Table of Content

10 March 2021, Volume 43 Issue 3

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Expert Forum

Optimizing the application of tuberculin skin test

HE Yi-jun, ZHANG Hao-ran, XIN He-nan, GAO Lei

Chinese Journal of Antituberculosis. 2021, 43(3):  204-210.  doi:10.3969/j.issn.1000-6621.2021.03.003

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China is one of the high-burden country for both tuberculosis (TB) and Mycobacterium tuberculosis (MTB) infection, implementing preventive intervention among populations under high risk of MTB infection and active disease development is an important component of TB control in China. The tuberculin skin test (TST) has been widely used for MTB infection testing and played an important role in assistant diagnosis of TB and high-risk populations monitoring, even though it’s result might be affected by multiple factors including BCG vaccination, environmental non-tuberculosis mycobacteria (NTM) infection and host immune status. Given the national conditions and the epidemiological characteristics of MTB infection in China, such influences could be controlled by innovating application strategy to guarantee the advantages of TST on MTB screening in big populations. In addition, with respect to the characteristics of various target populations, more detailed protocols on operation and result interpretation should be developed based on systematic studies to improve quality assurance of TST.

Influence of bovine tuberculosis on human health and its prevention and control strategy

LIU Yan-fei, LI Xue, CHEN Wei, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2021, 43(3):  211-216.  doi:10.3969/j.issn.1000-6621.2021.03.004

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Bovine tuberculosis is a widespread zoonotic disease that not only brings economic losses to the cattle industry, but also seriously threatens the health of people in developing countries. This article briefly summarizes the epidemic situation of bovine tuberculosis, the occurrence of bovine tuberculosis infection in humans and the risk factors of infection, analyzes problems in the prevention and control of bovine tuberculosis, and proposes the development direction of bovine tuberculosis prevention and control. It is expected to provide policy basis and technical guidance for effectively controlling tuberculosis in humans and animals, thereby reducing the burden of tuberculosis in China and achieving goals of the global End TB strategy.

Expert Note

Strengthen tuberculosis control strategy in key populations according to local conditions

CHENG Jun, ZHANG Can-you, CHEN Hui, ZHANG Hui, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2021, 43(3):  217-221.  doi:10.3969/j.issn.1000-6621.2021.03.005

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Strengthening key populations management is becoming more and more important for improving tuberculosis control nationwide. Authors summarized the key points and analyzed shortcomings of current tuberculosis control strategy in high risk population in this article. Considering the structure and characteristics of the key populations vary between region and region in terms of social development and TB epidemic, different strategies should be developed according to the local conditions. Authors suggest that precise tuberculosis control strategy should be implemented based on the risk classification of populations, places and times, and provide specific measurements.

Original Articles

Analysis of prevention treatment for tuberculosis in tumor necrosis factor antagonist users in some regions of China

ZHANG Li-fan, MA Hui-min, ZHENG Wen-jie, ZHANG Feng-chun, LIU Xiao-qing

Chinese Journal of Antituberculosis. 2021, 43(3):  222-227.  doi:10.3969/j.issn.1000-6621.2021.03.006

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Objective To investigate the prevention treatment for tuberculosis in patients treated with tumor necrosis factor (TNF) antagonists in some areas of China. Methods A total of 981 rheumatoid arthritis (RA) or ankylosing spondylitis (AS) patients treated with etanercept or infliximab from 13 large general hospitals in eastern, central and western China from March 2014 to February 2016 were selected. The clinical data of gender, age, hormone and immunosuppressant use, underlying disease, tuberculosis history, latent tuberculosis infection (LTBI) screening, chest X-ray or CT scan results, prevention treatment of tuberculosis were collected,. The proportion of LTBI and inactive tuberculosis screening, the proportion of prevention treatment for tuberculosis and the treatment regimens in RA or AS patients with TNF antagonist were analyzed. Results Of the 981 subjects, 779 (79.4%) were treated with etanercept and 202 (20.6%) with infliximab. Only 25.7% (252/981) subjects were screened for LTBI, and the positive rate was 18.3% (46/252). And 2.8% (27/981) of the subjects were diagnosed as inactive tuberculosis, of which 19 cases had a history of tuberculosis. Of the 712 patients (72.6%) who underwent chest X-ray and/or CT scan, 13 (1.8%) were reported inactive pulmonary tuberculosis. A total of 15 subjects received TB prevention treatment; 6 (13.0%, 6/46) of the patients complicated with LTBI received tuberculosis preventive treatment; none of the patients diagnosed as inactive tuberculosis received tuberculosis prevention treatment. Among the patients who received tuberculosis prevention treatment, 9 cases (60.0%, 9/15) were treated with isoniazid monotherapy for 1-18 months. Conclusion In some areas of China, the proportion of LTBI screening in RA or AS patients treated with TNF antagonists was low, the proportion of tuberculosis prevention treatment was low, the selection criteria of prevention objects were different, and the prevention scheme was not standardized.

A study of pharmacokinetic of rifapentine combined with isoniazid in the preventive treatment of tuberculosis in silicotic patients

YANG Qing-luan, LIU Qi-hui, LIN Miao-yao, XU Yu-zhen, LIU Xue-feng, HE Zhang-yu-fan, HUANG Xi-tian, HAO Bin, SHAO Ling-yun, ZHANG Wen-hong, RUAN Qiao-ling

Chinese Journal of Antituberculosis. 2021, 43(3):  228-232.  doi:10.3969/j.issn.1000-6621.2021.03.007

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Objective To evaluate the pharmacokinetic characteristics of rifapentine combined with isoniazid therapy (3HP for 3 months, once a week) for tuberculosis prevention in silicotic patients. Methods A total of 25 silicosis patients treated with 3HP regimen and pharmacokinetic monitoring in the First People's Hospital of Wenling City, Zhejiang Province from May 2015 to June 2018 were selected as the research subjects. At 8 weeks after the initiation of treatment, before taking the drug, the patients should stayed overnight (more than 10 h) without any food, peripheral venous blood was collected in limosis the next morning (0 h before taking the drug), and at 2, 4, 5, 6, 8, 12, 24, and 72 h after taking the drug. The plasma concentrations of isoniazid, rifapentine and their metabolites were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Pharmacokinetic parameters were obtained by analyzing the plasma concentration data using DAS 2.0 software. Results The pharmacokinetic parameters (M (Q₁, Q₃)) of isoniazid and theacetyl metabolite were as follows: AUC_(0-t), 14.1 (10.3, 22.2) and 7.6 (6.3, 8.4) μg·h/ml; AUC_(0-∞), 14.3 (10.7, 22.4) and 8.0 (7.2, 9.2) μg·h/ml; t_1/2, 1.6 (1.3, 1.8) and 6.0 (5.2, 7.9) h; t_max, 2.0 (2.0, 4.0) and 2.0 (2.0, 4.5) h; C_max, 3.7 (2.4, 5.5) and 6.6 (5.5, 9.8) μg/ml. And the main pharmacokinetic parameters (M (Q₁, Q₃)) of rifapentine and the active 25-desacetyl metabolite were as follows: AUC_(0-t), 919.6 (742.3, 1113.1) and 660.1 (517.6, 739.8) μg·h/ml; AUC_(0-∞), 1035.4 (758.2, 1191.3) and 913.4 (685.7, 1097.3) μg·h/ml; t_1/2, 18.3 (14.5, 21.6) and 32.3 (22.1, 46.3) h; t_max, 8.0 (7.0, 12.0) and 24.0 (18.0, 24.0) h; C_max, 32.2 (28.6, 37.7) and 15.1 (11.2, 18.2) μg/ml. All the subjects were followed up until 1 month after the completion of medication, of them, 14 cases (56.0%) had adverse drug reactions. Conclusion When the 3HP regimen was applied to prevent tuberculosis in silicotic patients, the metabolism of isoniazid was faster, while the metabolism of rifapentin was slower, which may be related to the occurrence of more adverse drug reactions in patients.

Analysis of treatment completeness and its influencing factors of 12-week preventive therapy among close contacts of pulmonary tuberculosis patients

YAO Xu, WU Cheng-guo, GONG De-hua, YAO Yu-xia, ZHANG Can-you, XU Cai-hong, XIA Yin-yin, CHEN Hui, CHENG Jun, ZHANG Hui

Chinese Journal of Antituberculosis. 2021, 43(3):  233-239.  doi:10.3969/j.issn.1000-6621.2021.03.008

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Objective To understand the treatment completeness and its influencing factors of 12-weeks’preventive therapy among close contacts of pulmonary tuberculosis (PTB) patients with latent Mycobacterium tuberculosis infection (LTBI). Methods A total of 989 close contacts of PTB patients with LTBI aged 5-64 who should finish their preventive therapy with informed consent were enrolled in the “13th Five-Years Plan” National Science and Technology Major Project-Intervention on latent infected close contacts of TB patients from August 30th, 2018 to July 30th, 2020. General demographic data, medication records, adverse reactions, and reasons of discontinued therapy were collected. Factors influencing the completeness of treatment was analyzed with Chi-square test and multivariate logistic regression model. Results Among 989 close contacts, 905 completed treatment, with a treatment completion rate of 91.51%. Among close contacts who did not complete their treatment, main reasons for discontinued therapy were “refusal to continue treatment” (41 cases, 48.81%) and “adverse reactions” (31 cases, 36.90%). Discontinued therapy mostly occurred in the first 2 months after treatment (72 cases, 85.71%). Multivariate regression showed that aged 50-64 years old (OR=3.71;95%CI:1.72-8.02), smoking (OR=1.79;95%CI:1.02-3.13) and local TB designated hospitals responsible for supervising preventive therapy (OR=4.51;95%CI:1.91-10.65) were risk factors for discontinuing medication. Conclusion Close contacts of PTB patients with LTBI had a high treatment completion rate for the 12-week regimen, but they were likely to discontinue therapy and have adverse reactions at early stage of treatment. Treatment completion rate was affected by age, smoking and institution responsible for supervising preventive treatment in county/district.

Study of screening methods of MTB/HIV co-infected patients in low TB and AIDS prevalence area

RAO Li-xin, XIAO Xiao, CHEN Jing, SHEN Xin, JIANG Qing-wu

Chinese Journal of Antituberculosis. 2021, 43(3):  240-247.  doi:10.3969/j.issn.1000-6621.2021.03.009

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Objective Retrospective analysis of data on two-way screening of HIV antibodies in TB patients and active TB in HIV/AIDS patients in Shanghai in the past 10 years, in order to evaluate the effectiveness of detection models and to provide a basis for further policies improvement. Methods Data about TB patients from 2012 to 2020 (68155 patients) were extracted from the database of National Tuberculosis Information Management System. Data concerning HIV/AIDS population from 2012 to 2020 were collected by the annual report of MTB/HIV screening program. Linear regression analysis was made to evaluate the annual trend of rate. Annual percentage change (APC) and number needed to screen (NNS) were calculated to estimate the effectiveness of the program. The univariate variance analysis and multivariate logistic regression analysis were used to evaluate the HIV-positive factors in 10769 TB patients in Shanghai Changning District and Pudong New Area from 2012 to 2019. Results In 2012—2020, Shanghai reported 308 MTB/HIV coinfection patients. Among which, 64 were newly infected HIV, accounting for 20.78%. HIV positive rate among TB patients decreased from 2.42% (32/1322) in 2012 to 0.50% (20/3995) in 2020 (APC=-16.64, t=-7.007, P<0.001), and the rate of active TB in HIV/AIDS patients also showed a decreasing trend from 1.02% (50/4912) in 2012 to 0.21% (25/11878) in 2020 (APC=-14.27, t=-4.038, P=0.005). Multivariate logistic regression showed that males (OR (95%CI)=5.386 (2.306-12.581)), ages 36 to 75 (36-45, 46-55, 56-65, 66-75 OR (95%CI) values were 26.243 (3.230-213.244), 32.736 (3.993-268.358), 20.309 (2.482-166.144), 13.461 (1.692-107.059)), death during tuberculosis treatment (OR (95%CI)=14.875 (3.192-69.312)), and comorbid with extra pulmonary tuberculosis (OR (95%CI)=3.451 (1.607-7.409)) were a risk factors for MTB/HIV infection. Conclusion The current MTB and HIV co-infection detection model adopted in Shanghai has achieved good results, and the HIV-positive rate of TB patients and the active TB diagnosis rate in HIV/AIDS patients have decreased rapidly. Males, aged 36 to 75, dead during treatment, and comorbid with extra pulmonary tuberculosis are the risk factors for MTB/HIV infection.

The correlation between rifampicin and isoniazid resistance-related gene mutations and resistance level in Mycobacterium tuberculosis

WANG Xi-jiang, TAN Yun-hong, HE Wen-cong, OU Xi-chao, LIU Dong-xin, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2021, 43(3):  248-254.  doi:10.3969/j.issn.1000-6621.2021.03.010

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Objective To determine the gene mutation profile for rifampicin and isoniazid resistance in Mycobacterium tuberculosis (MTB), and explore its relationship with drug resistance level, provide theoretical basis for the development of molecular drug resistant diagnostic tools to inform clinical decision. Methods MTB strains were collected from Xinjiang Uygur Autonomous Region (Keping, Yuepuhu and Shule county, 193 isolates) and Hunan province (Huaihua, Yongshun, Qidong, Taojiang and Leiyang county, 592 strains). Minimum inhibitory concentration (MIC) method was used to determine rifampicin and isoniazid resistant level. All drug resistant strains were sequenced with whole genome sequencing (WGS), then TB profiler were used for bioinformatics analysis to identify drug resistance mutations. Results Among the 785 MTB strains, 124 (15.80%) were rifampicin/isoniazid resistant isolates, including 74 rifampicin-resistant, 111 isoniazid resistant and 61 multidrug-resistant strains, the multidrug-resistant rate was 7.77%. rpoB gene mutations were detected in 97.22% (70/72) of rifampicin resistance strains, among which 98.75% (69/70) mutations were located in rifampicin resistance determination region (RRDR). The rare mutation associated with rifampicin resistance-I491F (outside the RRDR region) was detected in only one strain. Rifampicin resistance mutations were mainly located in rpoB 450, rpoB 445 and rpoB 435 loci, accounting for 81.43% (57/70), among which rpoB S450L was the most frequent mutation (45.71%, 32/70). rpoB 450 mutation corresponded to high rifampicin resistance (MIC≥16 μg/ml), rpoB 452 mutation mainly corresponded to low rifampicin resistance (MIC=2 μg/ml). For isoniazid resistance strains, 93.58% (102/109) had known drug-resistant related gene mutations, mainly distributed in katG315 and fabG1 promoter region (85.29%, 87/102). KatG S315T was the most common resistance mutation (57.84%, 59/102), mainly corresponding to high isoniazid resistance (MIC≥2 μg/ml), followed by fabG1 (C15T)(16.67%, 17/102) which mainly corresponded to low isoniazid resistance (MIC=0.25-1.00 μg/ml). Conclusion Different drug resistance mutations can cause different degree of drug resistance. For rifampin, the mutation in rpoB 452 corresponded to low level resistant, while the mutations in rpoB 445 and 450 corresponded to high level resistant. For isoniazid, fabG1 C-15T corresponded to low level resistant and the mutation in katG 315 corresponded to high level resistant.

Evaluation of the effect of skin reaction on 11 Mycobacterium tuberculosis antigens

DUAN Hui-juan, CHU Hong-qian, KONG Cheng-cheng, DAI Guang-ming, CAO Ting-ming, SUN Zhao-gang

Chinese Journal of Antituberculosis. 2021, 43(3):  255-260.  doi:10.3969/j.issn.1000-6621.2021.03.011

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Objective To evaluate the effect of 11 Mycobacterium tuberculosis (MTB) antigens on the evaluation of skin reactions of MTB-sensitized guinea pigs. Methods The 18 specific pathogen free (SPF) guinea pigs (female, weight: 250-300 g) were selected and divided into three groups of high dose (5 μg), medium dose (0.5 μg) and low dose (0.1 μg), with 6 guinea pigs per group. The guinea pigs were sensitized with MTB strain (H37Rv, ATCC27294). After successful sensitization, the guinea pigs were intracutaneously injected with TB-PPD, EC and 11 MTB antigens (including recombinant antigen Rv3872, MPT64, Rv1985c, Rv0222, Rv3117, Rv3120, Rv2346c, Rv3619c, Rv3425, Rv1738 and Rv2626c), 0.1 ml for each. The transverse and longitudinal diameters of swelling in injection sites were recorded at 24 h and 48 h after injection, and the average diameter of induration ((transverse diameter+longitudinal diameter)/2) was calculated, the average diameter ≥5 mm was defined positive. The differences in skin reactions of 11 MTB antigens compared with TB-PPD and EC were analyzed. Results After 24 h of antigen injection, the positive rates of Rv3120 and Rv3619c were 9/9 and 8/9, respectively at the dose of 5 μg; the skin reactions of EC and MPT64 were all positive at the dose of 0.5 μg. In the skin reactions, the average diameters of induration (M(Q₁, Q₃)) of TB-PPD (at the dose of 5 IU), EC (at the dose of 0.5 μg), MPT64 (at the dose of 0.5 μg), Rv3120 (at the dose of 5 μg) and Rv3619c (at the dose of 5 μg) 24 h after injection were all significantly bigger than those 48 h after injection (the average diameter of induration (9.00 (7.00, 11.00) mm vs. 6.50 (5.50, 8.25) mm, 13.00 (12.75, 14.25) mm vs. 9.00 (8.00, 9.75) mm, 9.50 (8.50, 12.50) mm vs. 8.50 (5.50, 9.50) mm, 8.50 (6.25, 9.25) mm vs. 5.00 (0.00, 5.50) mm and 6.50 (5.50, 8.25) mm vs. 3.50 (1.50, 4.75) mm; Z values were -2.494, -2.677, -2.207, -2.673 and -2.670, respectively; P values were 0.013, 0.007, 0.027, 0.008 and 0.008, respectively). At the 24 h skin reaction, the average diameter of induration of MPT64 (at the dose of 0.5 μg), Rv3120 (at the dose of 5 μg) and Rv3619c (at the dose of 5 μg) were all similar to that of TB-PPD (at the dose of 5 IU), with no statistical difference (H values were -0.496, 0.819 and 1.714, respectively; P values were 1.000, 1.000 and 0.865, respectively). The sizes of skin reactions between MPT64 (at the dose of 0.5 μg) and EC (at the dose of 0.5 μg) were similar, with no significant difference (H=2.288, P=0.221). The average diameter of induration of Rv3120 (at the dose of 5 μg) and Rv3619c (at the dose of 5 μg) were both significantly smaller than that of EC (at the dose of 0.5 μg) 24 h after injection (H values were 3.795 and 4.690, respectively; P values were 0.001 and 0.000, respectively). Conclusion The skin reaction of MPT64 (at the dose of 0.5 μg) and Rv3120 (at the dose of 5 μg) in guinea pigs were relatively better and showed great potential in the diagnosis of tuberculosis.

Identification of approriate reference genes for the detection of miRNA in tuberculosis and malignant pleural effusion

DONG Jing, JIA Hong-yan, SUN Qi, LI Zi-hui, WEI Rong-rong, DU Bo-ping, XING Ai-ying, PAN Li-ping, ZHANG Zong-de

Chinese Journal of Antituberculosis. 2021, 43(3):  261-267.  doi:10.3969/j.issn.1000-6621.2021.03.012

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Objective To explore an appropriate reference gene for quantitative identification of miRNA in tuberculous pleural effusion (TBPE) and malignant pleural effusions (MPE), using real-time quantitative PCR (qPCR). Methods A total of 78 patients were enrolled, including 47 patients with tuberculous pleurisy and 31 cases of cancer. Total RNA were extracted from the pleural effusion, and then qPCR based on SYBR Green primer were performed to conclude the concentration and amplification efficiency of the reference genes, including miR-16, miR-20a, miR-192, miR-1268, miR-4281, U6 and Cel-miR-39 in PE. The lower the cycle threshold (Ct) value, the higher expression levels of the genes and the more suitable for relative quantitative analysis. Furthermore, the amplification efficiencies of the qPCR primers ranging from 90% to 110% were suitable for relative quantitative analysis. GeNorm (M value), NormFinder (stable value) and BestKeeper softwares (standard deviation and coefficient of variation) were used to analyze the stability of the reference genes. The reference gene was more stable when M value, stability value or standard deviation and coefficient of variation were smaller. Meanwhile, the difference among repeated detections and the difference among various sample process procedures were also analyzed by paried t test. Results Among 78 PE samples, the expression level of miR-1268 (19.16±4.40), Cel-miR-39 (24.17±0.73) and miR-16 (24.52±1.65) were relatively higher, and the amplification efficiency were 90%, 101% and 110%, respectively. The specific melt curves of the 7 genes represented the higher specificity of the qPCR primers, while there is no significant difference among repeated tests or among various sample process procedures. GeNorm (M value=0.994), NormFinder (stability value=0.674) and BestKeeper (standard deviation=0.73,coefficient of variation=3.02%) analyses totally indicated that Cel-miR-39 was the best stable gene among all the samples. Conclusion Cel-miR-39 can be used as the standard reference gene for miRNA quantitative identification in pleural effusion.

Clinicopathological features of superficial lymphadenopathy caused by infectious diseases in HIV infection/AIDS patients

LIN Jing, ZHANG Chen, DONG Yu-jie, LIU Zi-chen, LI Kun, CHE Nan-ying

Chinese Journal of Antituberculosis. 2021, 43(3):  268-273.  doi:10.3969/j.issn.1000-6621.2021.03.013

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Objective To explore the clinicopathological features, morphological characteristics and distribution patterns of pathogens in HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases. Methods Eighty-eight HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases were retrospectively recruited between January 2018 and June 2019 from Guangxi Zhuang Autonomous Region Longtan Hospital, and the clinicopathological features were analyzed. These biopsy specimens of lymph nodes were examined with acid-fast staining, periodic acid-schiff (PAS) staining, Giemsa staining, taqman fluorescent quantitative PCR and fluorescence PCR melting curve method. Results Pathological diagnosis confirmed 50 cases of tuberculosis (TB), 36 cases of talaromycosis caused by talaromyces marneffei (TM) infection, 3 cases of nontuberculous mycobacterial diseases (NTM), 2 cases of co-infection of TB and TM, and one case of cryptococcus. These different infectious diseases showed similar histopathological manifestations with HE (hematoxylin-eosin,HE) staining. For example, 23 cases (26.1%) with TB, TM, TB complicated with TM and cryptococcus showed typical necrotizing granulomas, and 19 cases (21.6%) with TB, TB complicated with TM and TM showed atypical necrotizing granulomas. Special staining showed that acid-fast bacilli were detected in 38 cases (69.1%, 38/55) of mycobacterial infection, and fungus were found in 34 cases of TM and 1 case of cryptococcus by PAS and Giemsa staining. The results of molecular pathology showed that 52 cases were TB and 3 cases were NTM. Conclusion The histopathological features of HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases are atypical. Special staining and molecular pathological techniques are useful in improving diagnostic accuracy.

Analysis on treatment outcomes and influencing factors of 2158 patients with MTB/HIV co-infection

YANG Ni, SU Qian, XIAO Yue, LU Jia, SONG Yang, RAO Zheng-yuan, XIA Lan, HE Jin-ge, CHEN Chuang, ZHANG Ling-lin

Chinese Journal of Antituberculosis. 2021, 43(3):  274-279.  doi:10.3969/j.issn.1000-6621.2021.03.014

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Objective To analyze the outcomes of anti-tuberculosis treatment in MTB/HIV co-infection patients, and to explore risk factors affecting the success of the treatment, and to provide scientific evidence for effective control of MTB/HIV co-infection. Methods A total of 2249 TB patients diagnosed and registered as MTB/HIV co-infection and receiving treatment at the TB designated hospitals from 2017 to 2019 were enrolled into this study. Patients with no cause or time to discontinue treatment, changes in diagnosis, single drug resistance or multidrug resistance were excluded, and 2158 cases were included. The data of the patients were collected, which included demographic characteristics (gender, age, nationality, occupation), patients detection methods (source of patients, institutional level of first seeking) and disease characteristic (complicated with other TB, severe disease, time of HIV positive test, etiological test results, drug resistance, treatment classification, years of AIDS diagnosis) and treatment outcomes. The factors affecting patients’ treatment outcomes were analyzed. Results Among 2158 MTB/HIV patients, 442 cases were cured and 1505 cases completed therapy, and the treatment success rate was 90.22% (1947/2158). The adverse outcome rate was 9.78% (211/2158), including 134 cases (6.21%) died from non-tuberculosis disease, 22 cases (1.02%) lost, 16 cases (0.74%) died from TB, 13 cases (0.60%) discontinued therapy due to adverse reactions, 7 cases (0.32%) of failure, 1 case (0.05%) conversed to multidrug-resistant TB treatment, and 18 cases (0.83%) of other treatment outcome. Multivariate analysis indicated that the risk factors affecting the success of the anti-TB therapy in patients were associated with first seeking institution level and TB diagnosis results of different categories of MTB/HIV patients. Compared with patients whose first seeking institution at municipal level, those who visited county level had a lower risk of adverse outcomes (OR=0.525, 95%CI: 0.288-0.955).Positive TB patients had a 1.433-fold higher risk of adverse outcome than negative TB patients and those without etiological results (OR=1.433, 95%CI:1.053-1.951). Conclusion The adverse outcomes rate of MTB/HIV patients with positive etiology tests and fist diagnosed in municipal medical institutions are relatively higher. It is necessary to strengthen the health education and curative effect observation of the patients who are first diagnosed in municipal medical institutions and have positive etiological examination results, and adjust the treatment regimen in time, so as to improve the treatment success rate of the patients with MTB/HIV and improve the prognosis of the patients.

The analysis of papers on tuberculosis published by Chinese scholars from 2015 to 2019

SUN Yu-xian, JIAO Mei, XIE Shi-heng, ZHANG Li-jie, LIU Yu-hong, ZHU Xiao-li

Chinese Journal of Antituberculosis. 2021, 43(3):  280-284.  doi:10.3969/j.issn.1000-6621.2021.03.015

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Objective To analyze the situation of scientific and technological papers in the field of tuberculosis published by Chinese scholars from 2015 to 2019. Methods All of 29223 Chinese papers related to tuberculosis were retrieved using SinoMed and the citation related information of published papers was searched using CNKI; 3963 English papers related to tuberculosis were retrieved using PubMedPlus and the citation related information of published papers was searched using Jinan Quanfang Local PubMed retrieval system; retrieval time was from 2015 to 2019. The number of retrieved papers, the distribution of published journals, the organizations and regions of the first author, and the citation frequency were statistically analyzed. Results From 2015 to 2019, the total number of papers related to tuberculosis published by Chinese scholars in Chinese journals were 29223, which were 7155 (24.48%) in 2015, 6318 (21.62%) in 2016, 5499 (18.82%) in 2017, 5176 (17.71%) in 2018, and 5075 (17.37%) in 2019 respectively, showing a downward trend by year, with an average annual decline rate of 8.23%. The total number of papers published in English journals were 3963, with 710 (17.92%), 697 (17.59%), 775 (19.56%), 810 (20.44%), and 971 (24.50%) in each year, showing an increasing trend with an average annual growth rate of 8.14%. The proportion of papers published by Chinese authors in English journals (10.02% (710/7083), 9.62% (697/7243), 10.80% (775/7173), 11.39% (810/7112), 12.73% (971/7628)) also showed an increasing trend year by year; only 2 of the top 10 Chinese journals were sci-tech core journals, and among them, Chinese Journal of Antituberculosis published the largest number of papers (1260), accounting for 4.31% (1260/29223) of all papers published in Chinese journals. All the top 10 English journals were SCI journals. More first authors in Chinese journal were from tuberculosis specialized hospitals (top10: 8/10), and the institutions were located in Guangdong, Beijing, and Jiangsu (22.23%, 6495/29223). However, those with more articles published in English journals were general hospitals and research institutions (top10:8/10), while the institutions were located in Beijing, Shanghai and Guangdong (60.64%, 2403/3936), and the imbalance of regional distribution was more obvious compared with the papers published in Chinese journals (χ²=2621.70,P<0.01). The number of papers published by Beijing Chest hospital, Capital Medical University ranked first in both Chinese and English journals (801 and 203, respectively). The citation rate of papers published in Chinese journals was 68.11% (19903/29223), and total citation frequency was 78179. However, only 11 papers were cited more than 30 times, compared with 179 papers in English journals. Conclusion From 2015 to 2019, a large number of papers had been published in the field of tuberculosis by Chinese scholars, but the number of papers published in Chinese journals showed a downward trend year by year; at the same time, the distribution of scientific research output in different regions and institutions was obviously unbalanced, and the citation frequency of papers in Chinese journals was low.

Review Articles

A review of application of therapeutic drug monitoring in tuberculosis treatment

WANG Le-le, YANG Song, TANG Shen-jie

Chinese Journal of Antituberculosis. 2021, 43(3):  285-290.  doi:10.3969/j.issn.1000-6621.2021.03.016

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Therapeutic drug monitoring (TDM) is a technique that determining the dose of drugs based on the concentration of drugs in blood, urine or saliva, and developing therapeutic regimens to achieve the best treatment effect, and to reduce the drug resistance and adverse reactions. TDM is an important strategy of individualized treatment, which can provide references for individualized doses. Individual differences were found in blood concentrations of tuberculosis (TB) patients, and there were also many adverse reactions.All of these always caused ineffective treatment, relapse or drug resistance. TDM has not yet been standardized and no official guidelines have been developed in anti-TB therapy. However, TDM were recently recommend in foreign guidelines for TB patients who have risk of drug exposure altered or poor prognosis. Therefore, the authors reviewed the definition and clinical significance of TDM, as well as the detection techniques and methods, and application in anti-TB therapy, in order to provide references for clinicians.

Research progress on diagnostic methods of multidrug-resistant tuberculosis

ZHANG Chun-xia, XU Gui-sheng, SHI Jin-yan

Chinese Journal of Antituberculosis. 2021, 43(3):  291-294.  doi:10.3969/j.issn.1000-6621.2021.03.017

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The prevention and control of multidrug-resistant tuberculosis (MDR-TB) is of great significance for tuberculosis (TB) prevention and control, and has become a difficult and hot issue in the TB prevention and control field. Early detection of MDR-TB by conducting drug susceptible test can improve the treatment success rate of MDR-TB patients. The diagnostic methods of MDR-TB include traditional culture methods and new molecular biological diagnostic methods. The author did a literature review to the diagnostic methods of MDR-TB and hope it could provide more scientific evidences for MDR-TB prevention and treatment.

Special Articles

Interpretation of Clinical Guidelines for the management of Rifampicin-resistant Tuberculosis in South Africa (2019) and its comparison with Guidelines for Drug-resistant Tuberculosis Chemotherapy in China (2019)

FENG Ying, REN Fei

Chinese Journal of Antituberculosis. 2021, 43(3):  295-298.  doi:10.3969/j.issn.1000-6621.2021.03.018

Abstract ( 489 )   HTML ( 21 )   PDF (704KB) ( 327 )   Save

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To interpret the Clinical Guidelines for the management of Rifampicin-resistant Tuberculosis in South Africa (2019),including how to choose drugs,formulate treatment regimens as well as how to treat special patients, manage close contacts; and then to compare this South Africa Guidelines with the Guidelines for Drug-resistant Tuberculosis Chemotherapy in China (2019).