Table of Content

10 April 2015, Volume 37 Issue 4

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Effect of the metabolites in the tryptophan-kynurinine pathway on T-cell immunity among patients with tuberculosis

ZHANG Ying, ZHU Hui, LIANG Qian, ZHAO Li-ping, HUANG Hai-rong, HUANG Juan, SUN Zhao-gang

Chinese Journal of Antituberculosis. 2015, 37(4):  333-338.  doi:10.3969/j.issn.1000-6621.2015.04.001

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Objective  To identify the association between the changes of tryptophan (TRP) metabolites and the imbalance of the T-cell subsets in patients with tuberculosis (TB) and to explore the possible mechanism. Methods  The TB patients enrolled in this study came from Beijing Chest Hospital. Forty-five patients were randomly selected from 104 TB patients who were diagnosed in the hospital from September 2012 to December 2012 (patients with complications, such as diabetes, were excluded). At the same time, 39 healthy controlled subjects were randomly recruited from 100 volunteers who received physical examinations at Changping District TB Dispensary of Beijing. The proportions of regulatory T (Treg) cells and T helper 17 (Th17) cells in peripheral blood of enrolled TB patients and healthy subjects were tested by flow cytometry assay. By addng TRP and its metabolites (KYN and QA) to stimulate CD4⁺ and CD8⁺ T lymphocytes in vitro, their effects on cell apoptosis and proliferation were analyzed. SPSS 17.0 was used for statistic analysis. The results of the tests were presented as “x±s” and P<0.05 of t-test was regarded as statistical significance.  Results  To compare with the healthy control group, the proportion of the Treg cells in TB patients significantly increased ((1.49±0.82)% in TB group and(0.41±0.26)% in control group; t=33.64, P=0.000), and the proportion of Th17 in TB patients increased too ((1.04±0.72)% in TB group and (0.73±0.43)% in control group), but it was not significant difference (t=44.46, P=0.071). The results of stimulation tests in vitro showed that: high concentration of KYN (2.0 mmol/L) induced the apoptosis of CD4⁺ T cells ((8.40±3.28)% in healthy control group and (30.07±7.37)% in TB group; t=7.49, P=0.000) and CD8⁺ T cells ((15.31±1.88)% in control group and (26.36±1.09)% in TB group; t=4.89, P=0.003). However, after stimulated with a high concentration of TRP (2.0 mmol/L) or QA (2.0 mmol/L) for 24 hours, the proportions of apoptosis of the CD4⁺ T cells in TB group were (6.66±0.96)% and (6.85±0.43)% respectively, which slightly decreased comparing with the proportions in control group ((8.40±3.28)% and (8.40±3.28)%). The difference was not significant (t=6.42, P=0.189 and t=8.21，P=0.107); the proportions of apoptosis of the CD8⁺ T cells in TB patients were (16.48±4.75)% and (17.18±2.07)% respectively after stimulated with high concentration of TRP (2.0 mmol/L) or QA (2.0 mmol/L), which increased comparing with the proportions in control group ((15.31±1.88)% and (15.31±1.88)%). There was no significant difference between two groups (t=7.41, P=0.238 or t=8.02, P=0.121).  Conclusion  The amount of Treg cells significantly increased in the blood of TB patients. KYN may contribute to the differentiation of T cells by influencing apoptosis of CD4⁺ T cells and CD8⁺ T cells.

M.tuberculosis antigens inhibit the NLRP12 expression in monocytes from patients with active pulmonary TB

LIU Yan-hua, WANG Ruo, CHENG Xiao-xing

Chinese Journal of Antituberculosis. 2015, 37(4):  339-343.  doi:10.3969/j.issn.1000-6621.2015.04.002

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Objective  To study whether Mtb antigens have effect on the NLRP12 expression in peripheral blood monocytes, and provide experimental data to investigate the role of NLRP12 in tuberculosis.  Methods  Peripheral blood were collected from 15 healthy controls and 15 patients with active pulmonary tuberculosis. Monocytes were isolated from peripheral blood and then stimulated with Mtb antigens, including whole cell lysate of H37Rv strain and ESAT-6/CFP-10 peptide pool. Total RNA was extracted from unstimulated and stimulated cells, NLRP12 mRNA was detected by fluorescence quantitative PCR, and the difference of NLRP12 mRNA expression between stimulated and unstimulated cells was analyzed by paired t test.P value less than 0.05 was considered statistically significant.  Results The reduction of NLRP12 mRNA in monocytes from active pulmonary TB was significant following stimulation by whole cell lysate and peptide pool, which reduced to (1.09±0.78)×10^-2 (t=3.826, P<0.01) and (1.14±0.87)×10^-2 (t=3.695, P<0.01) from (1.8±1.26)×10^-2, respectively. The expression of NLRP12 mRNA in monocytes from healthy subjects was no significant change following stimulation by whole cell lysate and peptide pool, although which reduced to (1.2±0.87)×10^-2 (t=1.909, P>0.05) and (1.38±1.02)×10^-2 (t=1.151, P>0.05) from (1.65±0.99)×10^-2, respectively.  Conclusion  Mtb antigens can inhibit the NLRP12 expression in monocytes from patients with active pulmonary Tin vitro.

The detection and clinical significance of serum IL-6，IL-8 and TNF-α in patients with active tuberculosis

CHEN Xing-nian, LIU Qi-dong, WANG Hong, YE Zhi-jian, WU Mei-ying

Chinese Journal of Antituberculosis. 2015, 37(4):  344-347.  doi:10.3969/j.issn.1000-6621.2015.04.003

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Objective  To explore the clinical significance of detection of serum IL-6，IL-8 and TNF-α in patients with active tuberculosis(TB).  Methods  Seventy-one new TB patients (active TB group) and 21 TB patients who was diagnosed as TB and finished treatment (control group) in The Fifth People’s Hospital of Suzhou from September 2012 to June 2013 were enrolled. The serum contents of IL-6，IL-8 and TNF-α were examined using ELISA assay. SPSS 13.0 was used for data analysis. Median and interquartile range were used to describe numerical data. Wilcoxon rank testing was used for comparison between groups and Chi-square test was applied to compare categorical data. P<0.05 was considered statistically significant. Results (1) The medians of TNF-α in active TB group and control group were 11.5 pg/ml and 8.8 pg/ml respectively, and the interquartile ranges (P₂₅，P₇₅) were (9.6 pg/ml, 14.7 pg/ml) and (7.6 pg/ml, 11.2 pg/ml), respectively. There was a significance difference between the two groups (U=369.5, P<0.001). (2) The medians of IL-6 in active TB group and control group were 7.8 pg/ml and 2.0 pg/ml, respectively, and the interquartile ranges (P₂₅，P₇₅) were (3.1 pg/ml, 15.9 pg/ml) and (1.5 pg/ml, 5.4 pg/ml), respectively. The difference between the two groups was statistical significant (U=389.5, P=0.001). (3) The medians of IL-8 in active TB group and control group were 8 pg/ml and 8 pg/ml, respectively, and the interquartile ranges (P₂₅，P₇₅) were (5 pg/ml, 15 pg/ml) and (6.5 pg/ml, 13 pg/ml), respectively. There was no significance difference between the two groups (U=731.5, P=0.896). Conclusion The serum TNF-α and IL-6 in the development of active TB changes in a wide range, and the detection of TNF-α and IL-6 may help to determine the progress of active TB.

Diagnostic value of T-SPOT.TB for elderly pulmonary tuberculosis

WAN Rong, LI Ming-wu, LAI Ming-hong, LIU Yong-li

Chinese Journal of Antituberculosis. 2015, 37(4):  348-352.  doi:10.3969/j.issn.1000-6621.2015.04.004

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Objective  To evaluate the diagnostic value of T-SPOT.TB for the elderly pulmonary tuberculosis. Methods  From November 2010 to February 2012, 257 elderly inpatients (73 pulmonary TB patients with confirmed laboratory tests, 95 TB patients with clinical diagnosis, and 89 non-pulmonary tuberculosis patients) of the No.2 Department of Tuberculosis, The Third People’s Hospital of Kunming were recruited. The data were analyzed by SPSS 13.0. The sensitivity and specificity of T-SPOT.TB were compared with routine laboratory test such as acid-fast bacilli (AFB) smear and culture, skin test (PPD), TB-DOT/TB-CK, PCR for tuberculosis bacilli DNA (TB-DNA), and erythrocyte sedimentation rate (ESR). P<0.05 was considered statistically significant. Results  The sensitivities of T-SPOT.TB, PPD, TB-DOT/TB-CK, TB-DNA and ESR were respectively 87.7% (64/73), 57.4%(31/54), 71.4%(50/70), 77.6%(52/67) and 81.7%(58/71) for the TB patients with laboratory confirmation. The sensitivity of T-SPOT.TB was significantly higher than those of PPD and TB-DOT/TB-CK and the difference was statistically significant (χ²=5.831, P<0.05; χ²=15.083, P<0.01). The sensitivities of T-SPOT.TB, PPD, TB-DOT/TB-CK and ESR were respectively 86.3%(82/95), 57.3%(47/82), 42.4%(39/92) and 60.9%(56/92) for the patients with clinical TB diagnosis. The sensitivity of T-SPOT.TB was significantly higher than those of other laboratory tests (χ²=39.485, 18.726 and 15.650, P<0.01). The specificities of T-SPOT.TB, PPD, TB-DOT/TB-CK, TB-DNA and ESR were 92.1%(82/89), 82.7%(62/75), 83.1%(74/89), 98.9%(88/89) and 41.2%(35/85) respectively. The specificities of T-SPOT.TB was significantly higher than those of TB-DNA and ESR (χ²=4.712 and 51.254, P<0.05).  Conclusion The T-SPOT.TB has higher sensiti-vity and specificity in the diagnosis of elderly pulmonary tuberculosis, and it deserves the clinical expansion.

The growing challenge of nontuberculous mycobacteria

Chinese Journal of Antituberculosis. 2015, 37(4):  352-352.  doi:10.3969/j.issn.1000-6621.2015.04.005

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Studies on the phenotypically resistant characteristics and therapeutic effect of antitubercular drugs on M. tuberculosis clinical isolates from the patients with tuberculous meningitis

WANG Ting, ZHAO Yan-lin, PANG Yu, FENG Guo-dong, SONG Yuan-yuan, OU Xi-chao, PENG Jin-xiang, ZHAO Gang, ZHAN Li-ping

Chinese Journal of Antituberculosis. 2015, 37(4):  353-359.  doi:10.3969/j.issn.1000-6621.2015.04.006

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Objective  To study the phenotypically resistant characteristics and therapeutic effect of antitubercular drugs on M. tuberculosis clinical isolates from the patients with tuberculous meningitis (TBM).  Methods Five hundred cerebrospinal fluid (CSF) from suspected patients with tuberculous miningitis were cultured with Bactec MGIT 960. Twenty-five strains were isotated, and then identified the species by 16S rRNA gene sequencing, detected 14 anti-tuberculous drug susceptibility by Bactec MGIT 960 and 12 anti-tuberculous drug susceptibility by the proportional method of conventional solid culture. The minimal inhibitory concentrations (MICs) of 16 anti-tuberculous drugs on these isolates were determined. The bacterial sterilization rate was determined by calculating the ratio of maximal plasma concentration (C_max)/MIC to evaluated thetherapeutic effect of drugs on M. tuberculosis. Results Of 25 M. tuberculosis isolates, 13 were resistant to any anti-tuberculous drugs, 3 were multidrug-resistant. The ratios of C_max/MIC for rifampicin, moxifloxacin, levofloxacin, clofazimine, and p-aminosalicylic acid were 19.880, 63.333, 19.149, 75.000, and 50.855, respectively.  Conclusion  Most drug-resistant isolates from TBM patients were phenotypically resistant to isoniazid or rifampicin, the least isolates were phenotypically resistant to quinolone. The C_max/MIC values of moxifloxacin, clofazimine, p-aminosalicylic acid, levofloxacin and rifampicin were higher, suggesting that the combination of high doses of rifampicin and fluoroquinolones might improve the therapeutic effect of TBM. P-aminosalicylic acid and clofazimine might play an better role in antituberculous treatment of TBM.

CD4 cell count,sputum bacteria isolation identification and its drug sensitivity test of resistance in multi-drug resistant pulmonary tuberculosis patients

HU Yong-fang, ZHANG Hui-zheng, LIU Jia-xiu, LIN Yi-min, TAN Ke-hui

Chinese Journal of Antituberculosis. 2015, 37(4):  360-365.  doi:10.3969/j.issn.1000-6621.2015.04.007

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Objective  Investigate on sputum pathogenic bacteria and drug sensitivity test,blood CD4 cell count and in the multi-drug resistant pulmonary tuberculosis patients (multi-drug resistant pulmonary tuberculosis, MDR-PTB). Methods A retrospective analysis of 489 cases of CD4 cell count in patients with MDR-PTB and sputum isolation and identification of bacteria and its drug sensitivity test of the main pathogenic bacteria results by, non pathogenic bacteria are divided into pathogen group 206 cases, non pathogenic bacteria group with 283 cases. The measurement data in “x±s” said the count data expressed in percentage. Correlation between the two groups were compared using U test, χ² test, t test, with P<0.05 as the difference had statistical significance.  Results CD4 total cell detection results for (438±258)/μl, non pathogenic bacteria group (514±273)/μl, pathogen group (340±194)/μl, there was significant difference between two groups (U=8.23, P<0.01). Pathogenic bacteria group of 244 strains of bacteria were isolated, gram negative bacilli accounted for 50.4% (123/244), including pneumonia gram Lei Bojun, Enterobacter cloacae, Pseudomonas aeruginosa, Bauman-hemolytic Acinetobacter and Escherichia coli is ranked in the top 5; fungi accounted for 25.8% (63/244), Candida albicans is the main; gram positive cocci accounted for 23.8% (58/244), with Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus haemolyticus based. ESBLs bacteria detection rate of 5.3% (13/244); methicillin-resistant Staphylococcus aureus detection rate was 10.7% (26/244). In CD4 <400/L interval of pathogenic bacteria infection in 154 cases, accounting for pathogen group 74.8% (154/206). Thirty-five cases of single fungus, 3 cases of CD4 is less than or equal to 200/μl、 12 cases of 201/μl≤CD4≤400/μl，10 cases of 401/μl≤CD4≤ 600/μl, 10 cases of CD4 >600/μl. Bacteria and fungi in 28 cases, 17 cases of CD4 is less than or equal to 200/μl, 7 cases of 201/μl ≤CD4≤400/μl, 4 cases were dispersed in the other interval. The first 5 gram negative bacilli to amikacin, gentamycin, levofloxacin sensitive rate above 50.0%, except Pseudomonas aeru-ginosa to carbapenem sensitive rate was 100.0%; leather sensitive rate of gram-positive cocci to daptomycin, linezolid, vancomycin was 100%, resistant to penicillin, ampicillin ampicillin, ceftriaxone, shubatan rate in more than 60.0%. Conclusion Respiratory tract infections in patients with MDR-PTB in CD4 cells in low, CD4 is less than or equal to 400/L interval occurred bacteria, bacterial fungal infection, gram negative bacilli, but different pathogenic bacteria drug sensitivity of different, clinical attention should be paid to improving the immunity function of patients, accor-ding to etiological examination and the results of drug sensitive test, screening effective antibiotics.

Comparision on the detection effects of three methods for Mycobacterium tuberculosis ethambutol sensitivity test

SUN Qing, ZHAO Li-li, CHEN Yan, ZHAO Xiu-qin, WU Yi-mou, WAN Kang-lin

Chinese Journal of Antituberculosis. 2015, 37(4):  366-370.  doi:10.3969/j.issn.1000-6621.2015.04.008

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Objective  To compare the detection effects and the accordance of three drug sensitivity test (DST) methods based on bacterial culture for testing Mycobacterium tuberculosis (M.tuberculosis) sensitivity to ethambutol (EMB).  Methods One hundred and twenty-six M.tuberculosis clinical isolates sensitivity to EMB were detected with three methods, including L-J proportion method, Bactec MGIT 960 system (960 system) and microplate Alamar blue assay (MIC assay), and their results were compared interactively. The test data were analyzed using SPSS 17.0 software. The Kappa value between 0.4-0.75 represents moderately consistency, and Kappa value ≥0.75 shows excellent concordance, whereas Kappa value less than 0.4 means poor consistency.  Results The EMB sensitivity of 126 clinical M.tuberculosis isolates was tested by the three methods, the total consistency was 75.4%（95/126）. If L-J proportion method was used as the standard control, the sensitivity, specificity and consistency of 960 system and MIC assay were 62.8% (49/78), 100.0% (48/48), 77.0% (97/126) and 82.1% (64/78), 97.9% (47/48), 88.1% (111/126), respectively. MIC method showed a better consistency with L-J proportion method (Kappa=0.76), while 960 system represented a moderate concordance with L-J method (Kappa=0.56). If 960 system were taken as the standard control, the sensitivity, specificity and consistency of 960 system and MIC assay were 100.0% (49/49), 62.3% (48/77), 77.0% (97/126) and 98.0% (48/49), 77.9% (60/77), 85.7% (108/126), respectively. Both L-J proportion method and MIC assay showed high consistency with 960 system (Kappa≥0.70). If MIC assay was set as the standard control, the sensitivity, specificity and consistency of L-J proportion method and 960 system were 98.5% (64/65), 77.0% (47/61), 88.1% (111/126), and 73.8% (48/65),98.4% (60/61), 85.7% (108/126), respectively. The inconsistency among the three methods exis-ted in the MIC value of the drug concentration range 4.0 to 16.0 μg/ml.  Conclusion There were better consistency among the three detecting methods for testing M.tuberculosis sensitivity to EMB, but in which discrepancies existed on a certain extent. The results between 960 system and MIC assay were superb consistent. The MIC assay is more cost-effective, and more suitable for early diagnosis of M.tuberculosis resistance to EMB.

Study on the levels of injectable antituberculosis drug resistance in 117 Mycobacterium tuberculosis clinical strains

SONG Yan-hua，MA Li-ping，LU Yu，FU Yu-hong，GAO Meng-qiu

Chinese Journal of Antituberculosis. 2015, 37(4):  371-376.  doi:10.3969/j.issn.1000-6621.2015.04.009

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Objective  To observe the levels of the resistance and cross-resistance to streptomycin (Sm), kanamycin (Km), amikacin (Am), capreomycin (Cm) in Mycobacterium tuberculosis (Mtb) clinical strains by drug susceptibility test (DST).  Methods  The MICs of Sm, Km, Am, and Cm in 117 Mtb clinical strains were detected by microplate Alamar blue assay (MABA). The critical concentration of Sm, Km, Am, and Cm on Mtb were 2, 4, 1 and 2.5 μg/ml, respectively. When the MICs of Sm/Km/Am on Mtb were greater than critical concentration and ≤16 μg/ml, or 32-64 μg/ml, or >64 μg/ml, the drug resistances were defined as low level, moderate level, and high level, respectively. But that for Cm on Mtb was greater than critical concentration and ≤20 μg/ml, or 40-80 μg/ml, or >80 μg/ml.  Results  Of 117 Mtb clinical isolates, 83 were Sm-resistant, in which 63 isolates（75.9%）were high resitance, 18 isolates （21.7%） were low resistance, 2 isolates （2.4%） were moderate resis-tance. 78.3% of 23 Km-resistant strains and 94.7% of 19 Am-resistant strains were high-level resistance (MIC≥128 μg/ml), other isolates were low-level resistant to Am/Km, no moderate-level resistant isolates were observed. The MICs of 14 Cm-resistant isolates were 5-20 μg/ml, and there were not high level of Cm-resistant isolates. Of 83 Sm-resistant isolates, 27.7% (23/83) and 22.9% (19/83) were resistant to Km and Am respectively, 71.1% (59/83) were sensitive to both Km and Am. 78.3% (18/23) of Km-resistant isolates and 94.7% (18/19) of Am-resistant isolates were highly resistant to both Km and Am, which had no significant difference （χ²=1.157,P>0.05）. Five strains were low resistance to Km, but sensitive to Am. 68.4%（13/19） of Am-resistant isolates and 92.9% (13/14) of Cm-resistant isolates were resistant to both Am and Cm.  Conclusion  The majority of the Sm/Km/Am-resistant clinical isolates were high resistance, and the majority of the Cm-resistant clinical isolates were low resistance. Most of highly Sm-resistant isolates were susceptible to Km/Am. The highly Am/Km-resis-tant isolates showed cross resistance each other. A small proportion of lowly Km-resistant isolates were sensitive to Am. Most of highly Am-resistant isolates were low resistance to Cm. Almost all of Cm-resistant isolates were high resistant to Am.

Investigation of cross-resistance between rifampin and rifabutin in multidrug-resistant M.tuberculosis strains

SHEN Jing，ZHAO Yan-lin，PANG Yu，ZHANG Shun，DU Chang-ting，LIU Jie

Chinese Journal of Antituberculosis. 2015, 37(4):  377-382.  doi:10.3969/j.issn.1000-6621.2015.04.010

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Objective  To investigate the antibacterial effect of rifabutin and the cross-resistance between rifabutin and rifampin in multidrug-resistant Mycobacterium tuberculosis（MDR-TB）strains, to understand the mutation characteristics of rpoB gene among the strains with rifampin and rifabutin cross-resistance. Methods Using interval sampling method, 131 MDR-TB clinical strains were obtained from 401 MDR-TB isolates of National Drug Resistance Tuberculosis Baseline Survey in 2007—2008. Minimum inhibitory concentrations (MICs) of rifampin and rifabutin for these MDR-TB isolates were determined by microplate Alamar blue assay method.The mutations of rpoB gene were determined by DNA sequencing, and analyzed the effect of the rpoB gene mutations on rifabutin and rifampin cross resistance. Using SPSS 11.0 statistical analysis software, the cross-resistance was compared with Chi-square test. The difference was considered as statistical significance when P<0.05.  Results Of 131 MDR-TB strains, the median of rifampin MICs was 256 μg/ml, and the median of rifabutin MICs was 2 μg/ml. The cross resistant rate between rifampin and rifabutin was 76.47%(91/119). In addition, 113 isolates(86.26%, 113/131) harbored rpoB mutations, in which there were 7 types of single mutations, including codon 531, 526, 516, 513, 511, 522, and 533, codon 531(56.50%, 74/131) and codon 526(16.03%, 21/131) were the most frequently observed. Besides, the mutations at codon 526 and 531 were associated with cross-resistance between rifampin and rifabutin, their cross-resistance rates were 90.48%(19/21) and 78.38%(58/74) respectively, which had no statistically significant difference（χ² were 9.641 and 8.223, P<0.05).  Conclusion Rifabutin has cross-resistance with rifampin, but rifabutin showed better antimicrobial ability. The M. tuberculosis isolates with different rpoB mutations showed different cross-resistance between rifabutin and rifampin.

Factors affecting the hospitalization treatment of smear positive pulmonary tuberculosis patients in Chaoyang district, Beijing

HE Fang, ZHANG Hong, LIANG Rui-ying, ZHANG Ai-jie, LIU Ying-jie, LIU Hui

Chinese Journal of Antituberculosis. 2015, 37(4):  383-388.  doi:10.3969/j.issn.1000-6621.2015.04.011

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Objective  To explore the factors affecting the hospitalization treatment of smear positive pulmonary tuberculosis patients and provide reference for related policies of TB management in Beijing. Methods  A questionnaire was used to interview 340 smear positive pulmonary tuberculosis patients who registered in Chaoyang District Center for Disease Control and Prevention of Beijing from November, 2012 to August, 2014. The questionnaires was designed by experts, and its reliability Cronbach’s alpha coefficient was 0.85 and the reliability is good. The questionnaire includes 8 demographic characteristics（gender, age, residence, medical insurance, education level, marital status, family income source, family income） and 4 clinical signs and symptoms (whether with diabetes, whether cavitary PTB, the number of lung cavity and tuberculosis symptoms, including fever, cough, sputum, hemoptysis, chest pain, shortness of breath, fatigue, night sweats, body weight reduction). SAS 9.3 was used for univariate and multi-factor unconditional logistic regression analysis, P＜0.05 is considered statistically significant difference. Results  There were 328 TB patients who completed the final survey, among them, the response rate was 96.47% (328/340).76.83%（252/328）patients refused to be hospitalized for isolated treatment and 23.17% (76/328) received isolation treatment. Among patients who refused to live in hospital, the expense problem accounted for 52.38%（132/252）. The univariate analysis has shown the following factors statistically significant. They are the family residence (for patients received hospitalization treatment, the local family residence accounted for 65.79%（50/76）, the nonlocal family residence accounted for 34.21% (26/76); for patients refused the hospitalization, the local family residence accounted for 26.59%（67/252）, the nonlocal family residence accounted for 73.41%（185/252）; χ²=39.11，P<0.01); medical insurance (for patients received hospitalization treatment, the medical insurance accounted for 86.85%（66/76）, the new rural cooperative medical system：7.89% (6/76), at own pocket:5.26%（4/76）; for patients refused the hospitalization, the medical insurance accounted for 39.28%（99/252）, the new rural cooperative medical system：9.13%（23/252）, at own pocket: 51.59%（130/252）；χ²=57.02，P<0.01); family annual per-capita income (for patients received hospitalization treatment, 10 000:1.32%（1/76）, 20 000: 1.32%（1/76）, 30 000: 25.00%（19/76）, 40 000: 19.73%（15/76）, above 40 000: 52.63%（40/76）; for patients refused the hospitalization, 10 000: 31.35%（79/252）, 20 000: 8.73%（22/252）, 30 000: 13.10%（33/252）, 40 000: 17.06%（43/252）, above 40 000: 29.76%（75/252）；Z=5.28，P<0.01)；whether suffering from diabetes mellitus (for patients received hospitalization treatment, not with 76.32%（58/76）, yes 23.68%（18/76）；for patients refused the hospitalization, not with 88.49%（223/252）, yes 11.51%（29/252）；χ²=7.05，P<0.01); whether had cavitary PTB (for patients received hospitalization treatment, not with 67.11%（51/76）, yes 32.89%（25/76）；for patients refused the hospitalization, not with 78.17%（197/252）, yes 21.83%（55/252）；χ²=3.88，P<0.05); age (for patients received hospitalization treatment, average age 46.5（26，71）；for patients refused the hos-pitalization, average age 31.5（24，46）；Z=3.63，P<0.01); total score of all symptoms (for patients received hospitalization treatment 2（1，3）, for patients refused the hospitalization 2（1，2）；Z=2.37，P<0.05). The multiple variants logistic regression showed that age （Waldχ²=15.083，P<0.01，OR=1.045,95%CI=1.022-1.068）；marital status （Waldχ²=10.525，P=0.01，OR=5.484,95%CI=1.961-15.335）; family annual per-capita income（Waldχ²=22.087，P<0.01，OR=2.028,95%CI=1.510-2.723）；medical insurance（Waldχ²=21.444，P<0.01，OR=14.861,95%CI=4.742-46.571）; the new rural cooperative medical system（Waldχ²=6.645，P=0.01，OR=6.847,95%CI=1.586-29.562）; whether suffering from cavity（Waldχ²=3.877，P<0.05，OR=0.473,95%CI=0.225-0.997） and total score of all symptoms （Waldχ²=6.398，P<0.05，OR=1.447,95%CI=1.087-1926） are the influence factors for the isolation treatment of TB patients. Conclusion  The smear positive pulmonary tuberculosis patients with older age, higher family income, higher total score of all symptoms, suffering from PTB lung cavity, are more likely to be hospitalized for isolated treatment; compared with unmarried patients and self-paid patients, the patients who got married and covered by medical insurance/socialized medicine and the new rural cooperative medical system are more likely to be hospitalized for isolated treatment.

The drugs resistance status of pulmonary tuberculosis patients in Bortala Mongolia Autonomous Prefecture in 2013

LI Yu-xin，PA Zi-re，LIU Nian-qiang

Chinese Journal of Antituberculosis. 2015, 37(4):  389-392.  doi:10.3969/j.issn.1000-6621.2015.04.012

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Objective  To investigate the drug resistant status of pulmonary tuberculosis patients in Bortala Mongolia Autonomous Prefecture (hereafter referred as Bozhou). Methods  A total of 358 cases of PTB, including male 225 cases, female 133 cases, with the mean age of (50±20) years old, registered from January 1 to December 31 of 2013 in Bozhou(include Bole city, Jinghe county, Wenquan county) were enrolled in the investigation, among which, 192 cases were smear positive pulmonary tuberculosis patients(154 cases of initial treated patients, 38 cases of retreatment patients), 166 were smear negative patients. All patients received sputum smear and culture. All culture positive cases recieved eight kinds of drug sensitivity tests(four kinds of the first-line drugs including INH, RFP, EMB, Sm and four kinds of the second-line drugs, including Ofx, Am, Km, Cm). The descriptive and Chi square test were used for statistical analysis of the drugs susceptible results. P<0.05 is considered significant difference. Results  The first line drug resistant rate of patients with tuberculosis bacillus culture positive was 24.60% (46/187), this rate for initial treatment patients and retreatment patients was 22.81%(39/171) and 43.75%(7/16) respectively. Multidrug-resistant rate was 8.02%(15/187), that of the initial treatment patients was 5.26%(9/171) and the retreatment patients was 37.50%(6/16). The second line drug resistant rate was 5.35%（10/187）,for the initial treatment patients was 4.68%（8/171）and 12.50%（2/16） for the retreatment patients. The drug resistant rate of tuberculosis isolates vary with different characteristics. The drug resistant rate of male, female was 26.13%（29/111）, 26.32%（20/76） respectively, and age below 30 years old group, 30- years old group, above 60 age group was 26.19%（11/42）, 27.03%（20/74）, 25.35%（18/71） (χ² values were 0.0005, 0.03, P>0.05) respectively. The top five resistant drugs of eight kinds of antituberculosis drugs were Sm 19.79% (37/187), INH 14.44% (27/187), RFP 10.70% (20/187), Ofx 5.35% (10/187) and EMB 3.21% (6/187). Conclusion  The overall drug resistance situation of Bozhou is very serious. We should focus on epidemic trend of the multidrug resistant tuberculosis and establish dynamic monitoring of drugs resistant level continuously in order to provide theoretical support for prevention and control of multidrug-resistant tuberculosis.

The diagnosis and differential diagnosis value of interferon gamma induced protein 10 (IP-10) in tuberculosis

HE Hua, ZHOU Yu-jie, WEN Gao-yan, WANG Xin-ning, DING Chang, ZENG Yi

Chinese Journal of Antituberculosis. 2015, 37(4):  393-396.  doi:10.3969/j.issn.1000-6621.2015.04.013

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Tuberculosis is a public health and social issue of global concern, and its diagnosis and treatment are crucial in recent years, new Chemokine gamma interferon-inducible protein-10 (IP-10) was discovered, and its clinical application value in tuberculosis (including pulmonary tuberculosis, tuberculous pleurisy, extrapulmonary tuberculosis) has been investigated. The author reviewed literatures to analyze the diagnosis and differential diagnosis value of IP-10 in tuberculosis.

Risk of mycobacterial infections associated with rheumatoid arthritis in Ontario, Canada

Chinese Journal of Antituberculosis. 2015, 37(4):  416-416.  doi:10.3969/j.issn.1000-6621.2015.04.022

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