Table of Content

10 January 2020, Volume 42 Issue 1

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Expert Note

Boost the development of disease control and lead the progress of science and technology —the development of group standards for tuberculosis

Lei GAO,Hao-ran ZHANG,Jin WANG,Lan FENG,Shi-ming CHENG,Jian-jun LIU,Qi JIN

Chinese Journal of Antituberculosis. 2020, 42(1):  8-11.  doi:10.3969/j.issn.1000-6621.2020.01.004

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Standardization Law of the People’s Republic of China, revised in 2017, formally established the legal status of group standards which became a member of the national standards system. This article mainly summarized the current situation of standardization work in tuberculosis (TB) control and the practice of the Chinese Anti-tuberculosis Association in managing group standards, and it discussed the key directions of group standards development in the field of TB as well. In addition, given the coexistence of opportunities and challenges, to actively cultivate and develop group standards would greatly promote the control of TB.

Special Articles

Interpretation of “An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline:Treatment of Drug-Resistant Tuberculosis” and comparison with “Guideline for Chemotherapy of Drug Resistant Tuberculosis(2019)” in China

Yi-dian LIU,Xu-wei GUI,Xiao-na SHEN,Yuan-yuan YU,Lan YAO,Hai LOU,Wei SHA,He-ping XIAO

Chinese Journal of Antituberculosis. 2020, 42(1):  12-16.  doi:10.3969/j.issn.1000-6621.2020.01.005

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To interpret the “Treatment of Drug-resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline (ATS Guideline)”, including the drugs, formulating treatment regimen and duration, as well as treatment of isoniazid-resistant TB, preventive therapy of close contacts of MDR-TB; and then to compared “ATS Guideline” with “Guideline for Chemotherapy of Drug Resistant Tuberculosis (2019)” in China.

Standard·Guide·Consensus

Health check-up guide for rural residents(T/CHAA 005-2019)

Association Chinese Health

Chinese Journal of Antituberculosis. 2020, 42(1):  17-18.  doi:10.3969/j.issn.1000-6621.2020.01.006

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This standard stipulates the principles, institutional requirements, inspection items, service modes, data management and utilization requirements for carrying out the health check-up for rural residents. It is applicable to the standardized management of the health check-up for rural residents aged 15 years old and above under the relevant national laws and regulations.

Original Articles

MR imaging features of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis in adult patients

Feng-gang NING,Xin-hua ZHOU,Dai-lun HOU,Ping-xin LYU,Yan LYU,Wei HE

Chinese Journal of Antituberculosis. 2020, 42(1):  19-25.  doi:10.3969/j.issn.1000-6621.2020.01.007

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Objective To investigate the MR imaging features of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis in adult patients, in order to reduce the misdiagnosis and missed diagnosis. Methods Clinical and imaging data of 53 patients diagnosed of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis in Beijing Chest Hospital affiliated to Capital Medical University from February 2015 to July 2019 were retrospectively analyzed. And of them, 48 patients with complete information were selected. They were all tested with laboratory examination related tuberculosis (including cerebrospinal fluid examination), as well as MR scan and enhanced MR examination; the results were investigated was and evaluated. Results Of the 48 cases, symptoms of tuberculosis and respiratory symptoms were found in 24 cases (50.0%), 36 (75.0%) were with fever and headache, symptoms and signs of nervous system were found in 29 (60.4%) cases; diffuse miliary shadow of lungs was found by chest CT; cerebrospinal fluid examination were abnormal in 45 cases (93.8%), and protein elevated in 43 (89.6%), glucose (38, 79.2%) and chloride (37, 77.1%) reduced; all the patients underwent lumbar puncture, and intracranial pressure increased (>180 mm H₂O (1 mm H₂O=0.0098 kPa)) in 31 (64.6%). All the 48 patients were examined by cranial enhanced MRI. In 8 cases (16.7%), no tuberculosis lesion was found; brain parenchyma and/or meningeal tuberculosis were fond in 40 patients, including simple meningeal tuberculosis (n=9, 18.8%), simple parenchymal tuberculosis (n=19, 39.6%) and mixed intracranial tuberculosis (n=12, 25.0%). However, by MR, cranial lesions were found just in 35 patients; of the other 13 patients, 8 were found by enhanced MRI, and still no lesion was found in 5 cases. Of the 25 patients re-examined by MRI after 3-month anti-tuberculosis treatment, 11 improved, 7 worsened, 5 partially improved, and 2 without any change. Conclusion Fever, headache, symptoms and signs of nervous system, abnormal cerebrospinal fluid and biochemical examination, and increased intracranial pressure are often found in patients of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis, and MR scan could find most of the abnormalities. Enhanced MR could supply even more information. MR scan is an important examination for the diagnosis of intracranial tuberculosis.

Diagnostic value of CT and MRI in adult knee joint tuberculosis

Bin SIMA,Xiao-wei QIU,An-long WANG

Chinese Journal of Antituberculosis. 2020, 42(1):  26-30.  doi:10.3969/j.issn.1000-6621.2020.01.008

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Objective To compare the application value of CT and MRI in the diagnosis of adult knee joint tuberculosis. Methods Thirty-six patients with unilateral knee joint tuberculosis confirmed by surgical pathology from January 2017 to June 2018 in the Zhejiang Integrated Traditional and Western Medicine Hospital affiliated to Zhejiang Chinese Medical University were selected. The age of 36 patients (26 males and 10 females) ranged from 18 to 85 years, with an average of (52.3±18.9) years old. All patients underwent CT and MRI examinations after admission. The diagnostic discovery rates of the two methods was compared. Results The diagnostic discovery rates of bone destruction, bone death, synovium thickening, joint effusion and calcification were 58.3% (21/36), 52.8% (19/36), 22.2% (8/36), 36.1% (13/36), 30.6% (11/36) by CT, and 91.7% (33/36), 5.6% (2/36), 97.2% (35/36), 80.6% (29/36), 0.0% (0/36) by MRI. The diagnostic discovery rates of bone destruction, synovium thickening, and joint effusion by CT were significantly lower than those by MRI, while the diagnostic discovery rates of bone death, and calcification by CT were obviously higher than those by MRI, all with the statistically significant differences between groups (χ ² values were 8.96, 17.21, 39.03, 14.63, 17.24, P values were 0.003, 0.000, 0.000, 0.000 and 0.000, respectively). The diagnostic discovery rates of abnormal joint space, cold abscess around the joint, and concurrent sinus formation were 97.2% (35/36), 75.0% (27/36), 11.1% (4/36) by CT, and 94.4% (34/36), 80.6% (29/36), 11.1% (4/36) by MRI, without significant difference between the groups (χ ² values were 0.00, 0.32, 0.00, P values were 1.000, 0.571, and 1.000, respectively). Conclusion CT examination is dominant in finding dead bone and calcification predominate, while MRI examination has significant advantages in observing knee joint bone destruction, synovial thickening and assessing the degree of joint destruction.

Clinical features and manifestations of AIDS complicated with cervical lymph node tuberculosis

Yi-bo LU,Jing-ru ZHOU,Yi-mei MO,Shu-lin SONG

Chinese Journal of Antituberculosis. 2020, 42(1):  31-37.  doi:10.3969/j.issn.1000-6621.2020.01.009

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Objective To investigate the clinical features and CT characteristics of acquired immune deficiency syndrome (AIDS) complicated with cervical lymph node tuberculosis. Methods From Jan 2015 to July 2019, 142 clinical data of initial inpatients who diagnosed with cervical lymph node tuberculosis by cervical lymph node biopsy or postoperative histopathological examination at the Fourth People’ Hospital of Nanning were collected. These patients were divided into two groups based on whether complicated with AIDS: complicated group (AIDS with cervical lymph node tuberculosis, 42 cases) and non-complicated group (AIDS without cervical cancer without tuberculosis, 100 cases), and then the clinical characteristics and CT manifestation of the two groups were compared and analyzed. Results In the complicated group, several factors, including the proportion of male, age, cough ratio, fatigue ratio and fever ratio, were significantly higher than those in the non-complicated group (66.7% (28/42) vs 44.0% (44/100), χ ²=6.867, P=0.009; 41.69 (34.75, 47.00) years vs 30.64 (22.00, 32.75) years, Z=-5.300, P=0.000; 26.2% (11/42) vs 9.0% (9/100), χ ²=7.223, P=0.007; 16.7% (7/42) vs 1.0% (1/100), χ ²=10.867, P=0.001; and 38.1% (16/42) vs 8.0% (8/100), χ ²=13.339, P=0.000, respectively); however, the CD4 ⁺ T lymphocyte count (152.50 (69.25, 241.75) cells/μl) in the complicated group was obviously lower than that (598.00 (452.00, 748.00) cells/μl) in the non-complicated group (Z=-8.081, P=0.001). In addition, in the complicated group, several CT manifestations, including lymph nodes with a short diameter >2 cm (47.6% (20/42)), lymph node fusion (71.4% (30/42)), coexistence of complete and incomplete necrosis of the lymph nodes (45.2% (19/42)), involvement ≥3 areas (59.5% (25/42)) and involvement ≥4 areas (33.3% (14/42)), were significantly higher than those in the non-complicated group (27.0% (27/100), 53.0% (53/100), 4.0% (4/100), 31.0% (31/100), and 11.0% (11/100), respectively) (χ ²= 5.679, 4.136, 37.056, 10.075, and 10.170, respectively, all P<0.05), while the regular lesions (16.7% (7/42)), the clear borders (16.7% (7/42)), and incomplete necrosis (33.3% (14/42)) were remarkably lower in the complicated group than those (50.0% (50/100), 52.0% (52/100), and 90.0% (90/100)) in the non-complicated group (χ ²=13.677, 15.205, and 48.459, respectively, all P=0.000). Conclusion AIDS complicated with cervical lymph node tuberculosis usually occurred in males and patients over 40 years of age, as well as exhibited atypical clinical characteristics and significantly reduced CD4 ⁺ T lymphocyte counts. CT manifestations of these patients usually exhibited are more common for lymph nodes with a short diameter >2 cm, fusion, unclear borders, irregular morphology, lesions involved lymph nodes ≥ 3 areas, and more mixed necrosis.

Analysis of CT findings in patients with initial and retreated multidrug-resistant tuberculosis

Jia YANG,Sheng-xiu LYU,Guang-xiao TANG,Wei-qiang SHU,Hui-qiu WANG,Chang-ping YANG,Xue-yan LIU,Chun-hua LI

Chinese Journal of Antituberculosis. 2020, 42(1):  38-43.  doi:10.3969/j.issn.1000-6621.2020.01.010

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Objective To investigate the CT findings in patients with initial and retreated multidrug-resistant tuberculosis. Methods A total of 186 patients with multidrug-resistant tuberculosis diagnosed by drug susceptibility testing in Chongqing Public Health Medical Treatment Center from January 2016 to January 2019 were collected, including 80 newly treated patients as initial treatment group and 106 retreated patients as retreatment group. The lesion size, lesion morphology (tree in bud, acinar node, speckle shadow, large shadow, strip shadow, calcification shadow), the number and shape of cavity, the shape of cavity wall, bronchiectasis and other CT findings were compared between the two groups. The CT findings were statistically analyzed by χ ² test, and the difference was statistically significant (P<0.05). Results In the retreatment group (106 cases), there were destroyed lungs in 22 cases (20.8%,22/106), lesion size more than 3 lobes in 96 cases (90.6%,96/106), lesions located in the middle lobe and tongue segment in 91 cases (85.8%, 91/106), strip shadow in 58 cases (54.7%,58/106), calcification shadow in 29 cases (27.4%,29/106) and bronchiectasis in 82 cases (77.4%, 82/106), respectively, when compared for those (6.2% (5/106), 71.2% (57/80), 72.5% (58/80), 23.8% (19/80), 10.0% (8/80), 31.2% (25/80)) in initial group with the significant differences statistically (χ ² values were 7.730, 11.656, 5.098, 18.021, 8.621, 39.670, Ps<0.05). In the retreatment group (106 cases), Chest collapse occurred in 23 cases (21.7%, 23/106), mediastinal displacement in 38 cases (35.8%,38/106), pleural thickening in 83 cases (78.3%,83/106), when compared for those (5.0% (4/80), 7.5% (6/80), 53.8% (43/80)) in the initial treatment group with the significant difference statistically (χ ² values were 8.943, 20.288, 12.576, Ps<0.05). The incidence of cavity was 83.0% (88/106), the number of cavity more three in 63 cases (59.4%,63/106), thicken-wall cavity in 75 cases (70.8%, 75/106), thin-wall cavity in 43 cases (40.6%,43/106), moth-eaten cavity in 43 cases (40.6%,43/106), cluster cavity in 43 cases (40.6%,43/106) and cavity with rough inner wall in 22 cases (20.8%,22/106), when compared for those (56.2% (45/80),23.8% (19/80),51.2% (41/80),12.5% (10/80),16.2% (13/80),16.2% (13/80) and 7.5% (6/80)) in initial group with the significant difference statistically (χ ² value were 16.034,23.551,7.390,17.626,12.810,12.810 and 6.264, Ps<0.05). Conclusion The CT findings of retreated MDR-TB patients are more serious than those of the initial treatment group, such as wide lesion, destroyed lungs, multiple cavities and cluster aggregation, caseous pneumonia with moth-eaten cavity and varicose bronchiectasis.

Analysis of CT manifestations in 20 female patients with mammary tuberculosis

Hui-qiu WANG,Sheng-xiu LYU,Chun-hua LI,Wei-qiang SHU,Jia YANG

Chinese Journal of Antituberculosis. 2020, 42(1):  44-47.  doi:10.3969/j.issn.1000-6621.2020.01.011

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Objective The paper was aimed to analyze CT signs of mammary tuberculosis in females and investigate the diagnostic value of CT scan for these patients. Methods A total of 20 female patients with mammary tuberculosis, who were found with mammary lesions when undergoing chest CT and confirmed by surgical pathology in Chongqing Public Health Medical Center from August 2015 to May 2019, were enrolled, and then the CT manifestations and involvement of adjacent tissues and organs were analyzed. Results Of the 20 cases of mammary tuberculosis, 12 were presented with lesions in the right breasts, while 8 in the left breasts; there were 13 with single lesion and 7 with multiple lesions; the numbers of nodular, lump and flake morphologies were 16, 1 and 3, respectively; and the lesion size was measured with 1.0 cm×1.5 cm-5.1 cm×3.2 cm. Based on plain CT scan, there were 11 lesions with equal density,9 with slightly lower density, 4 with nodular calcification,17 with blurred borders, and 12 with uniform thickening of adjacent skin. According to CT enhancement scan, there were 15 lesions with ring enhancement, 3 with uneven enhancement, 2 with uniform enhancement, and 2 with accompanied sinus formation. Among them, 13 cases were accompanied by ipsilateral or bilateral axillary lymph node tuberculosis with annular enhancement, 5 cases had ipsilateral chest wall tuberculosis with marginal enhancement, and 10 cases had pulmonary tuberculosis. Conclusion The characteristic CT manifestation of mammary tuberculosis is ring enhancement, which is often accompanied by ipsilateral axillary lymph nodes, chest wall tuberculosis, and pulmonary tuberculosis.

Diagnostic value of multi-slice CT bronchial image post-processing technique in tracheobronchial tuberculosis

Pan CAO,Rong-rong LIU,Kuang-li LIANG,Ji-xin YUAN,Min LI,Yan-bin GAO,Dai-lun HOU

Chinese Journal of Antituberculosis. 2020, 42(1):  48-53.  doi:10.3969/j.issn.1000-6621.2020.01.012

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Objective To explore the value of bronchial image post-processing technique in the diagnosis of tracheobronchial tuberculosis by multi-slice CT (MSCT) scanning. Methods A total of 117 patients with high suspicion of TBTB due to clinical symptoms or MSCT axial images who underwent MSCT scans and bronchoscopy from June to December 2018 in the Tuberculosis Hospital of Shannxi Province were retrospectively collected. The axial plane images of all patients were post-processed with MSCT bronchial images. After bronchoscopy, tissue samples were obtained under the microscope and sent to the pathology department for pathological biopsy. Lastly, 69 patients with TBTB and 48 patients with non-TBTB were diagnosed. The diagnostic results of bronchoscopy and biopsy pathology were used as the reference standard to evaluate the sensitivity, specificity and accuracy of MSCT bronchial image post-processing technology for the diagnosis of TBTB, and a consistency test was used to evaluate the consistency of the diagnosis by two imaging physicians. Results Based on the results of bronchoscopy and biopsy pathology, the sensitivity, specificity, and accuracy of MSCT bronchial image post-processing technology for the diagnosis of TBTB were 97.10% (67/69), 43.75% (21/48), and 75.21% (88/117), respectively, and the consistency analysis result showed that the Kappa value was 0.44 (95%CI: 0.29-0.60). In addition, two imaging physicians had better consistency in the diagnosis of the disease through this method (Kappa=0.81, 95%CI: 0.68-0.93). Conclusion MSCT bronchial image post-processing technology has better diagnostic value for TBTB.

Study on resistance to rifampicin and isoniazid in 411 cases of pulmonary tuberculosis in Longyan City, Fujian Province

Man-e ZHANG,Wen-bin HUANG,Zhi-hua LU,Hong-bin ZHANG

Chinese Journal of Antituberculosis. 2020, 42(1):  54-59.  doi:10.3969/j.issn.1000-6621.2020.01.013

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Objective To retrospectively analyze the drug resistance to rifampicin and isoniazid in 411 cases of pulmonary tuberculosis (PTB) in Longyan City, Fujian Province, and provide a scientific basis for the prevention and treatment of tuberculosis in local areas. Methods From May 12, 2016 to August 17, 2019, 411 PTB patients who admitted to the outpatient department and hospitalized in the Second Hospital of Longyan City, Fujian Province were collected, including 312 patients with initial treatment and 99 patients with retreatment. Resistance to rifampicin and isoniazid and the mutation sites of related resistance gene were detected in 411 clinical isolates of Mycobacterium tuberculosis using gene chip technology, and the results were compared between patients with initial treatment and retreatment. Data were collated and statistically analyzed using Excel 2003 and SPSS 20.0 software, respectively. Comparison of count data was performed using the χ ² test. P<0.05 was considered statistically significant. Results In 411 PTB patients, the mutation rate of rifampicin and isoniazid at any site of patients with initial treatment was significantly lower than that with retreatment (9.3% (29/312) vs 54.5% (54/99), χ ²=95.483, P<0.05); and the multidrug-resistance rate of patients with initial treatment was obviously lower than that with retreatment (2.9% (9/312) vs 33.3% (33/99), χ ²=75.944, P<0.05). The mutation rate of rifampicin and isoniazid at any site was 20.2% (83/411), among which, the mutation rate of rifampicin resistance gene (ropB) was 5.4% (22/411), including 20 cases with single-site mutations and 2 cases with double-site mutations, and the mutation frequency of 531 (C→T) was the highest (40.9% (9/22)); the mutation rate of isoniazid resistance genes (katG and inhA) was 4.6% (19/411), including 13 cases with katG mutation and 6 cases with inhA mutation, and the mutation frequency of 315 (G→C) was the highest (63.2% (12/19)); the multidrug-resistance rate was 10.2% (42/411), including 40 cases with double-site mutations, 1 case with three-site mutation and 1 case with four-site mutation, and the mutation frequency of 531 (C→T) 315 (G→C) was the highest (47.6% (20/42)). Conclusion The drug resistance of PTB patients in Longyan City is mainly multidrug-resistant. The resistance to two drugs in patients with retreatment is more serious than that in patients with initial treatment, indicates that the situation of prevention and treatment is grim.

Comparative analysis of domestic real-time fluorescence quantitative PCR reagent and GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis

Chun-fang LYU,Jian-hong WU,Liu-zhu LU,Yang-feng XU,Sheng-yuan LIU

Chinese Journal of Antituberculosis. 2020, 42(1):  60-65.  doi:10.3969/j.issn.1000-6621.2020.01.014

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Objective To evaluate the clinical application of domestic real-time fluorescence quantitative PCR (FQ-PCR) reagent and GeneXpert MTB/RIF (GeneXpert) in the detection of Mycobacterium tuberculosis (MTB) in sputum specimens, and compare the detection efficacy of the two methods. Methods From January 2017 to December 2018, a total of 210 sputum specimens of suspected pulmonary tuberculosis cases were collected from Shenzhen Nanshan Center for Chronic Disease Control for smear microscopy, MGIT (Mycobacteria growth indicator tube) 960 culture, GeneXpert and FQ-PCR. Using MGIT 960 result as a reference standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GeneXpert and FQ-PCR methods were calculated and compared. The consistency of GeneXpert, FQ-PCR and MGIT 960 as well as the consistency between both techniques were compared. According to the grading reporting standard of smear microscopic examination results, the specimens were divided into six groups with progressively increasing bacterial load (negative, scanty, +, ++, +++, ++++), and the Ct mean value of each group detected by FQ-PCR and GeneXpert was compared. Results The sensitivity, specificity, PPV and NPV of GeneXpert were 83.7% (123/147), 87.9% (51/58), 94.6% (123/130), and 68.0% (51/57), respectively, while the sensitivity, specificity, PPV and NPV of FQ-PCR were 83.7% (123/147), 89.8% (53/59), 95.3% (123/129), and 68.8% (53/77), respectively. Kappa test was performed between FQ-PCR, GeneXpert and MGIT 960 results, and the consistency was 85.4% (176/206) between FQ-PCR and MGIT 960 results and 84.9% (174/205) between GeneXpert and MGIT 960 results, with the Kappa value of 0.70 and 0.66, respectively; and the consistency between GeneXpert and FQ-PCR was 92.8% (194/209) (Kappa=0.85). The mean Ct value of negative group and scanty group detected by FQ-PCR was (33.87±5.00) and (27.29±1.30) cycles, respectively, and the difference was statistically significant (t=5.56, P<0.001); while which by GeneXpert was (33.32±6.05) cycles and (23.99±3.36) cycles, respectively, and the difference was also statistically significant (t=5.19, P<0.001). There was no significant difference in mean Ct values between FQ-PCR and GeneXpert when smear negative samples were detected ((33.87±5.00) cycles vs (33.32±6.05) cycles, t=0.32, P=0.750). However, when the smear was positive (scanty, +, ++, +++, ++++), the mean Ct values of FQ-PCR were significantly higher than that of GeneXpert ((27.29±1.30) cycles vs (23.99±3.36) cycles, t=2.60, P=0.030; (27.95±2.85) cycles vs (23.10±4.05) cycles, t=4.71, P<0.001; (25.88±3.62) cycles vs (20.22±2.81) cycles, t=6.08, P<0.001; (24.79±2.46) cycles vs (20.31±4.16) cycles, t=3.85, P<0.001; and (22.38±2.72) cycles vs (16.48±2.78) cycles, t=9.02, P<0.001, respectively). Conclusion The domestic FQ-PCR method has good consistency with the GeneXpert results, which has high clinical application value for large-scale screening of tuberculosis and reducing the detection cost.

Quality of life assessment and risk factors analysis of 270 pulmonary tuberculosis patients

Xiao-ying JIANG,Yan-hua SONG,Yu-ying WANG,Zhi LIU,Feng-ling MI,Jian-qin LIANG

Chinese Journal of Antituberculosis. 2020, 42(1):  66-73.  doi:10.3969/j.issn.1000-6621.2020.01.015

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Objective To investigate the quality of life of patients with tuberculosis, and analyze its influencing factors. Methods A total of 336 tuberculosis patients hospitalized in Beijing Chest Hospital affiliated to Capital Medical University and the Eighth Medical Center of the People’s Liberation Army General Hospital from January to December 2018 were randomly selected as subjects in this study. The tuberculosis patients were investigated with questionnaires and European quality of life-5 dimensions (EQ-5D). A total of 336 questionnaires were distributed and 336 were actually recovered, with a response rate of 100.00%. There were 270 valid questionnaires with an effective rate of 80.36%. SPSS 19.0 software was used for data entry and statistical analysis, and Chi-square test and logistic regression were used for multivariate analysis. Results The visual analogue scaling (VAS) score of 270 tuberculosis patients was 73.59±18.24, and the EQ-index score was 0.78±0.29. The proportion of difficulty in five-dimension measurement was between 21.5% (58/270) and 30.7% (83/270). Logistic regression analysis showed that the risk factors of self-action ability were age (OR=4.291 (95%CI: 1.714-10.744)), conscious tuberculosis severity (OR=5.029 (95%CI: 1.810-13.971)), hemoptysis (OR=2.315 (95%CI: 1.036-5.173)). The risk factors of self-care ability were age (OR=6.652 (95%CI: 2.495-17.734)), conscious tuberculosis severity (OR=6.248 (95%CI: 2.099-18.597)). Risk factors for ability of daily activities included age (OR=3.028 (95%CI: 1.295-7.081)), conscious tuberculosis severity (OR=3.640 (95%CI: 1.471-9.010)), hemoptysis (OR=2.522 (95%CI: 1.146-5.554)). Risk factor for pain or discomfort was conscious tuberculosis severity (OR=7.923 (95%CI: 2.431-25.822)). Risk factors for anxiety or depression included conscious tuberculosis severity (OR=2.479 (95%CI: 1.007-6.102)) and psychological stress after illness (OR=5.112 (95%CI: 1.736-15.052)). Received tuberculosis-related health education (OR=0.259 (95%CI: 0.105-0.638); OR=0.227 (95%CI: 0.085-0.606)) was the protective factor of self-action ability and self-care ability. Conclusion Age and psychological stress are the main factors influencing the quality of life of tuberculosis patients. Receiving tuberculosis-related health education is the main protective factor affecting the quality of life of tuberculosis patients. We should strengthen the mental health management of tuberculosis patients, emphasize the importance of tuberculosis health education to improve the awareness of protection and prevention of patients, so as to improve the quality of life of tuberculosis patients.

The value of two techniques in detecting chest wall tuberculosis from different surgical specimens

Hang-kong REN,Li-ming DUAN,Qin-fang ZHEN

Chinese Journal of Antituberculosis. 2020, 42(1):  74-78.  doi:10.3969/j.issn.1000-6621.2020.01.016

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Objective To evaluate the value of GeneXpert MTB/RIF technology (GeneXpert) and BACTEC MGIT 960 liquid culture (MGIT 960) in detecting and diagnosing chest wall tuberculosis with different surgical specimens. Methods Two hundred and fourteen patients with suspected chest wall tuberculosis admitted from June 2016 to July 2019 in Xi’an Chest Hospital were recruited. Pus, caseous necrotic tissues and granulation tissues in the lesions were obtained through surgical operation. GeneXpert and MGIT 960 were used to detect the above specimens. One hundred and seventy-four cases of chest wall tuberculosis and 40 cases of non-tuberculous chest wall disease were confirmed by comprehensive clinical diagnosis and pathological examination. The sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of GeneXpert and MGIT 960 in the diagnosis of chest wall tuberculosis were evaluated with the clinical diagnostic results as the reference standard. The results (positive rate difference) of GeneXpert and MGIT 960 were compared among the three specimens. Statistical analysis was performed by Chi-square test, and P value less than 0.05 was considered statistically significant. Results Among these 214 suspected chest wall tuberculosis patients,174 cases were confirmed by preoperative blood test, imaging data and postoperative pathological results, and 40 cases were non-tuberculous chest wall disease. There were 18 cases of pyogenic chest wall abscess, 9 cases of chest wall cyst with common bacterial infection, 8 cases of connective tissue tumors, 3 cases of rib osteomyelitis and 2 cases of chest wall actinomycosis. With the clinical diagnosis as the standard, the sensitivity of GeneXpert to identify tuberculosis was 82.18% (143/174), the specificity was 97.50% (39/40), the positive predictive value was 99.31% (143/144), the negative predictive value was 55.71% (39/70), and the Kappa value was 0.618; The sensitivity of MGIT 960 identification of tuberculosis was 52.30% (91/174), the specificity was 100.00% (40/40), the positive predictive value was 100.00% (91/91), the negative predictive value was 32.52% (40/123), and the Kappa value was 0.291. The positive test results of the two techniques for the three types of surgical specimens were: granulation tissue (81.9%, 113/138), caseous necrotic tissue (68.8%, 88/128), and abscess (44.7%, 68/152). The positive rates was compared between pus group and caseous necrotic tissue group, χ ²=16.23, P<0.001; the positive rates were compared between caseous necrotic tissue group and granulation tissue group, χ ²=4.19, P=0.013; the positive rates were compared between granulation tissue group and pus group, χ ²=42.54, P<0.001. Conclusion The sensitivity of chest wall tuberculosis identified by GeneXpert is significantly higher than MGIT 960, and the specificity is comparable to that of MGIT 960, which can be used for rapid detection of surgical specimens. GeneXpert and MGIT 960 combined detection of three types specimens of suspected chest wall tuberculosis patients, granulation tissue positive rate is higher.