Table of Content

10 March 2019, Volume 41 Issue 3

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Original Articles

Analysis of clinical characteristics between lung cancer patients complicated by obsolete pulmonary tuberculosis with ground-glass opacity and with solid nodule

Jian-kun ZHU,Feng JIN,Cheng WANG,Yun-zeng ZHANG,Gao-feng QIAO,Da-wei LIU,Bin ZHAO

Chinese Journal of Antituberculosis. 2019, 41(3):  248-253.  doi:10.3969/j.issn.1000-6621.2019.03.002

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Objective To analyze the different clinical characteristics between lung cancer patients complicated by obsolete pulmonary tuberculosis with ground-glass opacity (GGO) and with solid nodule (SN) in order to indentify earlier and treat GGO type lung cancer complicated by obsolete pulmonary tuberculosis.Methods Forty-five patients with lung cancer complicated with obsolete pulmonary tuberculosis who were diagnosed in our hospital from January 2008 to February 2018 were selected. The patients with GGO type lung cancer complicated with obsolete pulmonary tuberculosis were divided into research group (“GGO group”, 16 cases). The patients with SN type lung cancer complicated with obsolete pulmonary tuberculosis were divided into control group (SN group, 29 cases). The clinical manifestation, CT scan, operation mode and pathological type of the two groups were analyzed retrospectively. t test was used in the comparison of measurement data and χ ² test was used in the comparison of enumeration data. The difference was statistically significant between the two groups when P less than 0.05.Results (1)Age: The average age in GGO group ((51.0±6.1) years old) was less than that ((59.6±8.4 ) years old) in SN group with significant difference statistically (t=3.58, P<0.001). (2) TB history: The average time of TB history in GGO group ((19.5±2.6) years) was shorter than that ((23.3±3.1) years) in SN group with significant difference statistically (t=4.16, P<0.001). (3) Diagnosis time: The average time of confirm diagnosis in GGO group ((382.0±27.0) days) was longer than that ((9.5±5.1) days) in SN group with significant difference statistically (t=77.69, P=0.000). (4) Regional lymph node metastasis: Local lymph node metastasis was not found in all patients (16,100.0%) in GGO group. However, in SN group, local lymph node metastasis was not found in only 16 cases (55.2%), ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary lymph nodes metastases (N1) in 9 cases (31.0%), and ipsilateral mediastinal and/or subcarinal lymph node metastasis (N2) in 4 cases (13.8%). The differences in two groups were significant statistically (χ ²=9.99, P=0.003). (5) The location relationship between tumor and tuberculosis foci: The foci located in the same lobe in 4 cases (25.0%) and in different lobe in 12 cases (75.0%) in GGO group. The foci located in the same lobe in 18 cases (62.1%) and in different lobe in 11 cases (37.9%) in SN group. The differences in two groups were significant statistically (χ ² =4.28, P=0.038). (6) Pathological types: There were squamous cell carcinoma in 1 case (6.3%), adenocarcinoma 14 cases (87.5%) and large cell carcinoma in 1 case (6.3%) in GGO group. There were squamous cell carcinoma in 12 case (41.4%), adenocarcinoma 15 cases (51.7%) and adenosquamous carcinoma in 2 case (6.9%) in SN group. The differences in two groups were significant statistically (χ ² =6.78, P=0.029). (7) Surgical method: There were lobectomy in 11 cases (68.8%), segmentectomy in 1 case (6.3%), wedge resection in 2 cases (12.5%) and lobectomy plus wedge resection in 2 cases (12.5%) in GGO group. There were lobectomy in all cases (29, 100.0%) in SN group. The differences in two groups were significant statistically (χ ² = 15.66, P=0.000).Conclusion Compared with SN type lung cancer, GGO lung cancer complicated with obsolete pulmonary tuberculosis has no specific clinical manifestations, low age of onset, long diagnosis period, no significant correlation between tumor distribution and tuberculosis foci, no correlation of mediastinal lymph node enlargement and lymph node metastasis, diversity of surgical methods and adenocarcinoma as dominant pathological types. It is a special type of lung cancer complicated with pulmonary tuberculosis.

Clinical characteristics and related factors of patients with secondary tuberculosis after malignant tumors

Juan-wen LIAN,Jia-ling XU,Tao HUA,Jie DING,Yu FAN

Chinese Journal of Antituberculosis. 2019, 41(3):  254-259.  doi:10.3969/j.issn.1000-6621.2019.03.003

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Objective To investigate the clinical characteristics and related factors of tuberculosis secondary to malignant tumors. Methods The clinical data of 163 cases of tuberculosis secondary to malignant tumors (referred as the observation group) admitted to Xi’an Chest Hospital from January 2014 to June 2018 were collected. In addition, 100 cases of tuberculosis and 100 cases of malignant tumors with complete clinical data during the same period were selected as the control group. The incidence, clinical characteristics, laboratory results, diagnosis and risk factors of tuberculosis secondary to malignant tumors were analyzed. Results The average age of the patients in the observation group was (62.50±9.02) years, which was higher than that of the patients with tuberculosis alone ((53.67±7.64) years), and the difference was statistically significant (t=2.65, P=0.014). In the observation group, the most common malignant tumor was lung cancer (36.20% (59/163)), and lung tuberculosis (47.85% (78/163)) was the most common secondary tuberculosis. The first diagnosis rate of tuberculosis in the observation group was 31.90% (52/163), which was lower than that in the simple tuberculosis group (62.00% (62/100)), and the difference was statistically significant (χ ²=22.86, P=0.000). The positive rate of pure protein derivative test of tuberculin in observation group was 41.72% (68/163), which was lower than that in simple tuberculosis group (66.00% (66/100)); the positive rate of etiology and/or pathology examination (68.71% (112/163)) was higher than that in simple tuberculosis group (53.00% (53/100)); and the differences were statistically significant (χ ²=8.78 and 7.11, respectively; Ps<0.05). Patients who aged over 60 years, with a history of tuberculosis, with poor tumor staging (TNM Ⅲ or Ⅳ), had not received cancer treatment, and had received chemotherapy before in the observation group were 73.01% (119/163), 22.70% (37/163), 78.53% (128/163), 35.58% (58/163) and 58.28% (95/163), respectively, which were higher than those in the simple malignant tumors (61.00% (61/100), 12.00% (12/100), 67.00% (67/10), 22.00% (22/100), and 49.00% (49/100)); the differences were statistically significant (χ ² values were 4.14, 4.27, 4.30, 5.40, and 4.23 respectively, all Ps<0.05). Conclusion Compared with simple tuberculosis patients, tuberculosis patients secondary to malignant tumors are older, and have lower first diagnostic rate of tuberculosis. They are diagnosed mostly according to etiology and pathology. Age ≥60 years old, previous history of tuberculosis, poor staging of tumors, no previous anti-tumor therapies and previous chemotherapy are associated with secondary tuberculosis in patients with malignant tumors.

Clinical value of surgical treatment in 74 pulmonary tuberculosis patients complicated with pulmonary aspergillosis

Yong LIAO,Qing CAI,Ming WEI,Jian-rong XU,Guo-qiang CHEN,Xi-feng HUANG,Wei LIU

Chinese Journal of Antituberculosis. 2019, 41(3):  260-265.  doi:10.3969/j.issn.1000-6621.2019.03.004

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Objective To analyze the clinical value of surgical treatment for pulmonary tuberculosis complicated with pulmonary aspergillosis. Methods We retrospectively analyzed the clinical data of 74 patients who were diagnosed pulmonary tuberculosis complicated with pulmonary aspergillosis and treated by lung resection in Guangxi Zhuang Autonomous Region Longtan Hospital from 2007 to 2016, including surgical methods, operative outcomes, postoperative complications and follow-up. Results Of the 74 patients, 68 (91.9%) underwent elective operation and 6 (8.1%) underwent emergency operation, 73 (98.6%) patients’ operations were successful, whereas 1 patient died of massive hemorrhage during operation. Among them, lobectomy in 54 cases (73.0%), segmentectomy in 5 cases, pneumonectomy in 2 cases, compound lung resection in 9 cases and wedge resection in 4 cases were conduced. Postoperative complications occurred in 24 cases (32.4%). One case had postoperative bleeding and was cured by thoracotomy. One case had respiratory failure and was successfully cured by ventilator assisted breath. Atelectasis occurred in 5 cases. They were treated by branchofiberoscope suction sputum therapy, of whom 4 cases achieved lung reexpansion, whereas 1 patient was ineffective and developed secondary respiratory failure (he refused further treatment and died after discharge). Empyema occurred in 4 cases. Three had bacterial empyema and were cured by continuous chest drainage. One case had aspergillus empyema, and was treated by video assisted thoracoscopic debridement 15 months after operation. However, the pulmonary artery was ruptured during operation and massive hemorrhage occurred. Then left pneumonectomy assisted by extracorporeal circulation was conducted, but the hemorrhagic shock could not been corrected and the patient died. Alveolar-pleural fistula occurred in 5 cases, of whom 3 were cured by continuous chest drainage, and 2 were cured by iodophor pleurodesis plus continuous chest drainage. Bronchopleural fistula occurred in 1 case. He was cured by continuous chest drainage for 3 weeks. Pleural space occurred in 7 cases without treatment. Seventy-two patients were followed up, of whom 1 died during the period of follow-up. Seventy-one cases (96.0%) were cured, and no pulmonary tuberculosis or pulmonary aspergillosis recurred; the duration of follow-up was 1-48 months, with an average of (11±3) months. Conclusion By selecting appropriate pulmonary tuberculosis patients complicated with pulmonary aspergillosis for lung resection, high cure rate and acceptable complication rate and mortality rate can be achieved, and most patients can be cured.

Surgical therapy in 43 abdominal tuberculosis patients complicated with intestinal perforation

Hui-hai XU,Shan-shan ZHANG,Zi-jian LI,Hai-liang QI,Xiu-ran DU,Hong-wei SU

Chinese Journal of Antituberculosis. 2019, 41(3):  266-271.  doi:10.3969/j.issn.1000-6621.2019.03.005

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Objective To explore the effect of surgical treatment for abdominal tuberculosis complicated with intestinal perforation.Methods Forty-three abdominal tuberculosis patients complicated with intestinal perforation who underwent surgery in Hebei Chest Hospital from 2008 to 2016 were included in the study. All patients were suspected of lung tuberculosis by chest X-ray or CT scan. The clinical data were descriptively summarized and analyzed, including preoperative clinical manifestations, laboratory tests and examinations, intraoperative exploration and surgical procedures, postoperative treatment and complications, treatment outcome, and follow-up data.Results All of the 43 patients were confirmed as abdominal tuberculosis via postoperative pathology examination. Eighteen out of the 32 non-emergency patients were clinically diagnosed before surgery, whereas all of the 11 emergency patients were not diagnosed before operation. All patients had intestinal perforation confirmed by intraoperative exploration, of whom 3 cases were preoperatively diagnosed with intestinal obstruction, 30 cases were intestinal obstruction with intestinal perforation (8 emergency patients and 22 non-emergency patients were diagnosed with perforation by diagnostic puncture before operation), and 10 cases were intestinal perforation. Forty patients (93.0%) underwent stage I ileostomy due to a wide range of lesions, among whom, 12 patients with incision infection were cured after incision dressing and drainage; 2 of the 8 patients with intestinal fistula died of multiple organ failure (one received conservative treatment and one underwent secondary surgery; both >65 years old), and the remaining 6 cases had good outcome after treatment; 2 cases of intestinal obstruction were cured, one by secondary surgery and one by conservative treatment; and the remaining 18 patients recovered well after ileostomy. In addition, 2 cases (one with ileocecal mass with perforation and one with mild abdominal infection) underwent ileocecal resection and ileocolon anastomosis. One case underwent partial ileectomy and intestinal anastomosis due to a single perforation in the proximal ileocecal area, concurrent with abdominal lymph node tuberculosis and adhesion of local lymph node nodules and perforation site, but mild abdominal infection. No postoperative serious complications occurred in the patient. Anti-tuberculosis treatments were stopped after 12 months of treatment due to cure outcome. Thirty-seven patients were followed up for 18 to 24 months after treatment discontinuation, and 4 patients were lost to follow-up. During the follow-up period, 16 patients had intermittent mild abdominal pain, and others were generally in good condition. Conclusion Abdominal tuberculosis with intestinal perforation is a serious complication of tuberculous. On the basis of standard anti-tuberculosis drug treatments, surgery is the primary choice with good outcome.

Outcome of debridement of local lesions combined with catheter irrigation and drainage in treating postoperative abscess in patients with thoracolumbar tuberculosis

Chen-guang JIA,Hui MA,Lian-bo WANG,Li-ming YAO,Zhuo LI,Feng-sheng LIU,Zhao-liang DONG

Chinese Journal of Antituberculosis. 2019, 41(3):  272-276.  doi:10.3969/j.issn.1000-6621.2019.03.006

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Objective To evaluate the outcome and application value of debridement of local lesions combined with catheter irrigation and drainage in treating postoperative abscess in patients with thoracolumbar tuberculosis.Methods This was a retrospective study of 41 thoracolumbar tuberculosis patients with postoperative abscess who were admitted to the Department of Orthopedics, the Chest Hospital of Hebei Province from January 2014 to December 2017, including 25 males and 16 females. There were 13 cases of thoracic tuberculosis and 28 cases of lumbar tuberculosis. Among them, 23, 41, 18 and 26 patients were complicated by psoas abscess, paraspinal abscess, sinus and subcutaneous abscess, respectively. All patients underwent local incision and debridement of abscesses combined with catheter irrigation and drainage. After intraoperative incision of abscesses, the lesions were removed and then the catheter was placed. Irrigation was continued for 6 to 23 days after surgery. Regular follow-up was performed to observe or determine incision healing, abscesses re-occurrence, red blood cell sedimentation rate (ESR) level, C-reactive protein (CRP) level, visual analogue scale (VAS) score, bone graft fusion and improvement in clinical symptoms.Results The time of debridement of local lesions combined with catheter irrigation and drainage ranged from 20 to 45 minutes in the 41 patients, with an average of (30.0±13.2) minutes. The bleeding volume ranged from 20 to 100 ml, with an average of (40.0±16.3) ml. No significant spinal cord, blood vessel or nerve injury occurred. In one patient, the sinus was re-appeared after removal of the catheter. After dressing and re-drainage, the incision healed well. In other cases, the incisions healed in one-stage surgery without the occurrence of delayed incision healing and sinus. No paraspinal, psoas or subcutaneous abscesses re-occurred after removal of the catheter. The ESR was (24.32±9.34) mm/1 h three weeks after surgery and (40.46±19.75) mm/1 h before surgery; the difference was statistically significant (t=8.43, P<0.05). The CRP was (13.41±6.20) mg/L three weeks after surgery and (20.56±10.00) mg/L before surgery; the difference was statistically significant (t=7.91, P<0.05). The average VAS score was (1.93±1.27) three weeks after surgery, which was statistically lower compared with (6.68±1.95) before surgery (t=16.79, P<0.05). All patients achieved bone fusion within 6 to 12 months after surgery. Conclusion For patients with abscesses after spinal tuberculosis surgery, debridement of local lesions combined with catheter irrigation and drainage shows advantages of timely removal of the lesions and adequate drainage and can reduce the occurrence of pus and the progression of lesions, standing for an effective method for complicated abscesses after spinal tuberculosis surgery.

Curative effect analysis of single-stage anterior debridement and internal fixation for cervical spine osteomyelitis

Wei-ping LI,Chuan-hui XUN,Hao GUO,Rui CAO,Wei-bin SHENG,Hai-long GUO

Chinese Journal of Antituberculosis. 2019, 41(3):  277-282.  doi:10.3969/j.issn.1000-6621.2019.03.007

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Objective To evaluate the clinical effect of treatment of cervical spine osteomyelitis via single-stage anterior debridement and bone graft fusion.Methods A retrospective information of 58 cases (male 36 cases, female 22 cases,) with cervical spine osteomyelitis treated by single-stage anterior debridement and bone graft fusion from June 2010 to June 2016 was collected. The mean age of these patients was 62.7±12.4 years (range 17-79 years). There were 10 cases of suppurative cervical spondylosis, 35 cases of tuberculous cervical spondylosis, 7 cases of Brucella cervical spondylosis and 6 cases of cervical spondylosis of unknown origin. The disease controlling statues was evaluated based on laboratory result of erythrocyte sedimentation rate and C-reactive protein. Eck fusion and grading criteria were taken to evaluate the fusion of vertebral body. The clinical effects were evaluated using the Visual Analogue Scale (VAS) and the Japanese Orthopedic Association score (Cervical) of cervical function. The data were analyzed by SPSS 23.0 statistical software. The measurement data were expressed by ($\bar{x}$±s). The data of preoperative and last follow-up were compared by paired t test. P<0.05 was statistically significant.Results All of 58 cases of patients’ symptom were significantly improved. The cervical VAS score: average (5.3±0.8)points before operation, average (2.3±0.8)points,(0.9±0.5)points,(0.6±0.5)points in one month、 six months after operation and the last time follow up, respectively.The postoperative VAS score was significantly lower than that before operation(Z=-6.75, P=0.00), The JOA score: average (11.0±0.9)points before operation, average (13.6±1.0)points,(15.6±1.0)points,(15.9±0.8)points in one month、 six months after operation and the last time follow up, respectively. The postoperative JOA score was significantly lower than that before operation (t=-51.10,P=0.00). All patients were not found internal fixation loosening and fracture in the follow-up period. 5 patients had hoarseness after operation, follow-up observation after a month of recovery. 2 patients with pyogenic infectious occurred wound infection two weeks after operation and recovery by re-debridement. Conclusion Cervical spine osteomyelitis treated by single-stage anterior debridement and bone graft fusion had a definite curative effect which can completely remove the lesionand remove the nerve compression.

To discuss the best time of ballon dilatation for the treatment of airway stenosis of tuberculosis

Zhi-min HU,Qiu-sheng JING,Ming-di WU,Jian-shuang ZHANG,Rong XIANG,Ya-wen CHENG,Li WANG,Xiao-man ZHOU

Chinese Journal of Antituberculosis. 2019, 41(3):  283-287.  doi:10.3969/j.issn.1000-6621.2019.03.008

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Objective To investigate the optimal time of balloon dilatation for tuberculous tracheal stenosis by comparing the effects and complications in different pathological stages.Methods A total of 62 patients with left main bronchial stenosis because of the tuberculosis (stenosis degree ≥50%) were collected from Wuhan Pulmonary Hospital from January 1, 2015 to December 31, 2017. The patients were divided into two groups through the different pathological stages. 32 cases in group A, which showed recovery period under bronchoscope; 30 cases in group B, which showed scar stage under bronchoscope, balloon dilatation was performed in both groups, and the treatment effects and complications of the two groups were observed.Results The immediate effective rate of balloon dilatation in group A was 93.8% (30/32) and the average times of balloon dilatation were (3.0±0.6). The immediate effective rate was 73.3% (22/30) in group B and the average times were (6.0±1.6). The differences were statistically significant (χ ²=4.77, P=0.03; t=9.89, P=0.01). The 6-month restenosis rate in group A (10.0% (3/30)) was lower than that in group B (27.3% (6/22)), the difference was statistically significant (χ ²=4.21, P=0.04). The incidence of minor hemorrhage, granulation hyperplasia and chest pain after balloon dilatation surgery in group A and B was 59.4% (19/32) and 50.0% (15/30), 31.3% (10/32) and 33.3% (10/30), 21.9% (7/32) and 26.7% (8/30), respectively. The difference was not statistically significant (χ ² were 0.55, 0.03 and 0.19, respectively; P values were 0.46, 0.42 and 0.66, respectively).Conclusion The optimal time of balloon dilatation for tuberculous tracheal stenosis was the recovery period after acute inflammation subsidence in the stenosis area rather than the scar stage.

Value of FPN in pulmonary tuberculosis screening on the thoracic radiography images

Pan CAO,Fei WANG,Zhe LIU,Jin-cheng LIU,Kuang-li LIANG,Ji-xin YUAN,Feng CHI,Ye-dong HUANG,Jian YANG

Chinese Journal of Antituberculosis. 2019, 41(3):  288-293.  doi:10.3969/j.issn.1000-6621.2019.03.009

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Objective To evaluate the value of feature pyramid network (FPN) for screening pulmonary tuberculosis on the thoracic radiography images (hereinafter referred to as “chest images”).Methods In this retros-pective study, chest images of 490 pulmonary tuberculosis patients who were hospitalized in the Tuberculosis Hospital of Shaanxi Province from January 2016 to December 2017 were collected, as well as chest images of 100 healthy outpatient controls. In addition, chest images of 332 and 58 pulmonary tuberculosis patients separately from Shenzhen, China and Montgomery, Maryland, USA in the NIH public dataset were also included. FPN was employed to classify and localize the radiographs and lesions. Two radiologists from tuberculosis hospitals examined and labeled the chest images of pulmonary tuberculosis patients in the above data. After data alignment and augmentation, the annotated radiographs were sent to the FPN, and the FPN was trained to obtain the final detection model. Then, the performance and generalization ability of FPN were tested with independent dataset, and the sensitivity, specificity and accuracy of FPN in distinguishing chest images of pulmonary tuberculosis patients from healthy controls were analyzed according to the criteria of positive sputum smear and evaluation by experienced radiologists. Meanwhile, the sensitivity and false positive rate of FPN in localizing tuberculosis lesions were evaluated based on manually labeled lesions. For the lesion detection and localization in the images, the free response receiver operating characteristic (FROC) score was used to evaluate the performance of FPN.Results The sensitivity, specificity and accuracy of FPN in diagnosing pulmonary tuberculosis on the test sets were 96.0% (96/100), 76.0% (76/100) and 86.0% (172/200), respectively. A total of 226 lesions were labeled on 100 positive chest images, while 242 lesions were detected in FPN, with sensitivity and false positive rate of 87.6% (198/226) and 14.0% (34/242), respectively. The FROC localization score could be up to 88.0%. Conclusion FPN can effectively differentiate chest images of pulmonary tuberculosis patients from healthy controls and implement the localization of lesions, which provide a reference for the deep learning-based classification and lesion localization of tuberculosis.

Effect of 18 months regimen in the treatment of multidrug-resistant pulmonary tuberculosis

Qi LI,Xiao-ying JIANG,Meng-qiu GAO,Yu-hong LIU,Kun-yun YANG,Xiao-hong KAN,Jian-qin LIANG,Ming TIAN,Jin-cheng LIU,Wen-yu CUI,Wen LIU,De-mei YU,Shou-yong TAN,Shen-jie TANG,Yu-qin LIU,Xuan LIANG,Li-hua QIU,Shi-feng SHAO,Fei GAO,Li JIE,Bao-yun CAI,Jian-ling BU,Li-ping MA,Zhi LIU,Lin XU,Juan DU,Min CAO,Jing-tao GAO,Wei SHU,Liang LI

Chinese Journal of Antituberculosis. 2019, 41(3):  294-301.  doi:10.3969/j.issn.1000-6621.2019.03.010

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Objective We observed and analyzed the effect of 18 months regimen containing 6 drugs in the treatment of multidrug-resistant pulmonary tuberculosis (MDR-PTB) with the purpose to provide evidence for shortening the treatment course of MDR-TB.Methods Six hundred and eighty-one confirmed MDR-TB patients were enrolled from 20 TB specialized hospitals in China from July, 2009 to December, 2015 among which 515 were treated with the 18 months regimen containing 6 drugs (observation group) and 166 were treated with 24 months regimen containing 5 drugs (control group). Results of TB bacilli culture, complete blood count, hepatic and renal function, electrocardiograph,etc were collected throughout the treatment. The treatment outcome (success, death, failure and lost to follow-up) and adverse effect were assessed at the end of treatment.Data were analyzed using SPSS 22.0 software. Measurement data were analyzed by t test or z test.Enumeration data were analyzed by Chi-square test.The clinical indicator with significant difference before treatment were further analyzed by logistic regression to identify the risk factors associated with treatment success rate.P<0.05 was considered significant difference statistically.Results The treatment success rate (64.66%, 333/515) in the observation group was higher than that of the control group (54.22%, 90/166) (χ ²=5.818, P=0.002) and the death rate in the observation group (2.33%, 12/515) was lower than that of the control group (5.42%, 9/166) (χ ²=4.015, P=0.045). The rate of failure (17.86% (92/515) vs 23.49% (39/166))(χ ²=2.561, P=0.109) and lost to follow-up ((11.46%, 59/515) vs 11.45% (19/166)(χ ²=0.000, P=0.997)) were similar between the two groups. The total incidence of adverse reactions in the observation group (24.85%, 128/515)was close to that of the control group (25.90%, 43/166)(χ ²=0.095, P=0.757). Analysis using logistic regression showed that ≥50 age (β=0.549,s $\bar{x}$=0.204,Wald χ ²=7.262,P=0.007,OR(95%CI)=1.731(1.161-2.579)) and selection of ethambutol (β=0.485,s$\bar{x}$=0.190,Wald χ ²=6.516,P=0.011,OR(95%CI)=1.625(1.119-2.359)) in the regimen were the risk factors for treatment success. Conclusion The efficacy of the 18 months regimen containing 6 drugs was equivalent to the regimen of standard 24 months regimen and didn’t increase the adverse reaction occurrence. Therefore, it is worth for clinical application.

In vitro activity of meropenem against non-tuberculous Mycobacteria

Xia YU,Jing-jing LUO,Li-ping ZHAO,Yang XU,Qian LIANG,Yi-feng MA,Ling-ling DONG,Hai-rong HUANG

Chinese Journal of Antituberculosis. 2019, 41(3):  302-307.  doi:10.3969/j.issn.1000-6621.2019.03.011

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Objective The main goal of this study was to evaluate the in vitro inhibitory activity of meropenem against non-tuberculous mycobacteria (NTM).Methods Alamar Blue Assay was performed with micro-well plate to determine the Minimal Inhibitory Concentrations (MICs) of 207 NTM strains against meropenem. The strains consisted of different NTM species and were isolated from January 2015 to December 2016 in Beijing Chest Hospital, Capital Medical University. Furthermore, 46 reference strains were also tested, which included 30 rapidly rowing mycobacterium (RGM) species and 16 slowly growing mycobacterium(SGM) species.Results Among the 30 tested RGM species, 26.7% (8/30) were resistant to meropenem. The meropenem resistant rates of clinical isolates of M.fortuitum and M.abscessus were 33.3% (11/33) and 82.5% (33/40), respectively. Meropenem exhibited moderate activities against SGM species. Among the 16 tested SGM species, 56.3% (9/16) were resistant to meropenem. The meropenem resistant rates of clinical isolates of M.gordonae, M.intracellulare, M.avium and M.kansassii were 20.0% (2/10), 63.9%(23/36),72.7%(16/22), and 95.6%(43/45), respectively. Conclusion This study demonstrated that meropenem had inhibitory activities against the majority RGM species and some SGM species in vitro, while had relatively better inhibitory activities against M.gordonae and M.fortuitum.

MIRU-VNTR genotyping and clustering of Mycobacterium tuberculosis isolates in Yichang

Xiao-jun LIU,Feng-hua YU,Yun-fang YU,L-yu JI,Pan ZHOU,Yan-lin ZHAO

Chinese Journal of Antituberculosis. 2019, 41(3):  308-314.  doi:10.3969/j.issn.1000-6621.2019.03.012

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Objective To determine the genotypes and clustering patterns of Mycobacterium tuberculosis in Yichang and provide evidence for use in the prevention and treatment of tuberculosis.Methods Sputum samples determined to be positive for Mycobacterium tuberculosis using gene microarrays were collected in Yichang from December 2016 to May 2017. After culturing in Roche medium, 367 Mycobacterium tuberculosis isolates were genotyped using the internationally recognised 24 locus MIRU-VNTR system, and the resolution and variation of the MIRU locus was evaluated using the Hunter-Gaston index (HGI) and genetic difference value (h). MIRU-VNTR results were analyzed using BioNumerics 5.0 software to calculate recent transmission rates. The study population of 367 strains, isolated from 367 patients, was subdivided into 321 strains isolated from new TB cases and 46 strains from relapsed cases. Clustering rates were analysed separately for each set of strains. The clustering rates for new and retreated cases were compared using the chi-square test. P<0.05 was considered statistically significant.Results Genotyping of the 367 M.tuberculosis strains using the 24 locus MIRU-VNTR system gave an HGI value of 0.999. The locus with the highest genetic diversity was QUB11b, with an h value of 0.79, and that with the lowest genetic diversity was MIRU24, with an h value of 0.03. A total of 324 genotypes were identified, polymorphisms being evident. Results from clustering analysis indicated that 90 strains formed 39 clusters, with a clustering rate of 24.52% (90/367) and the recent transmission rate of 13.90% (51/367). The clustering rate of strains from relapsed cases (21.74%, 10/46) was not significantly different from that for strains isolated from new cases (24.92%, 80/321) (χ²=0.220, P=0.639).Conclusion Tuberculosis cases in the Yichang area showed high genetic diversity and low transmission rates. Clustering rates were not linked to whether cases were new or relapsed cases.Results suggest that the majority of tuberculosis cases in Yichang are due to endogenous activation. There is also a limited amount of local transmission. Greater attention should be paid to tuberculosis prevention and control in Yichang.

Genotypic and transmission characteristics of Mycobacterium tuberculosis in Wuchang City, Heilongjiang Province

Ying PENG,Lu TANG,Xin-fa PEI,Xue-ZHi ZHANG,Bai-feng LIN,Li CHEN,Yan-ling YU,Fa-bin LI

Chinese Journal of Antituberculosis. 2019, 41(3):  315-321.  doi:10.3969/j.issn.1000-6621.2019.03.013

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Objective According to the correlation analysis between the differential gene detection of Mycobacterium tuberculosis 105 (RD105) and Beijing genotype strains in Heilongjiang Province, the genotypic and transmission characteristics of Mycobacterium tuberculosis in Wuchang City, Heilongjiang Province were analyzed, which provided effective control tools for tuberculosis in the region.Methods The Mycobacterium tuberculosis isolates from 121 patients with pulmonary tuberculosis who were registered and cultured positively in the tuberculosis control of Wuchang City, Heilongjiang Province (referred to as “TB prevention”) were tested for drug susceptibility testing by proportional susceptibility test, using RD105 deletion gene test and 7 Molecular typing of variable number of tandem repeats (VNTR), calculation of drug resistance rate, Hunter-Gaston index (HGI), clustering rate, ana-lysis of Mycobacterium tuberculosis DNA polymorphism and the correlation between Beijing genotype strains and drug resistance.Results In 121 strains of Mycobacterium tuberculosis in Wuchang City, Heilongjiang Province, the RD105 deletion gene was detected. The results showed that 101 strains were Beijing genotype strains, accounting for 83.5% (101/121), and the remaining 20 strains were non-Beijing genotype strains accounting for 16.5% (20/121). The resistance rates of 121 strains to isoniazid, rifampicin, ethambutol and streptomycin were 5.8% (7/121), 3.3% (4/121), 5.0% (6/121) and 15.7% (19/121), respectively. The resistance rates to the above four drugs were 5.0% (5/101), 3.0% (3/101), 5.9% (6/101) and 17.8% (18/101) in Beijing genotype strains, and were 10.0% (2/20), 5.0% (1/20), 5.0% (1/20), and 0.0% (0/20) in non-Beijing genotype strains. There was no significant difference about drug resistance rates between the Beijing type strains and non-Beijing type strains (χ ²=1.090, P=0.296). The resistance rate of 121 strains was 2.5% (3/121), of which 2 were Beijing family genotypes, 1 was non-Beijing genotypes. Beijing genotypes and non-Beijing genotypes were 2.0% (2/101) and 5.0% (1/20), respectively without significant difference statistically (χ ²=0.531, P=0.460). Further, using 7-site VNTR typing technology, the results showed that 121 strains can be divided into 17 gene clusters and 64 independent genotypes; each cluster includes 2-4 clinical isolates, and the largest cluster consists of 14 strains of tuberculosis. The composition of mycobacterial strains was 11.6% (14/121); the clusters of 57 strains of M.tuberculosis strains were 57, and the clustering rate was 47.1% (57/121). The minimum estimated infection rate is 33.1% (40/121). The 7-site VNTR test results showed a high degree of polymorphism, and the HGI values of each point were 0.513-0.786. According to the cluster analysis, 121 strains of M.tuberculosis strains can be divided into three large gene groups (Ⅰ group, Ⅱ group and group Ⅲ) and 81 genotypes. They were group Ⅰ accounted for 14.9% (18/121, including 15 genotypes), group Ⅱ accounted for 76.9% (93/121, including 59 genotypes), group Ⅲ accounted for 8.2% (10/121, including 7 genotypes).Conclusion The Beijing genotype is the main epidemic strain in Wuchang City, Heilongjiang Province, and the Mycobacterium tuberculosis in this area shows obvious genetic polymorphism. Among the drug-resistant strains, the Beijing genotype strains account for a relatively high proportion, and it is necessary to strengthen the monitoring and prevention of the dominant drug-resistant flora.

Cross-sectional study on the health examination and KAP of tuberculosis for the aged group in nursing home in Shanghai

Jing CHEN,Li-xin RAO,Ying-qing NI,Kai-kan GU,Yi-hui ZHENG,Xiao-feng LIU,Li-hong TANG,Peng LI,Chun-hua XU,Xin SHEN

Chinese Journal of Antituberculosis. 2019, 41(3):  322-329.  doi:10.3969/j.issn.1000-6621.2019.03.014

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Objective To describe the health examination and social care received by the aged group, as well as their KAP to tuberculosis (TB), in nursing home in Shanghai.Methods From Sep. to Dec. 2017, Twenty-one nursing homes were sampled, which located in three urban districts and four suburb districts (three from each district) in Shanghai. Four hundred and thirty-eight people aged over 60 years old, who were healthy enough and willing to be investigated, were sampled from selected nursing homes. Their demographics and health situation, as well as KAP of TB were analyzed and comparisons were carried out between nursing home of urban and suburb districts.Results Totally 438 aged persons were investigated, among which, 36.8% (161/438) were male and 75.8% (332/438) were over 80 years old. 92.7% (406/438) of them were Shanghai residents and 90.9% (398/438) had education background of middle school or even lower degree. 56.8% (249/438) of them had stayed in the nursing home longer than 1 year but shorter than 5 years. 88.6% (388/438) of them had chronic disease and 50.9% (223/438) had at least two kinds of chronic diseases. 82.9% (363/438) of the aged received chest X-ray test before entering nursing home but 28.3% (124/438) were not tested after entering the nursing home. Higher proportion of the aged receiving chest X-ray test were found in urban areas than in suburban areas, both before (93.2% (179/192) vs 74.8% (184/246), χ ²=25.82, P<0.001) and after (88.0% (169/192) vs 58.9% (145/246), χ ²=44.92, P<0.001) entering nursing home. 35.4% (155/438) of the old people were visited once a week or less frequently, more visiting were found in urban areas than in suburban areas (78.6% (151/192) vs 53.7% (132/246), χ ²=29.45, P<0.001). 70.3% (308/438) of the old people never left the nursing home within one year. The proportions of the old people who knew that TB was infectious and that it was an airborne disease were 86.1% (309/359) and 72.5% (224/309) respectively. Only 29.0% (104/359) of the aged knew that anyone who had chronic cough for more than two weeks should be suspected as TB patient.Conclusion Collaboration between nursing home and health facilities need to be established and improved to provide timely health examination for the aged group. Health education about TB knowledge and social care should also be strengthened for the aged group in nursing home.

Clinical Case Discussion

Inflammatory myofibroblastic tumor complicated by latent tuberculosis infection: a case report and review of the literature

Bin ZHAO,Jing-yu CHI,Chuan-qing WANG,Dai-lun HOU,Yun-zeng ZHANG,Cheng WANG,Feng JIN

Chinese Journal of Antituberculosis. 2019, 41(3):  330-337.  doi:10.3969/j.issn.1000-6621.2019.03.015

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Inflammatory myofibroblastic tumor (IMT) is a clinically rare neoplasm and its clinical diagnosis is difficult. It may be misdiagnosed as tuberculosis when the result of test for Mycobacterium tuberculosis infection is positive. The authors analyzed the clinical data of a case of malignant IMT complicated by latent tuberculosis infection in Shandong Provincial Chest Hospital Affiliated to Shandong University, and reviewed the related literatures. We pointed out that the possibility of rare low-grade tumor should be taken into account when no effect was achieved after anti-tuberculosis therapy. In order to obtain the correct diagnosis as soon as possible, it is necessary to perform multiple pathological examinations of different sites, and be prepared to seek pathology consultation from multiple hospitals.

Review Articles

Advances in biopsy of small pulmonary nodules

Jian-kun ZHU,Feng JIN

Chinese Journal of Antituberculosis. 2019, 41(3):  338-342.  doi:10.3969/j.issn.1000-6621.2019.03.017

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The benign and malignant diagnosis of pulmonary nodules is based on pathological biopsy. There are endless clinical studies on the biopsy methods of pulmonary nodules. The authors reviewed the methods of pulmonary nodule biopsy developed in recent years, including percutaneous pulmonary biopsy guided by CT and ultrasound, virtual navigation combined with radial probe bronchoscopy ultrasound biopsy, rapid on-site evaluation, transbronchial cryobiopsy and video assisted thoracoscopic surgery, in order to find a suitable method for lung nodule biopsy.

Progress of cryotechnique through bronchoscope in respiratory diseases

Rong-rong WANG,Zhi CHEN,Guang-yu ZHANG

Chinese Journal of Antituberculosis. 2019, 41(3):  343-347.  doi:10.3969/j.issn.1000-6621.2019.03.018

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Cryotherapy has existed in ancient times. With the development of medical devices and clinical technology, cryotechnique plays an important role in clinical application because of its unique advantages. Cryotherapy is not only used in the treatment of skin surface diseases,but also in the treatment of lung tumors, stomach tumors and other diseases of internal organs. In addition, cryotechnique through various endoscopes is also developing,and expands the scope of clinical application of cryotherapy. Cryotherapy through bronchoscope has been used for endobronchial biopsy and treatment of many diseases,such as malignant and benign central airway obstruction,removal of foreign bodies, bronchial tuberculosis. Studies have confirmed the effectiveness of cryotechnique in treatment of airway diseases. The application and progress of cryotherapy through bronchoscopy in respiratory diseases are reviewed.

Short Articles

Tuberculosis of the thymus—2 cases report and review of the literature

Da-wei LIU,Jian-kun ZHU,Feng JIN,Cheng WANG,Gao-feng QIAO,Yun-zeng ZHANG,Bin ZHAO

Chinese Journal of Antituberculosis. 2019, 41(3):  348-352.  doi:10.3969/j.issn.1000-6621.2019.03.019

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In the study, we reported two cases who diagnosed as thymic tuberculosis (TB), their clinical characteristics, such as symptoms, image findings, tuberculin skin test, T-SPOT.TB, treatment and outcome, were summarized and evaluated, retrospectively. Moreover, between 1958 and 2016, patients with thymic TB (n=24) reported by others (21 studies) were also analyzed. Overall, thymic TB is extremely rare. Although routine chest CT and other image findings suggest the disease, it couldn’t confirm it. Nevertheless, bacteriological and histological examinations can make a definite diagnosis, so in order to identify the cause of mediastinal mass, these assays should be considered in practice. In addition, for management of suspected thymic TB patients, diagnostic treatment should be prescribed timely, and the lesions should be treated surgically when indications arise. Meanwhile, it is recommended to follow standard anti-TB treatment for a better outcome.

Report of two cases of pulmonary tuberculosis complicated with venous thromboembolism

Jie ZHANG,Ying-qun JI

Chinese Journal of Antituberculosis. 2019, 41(3):  353-356.  doi:10.3969/j.issn.1000-6621.2019.03.020

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Venous thromboembolism (VTE) is one of the critical vascular diseases with high mortality. However, the clinical manifestation of patients suffered from pulmonary tuberculosis complicated with VTE is lack of specificity, which commonly leads to misdiagnosis or missed diagnosis, leading to an increased risk of death. The author reported two cases of pulmonary tuberculosis complicated with VTE and reviewed relevant literatures, with the purpose of improving the cognition of these diseases and guiding clinical standard treatment.

Bronchial mucosa keratosis combined with bronchial tuberculosis: a case report and literature review

Xiao-nan MA,Chang-li LIU,Qian-hong WU,Yi ZHOU

Chinese Journal of Antituberculosis. 2019, 41(3):  357-360.  doi:10.3969/j.issn.1000-6621.2019.03.021

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A case diagnosed as bronchial mucosa keratosis combined with bronchial tuberculosis was reported by Shaanxi Provincial Tuberculosis Hospital and the related clinical information and process for diagnosis and treatment of this patient were analyzed, the relevant literature was reviewed as well. The patient was a 27 years old man, a farmer. He was admitted to the hospital on January 26th, 2014 presenting with fever, cough with sputum, chest pain and dyspnea. No active lesions were seen in chest CT. The fiberoptic bronchoscopy examination showed a large amounts of yellow membranous attachments. Sputum Mycobacterium tuberculosis culture was positive. Pathological examination under fiberoptic bronchoscopy showed that the surface of bronchial mucosa was covered with squamous epithelium combined with hyperkeratosis, which was in accorded with the diagnosis of bronchial mucosal keratosis complicated with bronchial tuberculosis. Anti-TB drugs, isoniazid, rifampicin, pyrazinamide and ethambutol, were given to the patient for anti-tuberculous treatment. At the same time, sodium bicarbonate, dexamethasone and recombinant human epidermal growth factor were repeatedly lavaged under bronchoscopy and bronchoscopic cryo-therapy was also performed. After six months, the attachments were completely absorbed. Four years follow-up was done to this patient, and he had normal work and life. Based on the literature review results, the authors think that the clinical symptoms and signs of bronchial mucosal keratosis complicated with bronchial tuberculosis are lack of specificity. The diagnosis mainly depends on the history and pathological examination. According to the specific situation of the patients, anti-tuberculosis treatment can be implemented, as well as combined fiberoptic bronchoscope cryotherapy and bronchoscopic administration, etc, to cure the patients.

Genotypic analysis of Mycobacterium tuberculosis among prison population in Tianjin, China

Tong XIE,Chun-hua WANG,Hui ZHAO,Han-fang JU,Cheng MU,Zhi-rui WANG,Rui SUN

Chinese Journal of Antituberculosis. 2019, 41(3):  361-363.  doi:10.3969/j.issn.1000-6621.2019.03.022

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The aim of study was to evaluate the prevalence of the sublineages of Mycobacterium tuberculosis (MTB) Beijing genotype circulating strains based on the region of differences polymorphisms in the prisons in Tianjin, China. Overall 124 MTB strains, which were isolated from the sputum samples of patients with pulmonary tuberculosis in the prisons in Tianjin from Jan. 2013 to Jun. 2016, were included. Beijing genotype strains accounted for 93.5% (116/124). Among these Beijing genotype strains, 96 (82.8%) were modern Beijing strains, and 20 (17.2%) were ancient Beijing strains. Based on large fragment polymorphism analysis, the 116 Beijing genotype strains were further grouped in four sublineages. Among the 20 ancient Beijing strains, 7 (6.0%) strains were RD181(+), and 13 (11.2%) strains were RD181(-). Of the 96 modern Beijing strains, 95 belonged to RD150(+) sublineage, accounting for 81.9% of the Beijing genotype stains, and only 1 (0.9%) strain with RD150 deletion was found in this study. RD150(+) modern Beijing sublineage were predominant among the prisoners in Tianjin. Our data showed the need for continued surveillance of RD150(+) modern Beijing sublineage transmission among prison inmates in Tianjin, China.

Analysis of 894 strains of Mycobacterium tuberculosis resistance to first-line anti-tuberculosis drugs

Wei ZHAO,Si-jie LIU,Ke-wei LI,Li SHEN,Xin LIU,Peng QI,Xiu-jun YANG

Chinese Journal of Antituberculosis. 2019, 41(3):  364-368.  doi:10.3969/j.issn.1000-6621.2019.03.023

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The clinical isolates of Mycobacterium tuberculosis in sputum specimens of 894 patients with tuberculosis in 9 Cities (States) of Jilin Province from January 2016 to March 2018 were collected and analyzed. The susceptibility tests of rifampicin (RFP), isoniazid (INH), streptomycin (Sm) and ethambutol (EMB) were carried out. Among 894 strains of Mycobacterium tuberculosis, 546 (61.07%) were susceptible to first-line drugs, 348 (38.93%) were resistant to first-line drugs. The resistance rate was 36.30% (265/730) for initial treatment cases and 50.61% (83/164) for retreatment cases, and the difference was statistically significant (χ ²=11.53, P=0.001). The total multidrug-resistance rate was 10.07% (90/894). The drug resistance rate was higher in retreatment cases (20.73%, 34/164) than initial treatment cases (7.67%, 56/730), and the difference was statistically significant (χ ²=25.23,P=0.001). The drug resistance rate of all patients to first-line anti-TB drugs was Sm (25.95%, 232/894)>INH (18.57%, 166/894)>RFP (17.23%, 154/894)>EMB (9.73%, 87/894). The tuberculosis patients in Jilin Province have high resistance to first-line drugs, especially the retreatment patients. The situation of drug-resistant tuberculosis prevention and control is still serious, and the prevention and control of tuberculosis needs to be strengthened.