Table of Content

10 March 2014, Volume 36 Issue 3

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Emphasis on tuberculosis image analysis and imaging technology

ZHOU Xin-hua

Chinese Journal of Antituberculosis. 2014, 36(3):  145-148.  doi:10.3969/j.issn.1000-6621.2014.03.001

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Analysis on characteristics of CT imaging for local pulmonary consolidation lesions

ZHOU Zhen，Lv Yan，XIE Ru-ming，ZHOU Xin-hua，HE Wei，XU Jin-ping

Chinese Journal of Antituberculosis. 2014, 36(3):  149-154.  doi:10.3969/j.issn.1000-6621.2014.03.002

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Objective To improve diagnosis and differential diagnosis of local pulmonary consolidation lesions with CT imaging characteristics analysis. Methods We analyzed retrospectively CT imaging characteristics of local pulmonary consolidation in patients who admitted in Beijing Chest Hospital from Jan. 2009 to Dec. 2013. All patients were diagnosed definitely with CT guided percutaneous biopsy pathology. Data were analyzed statistically with Chi-square test.  Results （1）Lesions distribution: lesions distribution presented multiple pulmonary segments and solitary pulmonary segment. There were 22 cases（22/36） with pulmonary tuberculosis, 5 cases（5/20） with lung cancer, 5 cases（5/8） with pulmonary lymphoma, 9 cases（9/15） with pneumonomycosis and 2 cases（2/17） with organizing pneumonia in multiple pulmonary segments distribution. However, there were 14（14/36）, 15（15/20）, 3（3/8）, 6（6/15） and 15 cases（15/17） with the different corresponding diseases in solitary pulmonary segment distribution. The difference was significant statistically（χ²＝16.961，P<0.01）. Further analysis showed that the difference was from the statistic significant difference between pulmonary tuberculosis and organizing pneumonia（χ²＝11.348，P<0.005）.（2） Lesions morphology: lesions morphology was divided into segmental consolidation and subsegmental consolidation. There were 30 cases（30/36） with pulmonary tuberculosis, 9 cases（9/20） with lung cancer, 5 cases（5/8） with pulmonary lymphoma, 5 cases（5/15） with pneumonomycosis and 5 cases（5/17） with organizing pneumonia with the segmental consolidation. Meanwhile, there were 6（6/36）, 11（11/20）, 3（3/8）, 10（10/15） and 12 cases（12/17） in the different corresponding diseases with the subsegmental consolidation. The difference was significant statistically（χ²＝20.062，P<0.01）. Further analysis showed that the differences were statistic significant when compared pulmonary tuberculosis with lung cancer, pneumonomycosis and organizing pneumonia, respectively（χ²＝8.936, 12.295 and 14.970，all P values were less than 0.005）. （3）Air bronchogram in main lesion: there were 31 cases（31/36） with pulmonary tuberculosis, 12 cases（12/20） with lung cancer, 7 cases（7/8） with pulmonary lymphoma, 12 cases（12/15） with pneumonomycosis and 5 cases（5/17） with organizing pneumonia with air bronchogram in main lesions, the difference was significant statistically（χ²＝20.536，P<0.01）. Further analysis showed that the differences were statistic significant when compared organizing pneumonia with pulmonary tuberculosis and pneumonomycosis, respectively（χ²＝17.039 and 8.189，all P values were less than 0.005）.（4）Lesion enhancement: there were 22 cases（22/36） with pulmonary tuberculosis, 20 cases（20/20） with lung cancer, 8 cases（8/8） with pulmonary lymphoma, 12 cases（12/15） with pneumonomycosis and 14 cases（14/17） with organizing pneumonia with lesion enhancement. The difference was significant statistically between cases with lesion enhancement and without lesion enhancement（χ²＝14.595，P<0.01）. Compared pulmonary tuberculosis with lung cancer, the difference was statistic significant（χ²＝10.370，P<0.005）. （5）Satellite lesions: the satellite lesions were presented among 34 cases（34/36） with pulmonary tuberculosis, 2 cases（2/20） with lung cancer, 6 cases（6/8） with pulmonary lymphoma, 15 cases（15/15） with pneumonomycosis and 11 cases（11/17） with organizing pneumonia. The difference was significant between cases presented with satellite lesions or not（χ²＝12.067，P<0.01）. Compared lung cancer with pulmonary tuberculosis and organizing pneumonia, the difference was statistic significant, respectively（χ²＝39.933 and 7.968, all P values were less than 0.005）. （6）Diagnostic accordance rate between CT imaging and pathology: compared CT imaging diagnosis with CT guided percutaneous biopsy pathology, the diagnostic accordance rate ranged from 50.0% to 80.6% among these diseases.  Conclusion The characteristics of CT imaging with lesion distribution, morphology, air bronchogram, satellite lesion and lesion enhancement will contribute to certain value for diagnosis and differential diagnosis of local pulmonary consolidation lesions.

Analysis on imaging features in 84 cases with cervical tuberculosis

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

Chinese Journal of Antituberculosis. 2014, 36(3):  155-160.  doi:10.3969/j.issn.1000-6621.2014.03.001

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Objective To analyze the imaging features of cervical tuberculosis and provide references for its diagnosis and treatment.  Methods A retrospective analysis of 84 cases of cervical tuberculosis patients’ X-ray, CT and MRI, admitted from January 2002 to December 2012 was conducted. The number of vertebral body involvement by tuberculosis, distribution, the changes of vertebra body and of intervertebral space of the involved vertebra body were analyzed, as well as the changes of spinal canal and paraspinal soft tissue. The value of Cobb angle was measured if the kyphosis angular deformity existed. Pearson correlation analysis was used to analyze the correlation between Cobb angle and the vertebral bony defect height and the course. P<0.05 was set as the criteria of statistical significance.  Results Of 84 cases of cervical tuberculosis, there was 1 case (1.2%, 1/84) involving single vertebral body, 63 cases (75.0%, 63/84)involving two vertebral bodies, and 20 cases (23.8%, 20/84) involving more than three vertebral bodies. There were 13 cases (15.5%, 13/84) accompanied involving the attachments, and no attachments involvement alone. The cervical physiological curvature of all cases was changed. There were 64 cases (76.2%, 64/84) with varying degrees reduction of cervical physiological curvature, and 20 cases (23.8%, 20/84) with varying degrees of kyphosis of cervical or cervicothoracic vertebra. The Cobb’s angle ranged from 12° to 82°, with an average of (29.0±19.6)°. The Cobb’s angle was significantly correlated with the vertebral bony defect height and the course (correlation coefficient r was 0.752 to 0.962, P<0.01, with statistical significance). There were 76 cases (90.5%, 76/84) with varying degrees vertebral bone destruction, and 8 cases (9.5%, 8/84) showed no bone destruction with only MRI signal changed. There were 72 cases (85.7%, 72/84) with varying degrees stenosis of the vertebral gap, and 12 cases (14.3%, 12/84) showed no stenosis. There were 39 cases (57.4%, 39/68) with spinal canal deformation with dural sac and nerve root compression, and 23 cases (27.4%, 23/84) with paralysis symptoms. There were 12 cases of cervicothoracic vertebra lesion (C₇-T₁), which accounted for 52.2% (12/23). There were 76 cases (90.5%, 76/84) with paraspinal soft tissue swelling, in which there were 28 cases (36.8%, 28/76) with only paraspinal soft tissue swelling and 48 cases (63.2%, 48/76) with paraspinal soft tissue swelling and abscess.  Conclusion Imaging examination is significantly important for the diagnosis of cervical vertebra tuberculosis. It contributes to define the range and degree of disease invasion and to understand the configuration change of cervical vertebra, and to guide the clinical treatment planning.

MRI features of spinal tuberculosis：a study of 193 cases

NING Feng-gang, ZHAO Ze-gang, ZHOU Xin-hua, XIE Ru-ming, Lv Yan,HE Wei

Chinese Journal of Antituberculosis. 2014, 36(3):  161-165.  doi:10.3969/j.issn.1000-6621.2014.03.004

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Objective To analyze the MRI features of 193 patients with spinal tuberculosis，and to investigate the role of MRI in spinal tuberculosis． Methods One hundred and ninety-three patients diagnosed spinal tuberculosis by histopathology or bacteriology examination were admitted to Beijing Chest Hospital affiliated to Capital Medical University from September 2009 to May 2013 （male:113,female:80;age:5-87 years old,average age(47±15.1)years old）. The following parameters were assessed by MRI: the presence of vertebral body involvement， discs involvement，paravertebral abscess and displacement of the dural sac and spinal cord． Results Accor-ding to MRI images,a total of 525 vertebrae involvement were involved in the 193 patients，lumbar vertebrae involved alone(49.2%,95/193)was the most common,followed by the thoracic vertebrae involved alone（28.0%,54/193）, thoracolumbar vertebrae and lumbosacral vertebrae involved were seen in 13 cases each(6.7%，13/193;6.7%，13/193）,cervical vertebrae involved in 8 cases（4.1%，8/193）and cervico thoracic vertebrae was involved in 4 cases（2.1%，4/193）;the range of lesion vertebrae was from 1 to 9, 2 vertebrae involved was seen in 114 cases(59.1%). Analysis of MRI findings in 189 cases(97.9%,189/193) showed vertebral body deformation，and disc destruction was shown in 172 cases(89.1%,172/193) paravertebral abscess was noted in 182 cases(94.3%,182/193)． Dural sac and spinal cord compression were present in 138 cases(71.5%,138/193)，and 7 cases(3.6%,7/193)showed high signal intensity in the spinal cord on T2WI． Conclusion MRI images could detect several features of spinal tuberculosis including destruction of vertebrae，signal changes of intervertebral disc and the scope of paravertebral abscess．Meanwhile，it can show the compression of dural sac and displacement of spinal cord．It is of important value in diagnosis and treatment of spinal tuberculosis．

The value of multi-slice spiral CT image post-processing technique in diagnosis of bronchial tuberculosis

ZHANG Xu，HOU Dai-lun，QU Hui-fang，LIU Cheng

Chinese Journal of Antituberculosis. 2014, 36(3):  166-170.  doi:10.3969/j.issn.1000-6621.2014.03.005

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Objective To explore the value of multi-slice CT post-processing technique in diagnosis of bronchial tuberculosis, comparative analysis of the results of virtual bronchoscopy and bronchoscopy. Methods From October 1, 2011 to October 31, 2012, multi-slice spiral CT images were performed in 100 adult bronchial tuberculosis patients confirmed by the bacteriological examination and bronchoscopy．After lung spiral CT scanning, all original images were transferred to workstation for image post-processing．The best depictive MPR, VR, VE images were acquired to observe all the image characteristics（stenosis and wall thickening） of the bronchial branches and bronchial stenosis and bronchial wall ulcers, congestion, proliferation of granulation. Original axial images are the control group and post-processing images are the experimental group. Statistical analysis used SPSS 19.0. Results The rates of multi-planar reconstruction images corresponding to the stricture and abnormal thickening of the bronchus was 98.0%(98/100), 90.0%(90/100), the rates of original image corresponding to the stricture of bronchus was 69.0%(69/100), 56.0%(56/100). There was significant difference between two groups(χ²=6.67, P＜0.05). The rates of fibreoptic bronchoscopy images corresponding to the stricture and pathology change of the bronchus was 77.0%(77/100), 75.0%(75/100), the rates of CT virtual endoscopy images corresponding to the stricture and pathology change of the bronchus was 73.0%(73/100), 62.0%(62/100). No significant difference between the two groups(χ²=0.334, P＞0.05). Conclusion Images of multi-slice spiral CT could accurately demonstrate the bronchial tuberculosis，and provide scientific and objective foundation for early detection and the formulation of clinical treatment programs.

Characteristic analysis of atypical HRCT findings in 33 patients with pulmonary tuberculosis

XIE Ru-ming, Lv Yan, ZHOU Zhen, HE Wei, ZHOU Xin-hua

Chinese Journal of Antituberculosis. 2014, 36(3):  171-175.  doi:10.3969/j.issn.1000-6621.2014.03.006

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Objective To analyze the characteristics of atypical high resolution computered tomography (HRCT) findings in patients with pulmonary tuberculosis (TB), and to improve the diagnostic accuracy. Methods A retrospective investigation was conducted. The imaging characteristics of 33 pulmonary TB patients with atypical HRCT findings were analyzed and compared with the HRCT imagings of 50 patients with peripheral lung cancer, 33 patients with invasive lung cancer and 62 patients with nonspecific inflammation (including 33 patients with spherical pneumonia and 29 patients with patchy shadow) respectively. Pulmonary TB cases and non-TB cases (i.e. control group) were divided into 2 sub-groups respectively according to the form of lesions, and then the characteristics of CT imaging of the patients in different groups were compared. A Chi-square test was used to analyze the difference of imaging characteristic between different groups, P<0.01 was regarded as statistically significant.  Results Among 33 TB cases with atypical CT findings, one of the sub-groups (Group 1) contained 15 cases who were confirmed to have tuberculoma. Of which, the CT findings in 9 cases (60.0%, 9/15) showed one or more small, patchy and low-density areas in the lesions and boundaries were vague; the contrast-enhanced CT scanning showed that uneven enhancement appeared in most of patients with tuberculoma (66.7%, 10/15) while even enhancement appeared in most of patients with spherical pneumonia (75.8%, 25/33) and patients with peripheral lung cancer (66.0%, 33/50). The added value range of CT in 10 cases with tuberculoma was between 16-20 HU while the added value was more than 21 HU in 31 cases with spherical pneumonia and 42 cases with peripheral lung can-cer. The added value of CT in patients with tuberculoma was significantly lower than those in spherical pneumonia patients (χ²=20.202, P<0.01) and peripheral lung cancer patients (χ²=20.872, P<0.01). In the other sub-group (Group 2), which contained 18 TB cases whose CT findings showed uniform lesions, more or less slightly lower density areas were seen in lesions of only 2 cases (11.1%, 2/18). The CT findings in TB cases were no significant difference with the findings in patients with spherical pneumonia (2/29) and peripheral lung cancer (0/33); among 12 pulmonary TB cases who received the contrast-enhanced CT scanning, 10 cases (83.3%) showed uneven enhancement with more or less small, patchy and low-density areas in lesions and boundaries were vague while the small and patchy necrosis with vague boundary appeared in only 2 cases (10.5%, 2/19) with pneumonia, and no necrotic area appeared in patients with lung cancer. The features of contrast-enhanced CT scanning in patients with TB and patients with pneumonia, patients with lung cancer were significantly different (χ²=16.433 and 27.692, both P<0.001).  Conclusion Atypical CT findings of pulmonary TB are various, some characteristics of the CT findings may have certain of value for diagnosis, such as patchy opacities and spherical lesions, uneven density and moderate enhancement. For the patients who are difficult to be confirmed diagnosis by CT, their clinical manifestations should be considered and biopsy may be needed too.

Evaluation of dual-input CT perfusion in diagnosis of systemic artery-pulmonary artery fistula among TB patients with massive hemoptysis

AO Guo-kun, YUAN Xiao-dong, QUAN Chang-bin, QU Hai-xian, MA Ze-peng

Chinese Journal of Antituberculosis. 2014, 36(3):  176-179.  doi:10.3969/j.issn.1000-6621.2014.03.007

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Objective By comparing with digital subtract angiography (DSA), to prospectively evaluate the value of dual-input CT perfusion (DI-CTP) technique in detecting systemic artery-pulmonary artery fistula among patients with massive hemoptysis due to pulmonary tuberculosis (TB).   Methods Twelve pulmonary TB patients with massive hemoptysis underwent dual-input lung perfusion CT examination before DSA was performed. The parameters of DI-CTP at every segment of lung were recorded. And then, DSA results was used as a golden standard and the receiver-operating characteristic (ROC) curve analysis was performed to evaluate the effectiveness of DI-CTP technique in detecting systemic arterial-pulmonary arterial fistula and to determine the optimal perfusion para-meters (including pulmonary flow, PF; bronchial flow, BF and perfusion index, PI) with the corresponding diagnostic threshold, sensitivity and specificity.   Results A total of 216 lung segments were measured in 12 patients. Among them, 70 segments were confirmed to be positive (i.e. systemic artery-pulmonary artery fistula was made) by DSA while 146 segments were negative. The areas under ROC curves for PF, BF and PI were 0.697, 0.138 and 0.941 respectively; thus the area under ROC curve for PI was largest (P<0.001). So the PI was the optimum parameter and its diagnostic threshold was 96.25 with 88.00% sensitivity and 87.00% specificity.  Conclusion DI-CTP is valuable in detecting systemic artery-pulmonary artery fistula among pulmonary TB patients with hemoptysis, and can be used as a screening method before embolotherapy with DSA.

Value of endobronchial ultrasound-guided transbronchial needle aspiration in early diagnosis of mediastinal tuberculous lymphadenopathy

SUN Wen-wen，WU Fu-rong，XIAO He-ping，YAN Li-ping

Chinese Journal of Antituberculosis. 2014, 36(3):  180-183.  doi:10.3969/j.issn.1000-6621.2014.03.008

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Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in early diagnosis of patients with mediastinal tuberculous lymphadenopathy. Methods Eighty-seven patients, who were considered to have mediastinal tuberculous lymphadenopathy based on clinical indications and imaging, but with normal fiber bronchoscope examination results, were recruited in Shanghai Pulmonary Hospital from Jan 2010 to Dec 2012. All enrolled patients underwent EBUS-TBNA, and then samples obtained by EBUS-TBNA were performed pathological examination, smear, culture and PCR, drug susceptibility testing (DST) was performed for all patients with culture-positive. Patients who had negative results with all above mentioned examinations, a standardized diagnostic chemotherapy with 4 first-line anti-TB drugs was given for 3 months; if no improvement on imaging during 3 months, mediastinoscopy was carried out. Software SPSS 13.0 was used for data analysis. Results Sixty-six patients were diagnosed with TB using the samples obtained by EBUS-TBNA: pathological findings were consistent with TB in 38 patients (57.58%, 38/66), microbiological investigations yielded a positive culture of TB and/or positive smear in 21 patients (31.82%, 21/66; identified 3 drug-resistant cases), as well as a positive PCR in 40 patients (60.61%, 40/66); 1 patients was identified as non-tuberculosis mycobacteria (NTM); 5 patients were diagnosed with cancer; 2 patients were diagnosed with sarcoidosis. Thirteen patients did not have a specific diagnosis following EBUS-TBNA: 7 patients underwent mediastinoscopy and TB was confirmed in one, lymphoma was confirmed in 3 and cancer was confirmed in 3; 6 patients who responded to empirical anti-TB treatment were diagnosed with TB. A total of 73 patients were diagnosed as TB in this research and 66 of them (90.41%, 66/73) were diagnosed by EBUS-TBNA. Conclusion EBUS-TBNA may be useful in early diagnosis of mediastinal tuberculous lymphadenopathy, especially to drug-resistant TB. The use of PCR can be helpful for the diagnosis of TB.

A retrospective analysis of QIJIALIFEIJIAONANG in treatment of new pulmonary tuberculosis as adjuvant therapy

FANG- Yong，XIAO He-ping，ZHOU Qin-qi，WU Ya-qin，WANG Li-ting

Chinese Journal of Antituberculosis. 2014, 36(3):  184-188.  doi:10.3969/j.issn.1000-6621.2014.03.009

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Objective To analyze the clinical effect of Chinese medicine QIJIALIFEIJIAONANG in treatment of new pulmonary tuberculosis (PTB) as adjuvant therapy retrospectively.  Methods One hundred and twenty-eight new PTB patients who received standard treatment regimen of 2S(E)HRZ/4HR and QIJIALIFEIJIAONANG as adjuvant therapy in Shanghai Pulmonary Hospital from July 2012 to July 2013 were enrolled as the treatment group, and 112 cases of new PTB patients only treated by the standard regimen were enrolled as controls. Their sputum smear and culture outcome, imaging data, the grading score of traditional Chinese medicine (TCM) syndromes before and after treatment were recorded and analyzed statistically. The change of positive smear and culture outcome, effect on imaging, foci absorption, the change of cavity before and after treatment, and foci absorption and effect on TCM syndromes after anti-TB drugs were compared between the two groups, P<0.05 was considered statistically significant. Results At the end of treatment, the sputum smear negative conversion rate and sputum culture negative conversion rate of treatment group were 87.2% (41/47) and 83.9% (47/56), and those of control group were 87.8% (36/41) and 85.7%(42/49). The both differences of the two groups were not statistically significant (χ²=0.007, P=0.936; χ²=0.065, P=0.800). The foci absorption degrees of 128 cases in the treatment group were as follows: 10 cases (7.8%) showed significant absorption, 64 cases (50.0%) absorption, 27 cases (21.1%) no change, 27 cases aggravation (21.1%), those for control group were 8 cases (7.1%) significant absorption, 35 cases (31.3%) absorption, 40 cases (35.7%) no change and 29 cases (25.9%) aggravation. The differences between the two groups were statistically significant (Z=―2.290, P=0.022).The foci absorption rate was significantly higher in treatment group (57.8%, 74/128) than the control group (38.4%, 43/112) (χ²=8.979, P=0.003). The numbers of case with cavity closure, narrowing, no change and widening in treatment group were 16 (48.5%), 9(27.3%), 5 (15.1%) and 3(9.1%), and those for control group were 12 (48.0%), 8(32.0%), 3(12.0%) and 2(8.0%). There was no significant difference of cavity changing in imaging between the two groups (Z=-0.110, P=0.912). There were more cases with continual foci absorption in the treatment group (31/74, 41.9%) than control group (10/43, 23.3%) 3 months after the end of the treatment (χ²=4.150,P=0.042). There were 11 cases (14.9%) with foci absorption in treatment group, and 3 cases (7.0%) in control group 6 months after the end of the treatment, there was no significant difference between the two groups (χ²=1.606, P=0.205). There was significantly better effect in improving TCM syndromes in the treatment group than control group（Z=-2.723, P=0.006). The overall effective rate for TCM syndromes in treatment group was 90.6% (116/128), which was significantly higher than that in control group (81.3%,91/112) (χ²=4.427, P=0.035).   Conclusion The QIJIALIFEIJIAONANG is effective in treating tuberculosis as adjuvant therapy, especially in improving TCM syndromes and the foci absorption in lungs.

Expression and significance of cytokines in patients with chronic obstructive pulmonary disease complicated with pulmonary tuberculosis

ZHANG Zhan-jun, YAO Lan, TANG Shen-jie

Chinese Journal of Antituberculosis. 2014, 36(3):  189-193.  doi:10.3969/j.issn.1000-6621.2014.03.010

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Objective To explore the changes and the significance of cellular immune function in patients with chronic obstructive pulmonary disease (COPD) complicated by pulmonary tuberculosis (TB).  Methods Fifty in-patients with COPD complicated with pulmonary TB who were detected during July 2012 to June 2013 were enrolled in the study as a study group; the other 50 pulmonary TB patients, 50 COPD patients and 50 healthy people were also enrolled as the control groups. The percentages of NK cells (natural killer cell) and T lymphocyte subsets (such as CD4⁺, CD8⁺ and CD4⁺/CD8⁺) in peripheral blood were measured by flow cytometry-based antibody double-labeling method in all enrolled subjects; the levels of IL-1, sIL-2R, IL-6, IFN-γ and TNF-ɑ were also mea-sured using ELISA method. Single-factor analysis of variance was used for comparison among groups, and t test was used for comparison between two groups. Results The percentage of NK cell in the control group with COPD patients (15.34±8.11)% was higher than that in the control group with TB patients (12.53±7.14)% and the study group (12.37±6.96)% (t=2.08 and 2.20, respectively, both P<0.05). The percentage of CD4⁺ T lymphocyte in the control group with TB patients (39.80±9.42)% was higher than that in the study group (30.09±11.09)% (t=2.80, P<0.01). The level of IL-1 in the study group (30.14±20.84) ng/L was higher than that in the control group with COPD patients (23.54±9.94) ng/L (t=2.00, P<0.05). The level of sIL-2R in the control group with COPD patients (114.70±49.32) pmol/L was lower than that in the study group (168.78±94.92) pmol/L and the control group with TB patients (182.68±74.91) pmol/L (t=4.07 and 5.12, respectively, both P<0.01). The level of IL-6 in the control group with TB patients (75.62±75.97) ng/L was higher than that in the study group (51.46±35.86) ng/L and the control group with COPD patients (48.90±30.04) ng/L (t=2.68 and 2.97, respectively, both P<0.01). The level of IFN-γ in the control group with COPD patients (16.60±9.27) ng/L was lower than that in the study group (28.82±32.40) ng/L and the control group with TB patients (29.90±23.79) ng/L (t=2.89 and 3.15, respectively, both P<0.01).  Conclusion Compared with the patients in all control groups, the patients with pulmonary TB complicated by COPD in the study group have lower expression in NK cells and T lymphocytes, and an abnormal expression of IL-1, sIL-2R, IL-6 and IFN-γ.

The comparison of interferon-gamma release assay and tuberculin skin test on auxiliary detection of extrapulmonary tuberculosis

GE Yan-ping，XIAO He-ping

Chinese Journal of Antituberculosis. 2014, 36(3):  194-197.  doi:10.3969/j.issn.1000-6621.2014.03.011

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Objective  To compare the difference in the auxiliary diagnosis of extrapulmonary tuberculosis (EPTB) with interferon-gamma release assay and tuberculin skin test (TST).  Methods  One hundred EPTB patients (called ‘TB group’ in short）hospitalized in Shanghai Pulmonary Hospital and 81 cases received physical exa-mination（called ‘control group’ in short）from Jan.2012 to Jun.2012 were tested with interferon-gamma release assay and TST．The detection rates of the two methods were calculated and compared, P<0.05 was considered statistically significant. Results  Of 100 patients of tuberculosis group，the detection rates were 80.00% (80/100) and 46.00% (46/100) respectively for interferon-gamma release assay and TST, and the difference was statistically significant (χ²=24.80, P<0.05). Of 100 patients of tuberculosis group, 80 patients were positive in interferon-gamma release assay. Of 81 cases of control group, 21 cases were positive in interferon-gamma release assay. The difference of detection rate was statistically significant (χ²=51.76，P<0.05). Conclusion Interferon-gamma release assay has higher sensitivity and specificity than TST in auxiliary diagnosis of EPTB.

Analysis of short-term clinical therapeutic efficacy in 188 pulmonary tuberculosis patients with diabetes mellitus

SUN Lin，HU Ying-fen，LIU Yu-feng，WANG Jun，LIU Hui-hui，MA Ju-fei，WANG Qiu-zhen，MA Ai-guo

Chinese Journal of Antituberculosis. 2014, 36(3):  198-203.  doi:10.3969/j.issn.1000-6621.2014.03.012

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Objective The objective of this study was to find out the clinical characteristics of the pulmonary tuberculosis patients with diabetes mellitus （PTB-DM） and provide the reference frame and the feasible suggestions for their clinical treatment. Methods One hundred and eighty-eight inpatients with pulmonary tuberculosis complicated with diabetes mellitus patients in Qingdao Chest Hospital from December 2011 to June 2013 were recruited as objects in the study. And 188 pulmonary tuberculosis inpatients without diabetes mellitus in the same period were selected as the control group. Between the two groups, we analyzed and compared the clinical manifestation （expectoration, hemoptysis and chest tightness）, the incidences of sputum smear negative conversion and the lung CT （shape and position of lung lesions）. The Chi-square test or the U-test was used to analyze data. And the significance level of alpha is 0.05.  Results At the time of admission to hospital, the incidence of hemoptysis or bloody sputum in PTB-DM patients (32.45%, 61/188) was significantly higher than PTB group (18.62%,35/188) (χ²=9.456, P<0.05). After 2 months of treatment, the proportion of PTB-DM patients with expectoration, hemoptysis and chest tightness were 66.49% (125/188), 5.32% (10/188) and 23.94% (45/188) respectively, which were significantly higher than 51.06% (96/188), 1.60% (3/188) and 14.89% (28/188) in PTB group(χ²=9.231, 3.904, 4.913, all P<0.05). The improvement rate of expectoration and chest tightness in PTB group (36.84%（56/152）,74.07%（80/108）) was better than the PTB-DM group (20.89%（33/158）,56.31%（58/103）) (χ²=9.637, 7.352, all P<0.05). The sputum negative conversion rate of PTB-DM patients was 53.15% (76/143), which was significantly lower than 69.77% (90/129) of PTB group (χ²=8.609,P=0.003). The incidences of cord like high density shadow and calcification in PTM group (34.04%（64/188）,13.83%（26/188）) were higher than those in PTB-DM group (22.87%（43/188）,2.13%（4/188）) (χ²=5.761, 17.532, all P<0.05). The incidences of nodules and cavity in PTB group (7.98%(15/188),45.74%(86/188)) were lower than those in PTB-DM group (14.89%（28/188）,56.38%（106/188）) (χ²=4.438, 4.257, all P<0.05); The incidence of lung lesion that occurred in the back section and lower lobe basal segment was higher in PTB-DM group (74.47%（140/188）,46.28%（87/188）) than that in PTB group (63.30%（119/188）,26.60%（50/188）) (χ²=5.472, 15.721, all P<0.05).  Conclusion Compared with PTB group, the PTB-DM patients’ clinical manifestation are more serious and have less effect after short-term treatment. It is suggested that we should timely adjust and enhance the treatment for the PTB-DM patients and extend the treatment duration suitably.

Research progress of Mycobacterium tuberculosis latency-associated antigens

BAI Xue-juan，WU Xue-qiong

Chinese Journal of Antituberculosis. 2014, 36(3):  204-210.  doi:10.3969/j.issn.1000-6621.2014.03.013

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Tuberculosis (TB) is one of the major threats to human health worldwide. Mycobacterium tuberculosis (Mtb) latent infection is a major source of tuberculosis infection. Early detection, diagnosis and effective treatment of latent infection are the important measures to effectively control the spread of TB. Currently, the Mycobacterium tuberculosis latent infection-associated antigens include hypoxia, nutritional deficiencies and proteins related to resuscitation and reactivation. Some latent infection-associated antigens have the ability of T-cell-mediated immunity, especially more vulnerable to be recognized by latent infection populations, are expected to become a new type of Mtb latent infection diagnostic marker and vaccine candidates; some latent infection-associated antigens have strong B lymphocytes immunogenicity, are expected to have potential diagnostic value in tuberculosis diagnosis. These latent infection-associated proteins have good prospects on latent tuberculosis vaccines and diagnostic reagents in the future.