Table of Content

10 May 2023, Volume 45 Issue 5

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Special Topic

Strengthening the capability of non-tuberculosis-designated medical institutions to improve the diagnosis of tuberculosis

Liao Yixuan, Fang Chuangsen, Li Yanming

Chinese Journal of Antituberculosis. 2023, 45(5):  437-441.  doi:10.19982/j.issn.1000-6621.20230001

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Tuberculosis remains a major public health problem worldwide. The epidemic of novel coronavirus infection (COVID-19) has negative impact on the prevention and treatment of global tuberculosis, the dual challenges of both traditional and emerging respiratory infectious diseases need to be dealt with. There are many problems in the prevention and control of tuberculosis in non-tuberculosis-designated medical institutions. Under the new situation, as a country with high burden of tuberculosis, China needs to improve the diagnosis of tuberculosis in non-tuberculosis-designated medical institutions from various aspects.

Exploration and prospect of the construction of primary tuberculosis preventive treatment clinic

Wang Dakuan, Zhang Bin, Liu Zisen, Duan Weitao, Gao Lei

Chinese Journal of Antituberculosis. 2023, 45(5):  442-445.  doi:10.19982/j.issn.1000-6621.20230083

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As one of the countries with a high burden of tuberculosis (TB) in the world, China needs to strengthen TB preventive treatment as a tool of achieving the global goals of the End TB. Identifying individuals with latent infection of TB and providing preventive treatment for those at high risk of developing active disease, such as HIV infections, close contacts of microbiologically confirmed pulmonary TB patients, and clinical immunosuppressed patients, are important measures to decline the risk of developing TB. In order to actively explore the management and intervention mode for the high-risk populations with latent TB infection at the grass-roots level, promote the implementation and optimization of TB preventive treatment strategies, and constantly develop and transform the preventive treatment in the direction of specialization, refinement, precision and sustainability, the Disease Prevention and Control Center of Zhongmu County, Zhengzhou City, Henan Province established an independent TB preventive treatment clinic in February 2023. During the trial operation period, a comprehensive evaluation will be conducted on the effectiveness of outpatient operations in a timely manner. In this paper, the author will carefully analyze and summarize the work basis and main content of the construction of primary TB preventive treatment clinic based on the exploratory work conducted in Zhongmu County.

Progress and reflections on development of laboratory diagnostic technology for tuberculosis

Li Shanshan, Wang Yufeng, Shu Wei, Pang Yu

Chinese Journal of Antituberculosis. 2023, 45(5):  446-453.  doi:10.19982/j.issn.1000-6621.20220535

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Rapid and accurate laboratory diagnostic techniques are of great importance for the prevention and control of tuberculosis (TB). Since the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, significant achievements have been made in the development of TB diagnosis from traditional etiological diagnostics to immunological and molecular diagnostics. Nevertheless, the current diagnostic technologies remain unable to meet current requirements, thereby hampering the achievement of the End TB Strategy by 2035. In view of these challenges, the authors discuss the core diagnostic needs of TB prevention and control, and explore the important development pipeline of future laboratory diagnosis.

Interpretation of Standards

Strive for excellence with an emphasis on fundamentals and innovations: interpretation of the WHO Global Tuberculosis Report 2022

Shu Wei, Liu Yuhong

Chinese Journal of Antituberculosis. 2023, 45(5):  454-457.  doi:10.19982/j.issn.1000-6621.20230102

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Tuberculosis (TB) prevention and control work needs innovative research and development to accelerate the implementation of the World Health Organization (WHO) End TB Strategy. On 27th October 2022, WHO released the Global Tuberculosis Report 2022, updating the latest progress of global TB research and innovation. This paper reviews the key achievements in the areas of research and innovation for new diagnostics, drugs and regimens as well as vaccines introduced in the report, and discusses some of China’s indigenous progresses in related areas. This paper aims to make China’s TB professionals better informed about the latest research development in TB prevention and control around the globe, fostering indigenous TB innovation efforts with greater originality.

Interpretation of the World Health Organization’s Practical Manual on Tuberculosis Laboratory Strengthening (2022 Update) and consideration on strengthening tuberculosis laboratory network in China

Xia Hui, Zhao Yanlin

Chinese Journal of Antituberculosis. 2023, 45(5):  458-463.  doi:10.19982/j.issn.1000-6621.20230032

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The World Health Organization released Practical Manual on Tuberculosis Laboratory Strengthening (2022 Update) in January 2023. The manual updated and described the relevant elements of laboratory network strengthening. To help relevant staffs fully understand the contents of this manual, this article summarized and interpreted the key contents, and proposed some thoughts on strengthening tuberculosis laboratory network in China.

Original Articles

The role of miR-99a-5p in the immune regulation of host macrophages infected by Mycobacterium tuberculosis

Shi Yuting, Dong Jing, Jia Hongyan, Zhu Chuanzhi, Yang Bin, Li Zihui, Sun Qi, Du Boping, Xing Aiying, Zhang Zongde, Pan Liping

Chinese Journal of Antituberculosis. 2023, 45(5):  464-471.  doi:10.19982/j.issn.1000-6621.20220532

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Objective: To explore the role of specific microRNA in THP-1 cells mediated host defense against Mycobacterium tuberculosis (MTB) infection. Methods: Total RNA were extracted from THP-1 cells with or without MTB (H37Rv) infection, and then the miRNA expression profiles in THP-1 cells with or without MTB infection were identified using Illumina NovaSeq6000 next-generation sequencing platform. Four health controls were recruited and the human monocyte-derived macrophage (hMDM) were separated. Validation of differentially expressed miRNA between MTB infected and uninfected THP-1 cells, as well as that between MTB infected and uninfected hMDM, were performed by quantitative real-time PCR (qRT-PCR). The miRNA overexpression vector was constructed and transfected into THP-1 macrophages by lentivirus. The expression level of tumor necrosis factor-α(TNF-α), interferon-γ(IFN-γ) and colony-forming unit (CFU) in H37Rv infected THP-1 cells which were transfected with miRNA overexpression vector or control empty vector was tested using qRT-PCR. Results: miR-99a-5p was selected as the study target gene (P=0.021) by not previously studied and most significantly different, from 16 miRNA molecules with significant expression differences in second-generation sequencing results. By qRT-PCR validation in THP-1 cells and primary macrophages, miR-99a-5p expression within THP-1 infected groups (0.482±0.148) and primary macrophages (0.433±0.072) were significantly lower than the uninfected group (1.536±0.290 and 1.113±0.218)(t=6.476,P<0.001; t=3.167,P=0.019). CFU results of the THP-1 cells infected by MTB showed that the intracellular bacteria amount of miR-99a-5p overexpression cells at 24 h after infection was 64.0×10⁴ (52.0×10⁴,87.0×10⁴), which was significantly higher than that in the control cells (17.0×10⁴ (16.0×10⁴,24.0×10⁴))(Z=-2.323, P=0.029). Furthermore, the expression levels of TNF-α and IFN-γ in MTB infected miR-99a-5p over expression cells were 1.018±0.310 and 1.687±0.135, which were significantly lower than TNF-α (0.740±0.001) and IFN-γ (0.631±0.374) those in the MTB infected control cells (t=4.631, P=0.010; t=3.349, P=0.010). Conclusion: miR-99a-5p can inhibit the release of TNF-α and IFN-γ, promote the growth of MTB in macrophages. Therefore, the decreased miR-99a-5p expression after MTB infection may play a protective role in host innate immunity against MTB infection.

The performance of interferon gamma-induced protein 10 mRNA detection technology in auxiliary diagnosis of tuberculosis

Song Ruixue, Wei Rongrong, Dong Jing, Jia Hongyan, Du Boping, Sun Qi, Xing Aiying, Li Zihui, Zhu Chuanzhi, Zhang Zongde, Pan Liping

Chinese Journal of Antituberculosis. 2023, 45(5):  471-476.  doi:10.19982/j.issn.1000-6621.20220518

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Objective: To evaluate the performance of the interferon gamma-induced-protein 10 (IP-10) assay (IP-10.TB) in auxiliary diagnosis of tuberculosis (TB), and analyze the concordance between IP-10.TB assay and the whole blood interferon gamma release assay (QFT-GIT). Methods: Suspected TB patients were prospectively and consecutively recruited in Beijing Chest Hospital, Capital Medical University between November 2021 and July 2022. According to the clinical manifestations, routine biochemical examinations, histopathological, radiological and (or) etiological examinations, a total of 158 cases with conclusive diagnosis were finally included, and the subjects were divided into definite TB group (88 cases), clinically diagnosed TB group (29 cases) and non-TB group (41 cases). IP-10.TB and QFT-GIT assays were simultaneously performed on peripheral blood samples. The diagnostic performance of IP-10.TB and QFT-GIT were analyzed using the receiver operating characteristic curve. Accordance of IP-10.TB and QFT-GIT was analyzed by Cohen’s Kappa test. Results: Among the 158 participants, there were 7 cases (4.4%) with indeterminate results of IP-10.TB and 5 cases (3.2%) with indeterminate results of QFT-GIT, respectively. No significant difference was detected in the ratio of indeterminate results between IP-10.TB assay and QFT-GIT (χ²=0.346, P=0.556). The total sensitivity and specificity of IP-10.TB assay were 96.3% (95%CI: 90.1%-98.8%) and 64.1% (95%CI:47.2%-78.3%), respectively; while the total sensitivity and specificity of QFT-GIT assay were 97.2% (95%CI: 91.4%-99.3%) and 64.1% (95%CI: 47.2%-78.3%), respectively. The total concordance rate of these two methods was 92.5% (95%CI: 88.2%-96.8%), the positive concordance rate was 95.0% (95%CI: 91.0%-98.9%) and the negative concordance rate was 82.1% (95%CI: 68.0%-96.3%). The Cohen’s Kappa value was 0.760 (95%CI: 0.624-0.895, P<0.001) between IP-10.TB and QFT-GIT assays. Conclusion: These results showed that the performance of IP-10.TB was consistent with that of QFT-GIT for auxiliary diagnosis of TB.

Clinical value of common in situ pathological staining in diagnosis of pulmonary tuberculosis

Li Hongna, Mao Xin, Xu Biyu, Wu Chenyang, Dong Liru, Song Xudong

Chinese Journal of Antituberculosis. 2023, 45(5):  477-482.  doi:10.19982/j.issn.1000-6621.20220537

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Objective: To explore the clinical application value of four common in situ pathological detection techniques in the detection and diagnosis of pulmonary tuberculosis. Methods: Paraffin-embedded lung tissue samples were collected from 106 patients suspected of pulmonary tuberculosis in the Pathology Department of the North China University of Science and Technology Affiliated Hospital from January 2018 to June 2022. According to the clinical diagnostic criteria, 74 patients were diagnosed as pulmonary tuberculosis and 32 were diagnosed as non-pulmonary tuberculosis (including pulmonary sarcoidosis 10 cases, chronic non-necrotizing granulomatous inflammation 22 cases). Four common in situ pathological staining techniques (antacid staining, auramine O fluorescence staining, immunohistochemistry and in situ hybridization) and real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) were used to analyze and compare the diagnostic efficacy of the four techniques in the histopathologic diagnosis of pulmonary tuberculosis. Results: Based on the clinical diagnosis results, the sensitivity, specificity and Kappa values of acid-fast bacillus staining of paraffin-embedded lung tissue samples were 35.1% (26/74), 100.0% (32/32) and 0.246, respectively. The sensitivity, specificity and Kappa values were 56.8% (42/74), 93.8% (30/32) and 0.399 of auramine O fluorescence staining, 47.3% (35/74), 100.0% (32/32) and 0.351 of immune-histochemical detection, 78.4% (58/74), 100.0% (32/32) and 0.686 of in situ hybridization, and 81.1% (60/74), 100.0% (32/32) and 0.721 of qRT-PCR, respectively. Compared with the clinical diagnosis results, among the four in situ pathological techniques, only in situ hybridization had a higher Kappa value of 0.686. Conclusion: Based on clinical diagnosis results and real-time PCR, among the four in situ pathological detection techniques, in situ hybridization has a high consistency with clinical diagnostic results, and can be used for patients with pulmonary tuberculosis that cannot be diagnosed by histopathological morphology.

Evaluation of the effect of BS-400 Automatic Mycobacterium Liquid Culture System on Mycobacterium culture

Yue Yongning, Fan Dapeng, Shang Xuechai, Li Hao, Li Huanyu, Zhou Jinyang, Cai Long

Chinese Journal of Antituberculosis. 2023, 45(5):  483-487.  doi:10.19982/j.issn.1000-6621.20220411

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Objective: To evaluate the effectiveness of the BS-400 Automatic Mycobacterium Liquid Culture System (BS-400 Culture System) in cultivating Mycobacterium in clinical specimens. Methods: A total of 427 specimens of suspected tuberculosis patients who visited Hangzhou Thoracic Hospital Affiliated to Zhejiang University School of Medicine from March to May 2022 were collected. The specimens included 331 respiratory tract specimens (including sputum and respiratory lavage fluid) and 96 non-respiratory tract specimens (including cerebrospinal fluid, tissues, secretions, urine, bone marrow, necrosis, etc.), except blood and feces. All specimens were simultaneously cultured using the BACTEC MGIT 960 liquid culture system (MGIT 960 culture system) and the BS-400 culture system. Bacterial isolation and species identification would be carried out on samples with positive culture results. The differences in the positive rate, detection time, contamination rate, and cost of two culture systems for different types of Mycobacterium specimens were compared, and the detection efficiency of the BS-400 culture system for Mycobacterium infections in different types of specimens was evaluated using the culture results of the MGIT 960 culture system as a reference standard. Results: The positive rate of BS-400 culture system for respiratory tract specimens was 32.02% (106/331), and the contamination rate was 5.14% (17/331); the positive rate of culture for non-respiratory tract specimens was 17.70% (17/96), and the contamination rate was 1.04% (1/96), compared with those of MGIT 960 culture system (32.93% (109/331) and 5.44% (18/331), 15.63% (15/96) and 2.08% (2/96), respectively), the difference was not statistically significant (χ² values were 0.062, 0.030, 0.150, and 0.339, P values were 0.803, 0.862, 0.699, and 1.000, respectively). The detection time was 12.31 (7.89, 19.56) days of the BS-400 culture system, and was 9.79 (7.00, 16.58) days of the MGIT 960 culture system, with no statistically significant difference (Z=-1.895, P=0.058). Using the culture results of MGIT 960 culture system as a reference standard, the sensitivity and specificity of BS-400 culture system for detecting Mycobacterium infection specimens in respiratory tract were 93.58% (102/109) and 98.20% (218/222), and the Kappa value was 0.924; the sensitivity and specificity for detecting Mycobacterium infection specimens in non-respiratory tract were 100.00% (15/15) and 97.53% (79/81), and the Kappa value was 0.925. The testing cost of the BS-400 culture system (RMB (55±10) yuan per specimen) was approximately 70% of that of the MGIT 960 culture system (RMB (75±10) yuan per specimen). Conclusion: BS-400 culture system has high detection efficiency for Mycobacterium in clinical samples of suspected tuberculosis patients, and has good application value.

Diagnostic value of a nanopore sequencing assay of bronchoalveolar lavage fluid in smear-negative pulmonary tuberculosis

Yan Xiaojing, Wang Qingfeng, Yang Yang, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2023, 45(5):  487-492.  doi:10.19982/j.issn.1000-6621.20230036

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Objective: To determine the diagnostic accuracy of a nanopore sequencing assay for testing of bronchoalveolar lavage fluid (BALF) samples from suspected pulmonary tuberculosis (PTB) patients. Methods: Fifty cases with suspected PTB from Beijing Chest Hospital from November 2021 to April 2022 were collected. These cases were diagnosed based on results of MGIT 960 culture, GeneXpert MTB/RIF testing and nanopore sequencing of BALF samples collected during hospitalization. Taking the final clinical diagnosis as the reference standard, diagnostic accuracies of the three assays were compared. Results: Among the 50 cases analysed in this study, 22 (44.0%) were diagnosed as tuberculosis, 10 (20.0%) non-tuberculous mycobacteria and 18 (36.0%) bacterial pneumonia. Taking the clinic diagnosis as the reference standard, the sensitivity of nanopore sequencing assay technology, MGIT 960 culture and Xpert assay were 72.7% (16/22), 27.3% (6/22) and 31.8% (7/22), respectively, the specificity were 78.6% (22/28), 75.0% (21/28) and 96.4% (27/28), respectively, the accuracy were 76.0% (38/50), 54.0% (27/50) and 68.0% (34/50), respectively, and the Yoden index was 0.51, 0.02 and 0.28, respectively. Conclusion: Nanopore sequencing assay of BALF samples may have better diagnostic performance than Xpert and MGIT 960 cultures, and may improve the positive detection rate of BALF in suspected PTB patients. But this method cannot exclude pulmonary tuberculosis.

Effect of sugammadex on plasma concentration of rocuronium and muscle relaxation recovery in elderly patients with pulmonary tuberculosis after lobectomy

Zhang Xin, Liu Tao, Shi Zhiguo, Zhai Wenting, Chen Bin, Liu Wei

Chinese Journal of Antituberculosis. 2023, 45(5):  493-498.  doi:10.19982/j.issn.1000-6621.20220505

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Objective: To evaluate the effect of sugammadex on muscle relaxation recovery and rocuronium plasma concentration in elderly patients with pulmonary tuberculosis after lobectomy. Methods: Sixty-eight elderly patients undergoing pulmonary lobectomy for pulmonary tuberculosis under general anesthesia in Beijing Chest Hospital affiliated to Capital Medical University were selected and randomly divided into an observation group and a control group by computer-generated random sequence from September 20, 2021, to July 5, 2022, with 34 cases in each group. Four patients were excluded from the observation, and three from the control group. Thus 30 patients of the observation group and 31 patients of the control group were included in the analysis. Anesthesia was induced with 0.6 mg/kg rocuronium. TOFC=0 was maintained with rocuronium during surgery. When the second twitch (T₂) reappeared at the end of the operation, the observation group was given 2 mg/kg sugammadex while the control group was given 0.05 mg/kg neostigmine and 0.025 mg/kg atropine to antagonize muscle relaxation. Liquid chromatography-tandem mass spectrometry was used to detect rocuronium plasma concentrations at T₂ reappearance and 5 min and 30 min after muscle relaxation antagonism. The minutes to return to TOFR=0.7, 0.8, and 0.9 from T₂ were recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded before muscle relaxation antagonism and at 1, 2, 3, and 5 min after antagonism, together with time of spontaneous respiratory recovery, extubation, and postoperative hospital stay. Results: The plasma concentrations of rocuronium in the observation group were (82.9±13.9) μg/ml and (68.1±9.9) μg/ml at 5 min and 30 min after muscle relaxation antagonism which were significantly higher than those in the control group ((66.1±19.7) μg/ml, (44.0±16.0) μg/ml), and the differences were statistically significant (t=3.837, 7.046, both P<0.001). The recovery time of TOFR to 0.7, 0.8, and 0.9 in the observation group were (2.0±0.9) min, (2.5±1.1) min, and (3.9±2.8) min, respectively, which were significantly shorter than those in the control group ((7.3±3.6) min, (10.2±5.1) min, (15.8±7.8) min), and the differences were statistically significant (t=-7.829, -8.087 and -7.878, all P<0.001). The spontaneous respiration recovery time, extubation time, and hospital stay in the observation group were (12.1±5.4) min, (15.5±6.6) min, and (7.1±2.1) d, respectively, lower than the control group ((17.4±7.3) min, (19.5±7.0) min, and (8.6±3.4) d, respectively). And the differences between the two groups had statistical significance (t=-3.215, -2.295, and -2.065; P=0.002, 0.025, and 0.043). Conclusion: Using sugammadex after thoracoscopic lobectomy in elderly patients with pulmonary tuberculosis could rapidly increase plasma inactive rocuronium concentration, rapidly reverse muscle relaxation, and significantly shorten respiratory recovery time, extubation time, and hospital stay.

Analysis of risk factors for acute cerebral infarction combined with intracranial tuberculosis

Li Xiang, Qi Min, Jiang Jianjie, Wei Jialu, Fu Xuwen, Li Haiwen, Zhang Le

Chinese Journal of Antituberculosis. 2023, 45(5):  499-506.  doi:10.19982/j.issn.1000-6621.20220507

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Objective: To analyze the clinical characteristics and the risk factors of acute cerebral infarction in patients with intracranial tuberculosis. Methods: A retrospective study was conducted to collect 84 patients with positive cultures of Mycobacterium tuberculosis in cerebrospinal fluid admitted to the Kuming Third People’s Hospital of Kunming from July 2019 to December 2021. The clinical symptoms, laboratory test results and imaging findings of these study subjects were collected; based on the cranial magnetic resonance imaging (MRI) performance, these study subjects were divided into cerebral infarction group (32 cases, 38.1%) and non-cerebral infarction group (52, 61.9%). Univariate and multivariate logistic regression were used to analyze the risk factors of intracranial tuberculosis complicated with acute cerebral infarction. Results: Commonly clinical symptoms of intracranial tuberculosis included headache (95.2%,80/84), fever (73.8%,62/84), vomiting (52.4%,44/84) and unconsciousness (48.8%,41/84). The convulsions (7.1%,6/84) was rare. The peripheral blood magnesium concentration (median (interquartile)) of 0.80 (0.75, 0.85) mmol/L (normal value 0.73-1.06 mmol/L) in the non-cerebral infarction group was significantly lower than that of 0.84 (0.81, 0.89) mmol/L in the cerebral infarction group, and the difference was statistically significant (Z=2.079, P=0.038). In the cerebral infarction group, cranial MRI showed thickened meninges in the basal/annular cistern in 31 cases (96.9%), thickened meninges in the lateral fissure cistern in 21 cases (65.6%), and combined with thickened arterial vessel walls in 31 cases (96.9%). In the non-cerebral infarction group, cranial MRI showed thickened meninges in the basal/annular cistern in 26 cases (50.0%), thickened meninges in the lateral fissure cistern in 18 cases (34.6%), and combined with thickened arterial vessel walls in 28 cases (53.8%). The incidence of basal/annular cistern meningeal thickening, lateral fissure cistern meningeal thickening and arterial vessel wall thickening were significantly higher in the cerebral infarction group than in the non-cerebral infarction group, with significant differences (χ²=19.956,P=0.000;χ²=7.659,P=0.006;χ²=17.545,P=0.000). Multivariate logistic regression analysis showed that arterial vessel wall thickening might be an independent risk factor for intracranial tuberculosis combined with acute cerebral infarction (OR (95%CI)=27.128 (3.393-216.917)). Conclusion: The common clinical symptoms of intracranial tuberculosis included headache, fever, vomiting and unconsciousness, and the MRI result showed that thickening of the arterial vessel wall might be an independent risk factor for acute cerebral infarction.

Study on the effect of daily average temperature on the incidence of tuberculosis in Shufu County at Xinjiang, based on a distributed lag nonlinear model

Meiheriban·Maimaiti , Mawlanjan·Emam , Lu Dongmei, Zheng Yanling, Zhang Xueliang, Peng Xiaowang

Chinese Journal of Antituberculosis. 2023, 45(5):  507-513.  doi:10.19982/j.issn.1000-6621.20220488

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Objective: To investigate the effect of temperature on the incidence of pulmonary tuberculosis in Shufu County, Kashgar Region, Xinjiang Uygur Autonomous Region. Methods: The number of reported cases of pulmonary tuberculosis in Shufu County, Kashgar Region, Xinjiang Uygur Autonomous Region from January 1, 2017 to December 31, 2021 was sourced from the Chinese Infectious Disease Reporting System. Meteorological data for the same period in the region, including average daily temperature, average daily relative humidity, and average daily wind speed, were obtained from the China Meteorological Data Network. Spearman correlation analysis and distribution lag nonlinear model analysis were performed on the daily mean air temperature and daily incidence of tuberculosis cases to study the association effect of air temperature and daily incidence of pulmonary tuberculosis in Shufu County. Results: From 2017 to 2021, a total of 5212 cases of pulmonary tuberculosis were reported in Shufu County, including 2669 males and 2543 females; higher incidence in people aged ≥65 years old (3269 cases); the highest number of daily onset cases was 76; the median (quartile) of daily average temperature was 14.7 (2.30, 22.50) ℃. The Spearman correlation analysis showed a positive correlation between the daily incidence of tuberculosis and the daily average temperature (correlation coefficient 0.070, P<0.01). The results of the distributed lagged nonlinear model analysis showed a nonlinear relationship between air temperature and pulmonary tuberculosis. The effect of low temperature (-4 ℃) on the daily risk of pulmonary tuberculosis incidence in the 36-64-year-old population was more pronounced, and the RR values showed a trend of decreasing and then increasing with increasing lag time, reaching a maximum RR value at a lag of 28 d on the daily risk of pulmonary tuberculosis incidence in the 36-64-year-old population (RR (95%CI)=2.833 (1.581-5.078)). The effect of low temperature (-4 ℃) on the number of daily incidences of pulmonary tuberculosis in women was more pronounced, with a trend of decreasing and then increasing RR values as the lag time increased, also reaching a maximum RR value at a lag of 28 d on the risk of daily incidences of pulmonary tuberculosis in women (RR (95%CI)=2.377 (1.334-4.234)). Conclusion: Temperature was associated with the risk of pulmonary tuberculosis incidence in the population in Shufu County, Kashgar Region, Xinjiang Uygur Autonomous Region, and the risk of pulmonary tuberculosis incidence was increased in women and people aged 36-64 years in a low-temperature environment.

Study on the predictive effect of seasonal auto regressive integrated moving average model on the incidence of pulmonary tuberculosis

Ren Feilin, Liu Xiaoqi, Jin Meihua, Sun Xiuxiu

Chinese Journal of Antituberculosis. 2023, 45(5):  514-519.  doi:10.19982/j.issn.1000-6621.20220517

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Objective: To analyze the accuracy of seasonal difference auto regressive moving average (SARIMA) model in predicting the incidence of pulmonary tuberculosis (PTB). Methods: From January 2010 to December 2021, PTB incidence data of Huzhou City, Zhejiang Province collected through “Infectious Disease Reporting System” which was a subsystem of the “Chinese Disease Prevention and Control Information System”. SARIMA models based on monthly incidence rate and case number were established using data from January 2010 to December 2020 while the validation of the model used data from January to December 2021. Prediction effect of the two models were evaluated by two indexes, the mean absolute percentage error (MAPE) and the relative root mean square error percentage (RMSEP). Results: The best model of SARIMA were (0,0,1)(0,1,1)₁₂ for the case number and (0,0,1)(1,1,1)₁₂ for the incidence. The actual reported case number in September 2021 was above the upper limit of 95% confidence interval of the model prediction with a difference of 28.571%. The reported case number of other months were all within the predicted 95% confidence interval (109 cases). All monthly reported incidences were within the predicted 95%CI range. The maximum difference between the predicted incidence and the actual incidence was 8.665%. Counting annual cumulative case number and incidence in 2021, the differences between the predicted value and the true value of the case number model and the incidence model were 4.866% and 2.483%, respectively. MAPE of the case number model was 9.925%, and RMSEP was 14.167%. MAPE of the incidence model was 3.798%, and RMSEP was 4.463%, both were smaller than those of the case number SARIMA model. Conclusion: The SARIMA model based on the monthly reported PTB incidence and case number in Huzhou City from 2010 to 2020 had a good fitting effect. The predictive effect of SARIMA model of the incidence was better than that of the case number model.

Review Articles

Establishment and research progress of rabbit model of spinal tuberculosis

Yang Jun, Deng Qiang, Peng Randong, Li Junjie, Wang Yurong, Yang Haiyun, Du Jianqiang

Chinese Journal of Antituberculosis. 2023, 45(5):  520-525.  doi:10.19982/j.issn.1000-6621.20220516

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Tuberculosis is caused by Mycobacterium tuberculosis by invading human organs. Spinal tuberculosis accounts for 50% of extra-pulmonary tuberculosis and has become a serious orthopedic disease that threatens human health. The pathogenesis of spinal tuberculosis has not yet been fully understood, and the available anti-tuberculosis drugs and treatment options are limited. As a powerful tool for studying the pathogenesis of diseases and therapeutic drugs, animal models have received considerable attention. New Zealand rabbits are widely used as animal models in the experimental study of spinal tuberculosis because of their similar anatomical structure of lumbar vertebrae to humans, the manifestation of bone tuberculosis can reproduce the pathological manifestations of human tuberculosis, and the convenient operation of constructing spinal tuberculosis models. This article reviewed the construction method of spinal tuberculosis rabbit models and the application value in the pathogenesis of tuberculosis, the development of new anti-tuberculosis drugs and local drug loading research, to provide reference for the establishment and application of rabbit models in basic research related to spinal tuberculosis.