20.  doi:10.3969/j.issn.1000-6621.2014.01.004

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Objective To study the relationship between the antituberculosis drug-induced liver injury （ATDILI）and genetic polymorphism of drug metabolizing emzymes (DME)，including NAT2, GSTM1, GSTT1，and to illuminate the molecular mechanism of ATDILI.  Methods Of 208 inpatients in the initial treament of tuberculosis were admitted to the department of tuberculosis research, 309th Clinical Division of Chinese PLA, Amomg these patients 101 cases were with ATDILI while the other 107 cases without ATDILI were used as control. Polymorphisms of NAT2 were determined by polymerase chain reaction-direct sequencing(PCR-DS). The deletion in GSTM1 and GSTT1 genes was determined by multiplex PCR. Genotype frequencies were compared between cases and controls byχ² test using SPSS 12.0 software,Odds ratio (OR) and 95% confidence interval(95%CI) were calculated to analyze the relationship between genotypes and ATDILI.  Results （1）There were 40 patients with slow acetylator (39.6％) in 101 cases with hepatotoxicity and 13 with slow acetylator (12.2％）in 107 controls without hepatotoxicity. Patients with slow acetylator genotype (OR＝4.74, 95%CI:2.42-9.28; χ²=20.62, P<0.05) had a significantly higher risk of antituberculosis drug-induced hepatotoxicity than those with rapid or intermediate acetylator genotypes. (2) There were 64 patients with GSTM1 null genotype(63.4％) in cases with hepatotoxicity and 55 with GSTM1 null genotype (51.4％）in controls without hepatotoxicity. The GSTM1 null genotype (OR=1.64, 95％CI=0.94-2.84,χ²=3.038，P>0.05) had higher risk of ATDILI than GSTM1 non-null genotype no statistical significance).There were 48 patients with slow acetylator (47.5％) in cases with hepatotoxicity and 49 with slow acetylator (45.8％）in controls without hepatotoxicity, (OR=1.07, 95％CI=0.62-1.85,χ²=0.063，P>0.05). (3) The patients with slow acetylator genotype of NAT2 combined with GSTM1 null genotype(OR=10.21, 95%CI=3.87-26.96，χ²=20.62，P<0.005) had higher risk of ATDILI than those only with slow acetylator genotype (OR=4.74, P=0.000) or with GSTM1 null genotype (OR=1.64, P>0.05).  Conclusion The slow acetylators of NAT2 and the GSTM1 null genotype might be associated with ATDILI.

Clinical analysis of 32 cases with anti-tuberculosis drug induced hypersensitivity

DENG Guo-fang，LEI Jian-ping，DENG Qun，WU Yu-qing

Chinese Journal of Antituberculosis. 2014, 36(1):  21-24.  doi:10.3969/j.issn.1000-6621.2014.01.005

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Objective To explore the clinical characteristics and treatment strategies of anti-tuberculosis drug induced hypersensitivity. Methods Thirty-two cases with anti-tuberculosis drug induced hypersensitivity admitted to Jiangxi chest hospital from Jun.2006 to Dec.2012 were retrospectively analyzed, according to the clinical manifestation, laboratory test and prognosis (hypersensitivity group), and compared with those other 32 patients with allergic reaction but not hypersensitivity at the same period (non-hypersensitivity group). The categorical data were analyzed using t test by the SPSS 13.0 software. P value<0.05 was considered statistically significant. Results The symptoms of hypersensitivity group were fever,skin rash,abnormal liver and kidney function,thrombocytopeni（clinic manifestation），which were present earlier than in the comparison group((18.36±7.54) d vs (25.73±5.68) d), and significant differences were found between the two groups (t=4.41, P<0.01). Hospitalization time of hypersensitivity group was longer than the non-hypersensitive group ((34.23±9.37) d vs (16.71±5.25) d), the difference was statistically significant (t=9.23, P<0.01). Liver and kidney injury of hypersensitivity group were more serious than non-hypersensitive group (TBIL (122.36±75.74) μmol/L vs (18.35±7.16) μmol/L,DBIL (57.43±11.29) μmol/L vs (8.78±3.42) μmol/L,ALT (389.55±68.46) U/L vs (40.21±22.57) U/L,AST (294.81±53.72) U/L vs (38.77±14.86)U/L,CRE (155.27±86.43) μmol/L vs (89.12±29.37)μmol/L,BUN (9.39±6.72) mmol/L vs (5.28±1.75) mmol/L), significant differences were revealed between the two groups (t=7.73,23.40,27.39,25.99,4.09,3.34 respectively, P<0.01). Platelet count were lower in hypersensitivity group ((31.35±12.82)×10⁹/L vs (153.48±64.11)×10⁹/L), the difference between two groups was also significant (t=10.56，P<0.01).  Conclusion The anti-tuberculosis drug induced hypersensitivity is characterised by rapid onset, severe allergic reactions, multi-organ dysfunction and risk of mortality.Therefore， more attention should be paid to the hypersensitivity by TB medical staffs.

Trends of drug-resistant tuberculosis in Shanghai from 2007 to 2012

LI Jing, ZHANG Yang-yi, WU Jie, JIANG Yuan, WANG Li-li, YU Chen-lei, SHEN Xin

Chinese Journal of Antituberculosis. 2014, 36(1):  25-30.  doi:10.3969/j.issn.1000-6621.2014.01.006

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Objective To analyze the status and epidemic trend of anti-tuberculosis (TB) drug resistance in Shanghai from 2007—2012.  Methods 12221 new registered and sputum culture-positive cases in Shanghai during 2007—2012 were enrolled. Isolates obtained from each case were tested for susceptibility to first-line anti-TB drugs (INH, RFP, S and EMB) and species identification. The drug susceptibility testing result and demographic data of 10979 tuberculosis strains were used to analyze the status and trend of anti-TB drug resistance. Logistic regression model was used to determine the risk factors of drug resistance and multidrug-resistance.  Results The overall drug resistance rate was 23.0% (2522/10979), the total multidrug-resistance rate was 5.3% (587/10979), the initial drug and multidrug-resistance rate were 20.4% (1981/9702) and 3.4% (328/9702), and the acquired drug and multidrug-resistance rate were 42.4% (541/1277) and 20.3% (259/1277), respectively. There was no significant increase in total drug resistance (χ²=2.38, P>0.05), acquired drug resistance (χ²=0.23, P>0.05), total multidrug-resistance (χ²=0.33, P>0.05), initial multidrug-resistance (χ²=1.67, P>0.05) and acquired multidrug-resistance (χ²=0.48, P>0.05) in recent 6 years. The initial drug resistance rate significantly increased during 2007—2012 (χ²=9.02, P<0.05). The multivariate logistic regression analysis showed that the history of previous treatment for TB (OR=3.080, 95%CI＝2.717-3.492, P<0.05 and OR=7.781, 95%CI＝6.481-9.341, P<0.05) and age(41~≤60) (OR=1.270, 95%CI＝1.045-1.544, P<0.05 and OR=1.669, 95%CI＝1.064-2.620, P<0.05) were significantly associated with any drug and multidrug-resistance.  Conclusion There was no significant increase in total drug resistance rate and total multidrug-resistance rate. The history of previous treatment for TB is significantly associated with any drug and multidrug-resistance.

Effectiveness evaluation of the global fund program to fight tuberculosis aimed at floating population in  Xuhui  district in Shanghai

YANG Mei-xia, LI Shen-sheng, WANG Ke-li, ZHOU Ying, ZHANG Yi, XU Xiang, WANG Juan, JIANG Jing,ZHOU Yi-biao

Chinese Journal of Antituberculosis. 2014, 36(1):  31-36.  doi:10.3969/j.issn.1000-6621.2014.01.007

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Objective To evaluate the effectiveness of the fifth round of the global fund (GF) program to fight tuberculosis (TB) aimed at floating population in Xuhui district in Shanghai from October 1st, 2007 to June 30th, 2010.  Methods The situation of referral and tracing of the TB suspects in floating population, the treatment outcomes and management of TB cases in floating population before and after the program were compared. The key indicators on TB control by the increasing proportion of fixed base ratio and chain ratio before October 1st, 2007 i.e. the fund conduct one year with the key indicators after the fund conduct 2 years and 9 months （total for 33 months） from October 1st, 2007 to June 30th, 2010 (the program executing years were divided into 3 stages, i.e. stage Ⅰ, the first year of stage Ⅱ, the second year of stage Ⅱ) were compared as well. These indicators included the number of the registration of TB suspects, overall arrival rate, sputum negative conversion rate of new smear positive cases at 2 months of treatment, cure rate of new smear positive patients, treatment completion rate of active patients. The management situation of the cross-regional patients was also analyzed.  Results The annual increasing proportion of fixed base ratio of the key indicators increased obviously in stage Ⅰ, the first year of stage Ⅱ and the second year of stage Ⅱ. Those of the number of the registration of TB suspects were 12.29%((813－724)/724), 48.20%((1073－724）/724) and 59.81%((1157－724)/724). Those of overall arrival rate were 3.58%((91.14－87.99)/87.99), 2.45%((90.15－87.99)/87.99) and 7.96%((94.99－87.99)/87.99). The increasing proportion of fixed base ratio of sputum negative conversion rate of new smear positive cases at 2 months of treatment were 43.71%((82.46－57.38)/57.38), 55.93%((89.47－57.38)/57.38) and 49.37%((85.71－57.38)/57.38). Those of cure rate of new smear-positive patients were 31.10%((85.96－65.57)/65.57］), 48.50%((97.37－65.57)/65.57)and 48.15%((97.14－65.57)/65.57). Those of treatment completion rate of active patients were 30.18％((90.32－69.38)/69.38), 40.56%((97.52－69.38)/69.38)and 40.31%((97.35－69.38)/69.38)).  Conclusion Effectiveness of the global fund program to fight tuberculosis for the floating population was obvious. The execution of GF project has not only benefited the floating population, but also effectively improved the routine and overall level of TB control and management in Xuhui district.

Analysis on referral and arrival situation and diagnosis of pulmonary tuberculosis patients or suspicious tuberculosis patients reported by non-TB control institutions in Chifeng city through internet-based reporting system from 2009 to 2012

TIAN Fu-yuan，LIU Yan-mei， LIU Jian-xue，HU Wei，FU Shon-jun

Chinese Journal of Antituberculosis. 2014, 36(1):  37-40.  doi:10.3969/j.issn.1000-6621.2014.01.008

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Objective To understand the status of referral and arrival and diagnosis of pulmonary tuberculosis (PTB) patients or suspicious TB patients reported by internet-based reporting system by non-TB control institutions of Chifeng city from 2009 to 2012 in order to improve case detection.  Methods The referral, tracing and checking report forms of 10 812 PTB patients reported by non-TB control institutions in tuberculosis management information system of Chifeng from 2009 to 2012 was used. The referral arrival rate, tracing arrival rate, total arrival rate, detection rate and the contribution rate on TB case detection by non-TB institutions of 7981 cases referred was analyzed.  Results For the patients reported through internet-based reporting system by non-TB control institutions of Chifeng from 2009 to 2012, the referral arrival rate was 34.1%（648/1900）, 30.4%（613/2017）, 32.0%（632/1976） and 33.4%（698/2088） respectively. The tracing arrival rate was 85.5%（1071/1252）, 95.8%（1345/1404）, 95.8%（1288/1344） and 94.2%（1310/1390）. The total arrival rate was 91.3%（1734/1900）, 97.4%（1965/2017）, 97.4%（1924/1976） and 96.6%（2017/2088） respectively. Among arrival patients, the detection rate of active PTB was 59.7%（4563/7640） and that of smear positive PTB was 24.0%（1833/7640）. The contribution rate on active PTB case detection by non-TB institutions was 29.0%（4563/15 736） and on smear positive PTB was 27.7%（1833/6625）.  Conclusion The referral arrival rate had large room for improvement in Chifeng city, the tracing arrival rate and the total arrival rate maintained at a high level.

Analysis of clinical effect of alternate day therapy with fixed-dose combinations of anti-tuberculosis drugs

ZHANG Yan，ZHANG Jin-guo，FANG Deng-lou，ZHANG Yong-qiang，ZHANG Bao-zong

Chinese Journal of Antituberculosis. 2014, 36(1):  41-45.  doi:10.3969/j.issn.1000-6621.2014.01.009

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Objective To evaluate the clinical effect of alternate day therapy with domestic fixed-dose combinations (FDC) of anti-tuberculosis drugs, and to provide the reference for the popularization and application of alternate day therapy with anti-tuberculosis FDC.  Methods According to the principle of the pilot study (the counties of pilot group and control group had similar landform, population, the overall economic status, equipment and staff level of tuberculosis (TB) control institute), 1225 new pulmonary TB cases in 12 counties of Baoding were enrolled in “alternate day therapy with anti-TB FDC pilot group” (referred to as “FDC group”), and 1225 new pulmonary TB cases located in the other 11 counties of Baoding were enrolled in “anti-TB drugs blister pack drug group” (referred to as“blister pack group”), who were sampled by probability proportional to size(PPS) method among 2328 cases. The completion rates of clinical treatment, the sputum negative conversion rates after 2, 3, 6 months treatment, X-ray change of shadow and cavity at the end of treatment, and the adverse reactions of the two group were observed and compared. Chi-square test was used for categorical data, 0.05 was set as the criteria of statistical significance. Results Treatment completion rate was 94.53% (1158/1225) in FDC group and 90.94% (1114/1225) in blister pack group, and there was significant difference between two groups (χ²=11.73, P<0.01). The sputum negative conversion rates after 2, 3, 6 months treatment were 91.29% (262/287), 94.08% (270/287) and 97.56% (280/287) in FDC group, and were 89.05% (244/274), 93.07% (255/274) and 96.72% (265/274) in blister pack group, the differences between the two groups had no statistical significance (χ²=0.79, 0.24, 0.36, P>0.05). The effective absorption rate of shadow and cavity improvement rate in chest X-ray films at the end of treatment were 93.06% (845/908) and 89.60% (181/202) in FDC group, and were 91.99% (781/849) and 88.95% (169/190) in blister pack group, the difference between the two groups had no statistical significance (χ²=0.73, 0.04, P>0.05). The total rate of adverse reaction was 21.35%(237/1110) in FDC group and 22.62% (235/1039) in blister pack group, no significant difference was observed (χ²=0.50, P<0.05). There was no significant difference of abnormal blood routine, abnormal liver function and renal dysfunction between FDC group and blister pack group (χ²=1.16, 0.00, 0.21, P>0.05). Conclusion FDC shows similar efficacy in the treatment of TB as blister pack drug, and can improve the treatment completion rate, which can be used as replacement of traditional blister pack drugs.

Analysis of various osteoarticular tuberculosis specimen types with positive mycobacterial culture and positive TB-PCR results

DONG Wei-jie, QIN Shi-bing, ZHAO Li-ping, FU Yu-hong, HUANG Hai-rong

Chinese Journal of Antituberculosis. 2014, 36(1):  46-48.  doi:10.3969/j.issn.1000-6621.2014.01.010

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Objective To compare the positive culture rate in 4 specimen types, including abscess, caseation, granulation tissues and necrotic bone from osteoarticular tuberculosis patients and to analyze the combined positive rate of BACTEC MGIT 960 Mycobacterial Detection (MGIT 960), Lowenstein-Jensen (L-J) culture and TB-PCR testing. Methods Fifty patients who diagnosed osteoarticular tuberculosis by pathological examination were admitted to Beijing Chest Hospital affiliated to Capital Medical University from June 2011 to May 2012. Specimens(50 cases of abscess, 42 cases of caseation, 48 cases of granulation and 43 cases of necrotic bone) were collected during surgery from those patients. All of the 4 specimen types were cultured by both MGIT 960 and L-J medium. The abscess specimen was also detected by PCR testing. Results The positive culture rates of abscess, caseation, granulation tissues and necrotic bone by MGIT 960 were 40.0%（20/50）, 33.3%（14/42）, 33.3%（16/48）and 41.9%（18/43）respectively, while which was 20.0%（10/50）, 14.3%（6/42）, 20.8%（10/48）and 16.3%（7/43）by L-J culture. The positive rate of abscess detected by PCR was 48.0%（24/50). The positive rate combined with the two methods of Mycobacterium tuberculosis culture was 50.0%(25/50),which was raised to 68.0%(34/50) when the PCR testing was also combined. Conclusion In order to increase the positive culture rate, a variety of specimens should be selected from the osteoarticular tuberculosis patients. MGIT 960 culture can be used as the preferred method of bacteriological diagnosis. The positive rate of detection can be further enhanced by the combined utilization of MGIT 960, Lowenstein-Jensen medium and PCR testing.

Analysis of the drug-resistant status and risk factors of 4721 cases of hospitalized tuberculosis patients

DANG Li-yun, WEI Xiang-lan, FANG Ru-tang, PANG Jian-jian, ZHANG Zeng-xian, WANG Long-zhi, LIU Ye

Chinese Journal of Antituberculosis. 2014, 36(1):  49-54.  doi:10.3969/j.issn.1000-6621.2014.01.011

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Objective  To analyze the situation and risk factors of drug resistance(DR) of Mycobacterium tuberculosis (Mtb) among patients in Xi’an Tuberculosis and Thoracic Tumor Hospital retrospectively. Methods  From January 2008 to December 2012, a total of 4721 sputum culture positive patients visited the Xi’an Tuberculosis and Thoracic Tumor Hospital. Among these patients, 4238 (89.77%) were new patients and 483 (10.23%) were retreatment patients. We analyzed the drug susceptibility situation of their clinically isolated strains for 4 kinds of first line anti-TB drugs, namely streptomycin (S)、isoniazid (H)、rifampin (R)、ethambutol (E). The drug susceptibility test was carried out by absolute concentration method. Database were established using Excel. Statistical analysis was performed with SPSS 16.0 statistical software. Differences among groups were compared withχ² test. And the risk factors of total DR and multidrug-resistance (MDR) were also analyzed with Logistic regression analysis. P＜0.05 was considered statistically significance. Results  Among the 4721 sputum culture positive patients, the total DR rate, initial DR rate and acquired DR rate were 31.71% (149/4721), 27.35% (1159/4238) and 69.98% (338/483) respectively; the total MDR rate, initial MDR rate and acquired MDR rate were 12.20% (576/4721), 7.74% (328/4238) and 51.35% (248/483). The DR rates of the 4 kinds of first line anti-TB drugs were H (23.85%,1126/4721)、S (21.75%,1027/4721)、R(12.86%, 607/4721)、E(6.93%, 327/4721). In terms of resistance pattern, the majority were single-drug resistant (12.71%, 600/4721) and two kinds drug resistant (9.53%, 450/4721). DR and MDR rate of 20- and 40- were 31.13%,11.13% and 39.86%,18.65%, compared with <20 years, χ² values were 12.67,11.31 and 43.20,38.28, P value <0.05, OR value (95%CI) was 1.4（1.1-1.7）,1.4（1.0-2.1）and 2.2（1.7-2.8）,3.2（2.2-4.6）; DR and MDR rate of retreatment were 69.98% and 51.35%, compared with initial, χ² values were 274.48 and 715.3, P<0.05,OR values (95%CI) were 5.9（4.9-7.4）,13.7（10.9-17.2）; MDR of no DOTS was 11.29%,χ² values were 11.63, P<0.05,OR value (95%CI) were 1.4（1.1-1.6）.  Conclusion  The DR rate of Mtb in Xi’an Tuberculosis and Thoracic Tumor Hospital was relatively high. The patients from 20 to ＜60 were more likely to have DR and MDR and those who hadn’t received the DOTS strategies were more likely to have MDR.

The clinical analysis of the hospitalized elderly patients died from tuberculosis

CHEN Hong-mei, WU Xiao-guang, MA Li-ping, GAO Meng-qiu, HUANG Mai-ling, LIU Rong-mei, ZHANG Li-qun

Chinese Journal of Antituberculosis. 2014, 36(1):  55-58.  doi:10.3969/j.issn.1000-6621.2014.01.012

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Objective To analyze the clinical features of hospitalized elderly patients died from tuberculosis. Methods The information was collected in 163 inpatients died from tuberculosis admitted in Beijing Chest Hospital affiliated to Capital Medical University from Jan. 2008 to Dec.2012. Of 132 cases were males and 31 cases were females. The ratio of male and female was 4.26∶1. The average age was (78.09±7.285) years old in all patients, (78.73±7.095) years old in male and (75.39±7.579) years old in female, respectively. The nutritional status,radiographic characteristics, laboratory examination including sputum results, the cause of death and the other clinical data were retrospectively analyzed. Results Laboratory tests showed anemia in 133 cases (81.60%，133/163). Most patients suffered from hypoalbuminemia and lymphocytopenia(95.09%,155/163). Of 110 cases were smear positive (70.96%,110/155) and 28 cases were smear negative (18.06%,28/155).Lesions scattered more than 4 lung fields in 79 cases(48.47%,79/163). The main causes associated death were chronic function failure of the heart and lung（28.83%,47/163）, multiple organ failure (20.86%,34/163) and pathological deterioration in lung disease(16.56%,27/163）. Conclusion The elderly patients died from tuberculosis is associated with malnutrition, multiple organ failure and lung disease exacerbations.

Progress in TB preventive therapy

LIU Er-yong, CHENG Shi-ming, LAI Yu-ji, WANG Dong-mei, LI Tao, WANG Li-ming, WANG Ni, XU Xiao-yu, ZHOU Lin

Chinese Journal of Antituberculosis. 2014, 36(1):  59-63.  doi:10.3969/j.issn.1000-6621.2014.01.013

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The effective diagnosis and treatment of latent tuberculosis infection is one of the most important measures for TB prevention and control. The author reviewed the current published literature on tuberculosis preventive therapy and summarized the treatment regimens. This would be of great value for the TB health workers to select the appropriate treatment regimen for patients.

Malnutrition is the risk factor for anti-tuberculosis drugs liver damage

TAN Shou-yong, QIN Hong-juan, LI Yan-qiong

Chinese Journal of Antituberculosis. 2014, 36(1):  64-66.  doi:10.3969/j.issn.1000-6621.2014.01.014

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Tuberculosis is a contagious disease related to malnutrition. Malnutrition can affect synthesis of serum albumin in liver, and also induce or exacerbate drug-induced liver injury. Under the conditions of malnutrition, drug-induced liver injury caused by anti-tuberculosis drugs may lead to hepatic perfusion disorders, reduce the hepatic blood flow and the clearance of drugs, and exacerbate this disease. Therefore, during the treatment for patients with tuberculosis combined with malnutrition, anti-tuberculosis treatment and improvement the nutritional status, should be implemented actively. Improvement of the nutritional status in patients with tuberculosis is very important to reduce drug-induced liver injury and to guarantee anti-tuberculosis treatment performed smoothly.