Table of Content

10 September 2014, Volume 36 Issue 9

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Analysis of the core-authors group and changes of main evaluation index of the Chinese Journal of Antituberculosis in recent 10 years

FAN Yong-de, ZHANG Xiao-jin, GUO Meng, WANG Ran, YANG Ying, XUE Ai-hua

Chinese Journal of Antituberculosis. 2014, 36(9):  749-754.  doi:10.3969/j.issn.1000-6621.2014.09.002

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Objective  To analyze of the core-authors group and changes of main evaluation index of the Chinese Journal of Antituberculosis in recent 10 years (2004—2013), and provide a reference for the sustainable development of journals. Methods  We retrieved the first author and cited information of the papers published in the Chinese Journal of Antituberculosis between 2004—2013 by CNKI database, based on the price law and the comprehensive index evaluation method to determine core journal authors, descriptive analysis was made on core author of 2004—2013 and their institutions, and the change of main evaluation index. χ² _trend test was made to analyze whether the trend by year is statistically significant. Results  In 10 years, the journal published a total of 2091 papers, average 4.45 authors and 1.48 institutions involved, 46.52 times of download, and 4.19 times referenced for each paper. By calculation, we determined 352 candidates of core authors of the journal, finalizing of 125 authors. Ranking the number of core authors by institution, the first 5 institutions are National Center for Tuberculosis Control and Prevention, China CDC (17 authors), and Beijing Tuberculosis and Thoracic Tumor Research Institute (10 authors), and Guangzhou Chest Hospital, and Tongji University Subsidiary Shanghai Lung Hospital and Zhejiang CDC (all have 8 authors), and Guangdong TB Control Center (5 authors), and Beijing TB Control Institute (4 authors);77.60% (97/125) core authors distributed in Beijing, Guangdong and Zhejiang provinces, Shanghai Municipality, and Hubei, Fujian provinces. By 2012 the evaluation indicators of the journal have improved, of which total citation ranking in all journals increased from 510 to 428, impact factor increased from 0.570 to 0.911, impact factor rankings increased from 306 to 174, the composite scores increased from 36.9 to 61.0, comprehensive evaluation ranking in all journals increased from 804 to 265, the journal comprehensive evaluation ranking showed an increasing trend in all journals (χ²_trend=404.65,P<0.001). Conclusion  In 2004—2013, the journal has 125 core authors; however they are unevenly distributed and present the phenomenon of significant institutional, geographical aggregation. The comprehensive evaluation index rankings show an upward trend in all journals andjournals’ influence improved significantly.

Review and prospect of basic research on tuberculosis in China

ZHANG Jun-xian, LIANG Yan, WU Xue-qiong

Chinese Journal of Antituberculosis. 2014, 36(9):  755-763.  doi:10.3969/j.issn.1000-6621.2014.09.003

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The basic research on tuberculosis carry out around all aspects of the struggle between the human body and M. tuberculosis, from the genomic DNA to the transcriptome RNA, from the protein expressed to the metabolites, and then to the pathogenic role of M. tuberculosis on human body and the immune response produced by human body. Try to find out the intervention measures and control methods on tuberculosis. The research content is very rich. Owing to the limited space, this paper attempts to describe the main researches and their important progresses in bacteriology, immunology, molecular biology, vaccine, and new anti-tuberculosis drug in China, and also tries to point out the research prospect and existing problems.

The development of TB laboratory diagnostics in China

SONG Yuan-yuan, ZHENG Hui-wen, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2014, 36(9):  764-768.  doi:10.3969/j.issn.1000-6621.2014.09.004

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Laboratory diagnostics is the one of essential components for effective control and prevention of tuberculosis, the tuberculosis laboratory network was established since 1991 in China, the feasible diagnostics of Mycobacterium tuberculosis promoted tuberculosis diagnosis and treatment greatly, microbiological confirmation and drug susceptibility testing is important in guiding appropriate therapy especially in the context of TB, especially MDR-TB. The external quality assurance program has scaled up to the hospital system, and we should pay highly attention to quality assurance of tuberculosis laboratory, during the long-term struggle between the human being and Mycobacterium tuberculosis.

Review and prospect for tuberculosis diagnosis and treatment in China

ZHANG Li-qun, LIU Yi-dian, ZHU You-sheng, TANG Shen-jie

Chinese Journal of Antituberculosis. 2014, 36(9):  769-773.  doi:10.3969/j.issn.1000-6621.2014.09.005

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The level of diagnosis of tuberculosis in China has been improved significantly which has experien-ced from Ziehl Neelsen microscope in sputum smear and chest X-ray to various new diagnosis methods in clinical application treatment for tuberculosis has changed from the beginning of sanatoria treatment to the emergence of streptomycin and rifampicin, which has brought about a new era of the short course chemotherapy. In the future, in order to improve the diagnostic level, we should popularize new rapid diagnostic techniques and methods in the diagnosis of tuberculosis as soon as possible, including LED fluorescence microscope, BACTEC MGIT 960 culture system, Xpert Mtb/RIF assay, linear probe assay (LPA), gene chip, simultaneous amplification test (SAT), loop mediated isothermal amplification (LAMP), and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Meanwhile, future therapy should be focused on the research of new anti-TB drugs and targets, immunotherapy, therapeutic vaccines, interventional treatment, surgical treatment, and nanoparticle directed therapy to improve the cure rate at last.

The present status and progress in prevention and control of adverse reaction of anti-tuberculosis drugs

LEI Jian-ping

Chinese Journal of Antituberculosis. 2014, 36(9):  774-782.  doi:10.3969/j.issn.1000-6621.2014.09.006

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The adverse drug reaction （ADR） of anti-tuberculosis drugs is common, and it has complex and diverse reason. We should be familiar with its risk factors, improvethe laboratory examination methods, explore the reasonable adjustment of anti-tuberculosis treatment, the preventive measures against ADR, and the measures of treatment and withdrawal, so that the measures of TB prevention, treatment and management keep pace with the times.

Review and prospect of imaging diagnosis on extrapulmonary tuberculosis

Lv Yan, ZHOU Xin-hua

Chinese Journal of Antituberculosis. 2014, 36(9):  783-787.  doi:10.3969/j.issn.1000-6621.2014.09.007

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Extrapulmonary tuberculosis includes multiple systems, organs, sites and various types of tuberculosis and its diagnosis is relatively difficult than pulmonary tuberculosis. Timely and accurate diagnosis is the prerequisite for patients to be treated regularly and effectively. Imaging examination plays an important role in the lesions finding, diagnosis, differential diagnosis and the dynamic observation of lesions. Conventional imaging examination including ultrasonic, X-ray, CT, MRI and bone scanning has positive value of extrapulmonary tuberculosis diagnosis and curative effect observation. However, it has also some limitations. With the rapid development of ima-ging technology, in addition to study of morphological lesions, the molecular and functional imaging technology has become the development tendency and the research hotspot in the world. It is very important for diagnosis and differential diagnosis of extrapulmonary tuberculosis, especially central nervous system tuberculosis.

Review and prospect of Chinese diagnosis and treatment of bone and joint tuberculosis

QIN Shi-bing

Chinese Journal of Antituberculosis. 2014, 36(9):  788-792.  doi:10.3969/j.issn.1000-6621.2014.09.008

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Bone and joint tuberculosis is a serious infectious disease endangering people’s health. Nearly 95% are secondary tuberculosis of elsewhere. Most of patients suffering from tuberculosis of bones and joints will be di-sabled. And this disease will seriously affectpeople’s health, work and life. Since the founding of new China, the diagnosis and treatment of bone and joint tuberculosis has made great progress. However, today, due to various reasons, academic development is subject to certain constraints. There is a discrepancy between the progress of the bone and joint tuberculosis and the whole medicine system in our country. Look back to the past and look forward to the future, we need to review the the diagnosis and treatment of bone and joint tuberculosis, strive to promote the scientific development of the bone and joint tuberculosis treatment technology.

Current situation and prospect of pathological diagnosis and research on tuberculosis in China

ZHANG Hai-qing，CHE Nan-ying

Chinese Journal of Antituberculosis. 2014, 36(9):  793-797.  doi:10.3969/j.issn.1000-6621.2014.09.009

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In this paper, we reviewed current pathological diagnosis situation of tuberculosis (TB), and the roles of new molecular pathological techniques on TB diagnosis and basic research in China. Compared with other methods, pathological diagnosis has remarkable advantages in making definite diagnosis of TB cases, especially for bacteria negative pulmonary TB and extrapulmonary TB patients. Up to now, pathological diagnosis generally remains on histological and cellular level in our country, mainly focuses on histological characters and finding pathogens. TB-PCR tests are limited to a few department of pathology in large hospitals due to high requirements for laboratory, instruments and technicians. Development of the new subdiscipline molecular pathology has led pathological research and diagnosis approach into detecting biomacromolecules such as protein and nucleic acids, which brin-ging new development opportunities for pathological diagnosis and research of TB. In recent years, molecular techniques have developed rapidly and widely applied in testing sputum and body fluid samples. However, application of these new techniques on tissue samples is rather delayed and needs acceleration for clinical utilization. In future, TB pathological diagnosis should not only rely on histological changes, but also make more efforts in finding pathogens, identifying mycobacteria species, and detecting mutations of drug-resistant related genes, in order to provide more accurate evidences to improve efficiency of TB diagnosis and treatment.

Progress and prospect of tuberculosis control for the floating population in China

JIANG Shi-wen, LIU Xiao-qiu

Chinese Journal of Antituberculosis. 2014, 36(9):  798-801.  doi:10.3969/j.issn.1000-6621.2014.09.010

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This paper introduced China’s progress and achievements in tuberculosis control for floating population. Also describes problems and challenges, proposes directions for future development of tuberculosis control strategy in floating population in China.

Progress and prospect of Mtb and HIV co-infection prevention

ZHOU Lin, LIU Er-yong

Chinese Journal of Antituberculosis. 2014, 36(9):  802-805.  doi:10.3969/j.issn.1000-6621.2014.09.011

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In order to analyze the progress on Mtb and HIV co-infection prevention, problems and difficulties, explore solutions in order to improve work quality of Mtb and HIV co-infection prevention, we reviewed the related information on Mtb and HIV co-infection prevention in recent years including WHO annual reports, policy guides, policy documents and related manual issued in China, state-level pilot summary reports and relevant literature on Mtb and HIV co-infection diagnosis, treatment and management. Since 2004, WHO released the Mycobac-terium tuberculosis/HIV Joint Action Strategy, a relatively sound policy on Mtb and HIV co-infection treatment, management and prevention was established. National work on Mtb and HIV co-infection prevention has made great progress, conducted a series of pilot work centered on the surveillance of Mtb and HIV co-infection epidemic, two-way screening, INH preventive therapy. Since 2010, Mtb and HIV co-infection prevention work expand to the whole country in China. However, there remains to be further improved in terms of Mtb and HIV inter-agency cooperation, registration reports, bi-directional screening quality, and management of co-infection patients.

The retrospect and prospect of scientific popularization on tuberculosis control in China

ZHONG Qiu, YIN Jian-jun, GAO Cui-nan, ZHANG Jian-hui, ZHOU Lin

Chinese Journal of Antituberculosis. 2014, 36(9):  806-809.  doi:10.3969/j.issn.1000-6621.2014.09.012

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Along with the development of the society, the publicity and education of tuberculosis control in China have expanded gradually from small and weak to large and strong. The publicity and education of tuberculosis control has always been regarded as an important work by the pioneer, Chinese Antituberculosis Association. Until the 1960s, the publicity slogan “No Spitting” had played the most important role in the education for general public with some paper materials like antituberculosis leaflets and so on. More importance was attached to TB propaganda by Chinese government and the Ministry of Health during 1970s-1990s. Increased investment, the establishment of TB propaganda team and full role of the modern propaganda media made the national TB control work get significant progress and the modern tuberculosis control strategy be implemented national wide. Since the 21st century, the national tuberculosis propaganda, which is very important for us to achieving the global TB control milestones in 2005, has been focused on the popularization of antituberculosis core knowledge and strengthened by the “National Millions of Volunteers TB Knowledge Dissemination Action”. Looking to the future, to achieve the goal of 85% core information awareness set by the National Tuberculosis Control Program (2011—2015), several aspects of TB health education work still need to be paid more efforts: strengthen the leadership and policy advocacy of TB health education, give a full play to the superiority of the modern publicity media, take full advantage of the “National Millions of Volunteers TB Knowledge Dissemination Action”, integrate national TB health education resources and make full use of advantages of experts in Chinese Antituberculosis Association and so forth.

Investigation and analysis on the awareness of TB control and prevention knowledge among departure populations in Beijing

XIAO Li-li, CAO Shan-shan, WANG Jin, ZHAO Jia-heng, WU Si-yuan

Chinese Journal of Antituberculosis. 2014, 36(9):  810-814.  doi:10.3969/j.issn.1000-6621.2014.09.013

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Objective To investigate the public awareness on TB control and prevention in the Beijing departure population, so as to develop basis for education of TB control and prevention in these populations.  Methods Using 5 core information from questionnaire of awareness rate survey of The Fifth National Epidemiological Sampling Survey and 6 self-designed questions targeting quarantine requirements for outgoing personnel, based on cluster sampling, one-on-one inquiry was performed on the 5290 exiting travelers examined in our department from 1st January to 31st December, 2013. All the 5290 inquiries are returned and valid, validation rate 100.00%. The 5 key concepts are analyzed using Z test and rank-sum test of binomial distribution, and the 6 self-designed questions using F test and t test. P<0.05 is considered as statistically significant.  Results  (1)Total awareness rate for the 5 core information is 63.14%（16 700/26 450）, which was correlated with gender, urban/rural residence, education level and occupation, males（65.41%, 7950/12 155） had a higher awareness than females（61.21%, 8750/14 295）（Z=－6.428，P<0.05）, the awareness in the age group from 15 to 29 years old（61.33%, 5336/8700） was lower than that in 30 to 44 group (64.01%, 5518/8620), 45 to 59 group (64.01%, 4468/6980) and above 60 group (64.09%, 1378/2150)（Z=14.503，P<0.05）. In terms of the awareness rate by education level, graduates and postgraduates had the higher awareness (64.72%, 9465/14 625) than primary-school group (59.09%, 650/1100) and middle-school group (61.24%, 6568/10 725)(Z=25.718，P<0.05). Urban residents (63.72%, 14 475/22 715) had a higher awareness than rural ones (59.57%, 2225/3735)（Z=－4.01,P<0.05）. And medical personnel had higher awareness（75.22%, 346/460）than that in technicians (67.80%, 4644/6850), clerical workers (60.31%, 7678/12 730), oversea students (62.73%, 2942/4690) and business personnel (63.37%, 1090/1720)(Z=114.227，P<0.05). (2)Among the 6 self-designed questions the awareness（65.52%,3466/5290） of ‘TB patients develop severe during migration and have the risk of spread the disease’ was the highest, whereas the awareness（38.90%, 2058/5290） of the question ‘suspect TB patient need a sputum test’ was the lowest. The respondents’ age and occupation are the influence factors on the awareness of TB control and prevention (F=7.703, F=8.047, P<0.05). (3)The respondents’ main media sources of their TB knowledge were mainly medical staff face to face briefings 56.90%（3010/5290）, television 44.05%（2330/5290） and newspapers 43.78%（2316/5290）. Conclusion The awareness of tuberculosis core information and tuberculosis knowledge specific to quarantine requirements for Beijing port departure population needs to be improved, we should further strengthen publicity on relevant knowledge in this population. Face to face explain by medical personnel is the best publicity way.

Analysis of clinical characteristics and drug resistance in the patients with pulmonary tuberculosis complicated with Acinetobacter baumannii infection in Shandong Chest Hospital

YANG Yan, HU Hua, CHEN Ying, WANG Jun-ling, ZHU Xiao-ya, DONG Jiao, FAN Heng-jian

Chinese Journal of Antituberculosis. 2014, 36(9):  815-819.  doi:10.3969/j.issn.1000-6621.2014.09.014

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Objective To investigate the clinical characteristics of pulmonary tuberculosis complicated with Acinetobacter baumannii (Ab) infection, and to analyze Ab resistance to commonly used antibiotics. Methods One hundred and twenty-nine cases with pulmonary tuberculosis complicated with Ab infection were retrospectively analyzed from January 2009 to December 2012. The sputum specimens were inoculated in blood agar, chocolate agar and MacConkey agar. The susceptibility tests of 18 drugs including cefoperazone shubatan and imipenem were performed by VITEK-32 automatic microorganism analysis system.  Results One hundred and thirty-eight Ab strains were isolated from 129 patients, 25 strains (18.1%) in 2009, 32 strains (23.2%) in 2010, 39 strains (28.3%) in 2011, and 42 strains (30.4%) in 2012. Ab resistance to commonly used antibiotics increased year by year. The rates of Ab resistance to cefoperazone shubatan and imipenem were respectively 4.0% (1/25) and 12.0% (3/25) in 2009，9.4% (3/32) and 18.8% (6/32) in 2010，25.6% (10/39) and 28.2% (11/39) in 2011，50.0% (21/42) and 45.2% (19/42) in 2012. Conclusion Compared with 2009, the ratio of tuberculosis complicated with Ab infection increased significantly in 2012. Ab resistance to commonly used antibiotics increased year by year.

Ultrasonogram features in patients with different types of tuberculous pleurisy

HUANG Yi, GAO Ting, DANG Li-yun, XUE Xin, WANG Long-zhi, LIU Wen, LEI Ying, ZHANG Qi, MIN Wei-li

Chinese Journal of Antituberculosis. 2014, 36(9):  820-823.  doi:10.3969/j.issn.1000-6621.2014.09.015

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Objective To investigate the value of color Doppler ultrasound in the diagnosis and treatment of tuberculous pleuritis (TBP) which progressed to the different periods, to further improve the diagnosis of tuberculous pleuritis.  Methods A total of 165 patients who received thoracoscope or operation in the Xi’an Tuberculosis and Thoracic Tumor Hospital from February 2009 to April 2013 were involved in this study. Ultrasound was performed in all recruited patients before they received thoracoscope or operation. The pathologic result obtained through operation or thoracoscope was regarded as the standard. The results of ultrasound were compared with the pathologic results and the consistency of the classifications were analyzed by Kappa using SPSS 19.0.  Results  Among 165 patients with TBP, by using color Doppler ultrasound examination, 18 cases were diagnosed as type Ⅰ (13 cases were diagnosed as the same classifications by thoracoscope or operation), 28 cases were type Ⅱ (all of them were diagnosed as the same classifications by thoracoscope or operation), 43 cases were type Ⅲ (all of them were diagnosed as the same classifications by thoracoscope or operation) and 76 cases were type Ⅳ (75 cases were diagnosed as the same classifications by thoracoscope or operation). So the consistency rate of the classifications by using color Doppler ultrasound was 96.4% (159/165) and the Kappa value was 0.946, which meant the consistency was good. Conclusion Color Doppler ultrasound is a convenient and rapid examination method. It is valuable in clinical classification and treatment guidance for the patients with TBP.

Clinical analysis of 160 elderly pulmonary tuberculosis cases

ZENG Li-xiang，HONG Xiao-zhong, YANG Qing-wei, PENG Dong-dong，WANG Dong-min

Chinese Journal of Antituberculosis. 2014, 36(9):  824-829.  doi:10.3969/j.issn.1000-6621.2014.09.016

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Objective To investigate the clinical characteristics of elderly pulmonary tuberculosis (PTB), and to improve the level of diagnosis and treatment of elderly PTB.  Methods The clinical manifestations, imaging features, sputum examination results, PPD test results, complications, adverse reaction of anti-tuberculosis drugs and treatment effects of 160 elderly cases of PTB, who registered in Antituberculosis Institute of Shantou from January 2012 to December 2012, were analyzed retrospectively. SPSS 19.0 software was used for statistics. The detection rates of different ages were compared by Fisher exact probability test, comparison of complications in different groups was conducted by the composition of A and non A. P<0.05 was considered statistically significant and P<0.01 was considered significant difference. Results Elderly PTB cases accounted for 19.3% (160/828) of cases registered in the corresponding period. Cough (142/160, 88.8%) and expectoration (125/160, 78.1%) were the main symptoms, followed by loss of appetite (82/160, 51.3%). Cases with fatigue accounted for 47.5%(76/160), with weight loss accounted for 40.6% (65/160), with shortness of breath accounted for 39.4% (63/160), with hemoptysis sputum, fever, night sweat accounted for 18.1% (29/160), 16.2% (26/160) and 9.4% (15/160) respectively. Pulmonary infiltration, necrosis and proliferative lesions co-exist, most of the lesions was multiple lung area lesion (127/160, 79.4%) and cavitary lesions were common (66/160, 41.3%). The strong positive rate of PPD test was 29.5% (31/105), and that of 60- years-old group and above (34.7%, 26/105) was significantly higher than that of 70 to 84 age group (16.7%, 5/55) (Fisher’s exact test, P=0.011). Sputum acid fast bacilli (smear and/or culture） positive rate was high (121/160, 75.6%). Cases in positive bacteria group with cough accounted for 93.4% (113/121), while those in negative group accounted for 74.4% (29/39). Cases with expectoration in positive bacteria group accounted for 86.8% (105/121), while in negative group accounted for 51.3% (20/39). Cases with cough and expectoration in positive bacteria group were significantly higher than those in negative group (χ²=8.876, P<0.01;χ²=21.743, P<0.01). The complication was common (137/160, 85.6%), most of which was the lung infection (77/160, 48.1%). Other complications were diabetes mellitus (33/160, 20.6%), hypertension (28/160, 17.5%), chronic bronchitis (25/160, 15.6%) and emphysema (22/160, 13.8%). Drug-induced liver dysfunction wasthe most adverse reaction (36/160, 22.5%). The cure rate was 91.3% (146/160), among which the cure rate of new cases was 92.4% (134/145),and that of retreatment patients was 80.0% (12/15).During the treatment some patients had bad psychological health status due to economic difficulties (25/160, 15.6%). Conclusion The symptoms of elderly pulmonary tuberculosis are not typical, most of which are cough and expectoration. The chest lesions are wide and the cavitary lesions are common, sputum acid fast bacilli (smear and/or culture) positive rate is high, most of elderly pulmonary tuberculosis cases complicate with pulmonary infection, diabetes and other medical conditions. During the treatment some patients have bad psychological health status.

Annual report on clinical diagnosis and treatment progress of tuberculosis (2013) (Part 2 clinical treatment)

Clinic Society of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2014, 36(9):  830-854.  doi:10.3969/j.issn.1000-6621.2014.09.017

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Some progress had been made in the clinical treatment of tuberculosis in 2013. Headed to Bedaquiline, the new drugs had been used further in clinical. Vaccine research had new attempts in nanotechnology, adjuvant, etc. Preliminary results of an oral formulation V7 in immunotherapy showed that it has a certain application prospect. The report affirmed interventional treatment effect of bronchoscopy balloon dilation for tuberculous bronchial stenosis. Thoracoscopy treatment of tuberculosis encapsulated pleural had shown satisfactory effect. MDR-TB patients got better results through selecting the appropriate indications for surgery. Drug resistant tuberculosis of bone and joint needs a personalized surgical plan on the basis of individualized treatment. Standardized regimen for MDR-TB had some effect, which moxifloxacin-contained regimens may be better than levofloxacin, and the efficacy of Group 5 drug-contained chemotherapy regimens needs to be more observation. The WHO recommended isoniazid preventive anti-TB treatment for HIV patients. HIV patients with tuberculosis were recommended at least 6-month of isoniazid therapy continued the basis of standard programs to prevent recurrence. For making anti-TB treatment programs for large proportion of elderly TB patients, the drug side effects, the patient’s underlying disease and concomitant medications, taking aminoglycoside anti-TB drugs with caution, appropriate choosing of second-line drugs, and dose adjustment should be fully considered. Information of childhood tuberculosis was serious shortage, not only the lack of effective methods for diagnosis, but also attention should be strengthened because of the rapid progress of tuberculosis infection in childhood. In addition to streptomycin, the remaining first-line anti-TB drugs were safe for pregnant TB patients and short course chemotherapy was also effective and teratogenic effects and liver toxicity had not been confirmed. Drug-induced liver injury was the most common adverse reactions of anti-TB drugs. Expert advice for diagnosis and handling of drug-induced liver injury caused by anti-tuberculosis drug made by Chinese Society for Tuberculosis, Chinese Medical Association was annual important progress in 2013,while opinion of preventive protection treatment of liver was not uniform.