Table of Content

10 February 2022, Volume 44 Issue 2

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Expert Note

Strengthen multi-sectoral cooperation mechanism to further promote the tuberculosis prevention and control in China

ZHANG Hui, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2022, 44(2):  115-119.  doi:10.19982/j.issn.1000-6621.20210723

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Tuberculosis is a major public health and social problem of global concern. Based on the systematic review of the concepts and components of the World Health Organization multisectoral accountability framework for tuberculosis (MAT-TB), this article analyzes the Chinese status of MAF-TB implementation and the problems that need to be solved. And finally, it puts forward the suggestions for further steps to adapt and implement MAF-TB in China.

Attention should be paid to the research and development of Mycobacterium tuberculosis antigen detection technology

SUN Zhao-gang

Chinese Journal of Antituberculosis. 2022, 44(2):  120-124.  doi:10.19982/j.issn.1000-6621.20210558

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New fast and convenient early screening or diagnosis technologies are required because of new situation of tuberculosis epidemic prevention and control. Simple, fast and cheap immunological diagnosis technology is the focus and persistent efforts of tuberculosis researchers. At present, the antigen targets of Mycobacterium tuberculosis (MTB) include the detection of single antigen and the simultaneous detection of multiple antigens. The involved detection technologies include immunological technology, mass spectrometry technology and nanotechnology. With the development of technology, great progress has been made in detection technology and research ideas of MTB antigen. However, there are still some problems. The simultaneous detection of multiple specific antigens should be deeply developed in research of MTB antigen. The development of new nanomaterials and sensing methods, as well as the discovery and research of antigens with strong specificity and good immunogenicity, are help to get new improvement and development of MTB antigen detection method.

Original Articles

Study on the clinical efficacy of a 4-month treatment program for the initial treatment of smear-negative pulmonary tuberculosis with Mycobacterium vaccae Vaccine immune intervention

LIU Li-qin, XU Zu-hui, HUANG Yi-sheng, YAO Qi-neng, TAN Yun-hong, ZHOU Lin, XIA Yin-yin, LIU Er-yong, HUANG Guo-jun, BAI Li-qiong, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2022, 44(2):  125-130.  doi:10.19982/j.issn.1000-6621.20210563

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Objective: To evaluate the clinical efficacy, adverse drug reactions, and 1-year and 2-year follow-up recurrence for the 4-month treatment program with Mycobacterium vaccae Vaccine immune intervention in the smear-negative pulmonary tuberculosis treatment, and provide a basis for shortening the course of treatment. Methods: The consecutive cases diagnosed as smear negative pulmonary tuberculosis in Shaodong County and Yueyang County of Hunan province from November 2014 to April 2016 were enrolled in the study. They were enrolled in the ‘DAP epidemiological research system’ according to the inclusion order. They were randomly assigned to the observation group and the control group. Among them, 184 cases in the observation group were treated with 2H-R-Z-E/2H-R combined with Mycobacterium vaccae Vaccine, and 180 cases in the control group were treated with 2H-R-Z-E/4H-R. The clinical efficacy and adverse drug reactions at the end of the intensive treatment and the end of the treatment course were compared between the two groups, as well as the recurrence after 1 and 2 years of follow-up. Results: A total of 364 patients were enrolled, including 292 males (80.2%) and 72 females (19.8%), with an average age of (54±17) years. At the end of the intensive period and the end of the course of treatment, the symptom improvement rates of the observation group were 86.1% (130/151) and 96.0% (145/151), respectively; the control group were 86.5% (128/148) and 95.3% (141/148), respectively. There was no significant difference between the two groups (χ ²=0.010, P=0.921; χ ²=0.103, P=0.749). The absorption rates of chest X-ray lesions in the observation group were 19.0% (35/184) and 41.3% (76/184), respectively; in the control group, they were 18.9% (34/180) and 41.7% (75/180) respectively, and the difference was not statistically significant (χ ²=0.100, P=0.920; χ ²=0.005, P=0.944). The CD4 ⁺ T lymphocyte counts of the observation group were (643.3±207.1) cells/μl and (698.5±208.9) cells/μl; the control group were (600.5±183.2) cells/μl and (625.2±177.9) cells/μl, there was no statistically significant difference between the two groups (t=1.023, P=0.309; t=1.766, P=0.081). At the end of the course of treatment, the successful treatment rate of both groups was 100.0% (184/184,180/180). After the course of treatment, the 1-year and 2-year follow-up cumulative recurrence rate in the observation group was 0.6% (1/174) and 1.2% (2/167); the control group was 1.2% (2/172) and 1.8% (3/164) respectively, the difference was not statistically significant (Fisher exact Probability method, P values were 0.621 and 0.683 respectively). During the course of treatment, the incidence of adverse drug reactions in the two groups were 19.6% (36/184) and 28.3% (51/180) respectively, and the difference was statistically significant (χ²=3.846, P<0.05). Conclusion: The clinical efficacy of the 4-month regimen combined with Mycobacterium vaccae Vaccine immunotherapy was not inferior to the 6-month standard regimen in patients with smear-negative pulmonary tuberculosis. And the incidence of adverse drug reactions is low.

Exploration of the drug use pattern of traditional Chinese medicine in the treatment of pulmonary tuberculosis and its core drug action mechanism

LIU Yuan, CHEN Jie, SUN Hui, LIU Xing, LIU Meng-xing, LI Chi-chuan, YANG Bai-rong, YANG Min

Chinese Journal of Antituberculosis. 2022, 44(2):  131-140.  doi:10.19982/j.issn.1000-6621.20210433

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Objective: Based on data mining, we explored the drug use pattern of traditional Chinese medicine for pulmonary tuberculosis (PTB), mined out its common drug pairs, and explored the mechanism of action of core drugs on PTB using network pharmacology. Methods: A database was established for the Chinese herbal compounds meeting the inclusion criteria; association model was established using the Apriori algorithm; the active ingredients and targets of the core drug pairs were screened within the TCMSP database, while the PTB disease targets were retrieved by searching the Gene Cards database to analyze the drug-disease common targets, then the targets were entered into the String database to obtain the protein interaction network. DAVID database was used for GO and KEGG pathway enrichment analysis, and Cytoscape software was used to visualize the component-target-signaling pathway. Results: One hundred and fifty-six documents were screened, involving 272 Chinese herbal medicines. The top 5 herbs were Stemonae Radix (n=113), Ophiopogonis Radix (n=104), Astragali Radix (n=89), Bletillae Rhizoma (n=86) and Rehmanniae Radix (n=83). Association analysis showed that Bletillae Rhizoma and Stemonae Radix had the highest association (support=71.81%, confidence=80.99%, lifting ratio=1.28). With network pharmacological analysis for Bletillae Rhizoma and Stemonae Radix, the major effects exerted by them might be related with cancer, hepatitis B, tuberculosis, apoptosis, MAPK, TNF (all Ps<0.01). Conclusion: Data mining showed that Bletillae Rhizoma and Stemonae Radix were the core therapeutic drug pair for treating PTB. Network pharmacological analysis revealed primary mechanism of action for those core drugs on PTB, and provided ideas for new clinical drug combinations and new drug development.

Diagnostic value of GeneXpert MTB/RIF Ultra in testing surgical tissue specimens for diagnosing tuberculosis

LEI Jing, WU Xia, TAN Xiao-wen, LI Ai-fang, CUI Xiao-li, KANG Lei, PANG Jian-jian, REN Fei, WU Shou-zhen, YANG Han

Chinese Journal of Antituberculosis. 2022, 44(2):  141-146.  doi:10.19982/j.issn.1000-6621.20210668

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Objective: To evaluate the diagnostic value of GeneXpert MTB/RIF Ultra (Xpert Ultra) in testing surgical tissue and pus specimens for tuberculosis. Methods: This prospective research collected surgical tissue and pus specimens from clinically presumptive tuberculosis patients in Xi’an Chest Hospital from January to September 2021. These samples includes 49 surgical tissues and 36 pus from the same lesion of the patients. Xpert Ultra, GeneXpert MTB/RIF (Xpert), BACTEC MGIT 960 liquid culture (MGIT 960 culture), DNA real-time fluorescent quantitative nucleic acid amplification detection (FQ-PCR), RNA real-time fluorescence constant temperature amplification (SAT-RNA), DNA real-time fluorescence constant temperature amplification method (CTM-DNA) were performed on these specimens. The clinical diagnosis result was used as the reference standard to evaluate the diagnostic value of surgical tissues of the above-mentioned various methods; differences of positive rates of the tissues and pus specimens from the same yielded of tuberculosis patients (each 28) by each method were analyzed. Results: The sensitivity of Xpert Ultra (75.0%, 24/32) on tissue samples was significantly higher than that of Xpert (65.6%, 21/32), FQ-PCR (53.1%, 17/32), SAT-RNA (25.0%, 8/24), CTM-DNA (6.3%, 2/30) and MGIT 960 culture (37.5%, 12/32). The differences between Xpert Ultra and other methods were statistically significant (χ²=32.919, P<0.001; χ ²=21.866, P<0.001; χ ²=5.418, P=0.020; χ ²=15.228, P<0.001; χ ²=11.574, P=0.001). Consistency analysis results showed: Xpert Ultra was highly consistent with clinical diagnosis results (Kappa: 0.675), Xpert and FQ-PCR were moderately consistent with clinical results (Kappa: 0.570, 0.444), MGIT 960 culture was mildly consistent (Kappa: 0.294), SAT-RNA and CTM-DNA were very poorly consistent (Kappa: 0.188, 0.044).The areas under the receiver operating characteristic curve were 0.875 for Xpert Ultra, 0.828 for Xpert MTB/RIF, 0.766 for FQ-PCR, 0.688 for culture method, 0.625 for SAT-RNA and 0.531 for CTM-DNA. The positive rates of Xpert Ultra in detecting pus and tissue samples from the same lesion of patients were 78.6% (22/28) and 71.4% (20/28),and the difference was not statistically significant (χ ²=0.382, P=0.537). Conclusion: Xpert Ultra on surgical tissue and pus specimens had a high rapid diagnostic value for tuberculosis, and there was no need to detect different types of specimen from the same lesion of patients at the same time, but considering the availability and quality of sampling, tissue specimens should be preferred.

Clinical study on one-stage focal debridement and total hip replacement for treating active hip tuberculosis

YAO Li-ming, DONG Zhao-liang, YAO Xiao-wei, WANG Lian-bo, JIA Chen-guang, LI Zhuo, LIU Feng-sheng

Chinese Journal of Antituberculosis. 2022, 44(2):  147-152.  doi:10.19982/j.issn.1000-6621.20210580

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Objective: To evaluate the therapeutic plan and clinical effectiveness of one-stage focal debridement and total hip replacement (THR) in treatment of active hip tuberculosis. Methods: A retrospective analysis was done for 25 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in Hebei Chest Hospital from June 2015 to June 2018. All patients were treated with anti-tuberculosis chemotherapy regularly for 4-8 weeks (average (6.20±1.22) weeks). The abscess, acetabular sequestra and synovium around the joint were cleared in all operations. The removed normal femoral neck issue were used as implants in area of bone defects and cementless THR as artificial arthroplasty. All cases were confirmed as hip tuberculosis by pathological examination. Anti-tuberculosis treatment were applied for at least 18 months after operations. Operative conditions, healing of lesions, the erythroeyte sedimentation rate (ESR), the C-reactive protein (CRP), position of the prostheses, recovery of hip functions and complications were observed. Results: The follow-up period ranged from 24 to 60 months (average (35.62±8.64) months). The average ESR on 1 d preoperative, 1 month postoperative and at the last time of follow-up were (41.64±12.10) mm/1 h, (23.36±5.87) mm/1 h and (9.88±2.01) mm/1 h, respectively; the average CRP were (43.60±10.35) mg/L, (14.00±3.16) mg/L and (3.80±1.19) mg/L, respectively; the average Harris hip pain scores were 18.40±4.73, 41.68±3.15 and 43.52±1.33, respectively; the average Harris hip total scores were (33.00±6.01), (92.52±3.64), and (97.36±1.80), respectively; The average ESR and CRP on 1 month postoperative and at the last time of follow-up were significantly lower than those on 1 d preoperative (F=103.008, P<0.001; F=270.299, P<0.001). The average Harris hip pain scores and total scores on 1 month postoperative and at the last time of follow-up were significantly improved from 1 d preoperative (F=432.654, P<0.001; F=1832.393, P<0.001). All patients had first intention healing. No deep venous thrombosis, pulmonary embolism, periprostheyic fracture or joint dislocation happened. There were 1 case having incision ruptured into chronic sinus at 6 weeks after surgery, and got lesions healed after dressing and applying ointment for 2 months. Other cases all got recovered with no complications. The joint prosthesis were all well positioned during the follow-up period and no recurrence were observed. Conclusion: Peroperative effective anti-tuberculosis chemotherapy combined with one-stage debridement and THR in treatment of hip joint tuberculosis can significantly decrease hip pain and improve the hip function.

Effect of fiberboard stripping by uniportal video-assisted thoracic surgery in the treatment of tuberculous empyema

LIU Xiao-yu, XU Feng, ZHOU Yi-ming, DAI Xi-yong, SHENG Jian, JIANG Yu-hui, LIU Qi-bin, SHEN Lei

Chinese Journal of Antituberculosis. 2022, 44(2):  153-158.  doi:10.19982/j.issn.1000-6621.20210701

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Objective: To explore the effect of uniportal video-assisted thoracic surgery (U-VATS) with fiberboard stripping in the treatment of tuberculous empyema. Methods: Clinical data of 132 cases underwent fiber stripping in Wuhan Pulmonary Hospital were collected. According to the operation style, they were divided into open thoracotomy group (n=74, hospitalized from June 2017 to August 2018) and U-VATS group (n=58, hospitalized from May 2020 to June 2021). The duration of operation, intraoperative hemorrhage, drainage 48 h postoperative, postoperative hospital stay, tube time complications (including reoperation hemostasis rate, incision infection rate, the incidence of paresthesia on the surgical side of the chest wall) and effects of the two groups were analyzed. Results: The duration of operation time, 48 h drainage volume and postoperative hospital stay in U-VATS group were significantly lower than those in the open thoracotomy group (210.0 (165.0, 240.0) min vs. 270.0 (210.0,330.0) min, U=1134.725; 585 (450, 813) ml vs. 865 (695, 1040) ml, U=995.463; 9.0 (8.0, 11.0) d vs. 14.0 (11.0, 16.0) d,(U=635.841; all P<0.01). The intraoperative hemorrhage, postoperative tube time, total efficiency, reoperation hemostasis rate and incision infection rate in U-VATS group was no statisticall different from those in the open thoracotomy group (400 (300,800) ml vs. 350 (200, 600) ml, U=1774.672, P=0.086; 8.0 (7.0, 9.3) d vs. 9.0 (7.0, 14.0) d, U=1879.735, P=0.267; 0.0% (0/58) vs. 1.4% (1/74), χ²=1.163, P=0.281; 1.7% (1/58) vs. 4.1% (3/74),χ ²=0.637, P=0.425,respectively). The incidence of paresthesia on the surgical side of the chest wall was 95.9% (71/74) in the open thoracotomy group, which was significantly higher than that in the Uniportal Video-Assisted Thoracic Surgery group (15.5% (9/58), χ ²=101.834, P<0.01).After over 5 months follow-up, the total effective rate in the open thoracotomy group was 93.2% (69/74), which was not statistically different from that in the Uniportal Video-Assisted Thoracic Surgery group (94.8% (55/58),χ ²=0.149, P=0.928). Conclusion: Compared with open thoracotomy, U-VATS for the treatment of stage Ⅲ tuberculous empyema was safe and effective, with less trauma, and was worthy of clinical promotion.

Research of effectiveness of fluorescence PCR melting curve assay in detecting drug resistance of levofloxacin and moxifloxacin in patients with multidrug-resistant pulmonary tuberculosis

JIN Long, TIAN Qi, ZHANG Bao-qing, XING Hai-dong, GAO Ming-xia, ZHANG Xiu-ying, WANG Li-hua, ZHANG Xiao-lei

Chinese Journal of Antituberculosis. 2022, 44(2):  159-163.  doi:10.19982/j.issn.1000-6621.20210488

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Objective: To explore the clinical value of fluorescence PCR melting curve assay for rapid detection of levofloxacin (Lfx) and moxifloxacin (Mfx) resistance of multidrug-resistant pulmonary tuberculosis (MDR-TB) patients. Methods: From November 2018 to December 2019, 195 MDR-PTB patients from Infectious Disease Hospital of Heilongjiang Province were selected as subjects. All the patients were screened by fluorescence PCR melting curve assay and confirmed by the automatic BACTEC MGIT 960 Mycobacteria Culture System and proportion method of drug sensitivity test (DST). The accuracy of fluorescence PCR melting curve assay for detecting drug resistance to Lfx and Mfx of Mycobacterium tuberculosis (MTB) was analyzed. Results: Using the proportion method, among the 195 MDR-MTB strains, the drug resistance rates of Lfx and Mfx were 46.15% (90/195) and 48.72% (95/195), respectively. Using the above results as standard, the sensitivity, specificity, consistency and Kappa value of Lfx resistance of MTB were 95.56% (86/90), 73.33% (77/105), 83.59% (163/195) and 0.83; and the sensitivity, specificity, consistency and Kappa value of Mfx resistance of MTB were 95.79% (91/95), 77.00% (77/100), 86.15% (168/195) and 0.85 by fluorescence PCR melting curve analysis. Conclusion: The results of fluorescence PCR melting curve assay in detecting the resistance of MDR-TB to Lfx and Mfx were highly consistent with the results of proportion method of DST. Fluorescence PCR melting curve analysis assay is suitable for screening the drug resistance of MDR-TB to Lfx and Mfx.

Analysis of correlation between the level of matrix metalloproteinases and anti-tuberculosis drug-induced liver injury

LU Ni-hong, SHEN Ling-jun, LIU Hong-lu, CHEN Yang-jun, DU Ying-rong

Chinese Journal of Antituberculosis. 2022, 44(2):  164-168.  doi:10.19982/j.issn.1000-6621.20210627

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Objective: To analyze levels of matrix metalloproteinases (MMP) and the correlation between the levels and anti-tuberculosis drug-induced liver injury (ATB-DILI). Methods: A retrospective research was conducted in 98 pulmonary tuberculosis patients with ATB-DILI treated in the Third People’s Hospital of Kunming from June 2019 to June 2020 (case group), and 30 outpatients with physical examination in the same period were selected as the control group. A total of 6 ml fasting venous blood was collected from the subjects in the morning. The concentrations of MMP-1, MMP-2, MMP-7, MMP-9, MMP-13 and MMP-14 were detected by double antibody sandwich method. According to the clinical classification of ATB-DILI, the subjects of the case group were divided into hepatocyte injury type (group A), cholestasis type (group B), hepatic vascular injury type (group C), and mixed type (group D); according to the severity of ATB-DILI, they were divided into grade 0 (no liver injury), grade 1 (mild liver injury), grade 2 (moderate liver injury), grade 3 (severe liver injury), grade 4 (acute liver failure), and grade 5 (lethal). The MMP levels of different clinical classification groups and the control group were compared, and the correlation between MMP levels and ATB-DILI severity classification was analyzed. Results: According to ATB-DILI clinical classification, there were 51 cases in group A, 12 cases in group B, 15 cases in group C, and 20 cases in group D. According to the ATB-DILI severity classification, there were 33 cases in grade 1, 27 cases in grade 2, 22 cases in grade 3, 14 cases in grade 4, and 2 cases in grade 5. In groups A, B, C, D and control group, concentrations of MMP-1 were (89.1±11.2) ng/ml, (32.3±6.3) ng/ml, (47.5±9.1) ng/ml, (55.2±11.1) ng/ml, and (27.5±8.2) ng/ml, respectively; MMP-2 concentrations were (8.21±2.1) ng/ml, (6.2±2.3) ng/ml, (15.5±1.8) ng/ml, (7.2±1.6) ng/ml, and (3.2±1.3) ng/ml, respectively; MMP-9 concentrations were 36.1 (25.9, 47.3) ng/ml, 11.3 (5.1, 20.6) ng/ml, 14.1 (6.1, 21.3) ng/ml, 15.3 (3.8, 28.1) ng/ml, and 6.4 (2.8, 8.6) ng/ml, respectively; MMP-14 concentrations were 5.2 (2.8, 7.5) ng/ml, 6.0 (3.6, 8.9) ng/ml, 11.2 (5.2, 17.4) ng/ml, 4.0 (1.8, 6.2) ng/ml, 2.8 (1.4, 4.3) ng/ml. The concentrations of MMP-1 and MMP-9 in group A were significantly increased, and the concentrations of MMP-2 and MMP-14 in group C were also significantly increased, both the differences were statistically significant (F=7.983, P=0.031; H=9.979, P=0.041; F=9.381, P=0.010; H=10.555, P=0.032). MMP-9 concentrations in patients with ATB-DILI severity 1, 2, 3, 4, and 5 were 16.2(13.2, 19.3) ng/ml, 21.5(18.4, 23.6) ng/ml, 24.3(20.6, 27.1) ng/ml, 30.3(25.1, 35.3) ng/ml, 38.5(33.9, 43.1) ng/ml respectively, which was positively correlated with the severity classification (r=0.882, P=0.000). Conclusion: The concentrations of MMP-1, MMP-2, MMP-9 and MMP-14 in patients with different clinical types of ATB-DILI increased to different degrees. MMP-9 concentrations are positively correlated with ATB-DILI severity. MMP level may be an influencing factor for the occurrence of ATB-DILI.

Analysis of inconsistency between genotypic and phenotypic results of Mycobacterium tuberculosis rifampicin susceptibility test

WANG Shao-hua, ZHAO Guo-lian, WANG Pei, TAN Xiao-wen, CUI Xiao-li, KANG Lei, DANG Li-yun

Chinese Journal of Antituberculosis. 2022, 44(2):  169-173.  doi:10.19982/j.issn.1000-6621.20210445

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Objective: To investigate the inconsistency between the fluorescent PCR probe melting curve method (“melting curve method”) and the microplate method in detecting the susceptibility of rifampicin, and to provide an explanation for the inconsistency between clinical genotypic and phenotypic drug susceptability test (pDST) results. Methods: We collected the data of 2562 culture positive tuberculosis patients in Xi’an Chest Hospital from August 2019 to September 2020 and screened out 1294 strains with different results using melting curve method and microplate pDST. The correlation between the inconsistent results and the mutation of rpoB gene were analyzed by sequencing the rpoB gene. Results: Among the 54 patients (4.17%, 54/1294) whose melting curve testing results were inconsistent with the pDST test results, 45 were melting curve method positive for mutants but pDST negative, and 8 were melting curve method negative for mutants but pDST positive. One case was detected as having heterogeneous drug resistance by melting curve method, thus was excluded from the analysis. When the rpoB gene was mutated at codons of 507-512, the inconsistency rate with the pDST results was the highest (70.59%, 24/34), and the minimum inhibitory concentrations of the inconsistent strains tested with the microplate method were mostly ≤1 ug/ml. Leu511pro was the most frequently observed mutation, accounting for 45.28% (24/53), followed by Leu533pro, accounting for 15.09% (8/53) of all of the inconsistent strains. Both Asp516Tyr and His526Asn mutations accounted for 5.66% (3/53). All 8 strains that were melting curve method negative for mutants but pDST positive were sequenced as no mutation in the rpoB gene region. Conclusion: The mutations of Leu511Pro, Leu533Pro, Asp516Tyr and His526Asn in the rpoB region were the main reasons for the inconsistency between the genotypic and phenotypic results for Mycobacterium tuberculosis susceptibility to rifampicin, but whether it was related to the low-level drug resistance mechanism still need further research.

Evaluation of the effects of tuberculosis infection control training courses in China, 2016-2019

ZHANG Can-you, CHEN Hui, FA Li-feng, ZHANG Hui, CHENG Jun

Chinese Journal of Antituberculosis. 2022, 44(2):  174-180.  doi:10.19982/j.issn.1000-6621.20210544

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Objective: To evaluate the mastery, dissemination and application of tuberculosis infection control (TBIC) knowledge among trainees of the TBIC training courses. Methods: A cross-sectional survey was conducted in October, 2020, and 156 trainees who participated in the training course on TBIC held by the Chinese Center for Disease Control and Prevention from 2016 to 2019 were surveyed online, and 131 (84.0%) responded effectively. Descriptive statistics and thematic framework analysis were used to analyze the accuracy rates and dissemination of TBIC knowledge (30 questions), the improvement of the facility’s IC status, and the control effectiveness of coronavirus disease 2019 (COVID-19), as well as the problems and challenges faced by the facilities in improving TBIC. Results: The accuracy rate of TBIC knowledge ranged from 23.7% (31/131) to 100.0% (131/131), and the median accuracy rate (interquartile range) was 86.7% (80.0%, 93.3%). There were 18 questions with an accuracy rate greater than 90%, 23 questions greater than 80%, and 7 questions less than 80%. All 131 respondents gave feedback on the training effect, and 74.8% (98/131) of the respondents put forward 150 suggestions for improvement of TBIC to their regions/facilities, of which 141 (94.0%) were adopted. The regions/facilities adopted the most recommendations on personal protection (28, 18.7%). 48.1% (63/131) of the survey respondents disseminated the learned theories and skills in regular trainings in their regions/facilities. 85.5% (112/131) of the survey respondents raised 132 problems and challenges faced by the regions/facilities to improve the level of TBIC. 90.6% (48/53) of survey respondents from designated hospitals that admitted COVID-19 patients reported that the training course played an important role in successfully handling the COVID-19 epidemic. Conclusion: The training course has achieved remarkable results in mastering and disseminating the theory and skills of TBIC, improving the status of IC in attendees’ regions/facilities, and helping to fight against the COVID-19 epidemic. More attention and investments on IC are still needed.

Screening of latent infection of Mycobacterium tuberculosis and analysis of influencing factors in elderly patients with type-2 diabetic mellitus in Xuhui and Changning Districts in Shanghai

CHEN Jing, XIAO Xiao, WU Zhe-yuan, RAO Li-xin, WANG Juan, ZHANG Xia, SHEN Xin, YUAN Zheng-an

Chinese Journal of Antituberculosis. 2022, 44(2):  181-186.  doi:10.19982/j.issn.1000-6621.20210579

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Objective: To investigate the screening and risk factors of latent tuberculosis infection (LTBI) in elderly patients with type-2 diabetic mellitus (DM) in Shanghai. Methods: According to inclusion criteria, 885 type-2 DM patients aged over 60 years old in Xuhui (n=430) and Changning Districts (n=455)were sequentially selected. All of them were participated in community physical examination of basic public health service program from September to December 2019. γ-interferon release test was conducted to detect LTBI. The demographics, life behavior, history of DM and other chronic diseases, and tuberculosis contact information, as well as physical examination results,etc., were collected by questionnaire. Dichotomous unconditional logistic regression were used to analyze the risk factors of LTBI in elderly type-2 DM patients. Results: Of the 885 patients, 130 were positive in LTBI test with the positive rate of 14.7%, and the positive rate in Changning District was significantly higher than that in Xuhui District (17.4% (75/430) vs. 12.1% (55/455),χ²=5.057, P=0.025). The positive rate in patients with smoking behavior was significantly higher than that in patients without smoking behavior (22.5% (20/89) vs. 13.8% (110/796), χ ²=4.783,P=0.039). According to logistic regression, smoking was a risk factor of LTBI in elderly type-2 DM patients (OR (95%CI)=1.891 (1.031-3.468)). Conclusion: The prevalence of LTBI in elderly type-2 DM patients in Shanghai is relatively lower. Follow up and health education should be strengthened to DM patients with LTBI. LTBI screening could be conducted in elderly DM patients with smoking behavior.

Analysis of epidemiological characteristics of rifampicin resistance tuberculosis in Foshan City, Guangdong Province, 2011-2020

WANG Wei, YE Yi-nong, LIN Dong-zi, ZHONG Qian-hong, HUANG Fei, DU Fang-fang, CHENG Shi-ming, ZHOU Jie, ZHANG Xi-lin, ZHONG Qiu

Chinese Journal of Antituberculosis. 2022, 44(2):  187-192.  doi:10.19982/j.issn.1000-6621.20210554

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Objective: To analyze the epidemiological characteristics of rifampicin drug-resistant tuberculosis in Foshan City through the routine surveillance data, and then provide a reference for formulating control and prevention strategies. Methods: The medical records of general tuberculosis patients, suspected drug-resistant and drug-resistant patients in the Tuberculosis Information Management System of Foshan City from 2011 to 2020 were cleaned and compiled to establish a comprehensive database. Drug resistance screening, pathogen identification and drug resistance detection were analyzed in different years from different sources, and the trend of resistance in different years was compared. Results: Among the registered pathogenic positive pulmonary tuberculosis patients in Foshan from 2011 to 2020, the pathogenic positive rate increased from 34.0% (1629/4788) in 2011 to 56.7% (1505/2655) in 2020, with an average annual increase rate of 5.8%. The overall drug resistance screening rate shows an upward trend year by year. By 2020, the drug resistance screening rate of registered pathogenic positive patients had reached 100.0% (1505/1505). From 2011 to 2020, the rifampicin resistance rates of newly treated patients, retreated patients and patients registered in previous years were 1.9% (95%CI: 1.7%-2.1%), 18.9% (95%CI: 17.6%-20.3%) and 24.4% (95%CI: 23.1%-25.8%) respectively. The rifampicin resistance rate of newly treated patients registered in the current year had been maintained at a relatively low level, and the rifampicin resistance rate of retreated patients had decreased from 14.6% (13/89) in 2019 to 2.9% (2/69) in 2020. Conclusion: Routine tuberculosis surveillance data can reflect the epidemic situation of rifampin resistant tuberculosis in Foshan city. The registration of tuberculosis patients in previous years is the focus of the next step in the prevention and control of drug-resistant tuberculosis.

Review Articles

The research progress of 3-gene host transcriptional biomarkers (GBP5, DUSP3 and KLF2)

HAN Ting-ting, CHEN Qiu-qi, DENG Guo-fang

Chinese Journal of Antituberculosis. 2022, 44(2):  193-196.  doi:10.19982/j.issn.1000-6621.20210660

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Tuberculosis remains a major public health problem in the world. Especially in developing countries, there has a serious threat to human health. Further achieving the WHO’s goal of “End TB” by 2035, there urgently need new, fast, accurate and affordable detecting techniques for diagnosing TB and monitoring treatment responses. There have researches that shown to improve the tuberculosis clinical diagnosis and treatment monitoring with a 3-gene transcriptional biomarkers including guanylate binding protein5 (GBP5), dual specificity phosphatase3 (DUSP3) and Krüppel-like transcription factor2 (KLF2). To better understanding its clinical value, we have briefly summarized the finding, development, clinical importance and limitations of 3-gene host transcriptional biomarkers.

Research progress on related factors of depression tendency in patients with multidrug resistant tuberculosis

ZHOU Qian-ru, WANG Ling-hua

Chinese Journal of Antituberculosis. 2022, 44(2):  197-202.  doi:10.19982/j.issn.1000-6621.20210411

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Depressive tendency is one of the major problems existing in patients with Multidrug Resistant Tuberculosis (MDR-TB) which would affect patients’ treatment compliance, quality of life, mental and economic well-beings. Severe depression can lead to extreme behaviors and even suicide. This paper reviews the related factors and intervention measures of depression tendency in MDR-TB patients, and puts forward the development direction and suggestions for alleviating the psychological burden and depression tendency of patients from perspectives of individuals, families, communities, hospitals and national governments.