Table of Content

10 August 2019, Volume 41 Issue 8

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Original Articles

Performance characteristics of conventional ultrasound scanning and contrast-enhanced ultrasonography of pleural tuberculoma

Yang CONG,Yi ZHANG,Ke BI,Meng-jun SHEN,Hui-ming ZHU,Hong-wei CHEN,Yin WANG

Chinese Journal of Antituberculosis. 2019, 41(8):  808-815.  doi:10.3969/j.issn.1000-6621.2019.08.002

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Objective To provide a certain imaging basis for clinical diagnosis and interventional ultrasound, analyzing the image data of pleural tuberculoma with conventional ultrasound and contrast-enhanced ultrasound.Methods Retrospective analysis of 49 patients with pleural tuberculoma confirmed by pathology or laboratory examination from January to December 2018 in Tongji University Affiliated to Shanghai Pulmonary Hospital. All patients underwent routine ultrasound and contrast-enhanced ultrasonography. Morphology, longitudinal and transverse diameter values, marginal conditions, blood flow, presence or absence of pleural slip sign and calcification in conventional ultrasound scan mode; contrast-enhanced ultrasound was summarized and analyzed from both qualitative and quantitative aspects. Qualitative indicators of contrast-enhanced ultrasound include enhanced mode, enhanced intensity, enhanced morphology, enhanced uniformity, and presence or absence of necrotic areas and their types. Quantitative indicators include initial enhancement time, peak time, area under the curve, and gradient curve.Results A total of 49 lesions were included in the study in 49 patients. The largest lesions were selected from the two lungs for observation. Conventional ultrasonography showed that the lesions were mostly “D” shaped from the pleura to the lungs (71.43%, 35/49), round-like (18.37%, 9/49) and irregular shape (10.20%,5/49), intersecting the pleura thickening (89.80%, 44/49), with many edges compared with smoothing (59.18%, 29/49), most of them had lung slip sign (61.22%, 30/49); qualitative indicators of contrast-enhanced ultrasound showed that the lesions showed high enhancement (93.88%, 46/49), from external to internal perfusion. (91.84%, 45/49); perfusion morphology was dominated by annual enhancement (32.65%, 16/49) and bad branch enhancement (30.61%, 15/49); more common no enhancement zone (75.51%, 37/49), and the area of no enhancement area was more than <50% (65.31%, 32/49). In the quantitative contrast index of contrast-enhanced ultrasound, the enhancement time, peak time, and area under the curve of the lesion area were close to those of the chest wall tissue, and the initial enhancement time of the lesion and normal lung tissue (11.35 (9.58, 14.49) s and 5.35 (4.24, 7.38) s), peak time (26.79 (22.57, 30.17) s and 17.20 (14.81, 24.38) s), area under the curve (1018.61 (784.90, 1505.91) dB·s and 2853.05 (1428.96, 3261.56) dB·s), the differences were statistically significant (H=8.317, 5.356, 5.215; Ps<0.001); lesion and chest wall tissue began to enhance time (11.35 (9.58, 14.49) s and 10.70 (9.35, 13.37) s), peak time (26.79 (22.57, 30.17) s and 24.93 (21.05, 27.02) s) and area under the curve (1018.61 (784.90, 1505.91) dB·s and 711.89 (527.90, 1254.84) dB·s),the differences were not statistically significant (H=1.019, P=0.924; H=1.427, P=0.461; H=1.212, P=0.676).Conclusion Conventional ultrasound and contrast-enhanced angiography of pleural tuberculoma have certain characteristic performance and can provide diagnostic basis in clinical Identification and ultrasound interventional treatment.

Application value of superb micro-vascular imaging in classification of cervical tuberculous lymphadenitis

Meng-jun SHEN,Hong-wei CHEN,Ke BI,Yi ZHANG,Yang CONG,Yin WANG

Chinese Journal of Antituberculosis. 2019, 41(8):  816-821.  doi:10.3969/j.issn.1000-6621.2019.08.003

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Objective The aim of this study was to compare the difference of tuberculous lymph node blood flow display and ultrasonographic diagnosis before and after using superb micro-vascular imaging (SMI), and then explore the clinical application value of SMI in the diagnosis of cervical tuberculous lymphadenitis.Methods A total of 30 patients diagnosed with cervical tuberculous lymphadenitis from March to June 2018 who were admitted to Shanghai Pulmonary Hospital for ultrasound biopsy were retrospectively analyzed. There were 78 enlarged lymph nodes in 30 patients. The difference of blood flow signal display and ultrasonic classification between gray-scale ultrasound + color doppler flow imaging (CDFI) and gray-scale ultrasound + SMI were compared, and then they were compared with the pathological results.Results Based on CDFI blood flow mode, among 78 enlarged lymph nodes, there were 15 signed of internal blood flow, 14 signed of peripheral blood flow and 0 signed of mixed blood flow, with the blood flow rate of 37.2% (29/78). Based on SMI blood flow mode, among 78 enlarged lymph nodes, there were 19 signed of internal blood flow, 22 signed of peripheral blood flow, and 6 signed of mixed blood flow, with the blood flow rate of 60.3% (47/78). The difference was statistically significant (χ²=16.056, P=0.000) between CDFI and SMI blood flow modes. The classification results based on gray-scale ultrasound + CDFI were 16 (20.5%) Type Ⅰ, 22 (28.2%) Type Ⅱ, 19 (24.4%) Type Ⅲ, and 21 (26.9%) Type Ⅳ. The classification results of gray-scale ultrasound + SMI were: 22 (28.2%) Type Ⅰ, 14 (17.9%) Type Ⅱ, 21 (26.9%) Type Ⅲ, and 21 (26.9%) Type Ⅳ. The difference was statistically significant (χ²=8.000,P=0.018) between CDFI and SMI. The pathological results revealed that among 78 enlarged lymph nodes, 25 mainly showed lymphocytes and granulomatous lesions (corresponding to ultrasound type Ⅰ), 13 mainly showed solidified necrotic tissue (corresponding to ultrasound type Ⅱ), 20 mainly showed necrotic tissue and granulomatous lesions (corresponding to ultrasound type Ⅲ), and 20 mainly showed fibrous tissue hyperplasia (corresponding to ultrasound Ⅳ type). The classification results of gray-scale ultrasound + SMI and pathological results had excellent consistency (Kappa=0.948), with the compliance rate of 96.2% (75/78). Compared with the pathological results, the classification results of gray-scale ultrasound + CDFI also had a good consistency (Kappa=0.830), with the compliance rate of 87.2% (68/78).Conclusion SMI can significantly increase the display rate of blood flow in cervical tuberculous lymphadenitis, accurately classify lymphatic tuberculosis, and guide clinicians to choose effective treatment plans, which has higher clinical application value.

The value of conventional ultrasound combined with contrast-enhanced ultrasonography in the differential diagnosis of pleural-based pulmonary tuberculosis and bacterial pneumonia

Kai-wen WU,Ke BI,Yi ZHANG,Meng-jun SHEN,Yang CONG,Yin WANG

Chinese Journal of Antituberculosis. 2019, 41(8):  822-827.  doi:10.3969/j.issn.1000-6621.2019.08.004

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Objective To investigate the value of conventional ultrasound combined with contrast-enhanced ultrasonography in the differential diagnosis of pleural-based pulmonary tuberculosis and bacterial pneumonia.Methods A total of 35 patients with pulmonary tuberculosis (tuberculosis group) and 16 cases with bacterial pneumonia (pneumonia group) diagnosed by pathology, bacteriology or diagnostic therapy in Shanghai Pulmonary Hospital from January to May 2019 were enrolled. Conventional and contrast-enhanced ultrasound images of lesions between the two groups were analyzed, and the size, location, shape, echogenicity, enhancement pattern, arrival time, time to peak, clearance speed, incidence and characteristics of necrosis were compared.Results (1) Conventional ultrasound showed 28 cases (80.00%) with wedge shape, 5 cases (14.29%) with round-like shape, and 2 cases (5.71%) with irregular shape in the tuberculosis group; and 10 cases (62.50%) with wedge shape, and 6 cases (37.50%) with round-like shape in the pneumonia group, without significant difference between the two groups (χ²=4.109, P=0.128). There was hyperechoic between the deep lesion and the normal lung tissue, among which, “fragment sign” appeared 11 cases (31.43%) in the tuberculosis group and 13 cases (81.25%) in the pneumonia group, with the significant difference between the two groups (χ²=10.940, P=0.001); “Waterfall sign” appeared in 22 cases (62.86%) in the tuberculosis group and 3 cases (18.75%) in the pneumonia group, with the significant difference between the two groups (χ²=8.548, P=0.003). (2) Contrast-enhanced ultrasonography showed that arrival time of lesions was (8.43 (4.79,10.83)) s in the tuberculosis group and (7.80 (5.51,12.26)) s in the pneumonia group, without the significant difference between the two groups (U=0.721, P=0.471); arrival time difference between lesion and lung tissue was (1.47 (0.56,2.01)) s in the tuberculosis group and (2.00 (1.28,2.67)) s in the pneumonia group, without the significant difference between the two groups (U=1.453, P=0.146); peak intensity was (-41.89±5.72) dB in the tuberculosis group and (-44.89±5.72) dB in the pneumonia group, without the significant difference between the two groups (t=1.738, P=0.089); half time of intensity descent was (153.33 (124.02,180.00)) s in the tuberculosis group and (138.45 (128.70,147.09)) s in the pneumonia group, without the significant difference between the two groups (U=1.326, P=0.185). Necrosis occurred in 29 cases (82.86%, 29/35) in the tuberculosis group and 5 cases (31.25%, 5/16) in the pneumonia group, with the significant difference between the two groups (χ²=13.160, P=0.000). In terms of the characteristics of necrosis, 15 cases (51.72%, 15/29) presented with multiple non-interconnected sieve-like necrosis, 11 cases (37.93%, 11/29) presented with large patchy necrosis with regular shape and regular inner wall, and 3 cases (10.35%, 3/29) presented with almost total necrosis with circular enhancement of residual active margin in the tuberculosis group; 1 case (1/5) presented with large patchy necrosis with regular shape and regular inner wall, and 4 cases (4/5) presented with small patchy necrosis with regular shape and regular inner wall in the pneumonia group. There was significant difference between the two groups (χ²=26.692, P=0.000).Conclusion Conventional ultrasound shows the characteristic of “irregular fragment-like” hyperechoic behind the lesions of bacterial pneumonia. Contrast-enhanced ultrasonography shows that the incidence of necrosis in pulmonary tuberculosis is significantly higher than that in bacterial pneumonia, with the characteristics of “sieve-like” and “regular large patch” necrosis. These founds can provide diagnostic basis for the differential diagnosis.

Diagnostic value of contrast-enhanced ultrasound-guided percutaneous lung puncture biopsy in culture negative presumptive tuberculosis patients

Yi ZHANG,Ke BI,Hui-ming ZHU,Yang CONG,Meng-jun SHEN,Hong-wei CHEN,Yin WANG

Chinese Journal of Antituberculosis. 2019, 41(8):  828-832.  doi:10.3969/j.issn.1000-6621.2019.08.005

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Objective To explore the diagnostic value of percutaneous lung biopsy guided by contrast-enhanced ultrasound for culture negative tuberculosis.Methods A total of 56 patients were recruited who were admitted to Shanghai Pulmonary Hospital Affiliated to Tongji University from Jan.2018 to Dec.2018 and were diagnosed to be bacterial negative presumptive pulmonary tuberculosis. All patients underwent contrast-enhanced ultrasound and ultrasound-guided percutaneous lung biopsy. The results of conventional ultrasound and contrast-enhanced ultrasound, the detection rate of necrosis, the positive rate of puncture biopsy, and the complications were analyzed.Results The positive rate of ultrasound-guided percutaneous lung biopsy among 56 patients was 78.6% (44/56), including 35 cases of tuberculosis(79.5%, 35/44), 2 cases of non-tuberculosis mycobacterium, 2 cases of lung cancer, 5 cases of pneumonia, 12 cases of negative results(confirmed by diagnostic anti-tuberculosis treatment).The detection rate of intralesional necrosis of pulmonary tuberculosis by contrast-enhanced ultrasonography (68.1%,32/47) was higher than that by conventional ultrasonography (36.2%,17/47). There was a significant difference between those two methods (χ ²=9.592, P=0.002). Complications occurred only in 1 case (1.8%, 1/56) as hemoptysis during ultrasound-guided percutaneous lung biopsy, while the amount of blood was around 20 ml, symptom relived after 30 minutes, no hemoptysis thereafter. Conclusion For culture negative presumptive pulmonary tuberculosis cases, contrast-enhanced ultrasound-guided percutaneous lung biopsy is an effective and safe method for the diagnosis of negative tuberculosis, which has high clinical application value.

Diagnostic value of ultrasound-guided pleural puncture in suspected tuberculosis pleurisy

Yi HUANG,Han YANG,Xuan FENG,Yuan LIU,Yao-hui ZHANG,Qi ZHANG

Chinese Journal of Antituberculosis. 2019, 41(8):  833-837.  doi:10.3969/j.issn.1000-6621.2019.08.006

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Objective To compare and analyze the diagnostic value of pathological tissue and pleural effusion samples obtained by ultrasound-guided pleural puncture in suspected tuberculous pleurisy.Methods Two hundred and ninety-eight patients with suspected tuberculous pleurisy who were admitted to Xi’an Chest Hospital from January 2016 to May 2018 were retrospectively analyzed. Among them, 112 cases were clinically diagnosed as tuberculous pleurisy and 186 cases as non-tuberculous pleurisy. The specimens of pathological tissue and pleural effusions were obtained under the guidance of ultrasound, and the pathological sections of the biopsies were examined (“pathological examination”). The pleural effusions were cultured with Mycobacteria tuberculosis (concentrated collection method, liquid culture BACTEC MGIT 960 operating system, “MGIT 960 culture”). GeneXpert MTB/RIF detection (“GeneXpert detection”) and acid-fast bacillus staining smear examination (“smear examination”). The above-mentioned methods took clinically confirmed patients as reference criteria, and obtained their diagnostic sensitivity, specificity, positive predictive value, negative predictive value and Yoden index, in order to evaluate the effectiveness of various detection methods in the diagnosis of tuberculous pleurisy.Results The sensitivity of pathological examination, MGIT 960 culture, GeneXpert detection and smear examination were 41.96% (47/112), 73.21% (82/112), 58.93% (66/112) and 2.68% (3/112).The specificity was 99.46% (185/186), 100.00% (186/186), 100.00% (186/186) and 100.00% (186/186). The Yoden index was 0.41, 0.73, 0.59, 0.02.Conclusion The results showed that MGIT 960 culture with concentrated bacteria collection method had better sensitivity and specificity than other detection techniques and methods. The Yoden index was the highest, and had good clinical diagnostic value for tuberculous pleurisy.

Analysis of surgical treatment of 16 patients with spinal tuberculosis combined with AIDS

Yong-jie ZHAO,Nan-ping QIAN

Chinese Journal of Antituberculosis. 2019, 41(8):  838-842.  doi:10.3969/j.issn.1000-6621.2019.08.007

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Objective To explore and analyze the effect of surgical treatment of spinal tuberculosis combined with acquired immune deficiency syndrome (AIDS).Methods A retrospective study was used to select 16 patients who underwent surgical treatment of spinal tuberculosis with AIDS in the Department of Bone Tuberculosis of He’nan Provincial Infectious Diseases Hospital from May 2011 to October 2015. Among them, there were 10 males and 6 females. The average age was (38.0±14.0) years old ranged from 25 to 74 years old. The selection of surgical methods, intraoperative bleeding, operative time, drainage tube placement time, anti-tuberculosis drug treatment regimen, and bone graft fusion after follow-up for 36 months, complications and improvement of neurological function based on the standard from the American Spinal Cord Injury Association (ASIA) were analyzed.Results The average intraoperative bleeding volume, the average operation time, the average drainage time were (300.5±30.0) ml (ranged from 261-340 ml), (162.5±7.4) min (ranged from 154-176 min) and (6.2±0.8) days (ranged from 4.9-7.1 days), respectively. The wound healing was stageⅠin 14 cases and stage Ⅱ in 2 cases. The ultrasound guided abscess drainage was performed in 5 cases, 4 cases were underwent with simple anterior extraperitoneal tuberculosis focal debridement, and 2 cases were underwent anterior spinal tuberculosis debridement, iliac bone grafting and posterior pedicle screw internal fixation. Five cases were underwent pedicle screw internal fixation, intraspinal tuberculosis debridement and bone grafting. The chemotherapy regimen with 6H-R-Z-E-Lfx/12H-R-E was used in 14 cases till the end of course and the chemotherapy regimen was changed with 6Z-E-Lfx-Am-Pto-Pa/12-18Z-E-Pto-Pa due to INH and RFP drug resistance in 2 cases till the end of course. During the follow up for 36 months, no loosening of internal fixation, fracture, no complications were found in all patients. Ten cases of Bone grafting fusion was grade Ⅰ in 10 cases, grade Ⅱ in 5 cases and grade Ⅲ in one case. ASIA grade improved from grade C to grade D in 4 cases. Grade D to E in 6 cases and grade B to grade D in 2 cases.Conclusion Effective and sufficient courses of antituberculosis drugs, appropriate surgical methods, drainage tube placement time, individual chemotherapy regimen can achieve better efficacy for patients with spinal tuberculosis combined with AIDS.

Efficiency analysis of surgical treatment in patients suffering tuberculous empyema complicated with static cirrhosis

Hang-kong REN,Li-ming DUAN,Yi ZHANG,Ming-jun HU

Chinese Journal of Antituberculosis. 2019, 41(8):  843-847.  doi:10.3969/j.issn.1000-6621.2019.08.008

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Objective To evaluate the efficacy of surgical treatment of tuberculous empyema complicated with static cirrhosis.Methods Thirty-six patients who were suffering from tuberculous empyema complicated with static cirrhosis were enrolled from April 2013 to April 2018 in Xi’an Chest Hospital. The tuberculous empyema lesions were removed and the pleural resection was performed. The patient’s operation time, intraoperative blood loss, postoperative drainage volume, tube time, pulmonary complications, postoperative hospitalization time, and lung function changes were analyzed.Results The intraoperative blood loss, total 3 days postoperative drainage volume, postoperative tube time, and postoperative chest infection rate were (423.6±32.8)ml, (664.8±49.9)ml, (5.6±1.2)d, 16.7% (6/36). The postoperative pulmonary function index after 3 months were following: the forced vital capacity (FVC) was (90.6±8.6)%; the first expiratory volume (FEV1) was (85.0±6.6)%; the maximum expiratory peak flow rate (PEF) was (72.9±2.7)%; the ventilation volume (MVV) was (84.7±4.4)%, compared with the preoperative index ((68.9±7.5)%, (63.5±5.6)%, (64.1±3.6)%, (61.6±4.1)%), the difference was statistically significant (t=-11.37, P<0.01; t=-10.94, P<0.01; t=-13.36, P<0.01; t=-21.14, P<0.01). Thirty-six patients were followed up for 9 months and the symptoms disappeared; 34 wounds healed by first intention, 2 cases delayed healing and healed after 1 month with local dressing change. No recurrence patients.Conclusion Surgical treatment of static cirrhosis with tuberculous empyema is safe, feasible and effective. There is no cirrhosis activity and tuberculosis dissemination, but intraoperative blood loss and postoperative drainage volume should be vigilant.

Risk factors of acute kidney injury after surgery in adult spinal tuberculosis

Kun LI,Tai-jun LUO,Fei WANG,Hong-yan JIA,Zong-de ZHANG,Wei LIU

Chinese Journal of Antituberculosis. 2019, 41(8):  848-856.  doi:10.3969/j.issn.1000-6621.2019.08.009

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Objective To explore risk factors of acute kidney injury (AKI) after surgical treatment in adult spinal tuberculosis patients whose preoperative renal function were normal.Methods A retrospective study was conducted in spinal tuberculosis patients undergoing debridement surgery (posterior debridement and interbody fusion with internal fixation) in Beijing Chest Hospital Attached to Capital Medical University from 2009 to 2018, all the patients aged ≥18 years and their preoperative renal function were normal. According to exclusion criteria, 2068 of 2535 spinal tuberculosis patients were enrolled. Based on the inclusion criteria and guidelines of kidney disease improving global outcomes (KDIGO), 31 cases with AKI after surgery were selected as AKI group, and 62 cases with the same surgical treatment were control group. Data including age, gender, body mass index (BMI), preoperative hypertension, diabetes, heart disease, smoking history, chronic obstructive pulmonary disease (COPD), anti-tuberculosis drug treatment time, serum creatinine (Scr), blood urea nitrogen (BUN), hemoglobin (Hb), uric acid, albumin, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), ASA classification, anesthesia, hypertension, hypotension, surgical duration, intraoperative medication, Hydroxyethyl starch 130/0.4 sodium chloride injection, fluid volume, blood transfusion, blood loss, urine, postoperative pulmonary infection, postoperative hospital stay, number of deaths in the hospital, were analyzed using multivariate logistic regression, in order to explore the relationship of them and postoperative AKI.Results Univariate analysis showed that the preoperative age ≥60 years old (64.52% (20/31) vs. 41.94% (26/62), χ ²=4.216, P=0.040), BMI >25 (58.06% (18/31) vs. 30.65% (19/62), χ ²=6.486, P=0.011), history of hypertension (54.84% (17/31) vs. 29.03% (18/62), χ ²=5.864, P=0.015), hyperuricemia (87.10% (27/31) vs. 67.74% (42/62), χ ²=4.043, P=0.044), anemia (54.84% (17/31) vs. 19.35% (12/62), χ ²=12.126, P=0.001), and intraoperative blood loss ≥600 ml (64.52% (20/31) vs. 35.48% (12/62), χ ²=7.034, P=0.008) were in AKI group significantly higher than those in the control group;while preoperative eGFR ≥90 ml·min ^-1·(1.73m ²) ^-1 (67.74% (21/31) vs. 87.10% (54/62), χ ²=4.960, P=0.026) and intraoperative dexmedetomidine (41.94% (13/31) vs. 64.52% (40/62), χ ²=4.299, P=0.038) were significantly lower than those in the control group. According to multivariate logistic regression analysis, BMI >25 (Wald χ ²=4.916,P=0.027,OR(95%CI):4.391 (1.182-16.238)), hyperuricemia (Wald χ ²=4.412,P=0.036,OR(95%CI):5.896 (1.126-30.874)), eGFR≥90 ml·min ^-1·(1.73m ²) ^-1 (Wald χ ²=4.283,P=0.039,OR(95%CI):0.213 (0.049-0.921)), and anemia (Wald χ ²=9.396,P=0.002,OR(95%CI):8.173 (2.133-31.314)) before surgery were risk factors for postoperative AKI. Conclusion For postoperative AKI in the spinal tuberculosis patients with normal preoperative renal function, BMI >25 and preoperative hyperuricemia and anemia are risk factors; while preoperative high eGFR are protective factors.

Analysis of factors affecting wound healing time after natural ulceration of cervical lymph node tuberculosis and lymph node incision

Ying GAO,Lin WANG,Li-na CHEN

Chinese Journal of Antituberculosis. 2019, 41(8):  857-862.  doi:10.3969/j.issn.1000-6621.2019.08.010

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Objective To analyze the risk factors affecting wound healing time after natural ulceration of cervical lymph node tuberculosis and lymph node incision.Methods A totol of 189 patients with cervical lymph node tuberculosis admitted to the Department of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University were selected. Diagnosed as cervical lymph node tuberculosis by wound secretion culture and clinical comprehensive diagnosis, they met the inclusion criteria and underwent dressing changes after natural ulceration of cervical lymph node tuberculosis and lymph node incision in the outpatient department. The wound healing time of 189 patients was 62-166 days, with an average of (90.3±12.1) days. With the average wound healing time 90 days as the threshold value, 47 cases (24.9%) had a wound healing time ≥90 d (≥90d group) and 142 cases (75.1%) <90 d (<90d group). Univariate and multivariate logistic regressions were used to analyze the effect of age, gender, education, income, history of smoking, history of alcohol consumption, body mass index (BMI), maximum diameter of lesions, extent of lymph node involvement, whether complicated by diabetes, whether complicated by tuberculosis, whether regular of dressing changes, and other 12 related factors on the healing time of cervical lymph node tuberculosis wounds. Data were analyzed by χ ² test using SPSS 17.0, P<0.05 was considered statistically significant. Results Univariate analysis showed that there were statistically significant differences of BMI <18.4 (58.5% (83/142) vs. 85.1% (40/47); χ ²=11.040, P=0.001), number of involved lymph nodes ≥2 (22.5% (32/142) vs. 38.3% (18/47); χ ²=4.509, P=0.034), maximum diameter of lesions ≥ 2.0 cm (61.3% (87/142) vs. 80.9% (38/47); χ ²=6.047, P=0.014), complicated by diabetes (36.6% (52/142) vs. 57.4% (27/47); χ ²=6.296, P=0.012), irregular dressing changes (13.4% (19/142) vs. 72.3% (34/47);χ ²=61.835, P=0.000), etc. in the two groups of patients with wounding healing time <90 d and ≥90 d. Multivariate logistic regression analysis showed that the risk factors affecting wound healing of tuberculosis in cervical lymph nodes included BMI <18.4 (Wald χ ²=3.553, P=0.019, OR (95%CI):4.062 (0.117-7.981)), number of involved lymph nodes≥2 (Wald χ ²=4.223, P=0.040, OR (95%CI):2.134 (1.172-19.119)), maximum diameter of lesions ≥ 2.0 cm (Wald χ ²=8.573, P=0.003, OR (95%CI):2.669 (1.169-10.815)), complicated by diabetes (Wald χ ²=5.021, P=0.025, OR (95%CI):2.337 (1.776-4.442)), and irregular dressing changes (Wald χ ²=26.346, P=0.000, OR (95%CI):16.900 (14.061-32.786)). Conclusion Special attention should be paid to patients with BMI <18.4, number of involved lymph nodes ≥2, complicated by diabetes, maximum diameter of lesions ≥2.0 cm and irregular dressing changes to avoid prolonged lymph node tuberculosis wounds.

Clinical application of daily awaking execution scale in tuberculosis patients with mechanical ventilation and sedation

Qing-qing WU,Li-jun SONG,Lin ZHANG

Chinese Journal of Antituberculosis. 2019, 41(8):  863-868.  doi:10.3969/j.issn.1000-6621.2019.08.011

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Objective To explore the clinical effect of daily awaking execution scale in patients with pulmonary tuberculosis mechanical ventilation sedation,and to provide clinical basis for standardizing clinical nursing pathway.Methods The data of 127 patients with pulmonary tuberculosis admitted to the Tubercular Intensive Care Unit (ICU) of Zhejiang Provincial Integrated Chinese and Western Medicine Hosipital from January to June 2017 (before the scale was implemented) were collected, and 92 patients with type Ⅱ respiratory failure were selected, and 30 cases were randomly selected as control group by using digital table method in 49 patients who were included in the inclusion and exclusion criteria. Routine implementation of daily wake-up measures. From the collection of 142 patients with tuberculosis admitted to the Tubercular ICU from July to December 2017 (after the scale was implemented), 110 patients with type Ⅱ respiratory failure were selected, and 30 cases were randomly selected as observation group in 52 patients who were included in the inclusion and exclusion criteria. The daily wake-up execution scale was used on the basis of routine implementation of daily wake-up measures, and the incidence of adverse events such as sedative dosage, complete sobriety time after withdrawal, duration of mechanical ventilation, duration of sedation, ICU hospitalization time, emotional abnormalities and so on were observed in the two groups.Results Both groups of patients completed full observation in the Tubercular ICU. The observation group duration of sedation (100.50 (72.50,112.75)h), the total amount of sedative (110.00 (89.00,143.00)mg), the total waking time after withdrawa (29.50 (21.00,37.75)min), duration of mechanical ventilation (119.50 (99.25,138.0)h), Tubercular ICU hospitalization time (115.00 (103.75,170.25)h) were better than the control group for each of items respectivly (126.50 (85.70,172.25)h,152.00 (123.00,219.00)mg,35.50 (30.75,48.00)min,145.50 (123.00,227.00)h,182.00 (145.25,253.75)h)(Z=2.795,3.408,2.717,2.994,4.081; P=0.005, 0.001, 0.007, 0.003, 0.000). During wake-up, the observation group and the control group carried out 349 wake-up sands and 273 cases respectively, and no serious adverse events such as accidental tube extraction and fall occurred. The incidence of mood abnormalities, the incidence of heart rate abnormalities, the incidence of abnormal blood pressure, the incidence of human-machine confrontation in the control and observation groups, respectively ((67.77% (185/273) and 67.34% (235/349), 50.18% (137/273) and 47.56% (166/349), 35.90%(98/273) and 32.09% (112/349), 25.27% (69/273) and 26.36% (92/349)), and the success rate of spontaneous breath tests (56.82% (50/88) and 68.42% (78/114)) were not statistically significant (χ ²=0.013, 0.420, 0.992, 0.094, 2.880; P=0.909, 0.517, 0.319, 0.759, 0.090,respectively). Conclusion Through the organization and implementation of the daily wake-up scale, the clinical path of nursing in patients with mechanical ventilation sedative tuberculosis can be effectively standardized, the operability is strong, safe and practical, and it is worth the clinical application.

Analysis of sputum culture conversion at the end of 6 months and related risk factors among multidrug-resistant tuberculosis patients

Qing-chun LI,Min LU,Li-min WU,Le WANG,Meng WANG,Ke WANG,Yi-fei WU,Li XIE

Chinese Journal of Antituberculosis. 2019, 41(8):  869-875.  doi:10.3969/j.issn.1000-6621.2019.08.012

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Objective To investigate the sputum culture conversion (SCC) at the end of 6 months and related risk factors among patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB).Methods Retrospective cohort study was conducted among 365 MDR-PTB patients who were diagnosed and started anti-TB drug treatment during 2011 and 2015 in designated TB hospitals in Hangzhou. Demographic information and laboratory results were collected to analyze the SCC at the end of 6 months, and identify the related risk factors using the Hazard Cox regression Model.Results Of 365 enrolled participants, 332 were negative at the end of 6 months with the SCC rate of 90.96%; 287 (78.63%) were successfully treated, and 78 (21.37%) were unsuccessful. The median (Q₁, Q₃) time of SCC in the 332 SCC subjects was 85.0 (42.0, 106.5) d, of which 84.94% (282 cases) were successfully treated. Among the 33 cases without SCC, the treatment success rate was 15.15% (5 cases). Significant higher treatment success rate was observed among the participants who initialed SCC at 6 months than the participants who did not (χ ²=87.00,P=0.000). Cox regression analysis revealed that compared with patients without household registration in Hangzhou, patients with household registration in Hangzhou were more likely to initial SCC (SCC rate: 4.09/100 person years (149/36.41), adjusted hazard ratio (aHR) (95%CI): 1.37 (1.10-1.71)); compared with patients who were resistant to less than 4 drugs and aged <25 years old, patients who were resistant to no less than 4 drugs (SCC rate: 3.36/100 person years (119/35.43), aHR (95%CI): 0.76 (0.61-0.96)) and aged ≥25 years old (25-44 years group, SCC rate: 3.69/100 person years (143/38.80), aHR (95%CI): 0.56 (0.41-0.78); 45-64 years group, SCC rate: 3.36/100 person years (108/32.15), aHR (95%CI): 0.52 (0.37-0.73); ≥65 years group, SCC rate: 3.33/100 person years (27/8.10), aHR (95%CI): 0.45 (0.38-0.72)) were less likely to initial SCC. Conclusion The treatment success rate and SCC rate at the end of 6 months were relatively high in MDR-PTB patients in Hangzhou, while it costs longer time to initial SCC at the end of 6 months. Patients without Household registration in Hangzhou, patients with more resistant drugs and elder patients should be especially supervised and managed at early stage during their treatment to improve the treatment outcomes.

Evaluation of clinical diagnostic efficacy of four detection methods for Mycobacterium tuberculosis

Xiao-wei DAI,Shuang-shuang CHEN,Xin-yu YANG,Yan-feng ZHAO,Li-li TIAN,Jun-li YI,Hao CHEN,Bei-chuan DING

Chinese Journal of Antituberculosis. 2019, 41(8):  876-881.  doi:10.3969/j.issn.1000-6621.2019.08.013

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Objective To evaluate the diagnostic ability of Mycobacterium tuberculosis by acid-fast staining microscopy (smear), solid culture of L-J medium (L-J), liquid culture of BACTEC MGIT 960 (MGIT 960) and GeneXpert MTB/RIF (GeneXpert).Methods Sputum specimens from 451 suspected tuberculosis patients were collected from January 1, 2018 to December 31, 2018. Meanwhile, 4 testing methods including smear, L-J, MGIT 960 and GeneXpert were used for detection. The results of the 4 testing methods were based on the clinical diagnosis (generally divided into “tuberculosis patients” and “non-tuberculosis patients”), and the sensitivity, specificity, positive predictive value, negative predictive value and consistency of the 4 testing methods were calculated. The positive rate of the combined examination of the 4 testing methods was also calculated(one positive of any testing method was considered combined positive).Results The final clinical diagnosis was based on the criteria WS 288-2017, among 451 suspected tuberculosis patients, 227 tuberculosis patients (225 tuberculosis patients, 2 tuberculosis and tuberculous pleurisy), 224 non-tuberculosis patients (11 non-tuberculous mycobacterium (NTM) pulmonary disease, 6 old pulmonary tuberculosis patients, 181 lung shadows to be checked, 3 pleural effusion patients, 1 pulmonary fibrosis patient, 3 pneumonia patients, 1 lung cancer patient, 18 close contact screening patients). The sensitivity of smear, L-J, GeneXpert and MGIT 960 was 22.5% (51/227), 32.2% (73/227), 37.9% (86/227) and 43.2% (98/227), respectively. The specificity was 96.0% (215/224), 96.4% (216/224), 100.0% (224/224), 95.1% (213/224), respectively. The consistency rate was 59.0% (266/451), 64.1% (289/451), 68.7% (310/451) and 69.0% (311/451), respectively. The sensitivity of smear and L-J combination, smear, L-J and GeneXpert combination, 4 testing methods combination was 34.8% (79/227), 43.6% (99/227), 49.8% (113/227), respectively. The specificity was 96.0% (215/224), 96.0% (215/224), 93.8% (210/224), and the consistency rate was 65.2%(294/451), 69.6%(314/451), 71.6%(323/451), respectively.Conclusion Based on the clinical diagnosis as the reference standard, the sensitivity of MGIT 960 is the highest, the specificity of GeneXpert is the highest, and the 4 testing methods combination can significantly improve the sensitivity and the consistency rate with clinical diagnosis.

Application value of thinprep cytologic test in the diagnosis of pulmonary tuberculosis

Yi-min SUN,Zhen-qing WANG,Jia JIA,Hua-ping GU

Chinese Journal of Antituberculosis. 2019, 41(8):  882-886.  doi:10.3969/j.issn.1000-6621.2019.08.014

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Objective To explore application value of Thinprep cytologic test (TCT) in the diagnosis of pulmonary tuberculosis.Methods According to inclusion criteria,248 suspected tuberculosis patients from Zhangjiakou Infectious Disease Hospital between November 2017 and February 2019 were selected, and based on confirmed diagnosis,181 were pulmonary tuberculosis, while the other 67 were not. A total of 248 samples including sputum (n=101), pleural effusion (n=67) and bronchoalveolar lavage fluid (n=80), from the 248 patients one each according to their clinical features and symptoms, were tested with TCT, Z-N staining and MGIT 960, to detect mycobacterium. Data were analyzed by χ ² test using SPSS 19.0, P<0.05 was considered statistically significant. Results The positive rates of all 248 samples (53.63% (133/248) vs. 25.81% (64/248), χ ²=46.788, P=0.000), sputum (67.33% (68/101) vs. 36.63% (37/101), χ ²=19.736, P=0.000), pleural effusion (17.91% (12/67) vs. 7.46% (5/67), χ ²=9.449, P=0.002) and bronchoalveolar lavage fluid (66.25% (53/80) vs. 27.50% (22/80), χ ²=20.833, P=0.000) using TCT were significantly higher than those using Z-N staining. The positive rate of sputum using TCT was significantly lower than using MGIT 960 (67.32% (68/101) vs. 81.19% (82/101), χ ²=5.076, P=0.024), while the difference of the positive rates of pleural effusion (17.91% (12/67) vs. 25.37% (17/67), χ ²=1.100, P=0.294) and bronchoalveolar lavage fluid (66.25% (53/80) vs. 70.00% (56/8), χ ²=0.377, P=0.539) between the two methods were not statistically significant. Based on clinical diagnosis, sensitivities of TCT, Z-N staining and MGIT 960 in testing all the samples were 72.93% (132/181), 30.39% (55/181) and 85.64% (155/181), respectively; the consistency rates of the three methods were 79.84% (198/248), 48.79% (121/248) and 89.52% (222/248), respectively; the specificities were 98.51% (66/67), 98.51% (66/67) and 100.00% (67/67), respectively. Conclusion The positive rate and sensitivity of TCT in detecting mycobacterium from sputum, pleural effusion and bronchoalveolar lavage fluid were higher than those of Z-N staining, which is of important application value in clinical diagnosis.

A two-year follow-up study on latent tuberculosis infection among contacts of tuberculosis patients in an institutionalized population

Hong-xia FANG,Zhi-min XIE,Yu-bao QIN,Zhi-li LUO,Keng LAI,Xiu-qi YU,Yan WANG,Kai-qiao ZHENG,Chang-wei LIU,Zhi-cong CHEN

Chinese Journal of Antituberculosis. 2019, 41(8):  887-891.  doi:10.3969/j.issn.1000-6621.2019.08.015

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Objective To understand the prevalence of latent tuberculosis infection (LTBI) among TB contacts who were institutionalized for drugs in a compulsory rehabilitation center; further, to analyze the factors associated with risks of TB infection.Methods Five TB cases were detected during October to November, 2016. Tuberculosis skin test (TST) for TB infection were provided to all the institutionalized persons who had contacted the TB cases at the same period. Follow-up TSTs were given every 6 months to these contacts for two years. TST positivity is defined as an induration ≥10 mm for BCG-vaccinated (with a BCG scar), or ≥5 mm for people without a BCG scar, according to the WS 288-2017 Diagnosis for pulmonary tuberculosis. Prevalence of LTBI were measured, and logistic regression was applied for analyzing the factors associated with LTBI.Results Of the 792 TB contacts, 25 declined the TST. The prevalence of LTBI at the first TST examination was 57.9% (444 among the 767 contacts). During the follow-up, another 54 contacts who were negative at first became TST positive, led to an 16.7% (54/323) increment. In total, the 2-year positivity was 64.9% (498/767). Of the 498 TST positive cases, 54 had a diminished TST induration, which suggested a change to TST negative (10.8%, 54/498). Age (Wald χ ²=10.942,P=0.001,OR=1.04, 95%CI: 1.02-1.06), BCG vaccination (Wald χ ²=4.533,P=0.033,OR=1.41, 95%CI 1.03-1.93) and close contact to TB patients (Wald χ ²=6.343,P=0.012,OR=1.68, 95%CI: 1.12-2.52) were significantly associated with LTBI by TST in the study population. Conclusion The prevalence of LTBI is high among the institutionalized persons in the compulsory rehabilitation center. About one-sixth of non-infected by TST at the first testing could become LTBI positive while one of ten might change the LTBI status from positive to negative during a two-year period. Increased age, history of BCG vaccination and close contacts with TB patients had an increased possibility of TB infection by TST.

Epidemiological and spatial distribution characteristics of tuberculosis in Xinjiang Uygur Autonomous Region from 2008 to 2018

Zhen ZHAO,Nian-qiang LIU,Aihaiti YIPAER•,Xi-jiang WANG

Chinese Journal of Antituberculosis. 2019, 41(8):  893-899.  doi:10.3969/j.issn.1000-6621.2019.08.017

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Objective To investigate changes of epidemiological characteristics and spatial aggregation of tuberculosis in Xinjiang.Methods Data of tuberculosis incidence reported in Xinjiang from January 2008 to December 2018 were obtained through China Disease Prevention and Control Information System. Then distribution features were described and the epidemic curve and incidence map were drawn. The spatial autocorrelation analysis was used to calculate the Moran’s I value and draw the aggregation map of spatial correlation local index (LISA).Results From 2008 to 2018, a total of 479946 cases of tuberculosis were reported in Xinjiang. The male to female ratio was 1.16 (257337/222609).Age composition was mainly over 55 years old, accounting for 56.82% (272701/479946) of all cases. Occupation distribution was dominated by farmers, accounting for 70.61%(338890/479946). The reported incidences of tuberculosis were rising from 202.93/100000 to 304.94/100000 between 2008 and 2018, the chi-square test showed statistically significant differences ( {\chi }_{\mathrm{frequency}}^2 =19507.491,P<0.001). Except for the peak in July of 2018 (35.29/100000, 8628/24446713), the annual distribution peak of reported incidence in the months of 2008-2017 were always from January to March, ranging from 17.64/100000-25.06/100000 (3897/22087038-5339/21307980). The reported incidence rates in four prefectures of southern Xinjiang (kashgar, kezhou, aksu and hetian) were higher than other regions. In particular, the highest was in the county of Yingjisha in Kashgar prefecture (720.56/100000). Reported incidence rates presented spatial aggregation from 2008 to 2018, and the test showed statistically significant differences (Moran’s I=0.696,Z=11.462,P<0.001).There were a total of 17 high-high clustering areas, which were located in most counties in the four prefectures of southern Xinjiang. Conclusion Men and farmers are the key population for the prevention and control of tuberculosis, and southern Xinjiang is the key area for the prevention and control of tuberculosis in Xinjiang.

Analysis on the effect of pilot work of grading diagnosis and treatment and comprehensive prevention service model of tuberculosis in Futian District, Shenzhen

Hai-ming YE,Wen-si CHEN,Ju-fang ZHANG,Yu-fang LIAO,Jie XU,Jie CHEN,Sheng-nan ZHANG

Chinese Journal of Antituberculosis. 2019, 41(8):  900-904.  doi:10.3969/j.issn.1000-6621.2019.08.018

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Objective The aim of this study was to analyze the construction situation of tuberculosis prevention and control ability and the administrative situation of patient discovery and treatment after the implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model in Futian District, Shenzhen from 2017 to 2018, and then evaluate the effect of pilot work in Futian District.Methods The data after the implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model in Futian District from 2017 to 2018, including policy system established by Futian District, construction of tuberculosis prevention and treatment system, application of new diagnostic technology for tuberculosis, new management model for tuberculosis patients, were collected, and then compared with the data before the implementation of pilot work (from 2015 to 2016). Chronic Disease Prevention and Treatment Center in Futian District received 2093 suspected tuberculosis patients and 772 registered tuberculosis patients from 2015 to 2016; and received 2319 suspected tuberculosis patients and 690 registered tuberculosis patients from 2017 to 2018.Results In 2017, an assessment and funding allocation plan was formulated by Futian District and GeneXpert MTB/RIF rapid detection technology began to be enabled, and then remote video surveillance of Internet + DOT and home isolation measures for ordinary patients with smear-positive pulmonary tuberculosis were carried out. In 2018, the insured patients with tuberculosis (including multidrug-resistant tuberculosis) who admitted to specialist outpatient began to enjoy medical insurance of outpatient treatment for serious illness. From 2017 to 2018, the rate of active tuberculosis patients who treated in designated medical institutions was 82.43% (962/1167), the pathogenic diagnosis rate of patients with tuberculosis was 54.93% (379/690), the sputum culture rate of patients with tuberculosis was 94.49%, (652/690), the sputum culture detection rate of suspicious symptoms and suspected patients with tuberculosis was 89.00% (2064/2319), and the referral rate of patients with suspected tuberculosis reported by non-tuberculosis control institutions in the jurisdiction was 58.19% (1893/3253), which were significantly higher than those (72.35% (772/1067), 44.69% (345/772), 53.89% (416/772), 86.67% (1814/2093), and 52.17% (2199/4215)) from 2015 to 2016, respectively, with statistically significant differences (χ ²=32.61, 15.28, 305.17, 5.63, and 26.88, P=0.000, 0.000, 0.000, 0.020, and 0.000). From 2017 to 2018, the screening rate of tuberculosis by bacteriological examination in close contacts of positive patients was 100.00% (1128/1128), and the success rate of treatment for patients with tuberculosis was 95.24% (480/504); from 2015 to 2016, the screening rate of tuberculosis by bacteriological examination in close contacts of positive patients was 100.00% (1078/1078), and the success rate of treatment for patients with tuberculosis was 94.45% (698/739), which was both maintained at a high level. There was no statistically significant difference in the success rate of treatment (χ ²=0.37, P=0.540). Conclusion The implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model achieves favorable effects in Futian District, which can be promoted and further optimized.

Analysis on the effect of the pilot of hierarchical diagnosis and treatment and comprehensive prevention and control service model of tuberculosis in Tianshui City, Gansu Province

Jiang-hong LI,Lan ZHANG,Jun-yuan WANG,Cai-ying LEI,Shu-ping YAN,Xiao-lan LIU,Xiao-yan TAN,Shu-min YANG

Chinese Journal of Antituberculosis. 2019, 41(8):  905-909.  doi:10.3969/j.issn.1000-6621.2019.08.019

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Objective To summarize the experience of the pilot of hierarchical diagnosis and treatment and comprehensive prevention and control service model of tuberculosis and evaluate the effectiveness of the pilot in Tianshui, in order to provide evidence for the province’s promotion.Methods The data of the Tuberculosis Management Information System, a subsystem of the China Information System for Disease Control and Prevention were used to analyze the indicators of case detection, treatment, management and drug-resistant tuberculosis prevention and control of tuberculosis in the pilot counties (districts). The indicators were compared before (2016) and after the pilot (2018). Five pilot counties (districts) reported 537 cases of tuberculosis in 2016 and 799 cases in 2018.Results At the end of the pilot in 2018, a hierarchical diagnosis and treatment system was established in Tianshui, and designated hospitals and diseases were identified at prefecture and county (district) level. At the end of 2018, the sputum examination rate of patients with suspicious symptoms of tuberculosis and suspected patients in the pilot counties was 97.29% (4460/4584), and the pathogenic positive rate of tuberculosis patients was 53.47% (347/649), the management rate of tuberculosis patients in primary health care institutions was 96.52% (748/775), the treatment success rate of tuberculosis patients was 94.53% (1623/1717), the drug screening rate of pathogenic positive patients was 80.35% (229/285), and the treatment rate of patients with drug-resistant tuberculosis was 81.25% (13/16). Compared to baseline indicators (which were 90.99% (7178/7889), 10.72% (185/1726), 89.80% (1550/1726), 90.03% (1554/1726), 52.31% (113/216) and 30.00% (3/10) respectively), the differences were statistically significant (χ ² values were 184.67, 495.85, 32.32, 24.35, 44.58, 4.84, P values were 0.000, 0.000, 0.000, 0.000, 0.000, 0.009). Conclusion The pilot counties (districts) in Tianshui have established a hierarchical diagnosis and treatment model for tuberculosis, improved the security policy of tuberculosis prevention and control, and significantly improved the prevention and control indicators, providing a preliminary scientific basis for the comprehensive promotion of pilot work experience.