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    10 May 2021, Volume 43 Issue 5
    Expert Forum
    Making panoramic plan:extra-pulmonary tuberculosis needs to be integrated into the national tuberculosis program
    LIU Er-yong, LI Yu-hong, ZHOU Lin, ZHAO Yan-lin
    Chinese Journal of Antituberculosis. 2021, 43(5):  428-431.  doi:10.3969/j.issn.1000-6621.2021.05.003
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    To achieve the goal of ‘Ending the TB epidemic’,pulmonary tuberculosis and extra-pulmonary tuberculosis must be jointly prevented and controlled. This article summarized the current situation of extra-pulmonary tuberculosis in China, and systematically sorted out the difficulties and challenges in the prevention and treatment of tuberculosis from the aspects of laboratory testing methods commonly used in tuberculosis and problems in the prevention and treatment process. Based on this, the author puts forward the countermeasures and suggestions of integrating tuberculosis into tuberculosis prevention and control planning and management, implementing free diagnosis and treatment of tuberculosis, vigorously promoting the application of new diagnostic tools, strengthening scientific research on tuberculosis to improve the level of tuberculosis diagnosis technology, and carrying out multisectoral and multidisciplinary collaboration.

    Original Articles
    Effect of osteoporosis therapy on enhanced recovery after surgery among elderly patients with lumbar tuberculosis
    LI Yuan, QIN Shi-bing, DONG Wei-jie, FAN Jun, LAN Ting-long, TANG Kai, YAN Guang-xuan, WANG Heng
    Chinese Journal of Antituberculosis. 2021, 43(5):  432-436.  doi:10.3969/j.issn.1000-6621.2021.05.004
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    Objective To investigate the effect of perioperative osteoporosis treatment on enhanced recovery after surgery (ERAS) among elderly patients with lumbar tuberculosis. Methods Retrospective analysis was performed on 92 elderly patients (age ≥60 years) with lumbar tuberculosis who received surgical treatment in Beijing Chest Hospital of Capital Medical University from February 2017 to January 2020. All patients enrolled in the study had comorbidity of lumbar osteoporosis, and all patients received ERAS mode management. The patients were divided into the experimental group (48 cases) receiving anti-osteoporosis treatment and the control group (44 cases) not receiving anti-osteoporosis treatment. The effects of perioperative osteoporosis treatment on ERAS among elderly patients with lumbar tuberculosis were determined by comparing the differences of operative time, intraoperative blood loss, postoperative VAS score changes, postoperative bed time, postoperative bone graft fusion time, postoperative pedicle screw loosening, and postoperative complication rate. Results Lumbar tuberculosis was cured in all enrolled patients. After anti-osteoporosis treatment, postoperative bed rest time ((3.17±0.83) weeks), postoperative bone graft fusion time ((3.73±1.73) months) and postoperative incidence of pedicle screw loosening (6.2%, 3/48) in the experiemental group were lower than those ((3.91±0.86) weeks, (4.39±1.37) months, 15.9% (7/44)) in the control group, the differences were statistically significant (t=-4.208, P<0.001; t=-2.333, P=0.022; χ 2=4.310, P=0.038). There were no significant differences in operative time ((182.71±52.16) min, (173.75±37.83) min), intraoperative blood loss ((365.83±109.21) ml, (409.32±127.34) ml), postoperative VAS score improvement (5.29±1.24, 5.07±1.06) and postoperative complication rate (27.1% (13/48), 25.0% (11/44)) between the two groups (t=0.936, P=0.352; t=-1.762, P=0.088; t=1.033, P=0.304; χ 2=0.231, P=0.631). Conclusion Perioperative anti-osteoporosis therapy is an important part of ERAS measures for elderly lumbar tuberculosis patients complicated with osteoporosis, which can shorten postoperative bed time, maintain pedicle screw position, and accelerate bone graft fusion.

    Analysis of therapeutic effect of local application of thrombin lyophilized powder in the eradication of spinal tuberculosis focus
    FAN Jun, DONG Wei-jie, LAN Ting-long, TANG Kai, LI Yuan, YAN Guang-xuan, WANG Heng, QIN Shi-bing
    Chinese Journal of Antituberculosis. 2021, 43(5):  437-440.  doi:10.3969/j.issn.1000-6621.2021.05.005
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    Objective To explore the therapeutic effect of local application of thrombin lyophilized powder in the eradication of spinal tuberculosis focus. Methods A total of 106 spinal tuberculosis patients treated with parallel eradication of posterior spinal tuberculosis and internal fixation of bone graft between January 2020 and September 2020 from Beijing Chest Hospital Affiliated to Capital Medical University were retrospectively analyzed. They were divided into 2 groups according to the local use of thrombin during operation. The observation group (n=52) was treated with local use of thrombin for hemostasis, and the control group (n=54) was not treated with local use of thrombin. The intraoperative blood loss, 24 h postoperative blood loss, total postoperative flow, the maximum hemoglobin decrease, the percentage of hematocrit (HCT) one week after operation, the rate of blood transfusion, the occurrence of perioperative complications (thrombosis, incision nonunion, incision infection, subcutaneous hemorrhage, urinary tract infections, pulmonary infection, etc.), and the time of drainage tube removal of the two groups were compared. Results The postoperative flow 24 h postoperative, the total postoperative flow, the remove time of drainage tube, the HCT after the operation, the maximum hemoglobin decrease after the operation of observed group were significantly lower than those of the control group ((182.8±54.6) ml vs. (358.4±45.1) ml, t=2.732, P=0.009; (450.4±119.2) ml vs. (646.3±87.9) ml, t=2.264, P=0.037; (5.5±1.5) d vs. (7.2±2.1) d, t=2.132, P=0.048; (30.4±5.6) % vs. (27.2±7.3) %, t=2.238, P=0.049; (35.8±12.5) g/L vs. (48.3±17.9) g/L, t=2.056,P=0.043; respectively). The postoperative transfusion rates were 19.2% (10/52) and 27.8% (15/54) respectively in the two groups, and the difference was not significant. Conclusion Thrombin lyophilized powder can further reduce the total blood loss, the blood loss and the decreased value of hemoglobin within 24 h after the surgery of spinal tuberculosis, without increasement of the risk of postoperative complications, and can effectively promote the recovery.

    Analysis of influencing factors of postoperative cognitive dysfunction in elderly patients with spinal tuberculosis
    WAN Hai-fang, TAO Fan, ZHAO Jie, CHEN Yuan-hui, HUANG Yan-ming, FU Yun-bin
    Chinese Journal of Antituberculosis. 2021, 43(5):  441-445.  doi:10.3969/j.issn.1000-6621.2021.05.006
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    Objective To analyze the influencing factors of the postoperative cognitive dysfunction in elderly spinal tuberculosis patients undergoing the surgery, and to provide scientific evidence for the effective prevention of the perioperative neurocognitive disorders (PND). Methods A prospective observational research was conducted with 102 elderly spinal tuberculosis patients undergoing spinal surgery from Hangzhou Red Cross Hospital between January 2019 and June 2020. Clinical data of the patients were collected. Regional oxygen saturation (rSO2) was continuously measured during the operation, the cognitive function was also assessed by mini-mental state examination (MMSE) before and after the operation to analyze the influential factors of PND in elderly spinal tuberculosis patients after surgery. Results Among the 102 patients, 10 withdrawn and the other 92 completed the study. Of these 92 patients, 74 (80.43%) did not occur PND, and 18 (19.57%) occurred PND 7 days after operation, and 10 cases recovered 30 days postoperative. A univariate analysis revealed that the duration of rSO2 <60% intraoperative was 41.5 (33.5, 64.7) minutes in patients with PND, which was significantly longer than that in patients without PND (0.0 (0.0, 5.8) minutes, Z=-6.454, P=0.001). The multivariate logistic regression analysis showed that the risk of PND in patients with the duration of rSO2 <60% during 31-59 minutes was 5.903 (95%CI: 1.228-28.385) times as high as that in patients with the duration ≤30 minutes; the risk of PND in patients with the duration ≥60 minutes was 10.168 (95%CI: 1.177-87.857) times as high as that in patients with the duration ≤30 minutes. Conclusion The long duration of rSO2 <60% in the spinal tuberculosis surgery was a risk factor of PND. During the operation, attention should be paid to the change of cerebral oxygen saturation, and the timely intervention would help to avoid low cerebral oxygen saturation in patients.

    Effect of cortical bone trajectory screw fixation on postoperative rehabilitation of elderly patients with lumbar tuberculosis
    ZHANG Peng, FEI Jun, SHI Shi-yuan, HU De-xin, CHEN Gen-jun, ZHANG Chen-wei, WANG Min
    Chinese Journal of Antituberculosis. 2021, 43(5):  446-451.  doi:10.3969/j.issn.1000-6621.2021.05.007
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    Objective To explore the effect of cortical bone trajectory (CBT) screw fixation on enhanced recovery after surgery(ERAS)in elderly patients with lumbar tuberculosis. Methods Seventy-eight elderly patients with lumbar tuberculosis who underwent surgical treatment from January 2019 to January 2020 in Hangzhou Chest Hospital were enrolled. The patients were divided into CBT group and traditional group according to internal fixation methods, and then managed with ERAS. Among them, there were 38 cases in the CBT group admitted from July 2019 to January 2020, including 21 males and 17 females, average age (73.95±5.30) years; average T value of bone mineral density was -2.34±0.46; 30 cases got single-segment vertebral destruction, 8 cases got two-segment vertebral destruction; 12 cases with diabetes mellitus, 16 cases with hypertension, and 27 cases with pulmonary tuberculosis. There were 40 cases in the traditional group admitted from January 2019 to June 2020, including 23 males and 17 females, average age (73.75±5.02) years; average T value of bone density was -2.22±0.40; 34 cases got single-segment vertebral body destruction, 6 cases got two-segment vertebral body destruction; 13 cases with diabetes mellitus, 15 cases with hypertension, 30 cases with pulmonary tuberculosis. The operation time, intraoperative blood loss, 24 h postoperative VAS score, postoperative bedding time, length of hospital stay and postoperative complications were compared between the two groups. Results The operation time ((231.34±8.57) min), intraoperative blood loss ((483.34±58.90) ml), 24 h postoperative VAS score (4.11±0.83), postoperative bedding time ((7.32±1.85) d), length of hospital stay ((21.82±4.57) d) in CBT group were significantly lower than the traditional group ((246.98±11.81) min), ((517.48±37.16) ml), (5.10±1.06), ((8.33±1.62) d), ((24.38±3.25) d), the differences between them were statistically significant (t values were -6.664, -3.077, -4.601, -2.567, -2.863,P values were 0.000, 0.003, 0.000, 0.012, 0.005 respectively). In addition, the complication rate in the CBT group was 2.6% (1/38), while 7.5% (3/40) in the traditional group (χ2=0.949,P=0.330). Conclusion CBT screw fixation has a positive effect on ERAS in elderly patients with lumbar tuberculosis, which can significantly reduce intraoperative blood loss and operation time, promote recovery and shorten the length of hospital stay.

    Effect evaluation of rapid rehabilitation based systematic model in patients with sleep disorder after thoracolumbar tuberculosis surgery
    AI Ya-juan, HAN Xu
    Chinese Journal of Antituberculosis. 2021, 43(5):  452-456.  doi:10.3969/j.issn.1000-6621.2021.05.008
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    Objective Effect evaluation of rapid rehabilitation based system model in patients with sleep disorder after spinal thoracolumbar tuberculosis surgery. Methods This is a retrospective study, 216 patients with thoracolumbar tuberculosis were involved from February 2016 to August 2019 treated in the 8th Medical Center, PLA General Hospital. Among them, 104 patients were treated with routine nursing care after surgery from February 2016 to August 2017, 112 patients were treated with rapid rehabilitation based systematic nursing model after surgery from September 2017 to August 2019. Forty cases were randomly selected from the two models respectively. The differences between the two groups were compared in the pain degree (by visual analogue scales, VAS) on the 3rd day and 1st week after surgery, the sleep quality (by pittsburgh sleep quality index scale) and the physical activity ability (by Braden rating scale) on the 2nd week after surgery, and the postoperative hospital stay. Results The degree of pain in the observation group after postoperative were (4.22±0.81) and (2.22±0.82) on the 3rd day and 1st week respectively, which were lower than the control group (4.98±1.12) and (2.98±1.12), the differences were statistically significant (t=3.477 and 3.463, P<0.001). The degree of Pittsburgh sleep quality index at the second week after operation in the observation group was (5.65±2.40), which was significantly lower than the control group (6.98±1.12), the differences were statistically significant (t=3.176, P=0.001). There were 28 patients (70.0%) who were able to walk frequently two weeks after surgery in the observation group, the proportion was higher than that in the control group (42.5%, 17/40), the difference was statistically significant (χ2=6.146,P=0.013).In the observation group, the postoperative hospitalization time was (14.76±0.86) days, which was less than the control group ((15.22±0.54) days), the difference was statistically significant (t=2.865, P=0.002). Conclusion The systematic nursing model based on rapid rehabilitation has a significant clinical effect in patients with sleep disorder after thoracolumbar tuberculosis surgery, which can reduce pain, improve sleep quality, and promote the recovery of activity.

    Analysis of clinical efficacy of posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system for lumbar tuberculosis
    XUE Hai-bin, LUO Xiao-bo, SUN Fei, JIAN Wei, LI Jin-long
    Chinese Journal of Antituberculosis. 2021, 43(5):  457-462.  doi:10.3969/j.issn.1000-6621.2021.05.009
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    Objective To investigate the clinical efficacy of posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system in the treatment of lumbar tuberculosis. Methods From January 2013 to March 2019, 56 lumbar tuberculosis patients treated with posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system from Department of Orthopedics, 8th Medical Center, the General Hospital of Chinese People’s Liberation Army were retrospectively reviewed. Clinical data of all the patients were complete. The mean duration of symptoms was (3.4±1.1) months (range 2-6 months) in average and all patients had single motion segment involvement. The duration of operation, intraoperative blood loss, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) preoperative and postoperative, pain visual analogue scale (VAS), Oswestry disability index (ODI), ASIA stage, change of sagittal curvature of lumbar spine (lordosis angle of lesion site), bone graft fusion postoperative and complications were analyzed to evaluated the efficacy of the surgery. Results The mean follow-up was (21.5±5.8) months (range, 18 to 48 months), the mean duration of operation was (124.5±26.2) min (range, 90 to 180 min), the mean intraoperative blood loss was (248.4±46.7) ml (range, 150 to 400 ml). The incisions of all patients healed at the first stage. Sinus formation occurred in 2 cases 1-2 months postoperative, and healed after change of dressing and adjustment of anti-tuberculosis drugs. At the end of anti-tuberculosis treatment, both ESR and CRP of all the 56 patients returned to normal. At the last follow-up, all the patients were cured and no recurrence occurred. The VAS, ODI and lordosis angle of lesion site were significantly better than those preoperative ((0.68±0.15) vs. (9.45±1.72), t=34.805, P<0.001; (9.45±1.72) % vs. (75.84±9.61) %, t=50.889, P<0.001; (5.40±1.40)° vs. (2.80±0.60) °, t=-12.774, P<0.001, respectively). Four patients with ASIA grade D paraplegia had improvement to grade E. The bone graft was fused 6 to 10 months (mean, (7.5±1.2) months) after operation in 56 patients. There were no complications such as loosening, fracture or displacement of internal fixation during the follow-up. Conclusion Posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system had good efficacy and was minimally invasive, it was a feasible method for the treatment of lumbar tuberculosis.

    Application effect of enhanced recovery after surgery in perioperative nursing for spinal tuberculosis
    WANG Qian, ZHANG Ya-chao, ZHANG Lei, LEI Guo-hua
    Chinese Journal of Antituberculosis. 2021, 43(5):  463-467.  doi:10.3969/j.issn.1000-6621.2021.05.010
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    Objective To explore the application effect of enhanced recovery after surgery (ERAS) in perioperative nursing for spinal tuberculosis. Methods A prospective observational study was conducted in consecutive 159 spinal tuberculosis patients hospitalized in the Department of orthopedics, Beijing Chest Hospital from February 2020 to January 2021, all the patients were alternatively divided into observation group (n=79, treated with ERAS in perioperative nursing) and control group (n=80, treated with standard nursing in perioperative period). The first time of taking food, anal exhaust, defecation, getting out of bed and self-urination, the rate of catheter re-insertion, the incidence of complications, and the scores of numerical rating scale (NRS) were compared between the two groups. Results The first time of taking food, self-urination, anal exhaust, defecation, getting out of bed in the observation group were significantly earlier than those in the control group (12 (7,15) h vs. 47 (42, 52) h, Z=10.899, P<0.01; 5 (3, 6) h vs. 7 (5, 7) h, Z=5.307, P<0.01; (18.47±5.78) h vs. (45.54±7.94) h, t=24.600, P<0.01; (54.41±3.89) h vs. (65.37±5.96) h, t=13.748, P<0.01; (11.35±4.23) d vs. (14.57±5.63) d, t=8.364, P<0.01, respectively). The rate of re-insertion of urinary catheter and the incidence of complications in the observation group were both significantly lower than those in the control group (3.8% (3/79) vs. 15.0% (12/80), χ2=5.838, P=0.016; 12.7% (10/79) vs. 36.3% (29/80), χ 2=11.951, P=0.001). The scores of NRS 24 hours before operation, 2 hours, 24 hours and 72 hours after operation were significantly lower than those in the control group ((3.72±0.67) vs. (5.41±1.09), t=11.794; (3.70±0.88) vs. (4.51±0.73), t=6.320; (4.10±0.89) vs. (5.76±0.83), t=12.165; (3.32±0.84) vs. (4.24±0.73), t=7.374, respectively; all P<0.01). Conclusion The application of ERAS in perioperative nursing for spinal tuberculosis could promote the early recovery of patients after operation, reduce the postoperative complications and relieve the pain.

    Application of perioperative nutrition therapy in the treatment of spinal tuberculosis under the guidance of enhanced recovery after surgery
    MIAO Rui-rui, XIN Shi-zhen, TANG Liang, NING Hua-ying, BAO Yu-cheng, ZHANG Wen-long
    Chinese Journal of Antituberculosis. 2021, 43(5):  468-474.  doi:10.3969/j.issn.1000-6621.2021.05.011
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    Objective To explore the application of perioperative nutrition therapy in the treatment of spinal tuberculosis under the guidance of enhanced recovery after surgery (ERAS). Methods A total of 97 newly treated patients with active spinal tuberculosis who underwent surgical treatment in Haihe Hospital of Tianjing Municipality from January 2017 to December 2019 were chosen and randomly allocated into the observation group (49 cases) and control group (48 cases) by using random number table. Both groups were given standardized anti-tuberculosis drug therapy plus individualized and stepwise nutritional therapy. ERAS was applied on the observation group to guide preoperative and postoperative food and water intake and preoperative glucose load control. The control group took traditional plans to guide their preoperative and postoperative oral diet. The perioperative stepwise nutrition therapy, the immediate preoperative thirst and hunger, postoperative abdominal distension before breakfast of the second day after surgery, time of first gas, perioperative blood glucose were observed. Results Among the observation group, 12.24% (6/49) had preoperative thirst and 8.16% (4/49) experienced hunger, which were both lower than those of the control group (81.25%,39/48 and 54.17%,26/48) (χ2=46.425,P=0.000;χ2=24.021,P=0.000); 4.08% (2/49) of the observation group had postoperative abdominal distension, which was lower than that of the control group (18.75%,9/48) (χ2=5.189,P=0.023); 69.39% (34/49) of patients within the observation group had postoperative time to first gas ≤12 hours, higher than that of the control group (39.58%,19/48) (χ2=8.690,P=0.003); the perioperative blood glucose of both groups increased, but the postoperative blood glucose of the observational group was lower than that in the control group (7.89±1.39 mmol/L vs. 8.80±1.08 mmol/L)(t=-3.602,P=0.001). Conclusion Perioperative nutrition therapy under the guidance of ERAS is feasible, safe and effective in the treatment of spinal tuberculosis.

    Mechanism of miR-21-3p modulating the survival of Mycobacterium tuberculosis in host macrophage
    WU Tuo-ya, SHI Jin, GUO Ji-dong, LIU Yuan-yuan, PANG Yu, LU Jie, GAO Fei
    Chinese Journal of Antituberculosis. 2021, 43(5):  475-481.  doi:10.3969/j.issn.1000-6621.2021.05.012
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    Objective To investigate the regulatory role of miR-21-3p in the immune response of macrophages infected by Mycobacterium tuberculosis (MTB), and to explore the mechanism. Methods Peripheral blood mononuclear cells (PBMC) were collected from 6 patients with clinically confirmed tuberculosis and 6 healthy subjects. After transfection with miR-21-3p mimic (mimic), miR-21-3p inhibitor (inhibitor) and negative control (NC-mimic and NC-inhibitor), the cells were collected at different time points. The cell lines THP-1 and U937 were both infected by MTB standard strain H37Rv. Real-time fluorescence quantitative reverse transcription PCR (qRT-PCR) was used to detect the expression levels of miR-21-3p and pro-inflammatory factors. The target genes interacting with miR-21-3p were screened by bioinformatics tools, and the regulatory relationship was verified by qRT-PCR. Results The detection results of clinical specimens showed that the relative expression level of miR-21-3p in PBMC of the tuberculosis group was 7.286 (6.964, 10.483) significantly higher than that of the healthy control group (1.030 (0.997, 1.169), U<0.001, P=0.002). Cell experiment results showed that 24 h after MTB infection, the relative expression levels of miR-21-3p in cell lines THP-1 and U937 were 16.311 (15.543, 17.030) and 72.850 (65.343, 97.343), respectively, which were significantly different from those before MTB infection (1.038 (0.959, 1.165) and 1.029 (0.979, 1.200), both U<0.001, both P=0.002). Colon-forming unit (CFU) results of miRNA transfected cells infected by MTB standard strain H37Rv showed that the intracellular bacteria amount of miR-21-3p mimics group 24 h after infection was 7.5×10 4 (6.0×104, 8.8×104), which was significantly lower than that in NC-mimics group (13.5×104 (12.0×104, 14.0×104), U<0.001, P=0.002). Compared with NC-mimic group, the inflammatory response of macrophages to MTB infection was significantly enhanced in miR-21-3p mimic group, and the mRNA relative expression levels of IL-6 and TNF-α increased from 1.803 (1.729, 1.892) to 4.520 (4.234, 5.205) and 0.960 (0.858, 1.020) to 1.455 (1.372, 1.523), respectively, with statistically significant differences (both U<0.001, both P=0.002). The relative expression levels of IL-6 and TNF-α in inhibitor group were 0.927 (0.901, 1.050) and 0.781 (0.705, 0.805), respectively, which were significantly lower than those in NC-inhibitor group (1.819 (1.007, 1.953) and 1.101 (0.994, 1.202); U=2.000, P=0.009 and U<0.001, P=0.002, respectively). Bioinformatics tools were used to predict the matched genes with miR-21-3p sequences, and literature search was performed to screen out 6 candidate genes related to cell proliferation, apoptosis and immune processes. After macrophage group being transfected bymiR-21-3p, MTB standard strain H37Rv were used for infection and the detection of gene expression was detected. The results showed that the relative mRNA expression of miR-21-3p simulation group cyclin-dependent kinase 8 (CDK-8) was 0.445 (0.434, 0.467), significantly lower than that in the NC-mimic group (1.025 (0.917, 1.116), U<0.001, P=0.002); CDK-8 mRNA expression level in the inhibitor group was 1.255 (1.185, 1.466), significantly higher than that in the NC-inhibitor group (0.966 (0.947, 1.042), U<0.001, P=0.002). Conclusion miR-21-3p could inhibits the growth of MTB in host cells and plays an important role in the anti-tuberculosis immune process.

    A study of dynamic monitoring of drug sensitivity of Mycobacterium tuberculosis to bedaquiline and the mechanism of drug resistance
    WANG Lu, XUE Zhong-tan, WANG Yu-feng, SHANG Yuan-yuan, REN Wei-cong, YAO Cong, GAO Fei, PANG Yu
    Chinese Journal of Antituberculosis. 2021, 43(5):  482-486.  doi:10.3969/j.issn.1000-6621.2021.05.013
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    Objective To explore the minimal inhibitory concentration (MIC) of clinical isolates of Mycobacterium tuberculosis (MTB) to bedaquiline (Bdq) by drug sensitivity test, and to analyze the mechanism of drug resistance of MTB to Bdq at the gene level. Methods MTB strains were isolated from 189 pulmonary tuberculosis patients from the cooperative Hospital of NDIP (New Drug Introduction Protection) project. Among them, 130 patients only provided the baseline (within one week before taking the first dose of Bdq) positive strains, and the other 59 also provided the positive strains collected at 2, 4, 8, 12, 16, 20 and 24 weeks after being treated with Bdq. CMP1BDQ 96 well drug sensitive microplate was used to detect the drug resistance of baseline MTB isolates to Bdq and other 11 kinds of anti-tuberculosis drugs, and the drug resistance of MTB clinical isolates to Bdq in different periods after being treated with Bdq regimen. MTB strains resistant to Bdq were screened and sequences of four genes, Rv0678, atpE, pepQ and Rv1979c, were detected. Results MIC values of 86.2% (163/189) of the baseline MTB isolates were below 0.06 μg/ml, MIC50 and MIC90 were 0.03 μg/ml and 0.12 μg/ml, respectively; the primary resistance rate of baseline MTB isolates to Bdq was 2.1% (4/189); the acquired resistance rate of patients to Bdq during the treatment was 1.6% (3/189). Rv0678 mutation was detected in all of the 4 MTB isolates from patients with primary resistance to Bdq, but no atpE, pepQ, or Rv1979c mutations were detected; Rv0678 mutation was detected in MTB isolates from 3 patients with acquired resistance to Bdq, and Rv1979c was detected in 1 case, pepQ or atpE mutations were not detected; of the 3 patients with reduced sensitivity to Bdq, 2 of the MTB isolates were detected with Rv0678 mutation, 1 was detected with Rv1979c mutation, and atpE or pepQ mutations were not detected. Conclusion At present, the drug resistance rate of clinical isolates of MTB to Bdq is low, and drug resistance mutations all occur in known genes, no new drug resistance-related genes have been found.

    Early effectiveness and safety of bedaquiline containing regimen in treatment of multidrug-resistant and extensively drug-resistant tuberculosis: An one arm observational study of 24 weeks
    SHI Zheng-yu, WU Gui-hui, HUANG Tao, LIU Yu-hong, GAO Meng-qiu, CHEN Lei, LI Xi, YANG Ming, HE Wei, CHEN Yan, LU Xiao-li, GAO Jing-tao, LI Liang
    Chinese Journal of Antituberculosis. 2021, 43(5):  487-494.  doi:10.3969/j.issn.1000-6621.2021.05.014
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    Objective To evaluate the early effectiveness and safety of bedaquiline containing regimen in the treatment of multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). Methods Patients were enrolled in Chengdu Public Health Clinical Medical Center from Mar. 2018 to Aug. 2019 and then were given bedaquiline containing anti-tuberculosis treatment. Fifty cases were enrolled, among which 8 (16.0%), 20 (40.0%), 22 (44.0%) patients were with multidrug-resistant, pre-extensively drug-resistant and extensively drug-resistant tuberculosis respectively. Within 24 weeks, Mycobacterium tuberculosis culture conversion rate and treatment outcome were analyzed to assess treatment effectiveness. Adverse events and QTcF were recorded to assess treatment safety. Results Forty-five (90.0%) cases completed follow-up at 24 weeks, 3 cases were lost, 2 cases died. 84.2% (32/38) of the patients with base-line sputum culture positive had achieved sputum culture conversion, the median time for culture conversion was 8 (4,16) weeks. 84.0% (42/50) of patients showed favorable outcomes. BMI <18.5 was an independent risk factor for treatment success (OR=0.070, 95%CI=0.005-0.922). A total of 221 adverse events occurred in 47 patients (94.0%, 47/50), and 5 severe adverse events occurred in 5 patients (including 2 deaths). The median QTcF value of 50 patients at baseline was 397.5 (385.0, 411.0) ms, which fluctuated between 417.0 (402.0, 440.0) ms (at 24 weeks) and 434.0 (403.0, 445.0) ms (at 8 weeks) after treatment (420.0 (406.0, 438.0) ms at 4 weeks, 420.0 (390.0, 440.0) ms at 12 weeks, 420.0 (400.0, 439.0) ms at 16 weeks, 418.0 (399.0, 440.0) ms at 20 weeks). There were statistically significant difference on QTcF value at each monitoring time compared with that at baseline (Z=-3.903, P<0.001, at 4 weeks; Z=-3.770, P<0.001, at 8 weeks; Z=-2.673, P=0.008, at 12 weeks; Z=-3.370, P=0.001, at 16 weeks; Z=-3.550, P<0.001, at 20 weeks; Z=-3.013, P=0.003, at 24 weeks, respectively). Six patients (12.0%, 6/50) permanently stopped using bedaquiline due to QTcF >500 ms. Conclusion Using bedaquiline containing anti-tuberculosis regimen could achieve high culture conversion rates in patients with MDR and XDR-TB, it was well tolerated too.

    Classified evaluation of the effect of standard anti-tuberculosis regimen in the treatment of initial multidrug-resistant pulmonary tuberculosis
    YANG Hong, MA Jin-bao, REN Fei, LI Xue, WU Yan-qin, LI Rong, TAN Gan-wen, YANG Han
    Chinese Journal of Antituberculosis. 2021, 43(5):  495-500.  doi:10.3969/j.issn.1000-6621.2021.05.015
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    Objective To analysis the effect of standard anti-tuberculosis regimen and long course multidrug-resistant pulmonary tuberculosis (MDR-PTB) regimen in the treatment of initial MDR-PTB after classification and evaluation, and to provide evidence for classified treatment of initial MDR-PTB. Methods A prospective cohort study was conducted with 140 patients efficiently treated with standard anti-tuberculosis regimen (3H-R-Z-E/6H-R; H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol) for 1-2 months from the Drug-resistant Tuberculosis Department, Xi’an Chest Hospital between January 2017 and December 2018. The patients were divided into two groups using random number table method (n=70 each). After evaluation by the expert group based on imaging findings and drug sensitivity test results, the patients in one group were divided into group A (low-risk group, n=28, continued the standard anti-tuberculosis regimen) and group B (high-risk group, n=42, adjusted to long course MDR regimen). The patients in the other group were divided into group C (n=25, continued the standard anti-tuberculosis regimen) and group D (adjusted to long course MDR regimen, not included in this study) according to the chemotherapy guidelines for drug-resistant tuberculosis (2015 and 2019) and patients’wishes. The patients in group A and group C continued standard anti-tuberculosis regimen. The treatment outcomes, adverse reactions and recurrence of patients in groups A, B and C were compared and analyzed. Results At the end of treatment, the success rates in groups A, B and C were 82.1% (23/28), 71.4% (30/42) and 56.0% (14/25), respectively; the absorption rates of the three groups were 85.7% (24/28), 54.8% (23/42) and 56.0% (14/25), respectively. The success rate and absorption rate between group A and group B was not statistically significant (χ2=1.049, P=0.232; χ 2=0.567, P=0.452), but they all significantly higher than those in group C (χ 2=4.238, P=0.038; χ 2=5.747, P=0.018). The incidences of adverse reactions in groups A, B and C were 21.4% (6/28), 45.2% (19/42) and 20.0% (5/25), respectively. The incidence of adverse reactions in group A was significantly lower than that in group B (χ 2=4.148,P=0.042), but the difference was not significant between group A and group C (χ2=0.016, P=0.898). The recurrence rate of group A was lower than that of group C, but the difference was not statistically significant ((8.7% (2/23) vs. 14.3% (2/14), Fisher exact test, P=0.625). Conclusion The efficacy of the standard anti-tuberculosis regimen was consistent with that of the long course MDR regimen for the initial MDR-PTB patients, but the incidence of adverse reactions in patients treated with standard anti-tuberculosis regimen was lower than those treated with long course MDR regimen. Treatment outcome of MDR-PTB patients initially assessed as “low risk” was significantly better than those of the patients not assessed; however, the adverse reactions and recurrence rates were consistent. It is suggested that the standard anti-tuberculosis regimen should be applied based on scientific evaluation of initial MDR-TB patients.

    Bacteria distribution and drug resistance of co-infection patients of human immunodeficiency virus and nontuberculous mycobacteria in Chongqing
    LIU Min, LI Ming-jun, YU Qing, HE Kun, WU Yu-shan, YANG Hong-hong, LI Tong-xin
    Chinese Journal of Antituberculosis. 2021, 43(5):  501-505.  doi:10.3969/j.issn.1000-6621.2021.05.016
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    Objective To investigate the bacterial distribution and drug resistance of human immunodeficiency virus (HIV) and nontuberculous mycobacteria (NTM) co-infected patients in Chongqing. Methods The clinical data of 44 patients with HIV and NTM co-infection admitted to Chongqing Public Health Medical Center from June 2019 to June 2020 were retrospectively analyzed. The clinical characteristics of the patients, the bacteria distribution and the results of drug susceptibility test (DST) of NTM were analyzed. Results A total of eight species of NTM strains were identified in 44 patients. Mycobacterium avium accounted for 34.1% (15/44), Mycobacterium intracellular accounted for 20.4% (9/44), Mycobacterium for tuitum/suis and Mycobacterium Kansas accounted for 11.4% (5/44) respectively, Mycobacterium cheloni abscess subgroup and Mycobacterium gordonii accounted for 6.8% (3/44) respectively, Mycobacterium surga and Mycobacterium chrysogenes accounted for 2.3% (1/44) respectively, and the NTM strains in two patients (4.5%) could not be identified.The overall resistance rates to isoniazid, pasiniazide, azithromycin and rifampicin were 81.8% (36/44), 75.0% (21/28), 61.9% (13/21) and 45.5% (20/44), respectively. The relatively low resistance rates were rifabutin (6.8%, 3/44) and clarithromycin (11.4%, 5/44). Conclusion The incidence of NTM infection in HIV infected people in Chongqing is higher. Mycobacterium avium was the most common. The overall resistance rate of NTM was high, but the resistance rate to rifabutin and clarithromycin was relatively low.

    Influencing factors of patient delay and diagnosis delay among tuberculosis patients in schools of Tongzhou District, Beijing,2014—2019
    XIE Yan-tao, GAO Han-qing, WU Yue, WANG Sai-sai, KANG Wan-li, LIU Yang
    Chinese Journal of Antituberculosis. 2021, 43(5):  506-512.  doi:10.3969/j.issn.1000-6621.2021.05.017
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    Objective To explore the influencing factors of patient delay, diagnosis delay in pulmonary tuberculosis (PTB) patients in schools of Tongzhou District of Beijing, and to provide evidence for strengthening intervention measures. Methods One hundred fifty-two new PTB patients detected from 2014 to 2019 in schools of Tongzhou District of Beijing were selected as study subjects. Retrospective study method was used to collect the medical record data from the Chinese TB Management Information System, the case investigation data using uniform questionairre across Beijing and other school-related data.Chi-squared test and multivariate logistic regression were used to analyze the influencing factors of patient delay (from symptom onset to seeking health care >14 days), diagnosis delay(from seeking medical service to diagnosis >14 days) in those PTB patients. Results The median days (quartiles) from symptom onset to seeking health care was 4.0 (0.0,11.0) days while the median days (quartiles) from seeking medical service to diagnosis was 10.5 (6.0,19.0) days. The proportions of patient delay, diagnosis delay among all patients were 16.4% (25/152),34.9% (53/152), respectively. Multivariate logistic regression analysis showed that, the risk of patient delay for PTB patients in schools without morning and afternoon symptom examination was higher (OR (95%CI)=26.900 (3.188-226.978)) than those in schools with this practice; in contrast to passive detection, the risk of patient delay was lower among school PTB patients identified by health examination (OR (95%CI)=0.049 (0.005-0.436)) and by close contact screening (OR (95%CI)=0.088 (0.010-0.802)); patients whose symptoms onset in the second and third quarter of year had a lower risk of patient delay than that in the fourth quarter (OR (95%CI)=0.089 (0.020-0.391),OR (95%CI)=0.169 (0.036-0.801)); the risk of diagnosis delay was higher for patients who were firstly diagnosed in non-TB-designated medical institutions than in special TB medical institutions (OR (95%CI)=2.638(1.203-5.785)); compared with passive detection, the risk of diagnosis delay of patients detected by close contact screening was lower (OR (95%CI)=0.169(0.037-0.785)). Conclusion The influencing factors of patient delay, diagnosis delay of PTB patients in schools of Tongzhou District of Beijing were factors about patients, medical institutions and schools. Intervention should be strengthened targeting at those influencing factors. While improving the diagnosis ability and awareness of detecting TB in non-TB-designated medical institutions, we should focus on interventions for school related factors such as morning and afternoon symptom examination system and regular health examination system to reduce the chance of delay.

    Short Articles
    Value of CD44 and related cytokine levels in the diagnosis and prognosis evaluation of active pulmonary tuberculosis
    CHEN Ke-fan, XIONG Yu-jiao, JIAO Jia-huan, YUAN Shu-sheng
    Chinese Journal of Antituberculosis. 2021, 43(5):  513-515.  doi:10.3969/j.issn.1000-6621.2021.05.018
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    In order to explore the relationship between CD44 and upstream and downstream related cytokines and the development and prognosis of active pulmonary tuberculosis (PTB), a retrospective study was conducted. Eighty-six PTB patients from the Department of Infectious Diseases, Leshan People’s Hospital between January 2018 and July 2019 were collected as the observation group, and the control group included 40 healthy subjects having physical examination in the same period. Enzyme-linked immunosorbent assay was used to detect the expression levels of CD44, interferon-γ (IFN-γ) and tumor necrosis factor α (TNF-α). The results showed that the expression levels of CD44, TNF-α and IFN-γ in the observation group before treatment and 6 months after treatment (before treatment: (54.37±8.26) μmol/L, (42.72±6.12) μmol/L and (35.83±5.14) μmol/L, respectively; after 6 months of treatment: (20.14±3.25) μmol/L, (11.38±1.52) μmol/L and (16.42±2.57) μmol/L, respectively) were all significantly higher than those in the control group ((12.16±1.42) μmol/L, (5.38±1.06) μmol/L and (7.52±1.22) μmol/L, respectively) (t values were 21.147, 26.528, 20.712, 8.106, 9.132, 11.614, respectively; all P=0.000). In the observation group, the expression levels of CD44, TNF-α and IFN-γ 6 months after treatment were significantly lower than those before treatment (t values were 10.713, 18.552, 16.124, all P=0.000). The value of CD44 expression level in predicting PTB was analyzed using receiver operating characteristic curve. The area under the curve was 0.84 (95%CI: 0.77-0.91), the cut-off value was 26.74 μmol/L, and the sensitivity was 90.3%, he specificity was 86.4%, which indicated that detecting the expression level of CD44 in peripheral blood may have diagnostic and prognostic value for PTB.

    Identification and drug resistance of 439 clinical isolates of non-tuberculosis mycobacterium in Shandong
    FENG Bin-bin, JIN Feng, JING Hui, WANG Jun-ling, LIN Mei-ying, QIAO Xiu-li, LI Ming, QIU Li-hua
    Chinese Journal of Antituberculosis. 2021, 43(5):  516-520.  doi:10.3969/j.issn.1000-6621.2021.05.019
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    In order to analyze the distribution and drug resistance of clinical isolates of non-tuberculosis mycobacterium (NTM) in Shandong, 354 clinical isolates from patients with NTM lung disease in Shandong Provincial Chest Hospital from January 2015 to December 2019 were selected for strain identification, and drug resistance of the isolates to 25 drugs such as isoniazid, rifampicin and ethambutol was also analyzed (absolute concentration method was used before 2018, and microplate method was used after 2018). The results showed that 12 species were identified from 354 clinical isolates of NTM, and the main strains were Mycobacterium intracellular (69.77%, 247/354), Mycobacterium kansasii (12.71%, 45/354) and Mycobacterium abscessus (7.63%, 27/354). Of the patients, the proportion of the male was significantly higher than that of the female ((64.97% (230/354) vs. 35.03% (124/354), χ 2=18.639, P<0.01);the proportion of aged ≥45 years old was significantly higher than that of aged <45 years old (84.75% (300/354) vs. 15.25% (54/354), χ 2=42.363, P<0.01). One hundred and eighty-three (51.69%) NTM isolates were tested for drug sensitivity, of which 50 isolates were tested by absolute concentration method. The results showed that the drug resistance rate to ethambutol was 52.00% (26/50), and the drug resistance rates of the other 9 drugs (isoniazid, rifampicin, streptomycin, capreomycin, levofloxacin, p-aminosalicylic acid, amikacin, kanamycin, ofloxacin) were all higher than 86.00%. The other 133 isolates were tested by microplate method. The results showed that the drug resistance rates of moxifloxacin, amikacin and clarithromycin were all low (0.00% (0/133), 3.76% (5/133) and 6.02% (8/133), respectively), while the drug resistance rates of imipenem/cilastatin, doxycycline, minocycline and cotrimoxazole were all high (98.50% (131/133), 91.73% (122/133), 90.23% (120/133) and 90.23% (120/133), respectively). The drug resistance of different NTM strains to some drugs showed interspecific differences.

    Analysis of drug resistance of first-line anti tuberculosis drugs in Jingzhou City of Hubei Province from 2015 to 2019
    LI Jun, ZHANG Qing-ling, ZHANG Yu, YANG Shang-peng, ZHAO Jian, ZHANG Yun
    Chinese Journal of Antituberculosis. 2021, 43(5):  521-525.  doi:10.3969/j.issn.1000-6621.2021.05.020
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    To investigate the drug resistance to first-line anti-tuberculosis drugs among tuberculosis patients in Jingzhou City, Hubei Province, a total of 2 681 samples preliminarily identified as Mycobacterium tuberculosis were tested with BACTEC MGIT 960 for 4 first-line anti-tuberculosis drugs (streptomycin:S, isoniazide:H, rifampicin:R and ethambutol:E). The results demonstrated that the total drug resistance rate was 28.87% (774/2681). The total drug resistance rates among all patients (from 2015 to 2019, 31.55% (147/466), 32.52% (159/489), 30.84% (165/535), 25.04% (151/603) and 25.85% (152/588), respectively) and among retreatment patients (from 2015 to 2019, 60.13% (92/153), 55.94% (80/143), 59.71% (83/139), 42.67% (64/150), 51.38% (56/109), respectively) both demonstrated a downward tendency over time, differences were statistically significant ( χ trend 2 =12.716,P=0.013; χ trend 2 =12.418,P=0.014).The total multi-drug resistance rate of isolates was 12.23% (328/2681), which were 5.49% (109/1987) and 31.56% (219/694) among newly treated and retreated patients respectively. The proportion of drug-resistant isolates from newly treated patients and multidrug-resistant isolates within all drug-resistant isolates (from 2015 to 2019, the former were 37.41% (55/147), 49.69% (79/159), 49.70% (82/165), 57.62% (87/151), 63.16% (96/152); the latter were 24.29% (17/70), 26.67% (16/60), 32.35% (22/68), 33.33% (21/63), 49.25% (33/67), respectively) all demonstrated an increasing tendency over time, differences were statistically significant ( χ trend 2 =22.632,P<0.01; χ trend 2 =11.466,P=0.022). The order of drugs with higher proportion of drug resistance were isoniazid (20.51% (550/2681)), streptomycin (18.99% (509/2681)), rifampicin (14.77% (396/2681)), ethambutol (7.83% (210/2681)) in sequence.

Monthly, Established in Novembar 1934
ISSN 1000-6621
CN 11-2761/R

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    China Association for Science and Technology
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    Chinese Antituberculosis Association
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    Editorial Board of Chinese Journal of Antituberculosis
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    Editor-in-chief
    WANG Li-xia(王黎霞)
    Managing Director
    Ll Jing-wen(李敬文)
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