Table of Content

10 April 2018, Volume 40 Issue 4

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Original Articles

Clinical application of immunohistochemistry and PCR technique in pathological diagnosis of tuberculous lymphadenitis

Yu-jie DONG,Li ZHANG,Yu-xuan WANG,Li-juan ZHOU,Yang QU,Chen ZHANG,Hai-qing ZHANG,Nan-Ying CHE

Chinese Journal of Antituberculosis. 2018, 40(4):  348-352.  doi:10.3969/j.issn.1000-6621.2018.04.002

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Objective To evaluate the clinical value of immunohistochemistry (IHC) and polymerase chain reaction (PCR) methods in pathological diagnosis of tuberculous lymphadenitis. Methods Paraffin-embedded tissue specimens from 48 patients with tuberculous lymphadenitis who had undergone radical resection (the tuberculosis (TB) group) and 21 cases with other diseases in lymph node (the non-TB group) were collected during Jan 2012 to Jul 2013 in Beijing Chest Hospital, Capital Medical University. One-step IHC using antibody targeting Ag85B, Taqman fluorescent quantitative PCR and acid-fast staining were conducted. Their diagnostic efficiency were analyzed, taking the clinical final diagnosis as golden standard.Results The IHC and PCR showed significantly higher sensitivity than that of acid-fast staining (χ ²=6.27, P=0.012; χ ²=10.84, P=0.001, respectively), by the results of 52.1% (25/48) and 60.4% (29/48) versus 27.1% (13/48). However, there was no significant difference in sensitivity between IHC and PCR (χ ²=0.68, P=0.411). The detection results of IHC, PCR and acid-fast staining in non-TB group were all negative, with a specificity of 100% (21/21) for each test. The IHC and PCR had higher negative predictive value and accordance rate than acid-fast staining (47.7% (21/44), 52.5% (21/40), 37.5% (21/56), respectively; 66.7% (46/69), 72.5% (50/69), 49.3% (34/69), respectively). Conclusion IHC and PCR methods are simple and have higher sensitivity compared to acid-fast staining method. IHC and PCR showed good clinical application value in pathological diagnosis of tuberculous lymphadenitis.

The application value of T-SPOT.TB in patients with malignant tumor complicated with tuberculosis

Juan-wen LIAN,Li-yun DANG,Jia-ling XU,Yu FAN

Chinese Journal of Antituberculosis. 2018, 40(4):  353-357.  doi:10.3969/j.issn.1000-6621.2018.04.003

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Objective To analyze the clinical application value of T-SPOT.TB in detecting malignant tumor complicated with tuberculosis. Methods From January to December 2016, 102 patients with malignant tumor complicated with tuberculosis, 64 with malignant tumor, and 80 with tuberculosis were selected from Xi’an Chest Hospital. Peripheral blood mononuclear cells (PBMC) were isolated from the peripheral blood of each patient, and the performances of T-SPOT.TB in detecting different patient populations were analyzed. At the same time, the sensitivity and specificity of T-SPOT.TB in detection of malignant tumor complicated with tuberculosis were tested, as well as the consistency with acid-fast staining and/or pathological examination. Results The positive rate of T-SPOT.TB in detecting malignant tumor complicated with tuberculosis was 85.29% (87/102), and the positive rate in detecting malignant tumor was 26.56% (17/64); the difference was statistically significant (χ ²=57.97, P<0.01). The positive rate in detecting tuberculosis was 91.25% (73/80), and there was no statistical significance compared with that of malignant tumor complicated with tuberculosis (χ ²=1.50, P=0.221). Furthermore, the positive spot numbers of A and B antigen in different patient were also compared. For the patients with malignant tumor complicated with tuberculosis and those with tuberculosis only, the median (Q₁, Q₃) positive spot number of A antigen was 56.50 (30.25, 83.25) and 45.50 (32.00, 75.00), and that of B antigen was 63.50 (43.25, 98.00) and 55.00 (24.00, 101.50), respectively. The differences between the two patient populations had no statistical significance (Z=-0.66 and -0.30, P=0.539 and 0.796, respectively). The sensitivity and specificity of T-SPOT.TB for malignant tumor complicated with tuberculosis were 85.29% (87/102) and 73.44% (47/64), respectively. Compared with acid fast staining and/or pathological examination, the Kappa value of T-SPOT.TB was 0.61. Conclusion T-SPOT.TB has good detection efficiency for patients with malignant tumor complicated with tuberculosis, which can be used for auxiliary diagnosis.

Analysis of factors influencing T-SPOT.TB results in patients with tuberculosis

Hong-yun YIN,Wen-ling TAN,Jun MA,Yan-ping GE,Xiang SHI,He-ping XIAO,Yong-hong FENG

Chinese Journal of Antituberculosis. 2018, 40(4):  358-364.  doi:10.3969/j.issn.1000-6621.2018.04.004

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Objective To explore factors influencing T-SPOT.TB results in order to improve the accuracy of tuberculosis diagnosis.Methods Clinical data from 1537 inpatients was collected between May 2014 and April 2015 in Shanghai Pulmonary Hospital. Patients were grouped into a clinical TB group (1159 cases) and a clinical non-TB group (378 cases), according to the preliminary clinical diagnosis. Patients were then regrouped into a TB group and non-TB group according to the pathogenic diagnosis. The TB group (1103 cases) included 229 cases confirmed by acid-fast bacillus (AFB) staining and mycobacterium bacillus culture, and 874 cases confirmed by final clinical diagnosis, and the non-TB group (395 cases) included 94 cases with a previous history of tuberculosis or old tuberculosis lesions demonstrated by radiology, and 301 patients with no past history of tuberculosis. Thirty-nine cases, whose final diagnosis was uncertain, were excluded from the study. The 1103 cases in the TB group consisted of 557 cases of pulmonary tuberculosis, 107 cases of tuberculous pleurisy, 16 cases of lymphoid tuberculosis, 51 cases of osteoarticular tuberculosis, 7 cases of cerebral tuberculosis, 363 cases of multiple organ tuberculosis and 2 cases of other extrapulmonary tuberculosis. There were 93 cases of nontuberculous mycobacterial (NTM) infection among the 395 cases in the non-TB group. We retrospectively analyzed the sensitivity and specificity of T-SPOT.TB in the different groups and discuss factors influencing the results.Results (1) The diagnostic sensitivity of T-SPOT.TB in the clinical TB group and the TB group were 81.97% (950/1159) and 83.77% (924/1103), respectively, and the diagnostic specificity of T-SPOT.TB in these two groups were 53.44% (202/378) and 54.43% (215/395), respectively. The positive diagnostic ratio of T-SPOT.TB was 90.73% (235/259) for TB cases with positive AFB results and 92.58% (212/229) for those with positive culture results. (2) There was a significant difference in the positive rate of T-SPOT.TB between non-TB cases with a previous history of tuberculosis or with old tuberculosis lesions demonstrated by radiology (69.15%, 65/94), and non-TB cases with no previous history of TB (38.21%, 115/301; χ ²=27.65, P=0.000). (3) The TB specific antigen A and B spot counts in the TB-group (69.81% (652/934) and 69.67% (627/900) for spot counts ≥1 and spot counts ≥11) were significantly higher than in the non-TB group (46.83% (96/205) and 46.63% (83/178) for spot counts ≥1 and spot counts ≥11; Z=-14.20, -14.63, respectively; P<0.01). (4) The positive ratios of T-SPOT.TB for tuberculosis varied according to the type of organ lesion. The positive diagnostic ratio was highest for lymph node tuberculosis (87.50%, 14/16), followed by multiple organ tuberculosis (87.33%, 317/363), pulmonary tuberculosis (86.54%, 482/557), tuberculous pleurisy (74.77%, 80/107). The positive diagnostic ratio was low for cerebral tuberculosis (57.14%, 4/7) and osteoarticular tuberculosis (50.98%, 26/51). (5) The average age of NTM cases with positive T-SPOT.TB results (53.61±18.43) was higher than that of TB cases with positive T-SPOT.TB results (44.98±18.88) (t=-2.63, P=0.009). Conclusion Diagnostic methods, sputum bacteria counts, previous history of tuberculosis or old tuberculosis lesions, non-tubercular mycobacterium infection secondary to tuberculosis, and the type of tuberculosis can influence T-SPOT.TB results and should not be ignored in T-SPOT.TB-based TB diagnosis.

Diagnostic value of combined detection of sputum and pleural effusion with different techniques in tuberculous pleurisy

Gui-rong WANG,Shu-qi WANG,Guang-lu JIANG,Mai-ling HUANG,Xin-ting YANG,Xiao-you CHEN,Hai-rong HUANG

Chinese Journal of Antituberculosis. 2018, 40(4):  365-371.  doi:10.3969/j.issn.1000-6621.2018.04.005

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Objective To evaluate the diagnostic value of several tests in Mycobacterium tuberculosis (MTB) detection by the combination of pleural fluid and sputum in tuberculous pleurisy.Methods Of 1955 cases with tuberculous pleurisy admitted in Beijing Chest Hospital from January 2014 to March 2017 were retrospectively analyzed. There were 1232 cases (63.02%) with pulmonary parenchyma and 723 cases (36.98%) without pulmonary parenchyma. According to the positive detection rate of MTB in single and combined detection of sputum and pleural effusion by AFB, modified roche solid culture, BACTEC 960 and Xpert, the effect of pulmonary parenchyma lesion on the positive rate of MTB need to be analyzed.Results Of 1955 cases with tuberculous pleurisy, 535 cases (27.37%) of sputum and pleural effusion were examined by AFB and 353 cases (18.06%) by culture and 294 cases (15.04%) by Xpert. Among them, 188 cases (9.62%) were examined simultaneously by AFB, culture and Xpert. The positive rate of AFB, culture and Xpert (3.18% (17/535), 15.30% (54/353), 19.05% (56/294)) in detecting MTB in pleural effusion was significantly lower than that in sputum combination with pleural effusion (21.87% (117/535), 43.63% (154/353), 47.62% (140/294); χ ² were 85.31, 68.16 and 54.00, respectively. All P values were less than 0.01). In patients with pulmonary parenchyma disease, the positive rate of detection for MTB in pleural effusion by AFB, culture and Xpert alone (3.82% (13/340), 16.30% (37/227) and 23.91% (44/184)) was significantly lower than that in sputum (30.29% (103/340), 51.10% (116/227) and 60.33% (111/184); χ ² were 84.19, 61.53 and 50.04, respectively. All P values were less than 0.01), and also lower than that in sputum combination with pleural effusion (32.06% (109/340), 55.95% (127/227) and 67.93% (125/184); χ ² were 92.06, 77.32 and 71.79 respectively. All P values were less than 0.01). When using culture as gold standard, the sensitivity of AFB, culture and Xpert (48.36% (59/122), 79.38% (77/97), 80.49% (66/82)) in detecting sputum combination with pleural effusion was significantly higher than that in single pleural effusion (8.20% (10/122), 26.80% (26/97), 26.83% (22/82); χ ² were 48.52, 53.84 and 47.47 respectively. All P values were less than 0.01). The specificity of three tests in detecting sputum combination with pleural effusion was lower than that in single pleural effusion. There was no significant difference in AFB (χ ²=3.65,P=0.056), but significant difference in Xpert (χ ²=4.71, P=0.030) and AFB combination with Xpert (χ ²=5.67, P=0.017). Conclusion Due to the positive rate of MTB in sputum and pleural effusion was higher than that in single test, the combined detection of sputum and pleural effusion should be carried out in patients suspected of tuberculous pleurisy in order to improve the diagnostic value.

Application value of intracellular acid-fast staining in detection of Mycobacterium tuberculosis in body fluid specimens

Han YANG,Xiao-li CUI,Ai-fang LI,Zhen-yu YOU,Xiao-wen TAN,Li-yun DANG

Chinese Journal of Antituberculosis. 2018, 40(4):  372-377.  doi:10.3969/j.issn.1000-6621.2018.04.006

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Objective To explore the application value of intracellular acid-fast staining in the detection of Mycobacterium tuberculosis (TB) in body fluid specimens.Methods A total of 1236 body fluid specimens were collected from the patients who were suspected to have TB and sought health care at Xi’an Chest Hospital from April 2013 to April 2015, including 237 cerebrospinal fluid specimens and 999 pleural effusion and ascites specimens. The tests for detection of Mycobacterium tuberculosis were performed to the above samples by using the following methods: acid fast staining of Mycobacterium tuberculosis in leukocytes (modified acid-fast staining method or intracellular staining method), BACTEC MGIT 960 liquid culture of Mycobacterium tuberculosis (MGIT 960 liquid culture method) and polymerase chain reaction (PCR) fluorescence probe method (PCR method).Results As for the pleural effusion specimens, the sensitivity (18.52%, 160/864) and the positive rate (16.02%, 160/999) were found to be the highest ones by using the MGIT 960 liquid culture method, followed by using the intracellular staining method (sensitivity 13.66%, 118/864; positive rate 11.81%, 118/999), the sensitivity (6.94%, 60/864) and the positive rate (6.01%, 60/999) were the lowest ones by using the PCR method. The positive rate by using the intracellular staining method was significantly different from that by using the MGIT 960 liquid culture method and the PCR method ( {\chi }_{960}^2 =10.26, {\chi }_{\mathrm{PCR}}^2 =29.00; P<0.01). For the cerebrospinal fluid specimens, the sensitivity (22.15%, 35/158) and the positive rate (14.77%, 35/237) were the highest ones by using the intracellular acid-fast staining method, followed by using the MGIT 960 liquid culture method (sensitivity 12.03%, 19/158; positive rate 8.02%, 19/237) and the lowest ones were found by using the PCR method (sensitivity 3.16%, 5/158; positive rate 2.11%, 5/237). The positive rate by using the intracellular staining method was significantly higher than that by using the MGIT 960 liquid culture method and the PCR method ( {\chi }_{960}^2 =5.36, P=0.020; {\chi }_{\mathrm{PCR}}^2 =23.36, P=0.020). Conclusion Mycobacterium tuberculosis intracellular acid-fast staining method is very important in detection of Mycobacterium tuberculosis in the body fluid specimens, and it is an economic, simple, achieving the expected positive rate test method.

Preliminary study of a CDG-3 fluorescent probe for detection of Mycobacterium tuberculosis

Jian-nan WU,Cheng-cheng KONG,Feng-min HUO,Zhao-gang SUN

Chinese Journal of Antituberculosis. 2018, 40(4):  378-383.  doi:10.3969/j.issn.1000-6621.2018.04.007

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Objective To explore the potential use of fluorescent probe CDG-3 (a BlaC-specific green fluorescent probe) in the diagnosis of tuberculosis (TB).Methods To clarify the specificity of CDG-3, it was tested with Mycobacterium tuberculosis (MTB) H37Rv, Mycobacterium bovis, Mycobacterium africanum, standard strains of 35 clinically relatively different nontuberculous mycobacteria (NTM) and six different standard strains of respiratory tract pathogens by microscopic examination. To understand the clinical value of CDG-3, a total of 200 morning sputum specimens of outpatients with suspected pulmonary tuberculosis were collected between January and September 2016 in Beijing Chest Hospital. The specimens were evaluated by smear-microscopy, solid Roche culture, MGIT 960 liquid culture and the CDG-3 probe. Culture results were considered positive as long as either the solid Roche culture or MGIT 960 liquid culture results were positive.Results were analyzed statistically with SPSS 19.0 software.Results Using H37Rv as a standard, results obtained with the CDG-3 fluorescence probe for the detection of standard strains of Mycobacterium bovis and Mycobacterium africanum were all positive. Three of the 35 kinds of NTM standard strains (M.kansassi, M.malmoense and M.phlei) also tested positive, while the other 32 strains gave negative results. CDG-3 gave a positive fluorescence signal with Nocardia, but not with the other five respiratory tract pathogens. Testing sputum specimens using CDG-3 gave a positive rate for MTB of 53.0% (106/200), significantly higher than that for smear-microscopy (29.5%, 59/200) and mycobacterium culture (35.0%, 70/200) (χ ²=33.587,P=0.000;χ ²=21.121,P=0.000). Using culture results as the standard, the sensitivity of the CDG-3 probe (84.3%, 59/70) was higher than that of smear-microscopy (70.0%, 49/70); while its specificity was lower (63.8%, 83/130, compared to 92.3%, 120/130). Relative to clinical diagnosis (149 confirmed TB patients), the sensitivity of the CDG-3 probe (64.4%, 96/149) was higher than that of smear-microscopy (39.6%,59/149) and culture (44.3%,66/149), while the specificity of the CDG-3 probe (95%, 19/20) was lower than that of smear-microscopy (100%, 20/20) but higher than that of culture (90%, 18/20). Conclusion The CDG-3 fluorescent probe offers excellent specificity for MTB over many NTMs. The interaction between CDG-3 and respiratory tract pathogens needs further study. The CDG-3 probe has the advantages of being rapid, simple and giving a high detection efficiency, but its specificity is not so ideal.

Drug resistance surveillance of Mycobacterium tuberculosis in Southwest China from 2014 to 2015

Ai-jing MA,Xin-fu DUAN,Ping HOU,Yan-lin ZHAO

Chinese Journal of Antituberculosis. 2018, 40(4):  384-391.  doi:10.3969/j.issn.1000-6621.2018.04.008

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Objective To investigate the drug resistance of pulmonary tuberculosis patients in southwest China through drug resistance surveillance.Methods A total of 610 Mycobacterium tuberculosis (MTB) strains isolated from smear-positive pulmonary tuberculosis patients collected from 8 national drug-resistant surveillance sites in Chongqing, Sichuan and Yunnan Provinces from 2014 to 2015 were analyzed by the drug susceptibility test (DST) of the proportion method for four first-line anti-tuberculosis drugs including Isoniazid (INH), Rifampicin (RFP), Ethambutol (EMB) and Streptomycin (Sm), as well as five second-line anti-tuberculosis drugs including Kanamycin (Km), Ofloxacin (Ofx), Capreomycin (Cm), Protionamide (Pto) and para-aminosalicylic acid (PAS). The total drug-resistance rate, mono-resistance rate, drug resistance spectrum and multi-drug resistance rate (MDR) of MTB were analyzed. The differences in drug resistance rates by different regions and years were also analyzed.Results To the nine anti-tuberculosis drugs, the overall resistance rate and MDR rate were 19.51% (119/610) and 5.74% (35/610), respectively. Drug resistance rates ranked from high to low as INH (11.97%,73/610), Sm (10.66%,65/610), RFP (6.56%, 40/610), Ofx (6.56%, 40/610), PAS (2.62%,16/610), Km (2.13%, 13/610), EMB (1.15%, 7/610), Cm (0.49%, 3/610), and Pto (0.16%, 1/610). Among the 8 monitoring sites in southwest China, the statistical results showed that the highest MDR rate was 16.36% (9/55) in Tongjiang County, Sichuan Province; the highest INH resistance rate was 23.64% (13/55) in Tongjiang County, Sichuan Province; the highest Km resistance rate was 10.91% (6/55) in Tongjiang County, Sichuan Province. There was no significant difference in drug resistance rate (year 2014 (20.08%, 51/254); year 2015 (19.10%, 68/356)) and MDR rate (year 2014 (4.72%, 12/254); year 2015 (6.46%, 23/356)) between different years (χ ²=0.09,P=0.764; χ ²=0.83,P=0.363). Conclusion The drug resistance in southwest China is more severe and the surveillance of drug-resistant TB should be strengthened in this area.

Analysis on the clinical characteristics of tuberculosis infection in patients with rheumatic immune diseases

Guo-fang DENG,Yu-xiang WANG,Tao CHEN,Qing-wen WANG,Jun-feng ZHENG,Jie TAN,Pei-ze ZHANG

Chinese Journal of Antituberculosis. 2018, 40(4):  392-396.  doi:10.3969/j.issn.1000-6621.2018.04.009

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Objective This paper analyzed the status of tuberculosis infection patients with rheumatic immune diseases and discussed the characteristics of tuberculosis infection patients with rheumatic autoimmune diseases (RAD).Methods Among the 1218 patients who were screened for tuberculosis, a retrospective analysis was performed on 300 cases of tuberculosis (TB) infection in patients diagnosed as the RAD in Shenzhen Third People’s Hospital and Peking University Shenzhen Hospital between January 2011 and December 2015. Among 300 patients, 32 had systemic lupus erythematosus (SLE), 174 had ankylosing spondylitis (AS), and 73 had rheumatoid arthritis (RA). Besides, another 18 patients with sicca syndrome (SS), and 3 patients with dermatomyositis (DM). Tuberculin skin test (TST), X-ray, CT and aetiological methods were implemented to evaluate the status of tuberculosis infection and patients were followed for 24-36 months.Results Among 300 TB infection patients with rheumatic immune diseases,the incidence of latent tuberculosis infection (LTBI) was 86.33% (259/300), and that of inactive tuberculosis (IATB) was 9.0% (27/300). The incidence of active tuberculosis (ATB) was 4.67% (14/300). The incidence of TB infection in patients with RAD was 54.7% (164/300)in males and 45.3% (136/300) in females, which was statistically significant (χ ²=48.368,P<0.01). Among the 1218 patients who were screened for tuberculosis, the prevalence of TB infection (including LTBI+ATB+IATB), among different RAD patients was different which were as followed, among the patients with SLE, the patients with AS, the RA group, the SS group and the DM group was 9.5% (32/335), 37.7% (174/461), 22.7% (73/321), 26.4% (18/68), and 9.1 (3/33), respectively (χ ²=88.766, P<0.01). The prevalence of LTBI in patients with different rheumatic immune diseases was different, among the SLE group, the AS group, the RA group, the SS group and the DM group was 8.0% (27/335), 33.6% (155/461), 18.7% (60/321), 23.5% (16/68), and 3.0 (1/33) respectively (χ ²=84.971, P<0.01). Conclusion LTBI accounted for the main part of the RAD patients with tuberculosis infections,which was more frequent in males than in females. AS patients had the highest infection rate. Clinicians should enhance their understanding.

Clinical efficacy of the fixation technique by using cortical bone trajectory screws for monosegment lumbar spinal tuberculosis

Zeng-hui LU,Zhuo-jing LUO,Wei DUAN

Chinese Journal of Antituberculosis. 2018, 40(4):  397-403.  doi:10.3969/j.issn.1000-6621.2018.04.010

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Objective To evaluate the clinical efficacy of one-stage anterior debridement, bone grafting fusion and posterior cortical bone trajectory (CBT) screw fixation in combination with traditional pedicle screw internal fixation in lumbar single-segment instumentation for the treatment of monosegment lumbar spinal tuberculosis.Methods From January 2015 to January 2016, 42 patients with monosegment lumbar spinal tuberculosis in the First Affiliated Hospital of the Air Force Military Medical University of PLA were included in this analysis. All patients were divided into two groups based on the posterior internal fixation technique that was applied according to patient’s clinical situation and wish. Internal fixation was performed by CBT screws combined with traditional pedicle screws in 21 patients (A group) and by traditional pedicle screws in 21 patients (B group) after anterior debridement and bone grafting fusion. The Cobb angle, the Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue score (VAS) value of all patients were analyzed before and after surgery and during the follow-up period.Results Forty-two patients were followed-up from 18 to 30 months, with an average follow-up time of (24.1±4.5)months. Three months after surgery, the ESR, CPR and VAS were (13.5±5.5)mm/1h, (4.7±2.0)mg/L and (1.9±0.8) in group A and (12.9±4.9)mm/1h, (5.2±3.2)mg/L and (2.2±1.0) in group B, respectively. The differences were not statistically significant (t=0.32, -0.68 and -1.02; P=0.747, 0.500 and 0.312). The average correction degree and correlation loss of Cobb angle were (11.6±6.3)° and (1.7±1.2)° in group A and (9.9±5.9)° and (1.4±1.1)° in group B at the last follow-up, with no significant statistical differences (t=0.96 and 0.94; P=0.343 and 0.355). As to postoperative neurological improvement, 1 case with Frankel grade B before operation recovered to grade D; of the 5 cases with grade C before operation, 4 cases recovered to grade D and 1 case recovered to grade E; of the 26 cases with grade D before surgery, all recovered to grade E.Conclusion For patients with monosegment lumbar spinal tuberculosis, CBT screw fixation technique can fix and fuse the diseased single-segment and retain normal movement of the adjacent spinal column. It is indicative to monosegment lumbar spinal tuberculosis.

Correlative analysis on levels of serum carbohydrate antigen 125, ferritin and other tests with pleura invasion in pulmonary tuberculosis patients

Tian-bi TANG,Jian-ping WANG,Dong WU,Yong-ge GAO,Rong FAN

Chinese Journal of Antituberculosis. 2018, 40(4):  404-410.  doi:10.3969/j.issn.1000-6621.2018.04.011

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Objective To investigate the correlation between the results of serum carbohydrate antigen 125 (CA125), ferritin (SF) and other laboratory tests with the pleura invasion among the patients with pulmonary tuberculosis (TB).Methods From November 2013 to April 2017, a total of 296 patients with secondary pulmonary TB were admitted to Zhangjiakou Infectious Disease Hospital. The related data and information were collected from those patients. According to whether the pleura of the patients were invasive from their pulmonary lesions or not, the patients were divided into the pleura invasion group (207 cases) and the pleura non-invasion group (89 cases). Chemiluminescent immunoassay was used to exam the levels of serum CA125 and ferritin, and the examination results were showed with the median (quartile: Q₁, Q₃). The following examinations were performed to the patients, including sputum smear (Ziehl-Neelsen acid-fast staining method), Mycobacterium tuberculosis culture (MGIT 960 liquid culture), interferon gamma releasing assays (IGRA), highsensitive creactive protein (hsCRP) and other related laboratory tests such as hemoglobin (Hb), albumin (ALB) and pre-albumin (PA). The Mann-Whitney U test, chi-square test, spearman correlation analysis, logistic stepwise regression analysis were used, and the new variable regression equation (logit (P)), the receiver-operating characteristic curve (ROC) and the optimal cut-off value were also established to explore the causes of the changes of CA125, SF, hs CRP, sputum Mycobacterium tuberculosis, IGRA, Hb, ALB and PA, as well as the relationship between those indicators and the pleura invasion by pulmonary TB lesions.Results Among the examination results of the patients in two groups, CA125 (31.55 (18.45, 71.80)kU/L; 16.15 (9.55, 23.15)kU/L), SF (234.68 (128.27, 504.12)μg/L; 127.39 (86.31, 201.76)μg/L), hs-CRP (47.50 (16.00, 82.55)mg/L; 3.40 (0.78,7.73)mg/L) and the sputum bacteriological positive rate (32.85%, 68/207; 11.24%, 10/89) had the statistically significant differences (Z=-5.84, -4.87, -6.34 respectively, χ ²=296.00; P=0.000, respectively). The indicators of CA125, SF and hs-CRP in the patients of two groups were found to have significantly correlated with whether or not the pleura were invasive by pulmonary TB lesions through the spearman correlation analysis (r=0.38, 0.32,0.64, respectively; P=0.000, respectively). Logistic stepwise regression analysis showed that the results of CA125, SF, sputum Mycobacterium tuberculosis examination were correlated with whether or not the pleura were invasive by pulmonary TB lesions (OR=1.11, P=0.001; OR=1.01, P=0.005; OR=5.89, P=0.025). The area under the ROC curve of the new variable logit (P) (AUC, 0.88) was higher than that of the indicators of CA125 and SF (AUC, 0.78 respectively), and had obvious prediction probability (P=0.000, respectively). Spearman correlation analysis showed a significant correlation between the indicators of CA125, SF and the area of the invasive pleura by pulmonary TB lesions (Y) (r=0.69, 0.55, respectively; P=0.000, respectively). In linear regression analysis, Anova showed that lnCA125 and lnSF were significantly correlated with the pleura invasion (F=68.65, 29.45, respectively; P=0.000, respectively). Conclusion Sputum TB bacteriological positive, the increased levels of hs-CRP, serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the pleura invasion by pulmonary TB lesions, there is no correlation between IGRA and the pleura invasion. The increased levels of serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the area of the pleura invasion by pulmonary TB lesions.

Study on the bactericidal effect using a new type of medical dynamic air disinfector on MTB and other pathogenic microorganisms

Zhi-yong LIU,Shuai WANG,Tian-yu Zhang,Doi Norio,Shou-yong TAN,Xiao-bao XIE,Ya-min GAO,Yun-xiang TANG,Huo-feng JIANG,Wu XIE

Chinese Journal of Antituberculosis. 2018, 40(4):  411-415.  doi:10.3969/j.issn.1000-6621.2018.04.012

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Objective To evaluate the bactericidal effect of a new type of medical air disinfector (short for new air disinfector) using a new angular column-shaped photocatalyst system under the condition of man-machine co-existing environment, and to study the improvement of killing pathogenic microorganisms in the air. In particular, the air disinfection technique and method of killing Mycobacterium tuberculosis (Mycobacterium bovis BCG strain (short for BCG)) was used in this experiment.Methods A new air disinfector was used to sterilize the natural bacteria in the air in a 47m ³ laboratory room. The test was repeated three times, and the extinction rate was calculated separately each time. In two adjacent aerosol chambers with volume of 30m ³ (one for experimental control, for calculating the natural extinction rate of bacteria, one for disinfection test, for calculating the killing rate of bacteria), the bactericidal test was conducted to sterilize Staphylococcus albus and BCG in air. The experiment was repeated three times, and the natural extinction rate and killing rate were calculated respectively. The number of colonies in the air in the aerosol room of Staphylococcus albus and BCG after sterilization test should be from 1×10 ⁵CFU/m ³ to 5×10 ⁵CFU/m ³ and from 3×10 ⁴CFU/m ³ to 8×10 ⁴CFU/m ³. Results Air simulated field disinfection test using a new type of air disinfector was carried out disinfection test of Staphylococcus albus in air field with repeated three times. The natural extinction rates of Staphylococcus albus in air were 20.45%,20.00% and 20.36%, respectively. The bactericidal rates of three repeated disinfection tests were 99.97%, 99.96% and 99.95%, respectively. With three repeated tests on disinfection of natural bacteria in air field, the extinction rates of natural bacteria in air were 93.95%, 94.27% and 94.32%, respectively. With three repeated tests on disinfection of natural bacteria in air field, the natural extinction rates of BCG in air were 35.71%, 37.93% and 40.58% respectively. The bactericidal rates of three repeated disinfection tests were 99.67%, 99.61% and 99.73%, respectively.Conclusion Pathogenic microorganismcan and MTB in air environment could be killed strongly using a new type of medical air disinfector with angular column-shaped photocatalyst system.

Review Articles

New progress in the diagnosis of childhood tuberculosis

Lu XIA,Yao ZHANG,Shui-hua LU

Chinese Journal of Antituberculosis. 2018, 40(4):  416-419.  doi:10.3969/j.issn.1000-6621.2018.04.013

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Childhood tuberculosis is widespread, the morbidity and mortality are both high. WHO reported that the number of childhood tuberculosis have reached to 1 million all over the world, and the number of deaths have reached 140 thousand in 2016. In order to control the prevalence of childhood tuberculosis, WHO put forward a blueprint of “towards zero death for childhood tuberculosis”. However, childhood tuberculosis is without typical symptoms, and it is difficult to obtain specimens.Furthermore, the bacterial rate of Mycobacterium tuberculosis is low and diagnose of childhood tuberculosis is still very difficult. Therefore, zero death is still a huge challenge. It is very necessary to detect the best diagnostic method and improve the early diagnosis rate of childhood tuberculosis. This review is just of the latest diagnostic technology and procedures of childhood tuberculosis.

Study progress on susceptibility factors of developing pulmonary tuberculosis in pneumoconiosis patients

Jing MU,Li-qiong BAI,Gu-li JIANG,Yi-ren WANG,Xiao-min ZENG

Chinese Journal of Antituberculosis. 2018, 40(4):  420-424.  doi:10.3969/j.issn.1000-6621.2018.04.014

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Pneumoconiosis is one of the most important and serious occupational diseases in China. In recent years, the number of notified pulmonary tuberculosis (PTB) ranks as the second place in the class A and B infectious diseases after viral hepatitis. PTB is a common complication among pneumoconiosis patients and is caused by a combination of various factors. This article introduced the incidence of PTB in patients with pneumoconiosis in recent years in different areas of China, and analyzed the researches on the susceptible factors for developing PTB. It is concluded that the incidence of PTB is still high in patients with pneumoconiosis. The results showed that the possible susceptible factors included: the stage of pneumoconiosis, age of onset, the years exposure to dust, type of work, the age of exposure to dust and other occupational susceptible factors, as well as other susceptible factors such as gene and preventive medication. In recent years, the related researches more aimed at the diagnosis and treatment of pneumoconiosis tuberculosis, but less on the cause of the disease and how to prevent and control the disease. The existing researches have various shortcomings and differences, and need to be further verified. Through our study, we suggest that the regular physical examinations to the workers exposed to dust and the patients with pneumoconiosis should be strengthened to timely detect the patients with pneumoconiosis and the pneumoconiosis patients complicated with PTB. Populations with the susceptible factors for developing PTB, such as the pneumoconiosis patients at higher pneumoconiosis stage, workers with longer time exposure to dust or earlier age exposure to dust and engaging in excavation work, etc., should be regarded as the key populations of prevention and give special attentions. So the incidence of pulmonary tuberculosis in patients with pneumoconiosis can be reduced and the pneumoconiosis tuberculosis can be effectively controlled.

The role and application of cytokines interleukin-7 and interleukin-15 in tuberculosis infection

Bing-ye LIU,De-cheng WANG,Xiao-yong FAN

Chinese Journal of Antituberculosis. 2018, 40(4):  425-428.  doi:10.3969/j.issn.1000-6621.2018.04.015

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Interleukin (IL)-7 and IL-15, the members of IL-2 family, have attracted much attention because of their important roles in regulating T cell differentiation and proliferation and information and maintenance of immune memory recently. Both IL-7 and IL-15 have a heterotripolymer structure similar to that of IL-2, are involved in the Janus kinase (a class of non-transmembrane tyrosine kinases)/signal transducer and activator of transcription (JAK/STAT) signaling pathway, and play a role in regulating the balance of the helper T lymphocyte (Th) 1/2 cytokines. Compared with IL-2, IL-7 and IL-15 can sustainably play a role in maintaining anti-tuberculosis (TB) function of T lymphocytes, and differentially diagnose TB due to their dynamic profile during infection. Furthermore,IL-7 and IL-15 can enhance secondary immune responses and play an important role in the development of prophylactic or therapeutic anti-TB vaccines.

Short Articles

Cost-benefit analysis of tuberculosis prevention and control program from 2006 to 2015 in Taian

Jian-zhi LI,Jun LI,Ting REN,Ning LI

Chinese Journal of Antituberculosis. 2018, 40(4):  429-433.  doi:10.3969/j.issn.1000-6621.2018.04.016

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This study retrospectively analyzed the cost-benefit of the tuberculosis (TB) prevention and control plan in Taian city during the “11th Five-year” and the “12th Five-year” period by referring the methods on calculation of social cost, social effect, social benefit and cost-effectiveness ratio, which were used in the “Evaluation Protocol of National TB Control Program (2001-2010)”. The aim of this study was to provide reference for the implementation of the 13th Five-year plan for TB control and prevention in Taian City. This study shows that, during the “11th Five-year” period, the total funds used for TB prevention and treatment was RMB 10.7779 million yuan in Taian City, a total of 14936 patients with active pulmonary tuberculosis were notified for receiving free treatment, and 64426 persons were avoided from TB infections, 6443 persons were prevented to develop active TB. It was estimated that RMB 4.3893 million yuan medical expenses and around RMB 1.5 billion yuan overall social economic value were saved; it meant that RMB 1 yuan investment from the government can generate RMB 142.89 yuan social economic benefits. During the “12th Five-year” period, the total funds used for TB prevention and treatment was RMB 13.507 million yuan in Taian City, a total of 12146 patients with active pulmonary TB were notified for receiving free treatment, and 42623 persons were avoided from TB infections, 4263 persons were prevented to develop active TB. It was estimated that RMB 3.6 million yuan medical expenses and around RMB 2.3 billion yuan overall social economic value were saved; it meant that RMB 1 yuan investment from the government can generate RMB 169.65 yuan social economic benefits. This research suggests the cost-effectiveness of the TB prevention and control programme was obvious in Taian city by implementations of the 11th Five-year and the 12th Five-year TB prevention and control program, and the social economic benefits in implementation of the 12th Five-year plan period were higher than that in the implementation of the 11th Five-year plan period.

Evaluation of papers published in Chinese Journal of Antituberculosis (2003-2017)

Jia WANG,Jian-jun LIU,Jin-fang SUN,Hong-yan YAO

Chinese Journal of Antituberculosis. 2018, 40(4):  434-437.  doi:10.3969/j.issn.1000-6621.2018.04.017

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To analyze the characteristics, including the number of articles and the proportion of grant-supported papers published by Chinese Journal of Antituberculosis from 2003 to 2017. This information will provide the journal with suggestions on the future of article types to be published and the development direction of the journal. The author used bibliometric techniques to analyze the number of articles as well as the proportion of papers with funding support published by Chinese Journal of Antituberculosis from 2003 to 2017. There were a total of 3201 articles published between 2003 and 2017. The average number of article per paper decreased from 0.44 to 0.21. In the meantime, the average number of pages per article increased from 2.29 to 4.81. The proportion of grant-supported papers increased from 4.35% in 2003 to 51.08% in 2017. Chinese Journal of Antituberculosis should increase the number of articles published and the number of grant-supported papers to be published.