Table of Content

10 December 2019, Volume 41 Issue 12

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Expert Forum

Drug-resistant TB prevention needs to keep pace with the era of big data

Yong FANG,He-ping XIAO

Chinese Journal of Antituberculosis. 2019, 41(12):  1237-1240.  doi:10.3969/j.issn.1000-6621.2019.12.001

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The contradiction between the task of the prevention and control of drug-resistant tuberculosis and the lack of means is becoming more and more prominent, and the need for accurate diagnosis and treatment is also urgent. The application of the big data in the prevention, diagnosis and treatment of the disease has formed a good beginning, and the effect is also becoming more and more important, and it is also indispensable in the prevention and treatment of the modernization of drug-resistant tuberculosis. We need to grasp the pulse of the big data era, actively realize data sharing, data intensive and data protection, and pay attention to the cultivation of relevant talents in the field of health information technology.

Original Articles

Evaluation of interventional ultrasonography sampling in early diagnosis of superficial lymphatic tuberculosis

Wen-wen SUN,Yi ZHANG,Meng-jun SHEN,Hui-ming ZHU,Yin WNAG,Lin FAN

Chinese Journal of Antituberculosis. 2019, 41(12):  1241-1245.  doi:10.3969/j.issn.1000-6621.2019.12.002

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Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) guided percutaneous sampling in the early diagnosis of superficial lymph node tuberculosis. Methods A retrospective analysis was performed on patients with suspected superficial lymphatic tuberculosis admitted to the tuberculosis department of Shanghai Pulmonary Hospital from 2018.1.1-2018.12.31,who received lymph node puncture/biopsy guided by ultrasound. A total of 249 patients with complete record were enrolled, including 96 males and 153 females. The median age was 32 (16-82) years. Clinical data of patients were collected and a database was established to record the clinical characteristics of patients, the findings of interventional ultrasound and the result of pathological, bacteriological, and molecular biological examinations on the sampling tissues of lymph node. Then the diagnostic efficiency of interventional ultrasonography sampling was evaluated, data was analyzed with statistical methods. Results Two hundred and nineteen cases were diagnosed as lymphatic tuberculosis and 30 cases were diagnosed as non-TB. Using the final diagnostic results as reference standard, the sensitivity and specificity of pathology examination after interventional ultrasonography in the diagnosis of lymphatic tuberculosis were 86.76% (190/219) and 100.00% (190/190);that of bacteriological test were 31.51% (69/219) and 100.00% (69/69). The sensitivity and specificity of GeneXpert MTB/RIF in the diagnosis of lymphatic tuberculosis in 100 patients were 97.80% (89/91) and 100.00% (9/9). With the final diagnosis result as the gold standard, the overall sensitivity and specificity of interventional ultrasound guided sampling in the diagnosis of lymphatic tuberculosis were 97.72% (214/219) and 100.00% (30/30), respectively;The positive predictive value was 100.00% (214/214), and the negative predictive value was 85.71% (30/35),the coincidence rate was 97.99% (244/249) and the Kappa value was 0.91. Conclusion Interventional ultrasonography could be helpful for diagnosis of superficial lymphatic tuberculosis.

Study on the diagnostic value of IL-27 and ADA alone and in combination in the tuberculous pleurisy

Di WU,You-fei LIN,Xiao-hong CHEN,Jian-shan SHEN,Xiao-you CHEN

Chinese Journal of Antituberculosis. 2019, 41(12):  1246-1251.  doi:10.3969/j.issn.1000-6621.2019.12.003

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Objective To explore the value of diagnosis and differential diagnosis for tuberculous pleural effusion and malignant pleural effusion with human interleukin-27(IL-27) and adenosine deaminase (ADA) alone and in combination.Methods A total of 101 patients with pleural effusions admitted in Fuzhou Pulmonary Hospital of Fujian Province were enrolled during December 1, 2017 to July 29, 2018.All patients were diagnosed definitely by pathological evidenceobtained by closed pleural biopsy or medical thoracoscopy and bacteriological evidence obtained by culure from sputa or pleural effusion. According to the gold standard,they were divided into group of tuberculous pleural effusion in 61 cases (tuberculosis group) and group of malignant pleural effusion in 40 cases (as malignant pleural effusion group) including pulmonary mucosa-associated lymphoid tissue lymphoma,malignant pleural mesothelioma,pulmonary mueoepidermoid carcinoma,non-Hodgkin lymphomaand small cell lung carcinoma in each one case,and pulmonary adenocarcinoma in 33 cases. The levels of IL-27 and ADA from pleural effusion were detected by enzyme-linked immunosorbent assay (ELISA) and statistically analyzed. The cut-off values of IL-27 and ADA were determined for differential diagnosis between tuberculous and malignant pleural effusion using receiver operating characteristics (ROC) curve. IL-27 combined with ADA detection(series test,parallel test) was evaluated for diagnostic efficiency in diagnosis of tuberculous pleurisy.Results The concentrations of IL-27 and ADA in the tuberculous (409.48 (229.04, 954.97) ng/L and 45.88±14.33U/L) in the tuberculosis group were higher than those (115.74 (77.72, 161.97) ng/L and 10.50 (7.00, 15.00) U/L) in the malignant pleural effusion group with significant differences statistically (Z=3.139, P<0.01,t=4.006, P<0.01). By drawing ROC curve, The cut-off value of IL-27 and ADA from pleural effusion for distinguishing tuberculous pleural effusion from malignant pleural effusion were 176.31 ng/L and 28 U/L by drawing ROC curve.The sensitivity were 85.25% (52/61) and 93.44% (57/61) respectively, and the specificity were 82.50% (33/40) and 87.50% (35/40), respectively. The specificity (95.00%, 38/40) by series test was higher than that of IL-27 (82.50%, 33/40) and ADA (87.50%, 35/40) by alone test with a good sensitivity (81.97%,50/61). The sensitivity (96.72%, 59/61) by parallel test was higher than that of IL-27 (85.25%, 52/61) and ADA (93.44%, 57/61) by alone test. However, the specificity was low (75.00%,30/40).Conclusion IL-27 and ADA in pleural effusion have higher value in the diagnosis of tuberculous pleurisy, and the series test can improve the diagnostic efficiency for the differentiation between tuberculous pleurisy and malignant pleural effusions.

Diagnostic value of adenosine deaminase detection in tuberculous peritonitis

Jing LI,Yi-feng MA,Yu PANG,Zhuo WANG,Xiao-lin WANG,Jing FENG,Qian-hong WU

Chinese Journal of Antituberculosis. 2019, 41(12):  1252-1257.  doi:10.3969/j.issn.1000-6621.2019.12.004

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Objective To evaluate the diagnostic value of adenosine deaminase (ADA) detection in tuberculous peritonitis (TBP).Methods The laboratory testing data of peritoneal effusion specimens of 203 suspected TBP patients from Shaanxi Tuberculosis Hospital and Beijing Chest Hospital were retrospectively analyzed between January 2016 and December 2018, and then 119 suspected TBP patients who underwent acid-fast bacilli (AFB) smear microscopy (AFB smear), BACTEC MGIT 960 liquid culture (MGIT 960), GeneXpert MTB/RIF (GeneXpert) and ADA detection at the same time were included in this study. Among these cases, 73 were diagnosed as TBP patients, while the other 46 were non-TBP patients. The diagnostic efficacy of AFB smear, MGIT 960 culture, GeneXpert and ADA detection for TBP was evaluated with clinically diagnosed TBP patients as the reference standard, and the optimal critical value and area under curve (AUC) of ADA detection were analyzed by ROC curve.Results In 119 suspected TBP patients,the sensitivities of AFB smear, MGIT 960 culture, GeneXpert and ADA detection were 4.1% (3/73), 11.0% (8/73), 12.3% (9/73) and 86.3% (63/73), respectively; the specificities were 100.0% (46/46), 100.0% (46/46), 100.0% (46/46) and 84.8% (39/46), respectively; and the coincidence rates were 41.2% (49/119), 45.4% (54/119), 46.2% (55/119) and 85.7% (102/119), respectively. ROC curve analysis showed that the critical value of ADA detection for distinguishing TBP patients from non-TBP patients was 31.45 U/L, and AUC was 0.836.Conclusion The sensitivities of AFB smear, MGIT 960 culture and GeneXpert for detection of Mycobacterium tuberculosis in peritoneal effusion are all very low, while ADA exhibits promising detection efficiency with high sensitivity and specificity in early diagnosis of TBP, which can be used as an alternative for clinical diagnosis of TBP.

Therapeutic effect of debridement and bone grafting combined with external fixation for the treatment of wrist joint tuberculosis

Shang-sheng XU,Shi-bing QIN,Jun FAN,Yong-chao HUO,Sheng-lu BAI,Chun-wei WANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1258-1262.  doi:10.3969/j.issn.1000-6621.2019.12.005

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Objective To analyze the effectiveness of debridement and bone grafting combined with external fixation for the treatment of wrist joint tuberculosis.Methods A total of 32 patients with wrist joint tuberculosis who admitted to the Fourth People’s Hospital of Qinghai Province and the Beijing Chest Hospital of Capital Medical University from January 2016 to January 2019 were retrospectively analyzed. Among these patients, 17 cases were treated with conventional wrist joint debridement as a control group; and 15 cases were treated with debridement and bone grafting combined with external fixation as the observation group. The excellent rate of wrist function after treatment, the score of visual analog scale (VAS scale), the improvement of the quality of life scale (QOL) score, and the incidence of complications were compared between two groups.Results After 1 month of treatment, the excellent rate of wrist function in the observation group was 93.3% (14/15), which was significantly higher than that in the control group (58.8%, 10/17), with the statistically significant difference (χ ²=5.06, P=0.024); the VAS score of the observation group was (1.21±0.13), which was significantly lower than that of the control group (3.18±0.49), with the statistically significant difference (t=15.08, P<0.001); and the complication rate was 6.7% (1/15) in the observation group, which was significantly lower than that in the control group (41.2% (7/17)), with the statistically significant difference (χ ²=4.75, P=0.029). After 3 months of treatment, the QOL score of the observation group was (50.14±3.52), which was significantly higher than that of the control group (41.01±1.57), and the difference was statistically significant (t=9.67, P=0.000). Conclusion Debridement and bone grafting combined with external fixation can effectively improve the wrist function of patients with wrist joint tuberculosis, reduce pain, reduce the incidence of complications and improve the quality of life.

Diagnosis value of T lymphocyte detection for non-tuberculous mycobacteria diseases

Fang HUANG,Bo WANG,Guo-lian ZHAO,Hai-dong WANG,Li-yun DANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1263-1268.  doi:10.3969/j.issn.1000-6621.2019.12.006

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Objective To evaluate the value of T lymphocytes detection by flow cytometry in the diagnosis of non-tuberculosis mycobacteria (NTM) disease.Methods Totally, 162 cases of NTM pulmonary disease (NTM group), 143 cases of bacterial positive pulmonary tuberculosis (PTB group), 146 cases of tuberculous pleurisy (tuberculous pleurisy group),81 cases of tuberculous meningitis (tuberculous meningitis group) and 175 cases of other pulmonary diseases (control group, including 101 patients with bacterial pneumonia, 58 patients with mycoplasma pneumonia, 11 patients with bronchiectasis and 5 patients with pneumoconiosis) were retrospectively collected in Xi’an Chest Hospital from January 2013 to March 2019. The results of T lymphocytes detected by flow cytometry in 5 groups were summarized and comparatively analyzed. SPSS 23.0 software was used to statistically analysis, and the measurement data of non-normal distribution were expressed by median (quartile) (M(Q₁,Q₃)). Kruskal-Waills H test was used to compare the differences of T lymphocyte flow cytometry results between 5 groups as well as between the NTM group and other groups. P<0.05 was considered statistically significant.Results In the NTM group, PTB group, tuberculous pleurisy group, tuberculous meningitis group and control group, the total T lymphocytes were 1276.00 (987.00,1563.00),907.00 (661.00,1231.25),793.00 (556.50,1080.75),574.00 (296.00,883.00),and 1904.00 (1611.50,2093.50)cells/μl; CD4 ⁺ T lymphocyte counts were 868.00 (599.00,997.00),546.00 (384.75,744.00),445.00 (301.75,645.00),294.00 (134.00,462.00),and 1497.00 (925.50,1757.50) cells/μl;CD8 ⁺ T lymphocyte counts were 369.00 (252.00,573.00), 289.50 (192.00,400.75), 303.50 (206.75,441.00),243.00 (119.00,427.00), and 417.00 (279.50,644.50) cells/μl; and CD4 ⁺CD8 ⁺ T lymphocytes counts were 11.00 (7.00, 18.00), 6.00 (4.00, 11.00), 8.00 (6.00, 13.00), 5.00 (2.00, 9.00), and 9.00 (6.00, 12.50) cells/μl. The data of each group were the highest in the control group, followed by the NTM group, and the lowest in each tuberculosis groups. There were significant differences in total T lymphocytes, CD4 ⁺ and CD8 ⁺ T lymphocytes among the five groups as well as between NTM group and PTB group, tuberculous pleurisy group, tuberculous meningitis group and control group (H=339.898, 5.291, 6.968, 8.323, -7.662, Ps=0.000; H=384.960, 5.973, 8.777, 10.128, -6.641, Ps=0.000; H=66.345, 4.632, 3.503, 5.530, -0.897, Ps=0.000, respectively). There were significant differences in CD4 ⁺/CD8 ⁺ among the five groups as well as between NTM group and PTB group, tuberculous pleurisy group, and tuberculous meningitis group (H=59.508, 5.453, 3.189, 6.824, Ps<0.05). Conclusion The number of T lymphocytes in patients with NTM disease is lower than that in patients with other pulmonary diseases (control group), and higher than that in patients with tuberculosis in three groups. It can be used to judge the immune status of patients and has a certain auxiliary diagnostic value.

The status and risk factors of drug resistance tuberculosis in Shanghai, 2013—2017

Min WANG,Jing LI,Yang-yi ZHANG,Li-li WANG,Chen-lei YU,Yuan JIANG,Qi-chao PAN

Chinese Journal of Antituberculosis. 2019, 41(12):  1269-1276.  doi:10.3969/j.issn.1000-6621.2019.12.007

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Objective To analyze the status and risk factors of drug-resistant tuberculosis in Shanghai, and provide the basis for further developing the prevention and control measures. Methods A total of 34 165 patients with pulmonary tuberculosis were newly registered in Shanghai from 2013 to 2017, of which 9746 sputum culture-positive mycobacteria strains were sent to the Shanghai Center for Disease Control and Prevention by local designated tuberculosis hospitals, and received bacterial identification and solid proportional drug susceptibility testing. The following strains were excluded, including 1377 strains (14.13%) of non-tuberculous mycobacteria, 307 strains (3.15%) without drug susceptibility testing results, 63 strains (0.65%) of patients under 15 years old, 556 strains (5.70%) strains with missing or duplicated accession numbers. Finally, 7443 (76.37%) Mycobacterium tuberculosis (MTB) strains were included for analysis. SAS 9.4 software was used to analyze the characteristics of drug-resistant tuberculosis in Shanghai. The count data were analyzed by χ² test, while when the theoretical frequency was <5, Fisher’s exact probability method was used to calculate the bilateral P value; trend analysis was performed by Cochran-Mantel-Haenszel test; the influencing factors of drug-resistant tuberculosis and multidrug-resistant tuberculosis were analyzed by unconditional logistic regression model, and the test level was α=0.05. Results The total drug resistance rate, multidrug resistance rate and multiple drug resistance rate of tuberculosis in Shanghai from 2013 to 2017 were 21.03% (1565/7443), 4.98% (371/7443) and 4.16% (310/7443), respectively, of which the first two showed a downward trend ({\chi }_{\mathrm{trend}}^2=15.685, P=0.004; and {\chi }_{\mathrm{trend}}^2=6.554, P=0.011). The total drug resistance rates of tuberculosis patients resistant to any rifampicin, isoniazid, streptomycin and ethambutol in Shanghai from 2013 to 2017 were 6.01% (447/7443), 11.41% (849/7443), 15.75% (1172/7443), and 4.61% (343/7443), respectively. The total drug resistance rates of all four drugs showed downward trend, with the statistically significant difference ({\chi }_{\mathrm{trend}}^2=7.777, P=0.005; {\chi }_{\mathrm{trend}}^2=7.221, P=0.007; {\chi }_{\mathrm{trend}}^2=9.260, P=0.002; {\chi }_{\mathrm{trend}}^2=20.562, P=0.000). The total drug resistance rates of tuberculosis patients resistant to single drug, two drugs, three drugs, and four drugs were 11.88% (884/7443), 4.25% (316/7443), 2.22% (165/7443), and 2.69% (200/7443), respectively. Multivariate logistic regression analysis showed that the prevalence of drug-resistant and multidrug-resistant tuberculosis was lower in patients aged ≥65 year (β=-0.543, Wald χ²=23.036, P<0.001, OR=0.581, 95%CI: 0.466-0.725; β=-0.797, Wald χ²=11.538, P=0.001, OR=0.451, 95%CI: 0.285-0.714), and re-treatment was a risk factor for drug-resistant and multidrug-resistant tuberculosis (β=0.904, Wald χ²=93.722, P<0.001, OR=2.469, 95%CI: 2.056-2.964; β=1.636, Wald χ²=153.545, P<0.001, OR=5.135, 95%CI: 3.964-6.652). Conclusion The drug resistance status of tuberculosis is at a low level in Shanghai, showing a downward trend year by year. The prevalence of drug-resistant and multidrug-resistant tuberculosis is lower in patients aged ≥65 years, and higher in patients with re-treatment.

Value of GenoType MTBDRplus VER 2.0 in diagnosis of suspected tuberculosis patients and multidrug-resistant patients

Yuan LIU,Jun ZHOU,Xiao-li CUI,Fang HUANG,Jia-yuan LEI,Li-yun DANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1277-1282.  doi:10.3969/j.issn.1000-6621.2019.12.008

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Objective To evaluate value of GenoType MTBDRplus VER 2.0 (MTBDRplus 2.0) technology in rapid detection of Mycobacterium tuberculosis (MTB) and its resistance to rifampicin and isoniazid from sputum samples of suspected pulmonary tuberculosis patients.Methods The results of 1065 suspected pulmonary tuberculosis patients from Xi’an Chest Hospital between January and December 2018 were retrospectively analyzed. Of them, 96 cases of drug-resistant uncertainty and contaminated were excluded, the other 969 suspected patients were included as subjects finally. One sputum specimen collected from each patients was tested by GeneXpert MTB/RIF (GeneXpert), MTBDRplus 2.0, BACTEC MGIT 960 (MGIT 960) liquid culture. and MGIT 960 drug sensitivity test. If the result was positive and MTB was detected, MGIT 960 sensitivity test would be performed. The detection performance of MTBDRplus 2.0 for MTB and drug resistance of rifampicin and isoniazid was assessed according to the MGIT 960 liquid culture and MGIT 960 drug sensitivity test resultst.Results Among the 969 cases, MTB was detected positive by MGIT 960 liquid culture in 409 patients, while negative in 560 cases. Based on the results of MGIT 960 liquid culture, the sensitivity, specificity, Kappa value of MTBDRplus 2.0 were and GeneXpert in the detection of MTB was 91.0% (372/409), 93.8% (525/560) and 0.848, and those of GeneXpert were 92.9% (380/409), 92.5% (518/560) and 0.850, respectively. Based on the MGIT 960 drug sensitivity test results, the sensitivity, specificity and Kappa value of MTBDRplus 2.0 in detection of rifampicin resistance were 89.8% (53/59), 95.8% 295/308) and 0.817, and those of GeneXpert were 91.5% (54/59), 95.8% (295/308) and 0.828, respectively; while the sensitivity, specificity and Kappa value of MTBDRplus 2.0 in detection of isoniazid resistance was 80.4% (82/102), 96.3% (260/270) and 0.791.Conclusion MTBDRplus 2.0 technology is of better performance in detecting MTB from sputum samples of suspected tuberculosis patients, as well as the resistance of rifampicin and isoniazid.

Spatiotemporal characteristics on smear-positive pulmonary tuberculosis during 2013—2017 in Guangdong, China

Hui-zhong WU,Fang-jing ZHOU,Xia ZOU,Liang CHEN,Wen-pei WEN,Lin ZHOU

Chinese Journal of Antituberculosis. 2019, 41(12):  1283-1288.  doi:10.3969/j.issn.1000-6621.2019.12.009

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Objective To analyze the epidemiological condition and spatiotemporal characteristics of the smear-positive pulmonary tuberculosis (PTB) in Guangdong province from 2013 to 2017.Methods The information of the smear-positive PTB patients was collected by “China Disease Prevention and Control Information System and Tuberculosis Management Information System” in Guangdong province from 2013 to 2017, and accumulating 126848 cases were registered. In the same period, the resident population data of counties (districts) in Guangdong Province were from the annual statistical yearbooks of Guangdong Province. The vector map of Guangdong Province was used as the spatial structure database, and then the geographic information database was associated with the registration data of smear-positive PTB patients and population data. Spatial aggregation of the smear-positive PTB patients was explored by global and local spatial auto-correlation analysis.Results The average annual registration rate of smear-positive PTB patients was 24.1/100000 in Guangdong Province from 2013 to 2017. At the county (district) level, the smear-positive PTB showed spatial auto-correlation on the whole every year (Moran’s I value, 0.14-0.35), with the highest aggregation in 2017 (Moran’s I=0.35, Z=6.64, P=0.001). Local spatial auto-correlation analysis showed that the high-high clusters of smear-positive PTB patients were scattered throughout the province in 2013 and 2014, and the high-high clusters were mainly distributed in the Pearl River Delta (PRD) region during 2015-2017. Temporal and spatial scan analysis demonstrated that the primary cluster of which the center was Xiangzhou District of Zhuhai city covered 35 counties (districts) from April 2016 to December 2017 (log likelihood ratio (LLR)=358.47, relative risk (RR)=1.22, P<0.01). The two secondary clusters of which the center was Suixi county of Zhanjiang city covered 12 counties (districts) from June 2013 to May 2014 (LLR=338.33, RR=1.42, P<0.01), and of which the center was Jiexi county of Jieyang city covered 6 counties (districts) from January 2013 to April 2014 (LLR=211.34, RR=1.47, P<0.01).Conclusion The registration rate of smear positive PTB in Guangdong province shows spatial clustering distribution on the whole. In hot spots with dense population and floating population, such as the PRD, the risk of PTB transmission is high. Therefore, the treatment and management of PTB patients in these regions should be strengthened, which can prevent PTB spread to surrounding areas.

Analysis on key information awareness rate of tuberculosis prevention and control in patients with drug-resistant tuberculosis

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

Chinese Journal of Antituberculosis. 2019, 41(12):  1289-1300.  doi:10.3969/j.issn.1000-6621.2019.12.010

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Objective To investigate the awareness of key information of tuberculosis prevention and control among drug-resistant tuberculosis patients, and to provide direction and basis for more effective health education on drug-resistant tuberculosis prevention and control.Methods Two hundred and ninety-three drug-resistant tuberculosis patients from 20 hospitals and tuberculosis prevention and control institutions from March 2013 to January 2014 were investigated by a unified questionnaire. The investigation included basic information of patients, knowledge of key information of tuberculosis prevention and treatment, and clinical reports of patients. Two hundred and ninety-three questionnaires were sent out, and 293 were effective, with an effective rate of 100.0%, 223 (76.1%) patients reported to know the key information of tuberculosis, and further investigation on the awareness of key information of tuberculosis prevention and control was carried out in this group of patients. Statistical analysis was conducted on the general situation of the respondents and the awareness of key information of tuberculosis prevention and control, and further logistic regression analysis was used to analyze the influencing factors of awareness rate.Results 76.1% (223/293) of drug-resistant tuberculosis patients reported knowing about tuberculosis, while 23.9% (70/293) reported not knowing about tuberculosis. The overall awareness rate of 11 key information of tuberculosis prevention and control was 70.1% (1720/2453). The univariate analysis of tuberculosis knowledge awareness rate showed that the awareness rate of drug resistant patients did not drink or occasionally drink (70.3%, 1648/2343), with tuberculosis history (72.8%, 905/1243), with tuberculosis treatment (72.6%, 878/1210) and with tuberculosis course for one year or more (72.6%, 895/1232) had higher awareness rate, than those usually drunk (54.5%, 60/110) (χ ²=12.61, P=0.002), no history of tuberculosis (66.4%, 803/1210) (χ ²=12.04, P<0.001), no tuberculosis treatment (66.8%, 830/1243) (χ ²=9.88, P=0.007) and with tuberculosis course less than one year (66.6%, 813/1221) (χ ²=10.68, P=0.005). Multivariate analysis showed that the awareness rate was 1.97 times higher in patients who did not drink than those regular drinking patients (95%CI: 1.33-2.92, P=0.001), and patients with tuberculosis history were 1.36 times more likely to be aware of the knowledge of tuberculosis (95%CI: 1.14-1.61, P=0.001).Conclusion The overall awareness rate of tuberculosis prevention and control knowledge of drug-resistant tuberculosis patients is not high. It is necessary to carry out health promotion and education activities in drug-resistant tuberculosis patients such as usually drinking, no tuberculosis history, no tuberculosis treatment history, tuberculosis course less than one year, so as to improve the awareness rate of tuberculosis prevention and control.

Risk factors of multidrug-resistant tuberculosis in China: A meta-analysis

Jin-hong XU,Song YANG,Li-xin ZHANG,Ying ZHONG,Qian QIU

Chinese Journal of Antituberculosis. 2019, 41(12):  1301-1309.  doi:10.3969/j.issn.1000-6621.2019.12.011

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Objective This study systematically evaluated the risk factors for multidrug-resistant tuberculosis (MDR-TB) in China, which could provide an effective prevention and control strategy, and achieve the purpose of cause prevention (primary prevention).Methods The articles related to the risk factors of MDR-TB which published from January, 2005 to May, 2019 were searched in English databases (PubMed, Embase, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Internet, Wanfang, SinoMed and VIP database), and then meta-analysis was performed following the screening, extracting data and quality evaluation of the articles.Results According to the search results and inclusion and exclusion criteria, a total of 55 articles were included, and 9 risk factors related to MDR-TB were found by meta-analysis. The results showed that the migrant population (OR=1.92; 95%CI=1.48-2.51), low household income (OR=2.12; 95%CI=1.72-2.63), re-treatment (OR=6.28; 95%CI=4.72-8.36), anti-tuberculosis treatment history (OR=5.73; 95%CI=4.56-7.20), anti-tuberculosis treatment history ≥2 times (OR=4.41; 95%CI=3.35-5.80), adverse drug reactions (OR=4.89; 95%CI=2.48-9.62), treatment interruption (OR=3.59; 95%CI=2.02-6.38), lung cavity (OR=1.56; 95%CI=1.25-1.93) and smoking (OR=1.59; 95%CI=1.12-2.25) were closely related to the pathogenesis of MDR-TB.Conclusion The risk factors for MDR-TB in China are possibly migrant population, low household income, re-treatment, anti-tuberculosis treatment history, anti-tuberculosis treatment history ≥2 times, adverse reactions, treatment interruption, lung cavities and smoking.

Epidemiological characteristics of pulmonary tuberculosis in Ganzi Tibetan Autonomous Prefecture, 2014—2018

Guang-rong XU,Lin-rong PENG,Dan KUANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1310-1313.  doi:10.3969/j.issn.1000-6621.2019.12.012

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Objective To explore the epidemiological characteristics of pulmonary tuberculosis in Ganzi Tibetan Autonomous Prefecture from 2014 to 2018, providing scientific evidence for further prevention and control.Methods Descriptive statistics was employed for epidemiological characteristics analysis of pulmonary tuberculosis patients who were registered in 18 counties of Ganzi Tibetan Autonomous Prefecture (Ganzi) in the Infectious Disease Reporting and Information Management System from 2014—2018.Results Totally 13017 pulmonary tuberculosis cases were reported in Ganzi during the period of 2014—2018. The annual incidence declined from 194.13/100000 (2937/1124929) in 2014 to 261.08/100000 (2303/1186298) in 2018, and the reported annual incidence showed a downward trend (χ ²=114.99, P<0.01). The average annual incidence of the highest five districts were Shiqu (410.28/100000, 1813/441898), Yajiang (399.74/100000, 1059/264922), Baiyu (391.68/100000, 1167/297944), Ganzi (337.17/100000, 1231/365096) and Litang (286.19/100000, 1045/365144). The incidence of male (240.21/100000, 7131/2968651) was significantly higher than that of the female (208.00/100000, 5886/2829811) (χ ²=31200.06, P<0.01). The highest incidence was the age group of 15~ years old (545.55/100000, 2357/432045). Farmers (48.50%, 6313/13017), herdsmen (14.55%, 1894/13017) and students (14.33%, 1865/13017) were the top three occupational groups.Conclusion Although the annual incidence showed a downward trend, it still high in Ganzi Tibetan Autonomous Prefecture. Counties located in Northwest and high elevation were the high-incidence regions, and the farmers, herdsmen and students were the high-incidence populations.

Application of grey model in the prediction of tuberculosis epidemic trend in Yining City of Xinjiang Uygur Autonomous Region

Zhi-yuan CHEN,Yu-xue CHANG,Wuwat Yeerzhati•,Yu-lan ZHOU,Yue WANG,Zhi MA,Xiaokracti Bahetinur•,Yang XIANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1314-1317.  doi:10.3969/j.issn.1000-6621.2019.12.013

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Objective The grey model was used to fit the incidence of tuberculosis and predict the epidemic trend of tuberculosis in Yining City, Xinjiang Uygur Autonomous Region, which provided a basis for local tuberculosis prevention and control.Methods Basing on incidence data of tuberculosis reported in Yining City, Xinjiang Uygur Autonomous Region in 2012—2018, grey models (“GM model”) were used to simulate incidences of tuberculosis. The incidences of tuberculosis in Yining City from 2012 to 2018 were 151.56/100000 (781/515299), 134.60/100000 (721/535668), 146.51/100000 (820/559691), and 152.00/100000 (893/587507), 142.64/100000 (782/548241), 177.85/100000 (992/558860), 196.81/100000 (1124/571122) respectively. The MATLAB software (produced by MathWorks, USA) was used to establish a GM model of first-order variable differential equation. The posterior difference ratio C and small error probability P were calculated to test the fitting of GM (1,1) model. The model fitting effect will be considered as acceptable if the C value is less than 0.5 and the P value is greater than 0.8, then the extrapolation prediction can be performed; otherwise, residual correction should be performed for the model.Results Our model was proved to be fitting well. The average residual of the model was 0.195, the average relative error was 4.553%, the small error probability P was 0.83, and the posterior difference ratio C was 0.43. The predicted incidences of tuberculosis in Yining City from 2019 to 2021 were 203.28/100000, 218.87/100000 and 235.66/100000 respectively.Conclusion The incidence of tuberculosis in Yining City from 2019 to 2021 may continue to increase with an annual increase rate of 7.67%. It is necessary to continue strengthening prevention and control of tuberculosis and reduce the harm of tuberculosis to the population.

The job satisfaction survey and influencing factors analysis of management department in the tuberculosis hospital in Beijing

Na XIE,Qian-hui MA,Hui JIANG

Chinese Journal of Antituberculosis. 2019, 41(12):  1318-1324.  doi:10.3969/j.issn.1000-6621.2019.12.014

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Objective To analyze job satisfaction and influencing factors of management departments, and to explore ways to improve satisfaction, so as to improve the staff satisfaction, enhance the enthusiasm and creativity of the staff.Methods Literature review and Delphi method were used to design the questionnaire, 9 first-level indicators and 28 second-level indicators included. The reliability and validity coefficients were 0.970 and 0.910, respectively. The questionnaire was evaluated by level 5 of the Likert Attitude Scale. The higher the score, the higher the degree of satisfaction. A total of 103 questionnaires were sent out and 103 valid questionnaires were collected, with a recovery rate of 100.0%. Chi-square test, t test, correlation analysis and multiple regression were used to analysis. P-value <0.05 was considered statistically significant. Additionally, multivariate linear regression was used for multivariate analysis, and stepwise method was used for variable selection, P-value <0.05 was considered statistically significant.Results The overall satisfaction rate was 82.52% (85/103), the lowest satisfaction was the work environment (60.19%, 62/103), the highest was the work status (90.29%, 93/103). The satisfaction in male (4.40±0.65) was higher than that in female (4.04±0.84) which was statistically significant (t=2.196, P=0.030). Job development prospects (β=0.44, s {}_{\bar{x}} =0.06, t=5.593, P=0.000), leadership satisfaction (β=0.39, s {}_{\bar{x}} =0.07, t=4.900, P=0.000) and professional titles (β=0.17, s {}_{\bar{x}} =0.07, t=2.643, P=0.010) were the most important factors for overall satisfaction. Conclusion The overall satisfaction of the staff of management department of the hospital is in good condition. Career development prospects, leadership satisfaction, job titles are important factors affecting overall satisfaction.

Review Articles

Advances in the diagnosis and treatment of pulmonary tuberculosis complicated with diabetes

Yi MAO,Lin FAN,Yong LIU

Chinese Journal of Antituberculosis. 2019, 41(12):  1325-1329.  doi:10.3969/j.issn.1000-6621.2019.12.015

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Tuberculosis is still a major global health problem. In recent years, increasing evidence has demonstrated that diabetes increases the risk of tuberculosis infection, and tuberculosis complicated with diabetes can lead to adverse outcomes of tuberculosis, which brings great difficulties and challenges to the prevention and control of tuberculosis. By reviewing the latest epidemiological studies on tuberculosis complicated with diabetes in recent years, the authors expound the relationship between tuberculosis and diabetes. This paper further proves that two-way screening is beneficial to the early detection and treatment of diseases, and then summarizes the research progress in the diagnosis and treatment of tuberculosis complicated with diabetes, which is aimed to search for the optimal diagnosis and treatment methods and explore novel ideas for diagnosis and treatment.