Table of Content

10 November 2018, Volume 40 Issue 11

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Original Articles

Characteristics of the microbiome in lung tissue of patients with pulmonary tuberculosis

WANG Yu-xuan,WANG Chong,DONG Yu-jie,DU Wei-li,SONG Jing,LIU Zi-chen,LI Kun,LIU Shu-ku,CHE Nan-ying

Chinese Journal of Antituberculosis. 2018, 40(11):  1152-1158.  doi:10.3969/j.issn.1000-6621.2018.11.002

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Objective To explore the characteristics of the microbiome in the lung including necrosis, granuloma and normal lung areas of patients with pulmonary tuberculosis.Methods A total of 10 matched-pairs formalin-fixed and paraffin-embedded (FFPE) specimens were selected from 10 patients who were diagnosed as pulmonary tuberculosis in Beijing Chest Hospital from 2016 to 2017. The tissues were divided into necrotic, granuloma and normal lung areas using Leica Microsystems. Characteristics of microbiome was investigated using next-generation sequencing (NGS) technology.Results The major phyla in lung samples of pulmonary tuberculosis patients (relative abundance >1%) were Proteobacteria, Actinobacteria, Firmicutes, TM7 and Bacteroidetes. Adonis analysis based on bray_curtis distance showed that microbial communities were not significantly different at the phylum level. In genus level, seven mainly groups were detected (relative abundance >1%): Ochrobactrum (relative abundance of necrosis, granuloma and normal lung areas: (50.70±6.76)%, (56.18±7.50)%, (61.31±7.95)%), Sphingomonas ((7.50±2.07)%, (7.69±1.29)%, (3.81±2.08)%), Corynebacterium ((5.39±2.39)%, (5.23±1.39)%, (7.43±3.56)%), Brevundimonas ((1.67±0.42)%, (1.75±0.67)%, (2.09±0.34)%), Brevibacterium ((2.38±2.23)%, (2.60±2.60)%, (2.29±0.64)%), Sphingobacterium ((0.72±0.31)%, (0.78±0.26)%, (1.20±0.38)%) and Enhydrobacter ((1.25±1.28)%, (0.31±0.19)%, (0.67±0.80)%). Adonis analysis based on Bray-Curtis distance showed that the microbial community in normal area was significantly different from those in necrotic area (F=3.94, P=0.005) and granulomatous area (F=4.76, P=0.002). The relative abundance of Mycobacterium was very low and mainly existed in the necrotic areas ((0.81±1.92)%). Wilcoxon matched-pairs signed-ranks test showed that relative abundances of Mycobacterium were significantly different between necrotic and granulomatous areas ((0.81±1.92)% vs (0.01±0.01)%; Z=2.10, P=0.036), necrotic areas and normal lung areas ((0.81±1.92)% vs (0.01±0.02)%; Z=-2.37, P=0.018).Conclusion The relative abundances of Sphingomonas, Enhydrobacter, Kocuria and Mycobacterium decreased gradually from necrotic area, granuloma area to normal lung area, while the relative abundance of Ochrobactrum and Sphingobacterium showed the reverse trend. The characteristics of microbiome in lungs from pulmonary tuberculosis patients might be related to the changes of histomorphology in pulmonary.

Clinical value of PCR test in diagnosis of pulmonary tuberculosis by using CT-guided lung biopsy specimens

GUO Jun-hong,WU Chun-yan,DONG Zheng-wei,WU Wei,ZHANG Li-ping,LI Hui,HUANG Yan

Chinese Journal of Antituberculosis. 2018, 40(11):  1159-1163.  doi:10.3969/j.issn.1000-6621.2018.11.003

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Objective To explore the clinical value of polymerase chain reaction (PCR) test in diagnosis of pulmonary tuberculosis (PTB) by using CT-guided lung biopsy specimens.Methods A retrospective study was conducted by collecting information and data from a total of 111 patients, who visited Shanghai Pulmonary Hospital from January 2017 to March 2018 and were suspected to have PTB at beginning, finally, by pathological test or experimental therapy with anti-TB drugs, 73 (65.8%) cases were confirmed to be PTB patients and 38 (34.2%) cases were non-TB patients (3 patients had sarcoidosis, 17 patients had lung cancer, 3 patients were infected by cryptococcus, 4 patients were infected by aspergillus, 3 patients had lung abscess, 2 patients had foreign body granuloma and 6 patients had bronchiectasis). The biopsy specimens were obtained from all enrolled 111 patients by using CT-guided lung puncture and smear cytopathology examination was performed; among them, the biopsy specimens were obtained from 13 cases by using CT-guided coarse needle lung puncture and histopathological examination was performed because the diagnosis of those patients couldn’t be confirmed after cytopathology examination had been conducted for 2 times. At the same time, PCR test was also performed to those biopsy specimens to detect Mycobacterium tuberculosis (MTB) DNA. The final clinical diagnosis was regarded as a standard. Based on the clinical diagnosis results, the sensitivity, specificity, positive and negative predictive values, correct indices (consistency) of TB-PCR test in diagnosis of PTB by using cytopathological specimens, as well as the effects of TB-PCR test by using histopathological specimens were explored. SPSS 21.0 software was used for statistical analysis of the data. Count variables were analyzed by χ² test and P<0.05 was regarded as statistically significant difference. Results Regarding the final clinical diagnosis as a standard, the sensitivity, specificity, positive predictive value, negative predictive value and correct indices of TB-PCR test in PTB diagnosis by using cytopathological specimens were 83.6% (61/73), 89.5% (34/38), 93.8% (61/65), 73.9% (34/46) and 0.73 respectively. The positive rate of TB-PCR for PTB was 83.6% (61/73), which was significantly higher than that of single cytopathological examination (39.7% (29/73) (χ²=29.663, P=0.000). Among 73 cases with PTB, TB-PCR test by using histopathological specimens were performed in 13 cases and the results were positive in 8 cases; the results of TB-PCR test by using cytopathological specimens were positive in 12 cases. Among the PTB patients, 9 patients (12.3%, 9/73) were not diagnosed as TB by cytopathological and histopathological examinations, as well as the traditional tests (such as sputum smear microscopy and sputum culture); however, 4 patients were positive through TB-PCR test by using cytopathological specimens. Conclusion The diagnosis rate of PTB can be improved by using TB-PCR test with CT-guided lung biopsy specimens and this method has valuable of clinical application.

Diagnostic value of Mycobacterium tuberculosis antigen 85B and early secreted antigenic target 6-kDa antigen fusion protein for tuberculous pleurisy

AN Xiao-ying,YANG Yong-hui,ZHU Gui-yun,FANG Peng,BAI Hong-zhong,ZHANG Zhi-hua

Chinese Journal of Antituberculosis. 2018, 40(11):  1164-1169.  doi:10.3969/j.issn.1000-6621.2018.11.004

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Objective To explore the value of Mycobacterium tuberculosis antigen 85B (Ag85B) and early secreted antigenic target 6-kDa antigen (ESAT6) fusion protein in the diagnosis of tuberculous pleurisy.Methods Inpatients and healthy controls were enrolled in Hebei Chest Hospital from January 2014 to January 2015, including 45 patients with tuberculous pleurisy, 26 patients with non-tuberculous pleurisy, and 25 cases of healthy controls. Flow cytometry was used to detect the IFN-γ concentrations in the serum, and in the pleural effusion with and without the Ag85B-ESAT6 fusion protein stimulation. The number of CD4 ⁺ and CD8 ⁺cells in tuberculous pleurisy group and non-tuberculous pleurisy group patients was detected by immunohistochemical staining. The statistic analysis was performed by SPSS 13.0 software by t test, P<0.05 was considered as statistically significant.Results With and without stimulation of Mycobacterium tuberculosis Ag85B-ESAT6 fusion protein, the concentrations of IFN-γ in the blood of tuberculous pleurisy group were (42.63±10.51)pg/ml and (401.90±72.54)pg/ml, respectively, and non-tuberculous pleurisy group were (38.97±7.08)pg/ml and (40.04±6.80)pg/ml, respectively, and healthy control-group were (39.61±7.28)pg/ml and (39.86±6.97)pg/ml, respectively. Under the same condition, the concentrations of IFN-γ in tuberculous pleurisy group pleural effusion was (411.91±41.56)pg/ml and (1342.67±167.96)pg/ml, respectively, and non-tuberculous pleurisy group were (47.99±11.49)pg/ml and (48.76±11.25)pg/ml, respectively. The concentration of pleural effusion IFN-γ without stimulation was significantly higher in tuberculous pleurisy group than that in non-tuberculous pleurisy group(t=55.194, P=0.000). The stimulated concentration of blood IFN-γ in tuberculous pleurisy group was significantly higher than those in the other groups whether stimulated or not(t=32.879, 33.211, 33.204, P=0.000, 0.000, 0.000). The stimulated concentration of pleural effusion IFN-γ was significantly higher than those in the other groups whether stimulated or not(t=36.085, 51.478, 51.499, P=0.000, 0.000, 0.000). Immunohistochemical staining showed that the numbers of CD4 ⁺ and CD8 ⁺ cells in tissues between tuberculous pleurisy group (16349.91±2376.36, 10525.77±1164.86) and non-tuberculous pleurisy group (1853.64±670.40, 1327.15±175.55) was significantly different (t=14.381, 19.127, all P=0.000). Conclusion Mycobacterium tuberculosis Ag85B-ESAT6 fusion protein significantly increased the concentration of IFN-γ after stimulation of peripheral blood and pleural effusion, and showed potential clinical value for the diagnosis of tuberculous pleurisy.

Application value of molecular pathology in diagnosis of cervical lymph node tuberculosis and determination of drug resistance

MU Jing,LIU Zi-chen,SONG Jing,LI Kun,CHE Nan-ying,LIU Hong-gang

Chinese Journal of Antituberculosis. 2018, 40(11):  1170-1175.  doi:10.3969/j.issn.1000-6621.2018.11.006

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Objective To evaluate the clinical application value of molecular pathological methods in the diagnosis of cervical lymph node tuberculosis and its drug resistance.Methods Ninety-seven paraffin-embedded cervical lymph node specimens with tuberculosis (the tuberculosis (TB) group) and 20 specimens with other diseases (the non-TB group) were collected between March 2010 and October 2013 from the Beijing Chest Hospital. Ziehl-Neelsen (Z-N) staining and fluorescent quantitative polymerase chain reaction (FQ-PCR) were both performed on each specimen. Diagnostic efficiency of both methods was analyzed, Rifampin (RFP) and isoniazid (INH) resis-tances were detected by probe melting curve PCR.Results The sensitivities of Z-N staining and FQ-PCR were 22.7% (22/97), 67.0% (65/97), respectively. FQ-PCR showed significantly higher sensitivity than that of Z-N staining (χ²=38.53, P<0.001). The specificities of these two techniques were both 100.0% (20/20). The positive predictive values of the Z-N staining and FQ-PCR were 100.0% (22/22) and 100.0% (65/65), respectively, the negative predictive values were 21.1% (20/95) and 38.5% (20/52), respectively, and the coincidence rates were 35.9% (42/117) and 72.6% (85/117). Among 41 FQ-PCR positive TB samples, effective RFP and INH genotypic drug sensitivity test results were obtained in 10 and 27 samples, respectively, including 1 RFP resistant case and 13 INH resistant cases. Conclusion Molecular pathological techniques showed high sensitivity and specificity in detecting Mycobacterium tuberculosis DNA in FFPE specimens of cervical lymph node tuberculosis. Furthermore, the new techniques made it possible for pathological diagnosis of drug-resistant tuberculosis, and it can provide valuable evidences for accurate diagnosis and appropriate treatment.

Efficacy analysis of arthrodesis and modified fork-like arthroplasty for the treatment of total elbow joint tuberculosis

YAO Lin-ming,LAN Ting-long

Chinese Journal of Antituberculosis. 2018, 40(11):  1176-1182.  doi:10.3969/j.issn.1000-6621.2018.11.007

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Objective To analyze the efficacy of arthrodesis and modified fork-like arthroplasty after elbow joint debridement for the treatment of elbow joint tuberculosis, and to explore the value of fork-like arthroplasty in the treatment of elbow joint tuberculosis.Methods From February 2009 to February 2018, 48 adult patients with total elbow joint tuberculosis who underwent surgical treatment and followed up for more than 12 months in Shaanxi Provincial Institute for Tuberculosis Control and Prevention were selected. Among them, 20 patients from February 2009 to July 2015 underwent arthrodesis after elbow joint debridement (defined as arthrodesis group), and 28 patients from August 2015 to February 2018, underwent modified fork-like arthroplasty after elbow joint debridement (defined as arthroplasty group). The flexion and extension and rotation mobility, visual analogue scale (VAS score) and Mayo elbow performance score (MEPS) before and 12 months after surgery were compared between the two groups, in order to assess the surgical outcome in elbow and forearm function (including exercise, stability, pain, and daily living function). All patients were observed during follow-up. Statistical analysis was performed using SPSS 21.0 software. t-test was used to compare measurement data between two groups, and χ² test was used for categorical data. The difference was statistically significant at P<0.05. Results All 48 patients were followed up for 12 to 24 months, with an average of (13.4±5.5) months. Forty-five patients were cured in one-stage surgery. The incisions in three patients were not closed; but after local dressing and second debridement, all incisions were closed. In the arthrodesis group, the degree of joint mobility was reduced from (7.8±6.8)° in flexion and extension and (5.5±5.1)° in rotation preoperatively to 0° at 12 months postoperatively (t=5.111 and 4.819, Ps<0.001), and the VAS and MEPS scores were improved from (7.3±1.4) and (7.3±5.0) preoperatively to (1.0±1.0) and (17.5±4.7) at 12 months postoperatively (t=21.642 and 5.832, Ps<0.001). In the arthroplasty group, the degree of joint mobility was increased from (8.8±6.9)° in flexion and extension and (6.4±5.9)° in rotation preope-ratively to (58.8±15.4)° and (37.0±11.8)° at 12 months postoperatively (t=16.733 and 11.569, Ps<0.001), and the VAS and MEPS scores were improved from (7.5±1.2) and (6.3±4.8) preoperatively to (1.1±0.9) and (20.5±3.9) at 12 months postoperatively (t=22.055 and 13.587, Ps<0.001). 12 months after surgery, the arthroplasty group showed superior joint mobility in flexion and extension and rotation and MEPS compared with the arthrodesis group (t=20.222, P<0.001; t=16.560, P<0.001; t=2.424, P=0.037). There was no significant difference in VAS score (t=0.527, P=0.076) between arthroplasty and arthrodesis group.Conclusion Based on the standardized anti-tuberculosis drug treatment, the fork-like arthroplasty after the first-stage debridement is better than the arthrodesis after debridement in improving elbow joint activity and daily living function, and is more conducive to the treatment of adults patients with advanced elbow joint tuberculosis.

Analysis of surgical treatment for 176 intestinal tuberculosis patients with severe complications

WENG Jian-feng,HE Jian-miao,ZHAO Hua-zhou,QIU Xiao-chen.

Chinese Journal of Antituberculosis. 2018, 40(11):  1183-1188.  doi:10.3969/j.issn.1000-6621.2018.11.008

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Objective To explore the diagnosis and surgical treatment experience of intestinal tuberculosis with severe complications.Methods Data of 176 surgical cases of intestinal tuberculosis with severe complications from the 309th Hospital between May 2006 and May 2016 were retrospectively reviewed, including the timing of surgery, the choice of operation, postoperative complications, prognosis and follow-up results. Among the patients, 132 (75.0%) were complicated with intestinal obstruction, 16 (9.1%) were acute intestinal perforation, 7 (4.0%) were chronic intestinal fistula, 6 (3.4%) were intestinal obstruction and intestinal perforation, 11 (6.3%) were intestinal obstruction and intestinal fistula, 4 (2.3%) were intestinal bleeding.Results Thirty-one cases (17.6%) underwent emergency operation, 96 complete intestinal obstruction cases (54.5%) underwent operation after conservative treatment for 48-72hours, 31 (17.6%) incomplete intestinal obstruction cases and 18 (10.2%) chronic intestinal fistula cases were operated because of poor anti-tuberculosis effect. The 132 cases complicated with intestinal obstruction underwent intestinal adhesion lysis and partial small bowel resection; of them, 4 gave up surgery because of extensive intraperitoneal adhesion, 11 underwent partial small bowel resection with small bowel stoma, and then underwent second-stage operation. The 40 cases complicated with intestinal obstruction plus acute perforation or chronic fistula underwent partial enteric resection, 17 cases complicated with intestinal obstruction also underwent enterodialysis in addition, and 12 cases underwent enterostomy. Partial enterostomy was performed in 4 cases with intestinal bleeding and enterostomy was performed at the same time. Of all the 176 cases, 20 cases (11.4%) had early operative complications, including intestinal fistula in 2 cases, intestinal bleeding in 1 case, abdominal or pelvic abscess in 3 cases, pulmonary infection in 4 cases, deep vein thrombosis in 2 cases, and wound infection in 8 cases; all of these cases were cured by conservative treatment such as anti-infection, anticoagulation and dressing change. Two cases died after operation, the mortality rate was 1.1% (2/176). And 166 patients were followed up for 12-18 months, with an average follow-up time of (15.8±4.2) months, while the other 8 were loss to follow-up. The follow-up rate was 95.4% (166/174). Three months after operation, the clinical symptoms of intestinal tuberculosis were completely relieved in 143 cases (86.1%, 143/166), second operations were performed in 8 cases (4.8%, 8/166) due to intestinal obstruction, intestinal perforation or intestinal fistula after operation. Abdominal pain, abdominal distention, diarrhea and constipation symptoms could not be alleviated in 15 cases (9.1%, 15/166) during the follow-up period.Conclusion The severe surgical complications of intestinal tuberculosis should be operated in time. Correct operative timing, reasonable choice of operation and standardized anti-tuberculosis treatment are the keys to successful treatment for severe complications of intestinal tuberculosis.

Efficacy of early transfer training (bed-wheelchair) in the postoperative rehabilitation of senile patients with spinal tuberculosis

AI Ya-juan,LIU Xiang-dong,BI Na,ZHANG Ying,ZHANG Ya-ru,DAI Li-min,LUO Xiao-bo.

Chinese Journal of Antituberculosis. 2018, 40(11):  1189-1193.  doi:10.3969/j.issn.1000-6621.2018.11.009

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Objective To explore the efficacy of early transfer training (bed-wheelchair) in the rehabilitation of elderly patients with spinal tuberculosis after focal removal and bone graft fixation.Methods Patients with spinal tuberculosis who were admitted to the Spinal Minimally Invasive Department of the Orthopaedic Center of the 309th Hospital of Chinese People’s Liberation Army from February 2015 to March 2018, aged from 60 to 70 years, and were treated by removing lesions and bone grafting and fixation were selected. A total of 80 patients were included in this study. Forty patients who were admitted to hospital from February 2015 to August 2016 were allocated in the control group, and 40 patients admitted from September 2016 to March 2018 were allocated in the observation group. In the control group, the patients received routine bed functional exercise after the debridement and bone graft fixation, and received weight-bearing standing training on the 16th day after the surgery by wearing a brace. In the observation group, on the basis of the control group’s routine bed functional exercise, the patients underwent transfer training (bedside-wheelchair) with the help of doctors and family members on the 3rd day after the surgery when the patient’s vital signs were good. Serum albumin, hemoglobin, body mass index (BMI), physical activity and postoperative hospital stay were compared between the two groups.Results In the observation group, the serum albumin, hemoglobin and BMI of the senile patients with spinal tuberculosis were ((39.51±3.51)g/L, (122.11±10.14)g/L, and 20.16±2.84, respectively), which were superior to those in the control group ((36.33±3.43)g/L, (115.29±12.61)g/L, and 18.57±2.76, respectively). The differences were statistically significant (t values were 4.10, 2.67, and 2.54; P values were 0.000, 0.009, and 0.013, respectively). There were 28 patients (70.0%) who were able to walk frequently two weeks after surgery in the observation group. The proportion was higher than that in the control group (42.5%, n=17). The difference was statistically significant (χ²=6.15, P=0.013). The postoperative hospital stay in the observation group was (17.3±2.0) days, which was significantly less than that in the control group (18.6±0.8) days. The difference was statistically significant (t=3.82, P=0.000).Conclusion Early transfer training (bed-wheelchair) promotes rehabilitation, reduces the length of hospital stay, and reduces costs.

Analysis of reasons on misdiagnosing as tuberculous pleurisy in 17 cases with malignant pleural mesothelioma

WANG Zhi-gang,DING Hong

Chinese Journal of Antituberculosis. 2018, 40(11):  1194-1200.  doi:10.3969/j.issn.1000-6621.2018.11.010

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Objective In order to reduce misdiagnosis of patients with malignant pleural mesothelioma (MPM), to explore the clinical characteristics of MPM and analyze the differences between MPM and tuberculous pleural effusion (TPE).Methods The clinical information and data were collected from 17 patients with MPM who hospitalized at Panjin Infectious Disease Hospital in 2010-2017 and were misdiagnosed as TPE. A retrospectively analyzed was conducted to understand the causes of misdiagnosis and to provide preventive suggestions.Results Most of the enrolled patients with MPM were male (70.6%, 12/17), aged more than 40 years old (70.6%, 12/17) and only 1 patient was determined to have a history exposing to asbestos; patients whose lesions located on the right side of lung (52.9%, 9/17) were more common than those whose lesions located on the left side (35.3%, 6/17); the most common symptom was chest pain (82.4%, 14/17) while fever was rare (17.6%, 3/17). The misdiagnosis time was from 6 days to 18 months with average of (80.6±132.6) days. At the first visit to the hospital, the results of exfoliated cells examination and acid fast bacilli examination in the 17 cases with pleural effusion were negative; the tuberculin test (PPD test) results were positive in 8 cases (47.1%) and among them, 2 cases were strongly positive; the blood T-SPOT.TB test results were positive in 6 cases (35.3%). The biochemical examination results of pleural effusion were as follows: the pleural effusion was exudative, and the color was yellow in 11 cases (64.7%); the proportion of lymphocyte was the highest (50% to 86%) in white blood cells (WBC) and it was counted as 1300-7500×10⁶/L (normal value <100×10⁶/L). The following indicators were all increased: the value of lactate dehydrogenase (LDH) was 280-1 520 U/L (normal value <200 U/L) and the average value was ((439.76±301.82) U/L), adenosine deaminase (ADA) increased in 6 cases (35.3%) (32-56 U/L (normal value was 4-24 U/L), with average of ((26.76±11.96) U/L). The carcinoembryonic antigen (CEA) blood test results were normal in all cases while CEA in pleural effusion increased in 2 cases (11.8%) (one was 8.6 μg/L, the other was 9.2 μg/L (normal value ≤5 μg/L). All cases were found to have pleural thickening by CT scan, and pleural thickening was found to exceed 1 cm in 11 cases (64.7%). Finally, the diagnosis of all 17 cases were confirmed by pathological examinations, including 7 cases were confirmed by thoracentesis and pleural biopsy, 9 cases were confirmed by thoracoscopic biopsy, and 1 case was confirmed by thoracotomy biopsy. The pathological findings were epithelioid-type MPM (11 cases, 64.7%). Conclusion Due to lack of specificity on clinical manifestations, laboratory tests and early CT features in MPM patients comparing with those in TPE patients, so they are easily misdiagnosed as TPE. To confirm the diagnosis of MPM, pathological biopsy or surgical biopsy methods are needed.

Status and structural equation model analysis of knowledge, attitude and practice of tuberculosis prevention and control among college students in Xi’an

CAO Yi,ZHANG Shao-ru,ZHANG Tian-hua,JIANG Hua-lin,REN Dan,LI Yan,REN Jing,LIU Hai-ni,HUA Zhong-qiu.

Chinese Journal of Antituberculosis. 2018, 40(11):  1201-1207.  doi:10.3969/j.issn.1000-6621.2018.11.011

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Objective To realize the current situation on knowledge, attitude and practice (KAP) of tuberculosis (TB) prevention and control among non-medical students in Xi’an, construct a structure equation model (SEM) of students’ KAP of TB control based on KAP theory to explore the interaction mechanism of basic information, history of contact and health education, knowledge, attitude and behavior, and then put forward to the suggestions and countermeasures for the practice of TB prevention and control in colleges.Methods Eight hundred and fifty-one students from 4 non-medical colleges of Xi’an selected by purposive sampling were investigated with the questionnaire of the national survey of KAP to TB control designed by the Chinese Center for Disease Control and Prevention (which includes items related knowledge, attitude, behavior of TB prevention and care), and a self-design general information questionnaire (including questions related students’ basic information and personal history) from Dec. 2016 to Mar. 2017. A total of 808 valid questionnaires were collected with an effective rate of 94.9%. Amos 21.0 was used to analyze the relationship between basic information, personal history, knowledge, attitude and behavior.Results The score of knowledge related TB prevention and care was low. About 70.8% (1715/2424) and 37.1% (600/1616) students hold a positive attitude and behavior, respectively. The KAP structural equation model fitting degree was good. Some goodness-of-fit indices were as follows: goodness of fit index=0.97, adjusted goodness of fit index=0.95, comparative fit index=0.95. The results of SEM showed that personal history, knowledge and attitude had positive effects on behavior. Knowledge had the biggest total effect of 0.74 on behavior: the direct effect coefficient was 0.69 (CR=8.38, P=0.003), and the coefficient of indirect effect of knowledge on behavior through influencing attitude was 0.05 (P=0.003). The personal history had an indirect influence behavior with the coefficients of 0.45 (P=0.001). Attitude had a minimum direct effect of 0.16 on behavior (CR=2.79, P=0.007).Conclusion Knowledge of TB prevention and care among non-medical students in Xi’an needs to be improved. Knowledge, personal history, and attitude all can affect students’ behavior of TB prevention and control, whereas the effect of attitude is limited. Therefore, comprehensive and effective interventions should be taken to improve the students’ awareness of TB, establish a correct attitude towards TB prevention and control, and make them actively learn and disseminate knowledge of prevention and control, emphasizing on the simultaneous development of KAP.

Analysis of outpatient treatment cost of common tuberculosis patients in Hanzhong under different payment models

ZHANG Hong-wei,XU Jing,DENG Ya-li,ZHANG Tian-hua

Chinese Journal of Antituberculosis. 2018, 40(11):  1208-1213.  doi:10.3969/j.issn.1000-6621.2018.11.012

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Objective To analyze the outpatient treatment cost of tuberculosis (TB) patients who had not been hospitalized for the whole course of treatment under different payment models, and to provide a reference for the development of the payment policy for the financing of TB patient.Methods The data of the treatment cost of 1388 TB outpatients who completed treatment in Hanzhong designated TB hospital from January 2014 to June 2015 were collected and collated, which included 1204 cases of primary treatment and 184 cases of retreatment. The median variables (four quantiles) (M (Q₁, Q₃)) were used to describe the variables of days of medical consultation, number of visit, average cost of diagnosis and treatment per time, total cost of diagnosis and treatment, etc. Rank sum test and chi-square test were used to analyze the above variables with different treatment classification, type of health insurance, type of reimbursement and percentage of out-of-patient cost. P<0.05 was statistically significant.Results The medians of total cost of diagnosis and treatment for the primary and retreatment patients was 1580.45 Yuan (1259.70 Yuan, 2420.23 Yuan) and 1920.13 Yuan (1497.81 Yuan, 2300.44 Yuan) respectively, with statistical significance (Z=-3.267,P=0.001). The medians of average outpatient cost for single disease quota payment was 241.40 Yuan (199.21 Yuan, 358.30 Yuan), for single disease settlement according to facts was 175.00 Yuan (144.64 Yuan, 212.07 Yuan), for non-single disease payment was 140.46 Yuan (128.05 Yuan, 63.76 Yuan), and for out-of-pocket payment was 107.55 Yuan (94.71 Yuan, 136.37 Yuan), there has statistically significant difference (χ²=408.726, P=0.000). The medians of total cost for those payment models were 2054.14 Yuan (1460.23 Yuan, 2655.98 Yuan), 1342.51 Yuan (1002.25 Yuan, 1820.33 Yuan), 1018.15 Yuan (869.65 Yuan, 1321.55 Yuan) and 674.20 Yuan (495.03 Yuan, 848.07 Yuan) respectively, with statistical significance (χ²=342.875,P=0.000). 5.65% (68/1204) of primary treatment patients exceeded the outpatient quota of 3000 Yuan, and 4.35% (8/184) of re-treatment patients exceeded the quota of 4000 Yuan. The average non-service compensation was 770.00 Yuan per patient settled according to single-disease quota, and this of other models were 0. The average amount of out-of-pocket payment for the patient with single-disease payment was 409.65 Yuan (233.82 Yuan, 702.15 Yuan),with the proportion 24.84% (619580.87/2494194.76), which was lower than that of non-single disease payment patients 51.32% (8245.05/16065.98), with statistical significance (χ²=5967.453, P=0.000). The proportion of out-of-pocket payment for single-disease quota payment patients was 24.52% (441100.08/1798921.41), which was significantly lower than that of patients with single-disease settlement according to facts (χ²=355.422, P=0.000). Conclusion The quota payment for outpatient diagnosis and treatment of TB does not increase the financial burden of the hospital, and can reduce the economic burden of the patients. The outpatient diagnosis and treatment cost of TB patients should be included in the scope of the single-disease quota settlement policy and promoted, but it needs further improvement in practical application.

Comparative study on characteristics of patients with pulmonary tuberculosis detected through active screening or passive case-finding methods in 9 counties in Sichuan Province

LI Ting,HE Jin-ge,LI Yun-kui,LI Jing,XIAO Yue,WANG Dan-xia,LU Jia,XIA Yong,CHEN Chuang,WU Jian-lin

Chinese Journal of Antituberculosis. 2018, 40(11):  1214-1220.  doi:10.3969/j.issn.1000-6621.2018.11.013

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Objective To explore the effects and roles of active and passive methods in detection of patients with pulmonary tuberculosis (PTB) by comparing and analyzing the characteristics of detected TB cases in 9 districts/counties in Sichuan Province.Methods The information and data of active PTB patients, who were detected through active screening method at township level (hereinafter referred to as “active case detection”) in 9 counties in Sichuan Province from 2012 to 2016, were collected; at the same time, the information and data of active PTB patients, who were detected through passive method (such as sought of health care with symptoms, referral and tracing) and notified in the China CDC’s TB recording and reporting system (hereinafter referred to as “passive case detection”) in the same areas and same period, were also collected. The social and demographical characteristics, clinical features, as well as the results of laboratory examinations, etc. in two groups of patients were compared. The count variables were analyzed by using Chi-square test and P<0.05 was regarded as a statistically significant difference.Results A total of 272 active PTB patients were detected through active case detection method and the detection rate was 498.87/100000 (272/54523); among those 272 cases, 71 cases were asymptomatic (26.10%, 71/272). In the same areas and same period, a total of 1868 active PTB cases were detected through passive case detection method and registered. The registration rate was 67.04/100000 (347/517584) and 78.36/100000 (374/472596), 63.76/100000 (300/470504) respectively in 2014, 2015 and 2016. The registration rate of active PTB patients in these 3 years was no significantly difference ($\chi^2_{趋势}$=0.288, P=0.591). The average age of the patients in the active case detection group was (56.76±16.64) years old, which was higher than that of patients in the passive case detecting group ((44.70±18.38) years old) (U=158318.500, P=0.000). The proportion of patients aged ≥60 years in the active case detection group (52.57%, 143/272) was significantly higher than that of patients in the passive case detection group,(25.37%, 474/1 868) (χ²=99.831, P=0.000); the proportion of patients living in village in the active case detect group (80.51%, 219/272) was significantly higher than that of patients in the passive case detection group (45.88%, 857/1 868) (χ²=113.941, P=0.000). In the active case detection group, the proportions of patients with sputum smear positive (19.12%, 52/272) and cavities (11.03%, 30/272) were significantly lower than those of patients in the passive case detection group (31.16%, 582/1 868 and 24.68%, 461/1868 respectively) (χ²=23.311 and 25.020, P=0.000). The constituent ratios of the patients detected by active and passive case detection methods in 9 counties were significantly different in the 5 years (χ²=90.000, P=0.000); the constituent ratio of the patients living in villages and detected through passive case detection method (79.65%, 857/1076) was significantly lower than that of patients living in cities (95.02%, 1011/1064)(χ²=113.941, P=0.000).Conclusion Active case detection method can be a helpful supplement to passive case detection method. It has great value on improving case detection, especially in rural areas and the elderly.

Review Articles

Progress in clinical application of molecular pathological diagnosis of tuberculosis

SONG Jing,CHE Nan-ying

Chinese Journal of Antituberculosis. 2018, 40(11):  1221-1225.  doi:10.3969/j.issn.1000-6621.2018.11.014

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Pathology plays important roles in diagnosis of tuberculosis, especially in intractable cases such as sputum-negative pulmonary tuberculosis and extrapulmonary tuberculosis. “ Chinese Expert Consensus on Pathological Diagnosis of Tuberculosis” published in 2017 pointed out that definite pathological diagnosis of tuberculosis should meet both of the criteria: (1) basic tuberculous histological changes are found, (2) definite etiological evidences are confirmed by molecular pathology. In recent years, molecular pathological techniques play more and more important roles in the diagnosis and differential diagnosis of tuberculosis. The author reviews the progress of molecular pathological techniques in diagnosis of tuberculosis, non-tuberculous mycobacterial diseases, and drug-resistant tuberculosis.

Progress in metabolomics research on tuberculosis

WEI Jin-tao,LI Hua,QIU En-ming.

Chinese Journal of Antituberculosis. 2018, 40(11):  1226-1230.  doi:10.3969/j.issn.1000-6621.2018.11.015

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World Health Organization (WHO) has proposed terminating tuberculosis epidemic globally by 2035.To achieve this goal, new breakthroughs are urgently needed through researches on the mechanism of drug resistance development in Mycobacterium tuberculosis, the search for new tuberculosis diagnostic markers, and the development of new anti-tuberculosis drugs. Metabolomics is an emerging omics technique for studying endogenous metabolic changes in the body. Compared with the issues, such as genetic complexity and post-transcriptional modification, etc., which are faced by other omics researches, metabolomics may directly reflect the changes in the body’s endogenous metabolic information, obtain the metabolic markers of the organisms for disease prevention through multivariate statistical analysis and can provide guidance on the diagnosis, treatment, prognosis of disease. At present, metabolomics has been widely applied in the research of tuberculosis and achievements have been made in terms of the diagnosis and treatment of tuberculosis. The recent progress of metabolomics in tuberculosis research is summarized in this paper.

Clinical Case Discussion

A case of pulmonary cryptococcosis with mediastinal tuberculous lymphadenitis——report of case and review of literature

ZHU Gui-yun,LI Xiao-xia,KANG Li-fei,CHEN Ning,YANG Yong-hui

Chinese Journal of Antituberculosis. 2018, 40(11):  1231-1234.  doi:10.3969/j.issn.1000-6621.2018.11.016

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Pulmonary cryptococcosis is an acute, subacute or chronic pulmonary fungal disease caused by inhaling cryptococcus spores, and often disseminates to the central nervous system and results in cryptococcal meningitis. Recent studies show that the incidence of pulmonary cryptococcosis is increasing. The clinical symptoms, chest imaging and laboratory examinations for pulmonary cryptococcosis are not specific and these cases are often misdiagnosed. A patient with pulmonary cryptococcosis complicated with mediastinal tuberculous lymphadenitis was recently consulted in Hebei Chest Hospital. This case was misdiagnosed as lung cancer according to imaging and clinical symptoms in other hospital, and then misdiagnosed as tuberculosis after surgery. The diagnosis was confirmed after the pathological consultation and related examination in our hospital. The clinical, imaging and pathological features were analyzed retrospectively based on relevant literature to improve the diagnostic level and avoid misdiagnosis and mistreatment.

Short Articles

Auxiliary diagnostic value of GeneXpert MTB/RIF assay for extrapulmonary tuberculosis of fine needle biopsy tissue eluent

LIU Qi-liang,LEI Mei,SHI Yi-qun,ZHANG Jing

Chinese Journal of Antituberculosis. 2018, 40(11):  1235-1236.  doi:10.3969/j.issn.1000-6621.2018.11.017

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To evaluate the auxiliary diagnostic value of GeneXpert MTB/RIF (GeneXpert) for detecting extrapulmonary tuberculosis based on fine needle biopsy tissue eluent, a total of 103 patients with extrapulmonary tuberculosis in Wuhan Pulmonary Hospital between January 2016 and December 2017 were enrolled. All of these patients were operated through fine needle puncture and the biopsy tissue eluent were tested by tuberculosis-DNA PCR assay, GeneXpert, tuberculosis solid culture and smear method, respectively. The results showed that the sensitivity of GeneXpert (78.6% (81/103)) was significantly higher than that of tuberculosis solid culture (26.2% (27/103)) and smear method (16.5% (17/103)), and the differences were statistically significant (χ ² values were 56.76 and 79.72, respectively; all P values <0.05). Hence, it is clear that GeneXpert showed a higher diagnostic sensitivity for detecting extrapulmonary tuberculosis based on fine needle biopsy tissue eluent.