Table of Content

10 November 2014, Volume 36 Issue 11

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Discussion on the immunoprophylaxis strategy of tuberculosis in China

LU Jin-biao, ZHAO Ai-hua, WANG Guo-zhi, XU Miao

Chinese Journal of Antituberculosis. 2014, 36(11):  927-929.  doi:10.3969/j.issn.1000-6621.2014.11.001

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At present, the domestic and foreign researchers basically reached an agreement on the ideas for the tuberculosis prevention and control. That is, in the case of no substitutes for currently used BCG, researchers should explore new prime vaccines, BCG prime-boosting vaccines and the vaccines for latent tuberculosis infection. These three types of new tuberculosis vaccines will focus on the populations with different immune markers. Therefore, how to screen the different types of people and then vaccinate with the corresponding vaccines is a key point in the TB control. The authors discussed on the above issues and try to propose the views on the immunoprophylaxis strategy of tuberculosis in China.

Factors influencing short-term prognosis of tuberculosis meningitis in children

REN Fei，LI Dong，ZHOU Qian-qian，GOU Chao-lun，XUE Xin

Chinese Journal of Antituberculosis. 2014, 36(11):  930-935.  doi:10.3969/j.issn.1000-6621.2014.11.002

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Objective To explore the risk factors influencing short-term prognosis of tuberculosis meningitis (TBM) in children．Methods The clinical records of 83 hospitalized children with TBM from January,1, 2008 to December,31, 2012 in Xi’an Tuberculosis and Chest Tumor Hospital were evaluated retrospectively．Fifty-three cases (63.9%) resulted in a good prognosis and 30 cases (36.1%) resulted in a poor prognosis．A total of 36 potential factors influencing short-term prognosis of TBM were firstly evaluated by Univariate analysis. A Student’s t-test (t) was used to compare the mean values of the continuous measurements, such as cerebrospinal fluid (CSF) analysis. Aχ² test (or Fisher’s exact test for small proportions) was used for categorical variables, such as age, gender, clinical manifestations, hydrocephalus. And then take the 10 variables with a statistically significant difference into the logistic regression，which was used to model the probability of having a poor prognosis. A P-value <0.05 was considered statistically significant difference. All statistical analyses were conducted on a personal computer with the SPSS for Windows (version 18.0) software package. Results The Univariate analysis revealed 10 factors associated with a poor short-term prognosis（P<0.05）: vomiting(the rates in the cases with a good prognosis and poor prognosis were 50.9%（27/53） and 76.7%（23/30）,χ²＝5.292), positive signs of meningeal irritation（the rates in the cases with a good prognosis and poor prognosis were 67.9%（36/53） and 100.0%（30/30）,χ²＝9.318）, cranial nerve involvements（the rates in the cases with a good prognosis and poor prognosis were 11.3%（6/53） and 33.3%（10/30）,χ²＝13.561）, paralysis（the rates in the cases with a good prognosis and poor prognosis were 5.7%（3/53） and 26.7%（8/30）,χ²＝7.353）, clinical stage of TBM（in the cases with a good prognosis the rates of early stage, middle stage and late stage were 26.4%（14/53）,56.6%（30/53） and 17.0%（9/53）,while in the cases with a poor prognosis the rates were 3.3%（1/30）, 30.0%（9/30） and 66.7%（20/30）,χ²＝22.162）, coma（the rates in the cases with a good prognosis and poor prognosis were 17.0%（9/53） and 60.0%（18/30）,χ²＝14.922），seizures（the rates in the cases with a good prognosis and poor prognosis were 22.6%（12/53） and 70.0%（21/30）,χ²＝17.939），obvious abnormalities in brain iconography（in the cases with a good prognosis the rates of normal brain iconography, hydrocephalus alone, intracranial lesions alone, hydrocephalus and intracranial lesions were 49.1%（26/53）, 32.1%（17/53）, 15.1%（8/53） and 3.7%（2/53）, while in the cases with a poor prognosis the rates were 16.7%（5/30）, 56.7%（17/30）, 6.7%（2/30） and 20.0%（6/30），χ²＝14.571）, elevated protein concentrations in CSF（the levels in the cases with a good prognosis and poor prognosis were （1.38±1.07）g/L and（2.29±1.93）g/L，t＝2.741）, decrease chlorine concentrations in CSF（the levels in the cases with a good prognosis and poor prognosis were （115.59±8.85）mmol/L,（109.55±7.83）mmol/L,t＝3.116）. Multivariate logistic analysis revealed that 3 independent risk factors for a poor short-term prognosis:coma (OR=13.670, 95%CI=4.268-43.768), hydrocephalus (OR=6.895，95%CI=1.439-33.031) and late-stage TBM (OR=10.580，95%CI=2.866-38.091).  Conclusion Coma, late-stage TBM and hydrocephalus are risk factors for a poor prognosis for children with TBM. Diagnosis and treatment as early as possible are the most important ways to improve the short-term prognosis.

Clinical research of chemotherapy combined with ultrasound-guided percutaneous conductivity in the treatment of pulmonary tuberculosis

MAO Xiao-hui，WANG Long-zhi，CAI Shu-bo，CAO Si-zhe，WANG Bo，WU Xuan，MA Ting-xi，XU Shu，DANG Li-yun

Chinese Journal of Antituberculosis. 2014, 36(11):  936-940.  doi:10.3969/j.issn.1000-6621.2014.11.003

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Objective To explore the clinical effect of ultrasound-guided percutaneous conductance chemotherapy in the treatment of patients with cavity pulmonary tuberculosis (TB).  Methods One hundred and eighty smear and (or) culture positive retreatment pulmonary TB patients with cavity lesions who were diagnosed in Xi’an Tuberculosis and Thoracic Tumor Hospital from December 2011 to August 2012 were enrolled in this study. They were randomly divided into two anti-TB chemotherapy groups: oral administration combined with ultrasound-guided percutaneous conductance (study group, 92 cases) and oral administration only (control group, 91 cases). The treatment regimen for all patients in both groups was same (2HRZES/6HRE). The following indicators were observed and recorded respectively at 3 time-points (1 month, 3 months and 6 months of treatment): improvement of symptoms, sputum conversion rate, rate of lesion shrink, rate of cavity shrink, as well as appearance of complications and adverse reaction. Results In the study group, the sputum conversion rates were 50.00%（45/90）, 66.67%（60/90） and 83.33%（75/90） respectively at the end of 1 month, 3 months and 6 month of treatment, which were significantly higher than those in the control group (31.11%, 28/90；40.00%，36/90 and 52.22%， 47/90; χ²=6.660, 12.857 and 19.943, P≤0.01). The effective rates of treatment (lesion and (or) cavity shrink) in the study group were 40.00%（36/90）, 50.00%（45/90） and 83.33%（75/90） respectively at 3 time-points, which were significantly higher than those in the control group (15.56% (14/90), 31.11% (28/90) and 50.00% (45/90); χ²=13.460, 8.149 and 22.540, P<0.01). There was no significant difference in the complication and adverse reaction between study (10.00%, 9/90) and control groups (14.44%, 13/90) (χ²=0.829, P=0.363). Conclusion The sputum conversion rate of pulmonary TB patients can be improved by using chemotherapy combined with percutaneous ultrasound-guided conductivity. It is a safe, effective and new route of administration on TB treatment.

Application of vacuum sealing drainage and focus clearance technique for the treatment of thoracic tuberculosis

WANG Hai-jiang, NING Xin-zhong, XIA Zhao-hua,WEI Qi-feng, YAN Yao-ming, MA Ke

Chinese Journal of Antituberculosis. 2014, 36(11):  941-944.  doi:10.3969/j.issn.1000-6621.2014.11.004

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Objective To explore the effect of constant vacuum sealing drainage (VSD) and focus clearance among the postoperative patients with thoracic tuberculosis (TB) in the type of ulceration or thoracic wall incision infection conditions.  Methods A retrospective analysis of clinical data was performed on 34 patients with thoracic TB who were hospitalized in the 3rd People’s Hospital of Shenzhen and received continuous VSD and focus clearance from March 2011 to March 2014. The effect and prognosis of the patients were analyzed. Results The incision healed in 32 cases while partial wound infection happened in 2 cases (they were cured after dressing change). All cases were cured and no recurrence during the follow-up (an average of one year and a range of 3-24 months).  Conclusion The continuous VSD and focus clearance technique can reduce the recurrence of thoracic TB and its clinical effect is satisfied.

Effect analysis of combined treatment of traditional Chinese medicine and western medicine on tuberculosis of cervical lymph nodes with cold abscess

ZHAO Li, MENG Er-wang, XU Yu-feng, ZHANG Chun-xia, LI Yong

Chinese Journal of Antituberculosis. 2014, 36(11):  945-947.  doi:10.3969/j.issn.1000-6621.2014.11.005

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Objective To observe the effect of combined treatment of traditional Chinese medicine and wes-tern medicine on tuberculosis of cervical lymph nodes with cold abscess. Methods Sixty-four patients with tuberculosis of cervical lymph nodes and cold abscess who were treated in our hospital in the past four years (2007—2012) were study objects. They were randomly divided into 2 groups. The patients in the first group (control group) didn’t adopt traditional Chinese medicine, they were treated by 4HRZE/8HR regimen, after surgical debridement local wound was performed the isoniazid (50 mg/ml) flushing followed by oil gauze tamponade. The patients in the second group (combined treatment group) adopted 4HRZE/8HR and traditional Chinese medicine Jieheling, after surgical debridement local wound was performed the isoniazid (50 mg/ml) flushing followed by oil gauze tamponade with traditional Chinese medicine pills (the major constituents were calcined gypsum, yellow lead, dragon’s blood and borneol, etc.). STATA 8.0 was used for analysis. Chi-square test was apllied to compare the difference of cure rates and relapse rates of the two groups, P<0.05 was considered statistically significant.  Results The cure rate of the combined treatment group (81.25%, 26/32) was significantly higher than that of the control group (53.13%, 17/32) (χ²=6.74, P<0.05). The relapse rate of the combined treatment group (7.69%, 2/26) were significantly lower than the control group (35.29%, 6/17) (χ²=5.17, P<0.05).  Conclusion Combined treatment of traditional Chinese medicine and western medicine on tuberculosis of cervical lymph nodes with cold abscess has higher cure rate and lower relapse rate than western medicine treatment.

Efficacy and safety of Qijialifei capsule in adjuvant chemotherapy for retreatment pulmonary tuberculosis

XI Xiu-e, LI Ming-ying,WANG Xia,WU Zhen-xuan,SHANG Hao-zhen

Chinese Journal of Antituberculosis. 2014, 36(11):  948-952.  doi:10.3969/j.issn.1000-6621.2014.11.006

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Objective To evaluate the efficacy and safety of Qijialifei capsule，a kind of Chinese traditional medicine，as adjuvant treatment for retreatment pulmonary tuberculosis. Methods Two hundred cases of retreatment pulmonary tuberculosis hospitalized in the First Affiliated Hospital of Xinxiang Medical College from June 2010 to June 2012 were randomly divided into the observation group (100 cases) and the control group (100 cases)．The base condition of two groups was comparability. All patients received the therapy of 2HRZES／6HRE．The patients in the observation group took Qijialifei capsule. Ninety-seven cases in the observation group and 98 cases in the control group completed the treatment．Then comparisons were made between the two groups in the sputum tubercle bacillus conversion rate，focus improvement rate, cavity closing rate, the cellular immune function, and improvement of clinical symptoms. The software SPSS 13.0 was used, measurement data and enumeration data were compared with t-test andχ² test, respectively, P<0.05 was considered statistically significant. Results At the end of intensified therapy period and the end of the whole therapy, the sputum tubercle bacillus conversion rate in the observation group (81.33%（61/75）, 94.67%（71/75）) was significantly higher than those in the control group (67.57%（50/74）, 83.78%（62/74）), there were significant differences between the two groups（χ²=4.36, 6.01，all P＜0.05）. At the end of intensified therapy period, the focus improvement rate and the cavity closing rate in the observation group (74.23％(72/97), 26.80％(26／97)) were higher than those in the control group (54.08％(53/98), 12.24％(12／98)) (χ²=3.91, 6.59，all P＜0.05). At the end of the whole therapy the focus improvement rate and the cavity closing rate in the observation group (93.82％(91/97), 55.67％(54／97)) were higher than those in the control group (78.57％(77/98), 30.61％(30／98)) (χ²=9.49，12.48，P＜0.05)．By the end of the whole therapy，the numbers of CD3⁺、CD4⁺、CD4⁺／CD8⁺ of patients in the observation group (（67.13±6.98）%,（44.22±8.11）%, 1.61±0.33) was higher than those in the control group (（62.03±6.12）%, （41.15±7.26）%, 1.50±0.34), with significant differences between the two group （t=5.42, 2.78,2.29, all P＜0.05)．Conclusion Qijialifei capsule as adjuvant treatment can improve the sputum tubercle bacillus conversion rate, radiographic focus improvement rate, and cavity closing rate in the treatment for patients with retreatment pulmonary tuberculosis, which also improves the cellular immune function of patients and alleviate the symptoms.

The value of low dose CT in the follow-up of secondary pulmonary tuberculosis

YU Xin-hua, LI Hui-ru, WANG Fu-kang, FENG Hui-yong, LI Wei-yu

Chinese Journal of Antituberculosis. 2014, 36(11):  953-957.  doi:10.3969/j.issn.1000-6621.2014.11.007

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Objective Discussion on the application value of low dose CT in pulmonary tuberculosis with long-term follow-up examination. Methods Routine follow-up CT scaned 140 anti-TB treated patients with se-condary pulmonary tuberculosis from 2012 January to 2013 June in Guangzhou Chest Hospital, 70 cases of low dose CT scanning (observation group) and 70 cases of routine dose CT scanning (control group). Scored the CT image quality of 2 groups according to 4 standards (edge of tissue or organ, tissue density difference, image artifact and image noise), each standard score 1 points, each patient out of 4 points. Recorded the radiation dose (CTDIvol, DLP) in 2 groups. Write CT diagnosis reports in the 2 case of contrast front piece and the front piece. Analysis and comparison of the changes in 2 diagnostic reports, and scores (Image description and diagnosis conclusion had not changed for 4 points. Image description partly changed and the diagnosis conclusion without change for 3 points. When image description and diagnosis conclusions have changes, the main diagnosis conclusion haven’t changes, it is 2 points while main diagnostic conclusion partly change it is 1 point. The main diagnosis conclusion completely changed for 0 points). To judged if there are significant differences in image quality score, changes score of diagnosis report and radiation dose by t test. Results In observation group and the control group, their image quality score were (3.268±0.463) and (3.507±0.448); changes score of diagnosis report were (2.929±0.983) and (3.186±0.952); radiation dose of CTDIvol were (10.417±1.190)(mGy) and (19.214±1.956)(mGy), DLP were (94.514±13.844)(mGy×cm) and (177.129±17.048)(mGy×cm), respectively. The two groups had significant difference in image quality score and radiation dose CTDIvol and DLP（t=3.106，P=0.002；t=32.149，P<0.001；t=31.474，P<0.001）, had no significant difference in changes score of diagnosis report（t=1.572，P=0.118）. Conclusion Low dose CT can significantly reduce the radiation dose, and has no obviously effect for the diagnosis report. Low dose CT scanning might become a routine application of model CT check follow-up after treatment of tuberculosis.

The diagnostic value of PCR-DNA sequencing for the rapid detection of ethambutol-resistance in Mycobacterium tuberculosis: a Meta-analysis

CHENG Song, LI Yuan-yuan, HU Zhong-yi, CUI Zhen-ling

Chinese Journal of Antituberculosis. 2014, 36(11):  958-965.  doi:10.3969/j.issn.1000-6621.2014.11.008

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Objective Using a Meta-analysis to evaluate the diagnostic value of PCR-DNA sequencing for the detection of embB gene mutations in Mycobacterium tuberculosis. Methods The relevant studies were searched in PubMed, Web of Science, OVID, Cochrane library, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu datebase. At first, 767 citations were identified from all researches, 566 studies were obtained after excluding duplicate citations, 477 studies were preliminarily excluded by reading the titles and abstracts of all studies，and the residual 89 were included into screening full text, 18 independent studies were included at last. QUADAS-2 (quality assessment of diagnostic accuracy studies) was used to assess the quality of included studies, heterogeneity was analyzed using Q tests. Using Meta-Disc (version 1.4) to count statistical measures including pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), etc.. Results The pooled sensitivities (95% confidence interval (CI)) of PCR-DNA sequencing for detecting the mutations of embB306 codon, combination of embB306 and 406 codons, and combination of embB306, 406 and 497 codons were 0.56 (0.53-0.59), 0.60 (0.56-0.64), 0.76 (0.70-0.81), respectively. Their pooled specificities (95%CI) were 0.93 (0.92-0.94),0.89 (0.86-0.91), 0.89 (0.83-0.93), respectively. The DOR were 17.59 (9.35-33.10), 15.24 (5.51-42.11), 33.69 (4.53-250.90), respectively.  Conclusion The summarized specificity of PCR-DNA sequencing for detecting the mutations of embB 306,406，497 codons in Mycobacterium tuberculosis was high, and it was appropriate choice for detecting drug resistance to ethambutol.

Application of somatostatin in the treatment of tuberculous ileus

WEI Guo, HE Yong, ZHAO Yong, HUA Xin, LIU Lin

Chinese Journal of Antituberculosis. 2014, 36(11):  966-969.  doi:10.3969/j.issn.1000-6621.2014.11.009

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Objective To study the applied value and duration of somatostatin in the treatment of tuberculous ileus.  Methods Seventy-eight patients with tuberculous ileus from Public Health Clinical Medical Center of Chengdu City, China from January 2009 to August 2013 were divided into 42 cases in treatment group and 36 cases in control group. The cases in control group received conventional conservative therapy combined with anti-tuberculosis (TB) therapy (Regular anti-TB treatment, fasting, continuous gastrointestinal decompression, maintain water electrolyte and acid-base balance, etc.). The cases in treatment group received somatostatin therapy on the basis of the control group (24 hours continuous intravenous infusion of somatostatin). The patients were observed the improvement of abdominal pain, abdominal distension, the time of anal independent exhaust, and X-ray changes before and after treatment.  Results In treatment group, 34 cases (81.0%, 34/42) were effective, and 8 cases (19.0%，8/42) were invalid. In control group, 20 cases (55.6%，20/36) were effective, and 16 cases (44.4%，16/36) were ineffective. The efficiency of the treatment group was significantly higher than the control group (χ²=5.870, P<0.05). Compared with conventional therapy, somatostatin therapy of treatment group significantly shortened the time of alleviating abdominal pain and distension ((3.60±1.33)d vs (4.47±1.61)d, t=2.636, P<0.05), anal independent exhaust ((5.95±1.51)d vs (7.19±1.90)d, t=3.218, P<0.05), X-ray sign recovery ((10.40±2.64)d vs (13.36±4.29)d, t=3.720, P<0.05). The effective rates of using somatostatin for 3 days, 7 days, and 10 days in treatment group were 40.5%（17/42）, 59.5%（25/42）, and 81.0%（34/42）, respectively. Three days, 7 days, and 10 days of somatostatin therapy increased 40.5%（17/42）, 32.0%（8/25）, and 52.9%（9/17）significant efficiencies, respectively. There were statistical significance among the increased efficiencies for 3 days, 7 days, and 10 days of somatostatin therapy (χ²=5.536, P=0.019; χ²=13.432, P=0.000).  Conclusion Somatostatin used in treatment of tuberculous ileus can get satisfactory curative effect. Somatostatin using 10 days can still significantly improve the efficiency.

Analysis of case finding strategy of multidrug-resistant pulmonary tuberculosis patients

ZHAO Jin, RUAN Yun-zhou, LI Ren-zhong, CHENG Jun, WANG Li-xia

Chinese Journal of Antituberculosis. 2014, 36(11):  970-975.  doi:10.3969/j.issn.1000-6621.2014.11.010

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Objective To evaluate different case finding strategies of MDR-TB, and to provide evidence for developing case finding strategy appropriately. Methods According to geographic and economic conditions, Tianjin, Wanzhou, Puyang, Quzhou and Daqing were selected as study areas. The sputum specimens of smear positive pulmonary tuberculosis(PTB) cases in Tianjin, Daqing and Puyang were sent to prefecture lab for culture and drug susceptibility test (DST) (Model 1), those in Quzhou and 6 counties (districts) were cultured in the lab at county level, and the positive cultural substance were sent to prefecture lab for DST (Model 2). 7733 cases of smear positive PTB in 5 areas and all 3427 cases of smear negative patients in Tianjin registered from March 2010 to February 2013 were screened with sputum culture and DST (isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin and kanamycin). Delay of diagnosis, MDR-TB and XDR-TB detection rate were collected and analysed by descriptive method and Chi square test by SPSS 13.0. Results Specimen examination rates of Model 1 and 2 were 76.5% (3078/4026) and 90.4% (2017/2232) respectively, and the difference had statistical significance (χ²=183.7, P<0.05). The culture positive rate of Model 1 and 2 were 89.9% (2455/2730) and 87.2% (2232/2559) respectively, there was no statistical significance (χ²=0.2234, P>0.05). The median of MDR diagnosis delay by traditional DST was 104 (86, 138) d, some even longer than 1 year. The detection rates from the highest to lowest were retreatment (17.1%, 129/755), new smear positive (2.1%, 97/4534) and smear negative (0.5%, 9/1937). Conclusion Depending on the resources of different settings, either culture and DST by prefectural-level model or culture by county-level and DST by prefectural-level model are reasonable. Because traditional DST takes longer period, rapid molecular test for drug resistance is recommended for developed setting. Selecting smear positive patient as the scree-ning objects covers majority of MDR-TB patients, screening MDR-TB among smear negative is recommended for developed setting.

Analysis on the present management of the HIV positive tuberculosis patients in key districts of Mtb and HIV co-infection control in Guangdong

YIN Jian-jun, CHEN Xun-xun, LI Jian-wei, JIANG Li, ZHONG Qiu, ZHOU Lin

Chinese Journal of Antituberculosis. 2014, 36(11):  976-979.  doi:10.3969/j.issn.1000-6621.2014.11.011

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Objective To analysis the present management of the HIV positive tuberculosis patients in key districts of Mtb and HIV co-infection control in Guangdong, and to provide reference for co-infection control improvement.  Methods The registration, treatment management and effect of the 103 HIV positive tuberculosis cases registered from January 2012 to June 2013 in 11 key Mtb and HIV co-infection control districts in Guangdong were analyzed with retrospective methods.  Results “Cough, expectoration for more than 2 weeks” occurred in 85.4% (88/103) of the HIV positive tuberculosis patients. Most patients (91.3%, 94/103) had typical chest X ray of tuberculosis showing patchy and cord sign. Only 45.6% (47/103) of the patients had confirmed record of ART and 41.7% (43/103) had definite CD4⁺ T lymphocyte counts. One patient refused the treatment for certain reason and more than half (53.9%, 55/102) of the patients received DOT for the whole treatment. The treatment success rates of new smear positive and new smear negative cases were 87.8% (36/41) and 87.9% (51/58) respectively, and 2 out of 3 retreatment cases were cured. Four new smear positive cases and 3 new smear negative cases dead.  Conclusion Although certain achievements have been made for HIV positive tuberculosis cases management in the Mtb and HIV co-infection key districts of Guangdong, the integration of anti-TB chemotherapy and ART, and reducing the mortality still need to be further strengthened.