Table of Content

10 January 2026, Volume 48 Issue 1

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Guideline·Standard·Consensus

Expert consensus on TCM syndrome differentiation, treatment principles, formulas, and herbs for latent tuberculosis infection

Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences , Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University , Chinese Antituberculosis Association , Editorial Board of the Chinese Journal of Antituberculosis

Chinese Journal of Antituberculosis. 2026, 48(1):  1-8.  doi:10.19982/j.issn.1000-6621.20250421

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The preventive treatment of latent tuberculosis infection (LTBI) is a key link in the strategy to end the epidemic of tuberculosis. However, the preventive treatment of tuberculosis in modern medicine has many challenges, such as many adverse reactions and poor patient compliance. In contrast, traditional Chinese medicine has shown unique advantages in the preventive intervention of LTBI based on the concept of preventing diseases before they occur and the theory of suppressing pathogenic diseases, which is crucial for achieving precise diagnosis and treatment of LTBI. In order to clarify the TCM syndrome differentiation and classification of LTBI and the corresponding treatment and prescription, Institute of Clinical Basic Medicine of Chinese Medicine of the Chinese Academy of Traditional Chinese Medicine, Lishui Hospital of Traditional Chinese Medicine of Zhejiang Province, Chinese Antituberculosis Association, and Editorial Board of Chinese Journal of Antituberculosis jointly organized domestic experts in various fields of tuberculosis, including experts in TCM theory, TCM clinic, epidemiology, and basic research, and wrote the Expert consensus on TCM syndrome differentiation, treatment principles, formulas, and herbs for latent tuberculosis infection (hereinafter referred to as the “Consensus”). This consensus system elaborates on the core elements of traditional Chinese medicine etiology and pathogenesis, syndrome differentiation and typing of LTBI, as well as the key points of syndrome differentiation for special populations. At the same time, the categories and key characteristics of TCM syndrome differentiation were clarified, and corresponding treatment methods and prescriptions were recommended for each syndrome type, aiming to provide reference for the precise diagnosis and treatment of LTBI.

Expert consensus on the application of host biomarkers for tuberculosis

Jiangxi Chest Hospital/Jiangxi Provincial Key Laboratory of Tuberculosis , Guangzhou National Laboratory , Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2026, 48(1):  9-20.  doi:10.19982/j.issn.1000-6621.20250426

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Tuberculosis is a major infectious disease that seriously threatens human health. Although global progress has been made in its prevention and control, its morbidity and mortality rates remain high. The situation for tuberculosis control in China is particularly severe, posing a significant public health challenge. In the clinical management of tuberculosis, unresolved difficulties persist, including the risk assessment of progression from latent tuberculosis infection (LTBI), the early detection of active tuberculosis (ATB), and the monitoring of anti-tuberculosis therapy. As objective indicators reflecting the host’s pathological and immunological responses, biomarkers are crucial for optimizing diagnosis and guiding individualized therapy. To this end, the Chinese Antituberculosis Association, Guangzhou National Laboratory, and Jiangxi Chest Hospital jointly organized domestic experts in relevant fields, combined with the latest progress at home and abroad and China’s national conditions, to develop the Expert consensus on the application of host biomarkers for tuberculosis. This consensus focuses on host-derived biomarkers, systematically reviewing the current applications and evidence for those based on cell-mediated immune responses, host gene expression profiles, and cytokines in the management of tuberculosis. Furthermore, it addresses key clinical questions—including the diagnosis and progression risk assessment of LTBI, early and differential diagnosis of ATB, identification of drug-resistant tuberculosis, dynamic monitoring of treatment response, and prediction of relapse risk. Based on the principles of evidence-based medicine, the consensus puts forward specific recommendations and practical suggestions. It aims to provide guidance for clinicians, laboratory professionals, and public health practitioners in China on the scientific selection, standardized application, and accurate interpretation of tuberculosis biomarkers, with the goal of improving the level of tuberculosis prevention and control.

Original Articles

Analysis on the current situation and trend of tuberculosis disease burden of people aged ≤24 in China from 2000 to 2021

Sun Qing, Wang Xiaoping, Yang Xiaomei, Han Ruihao, Gu Yeqiu, Fu Jian

Chinese Journal of Antituberculosis. 2026, 48(1):  21-33.  doi:10.19982/j.issn.1000-6621.20250315

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Objective: To analyze the disease burden and changing trends of tuberculosis among individuals aged ≤24 in China from 2000 to 2021, and to provide evidence for the formulation of tuberculosis prevention and control strategies for this demographic. Methods: Age-standardized incidence, infection, mortality, and disability-adjusted life-years (DALYs) rates for tuberculosis among individuals aged ≤24 were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Joinpoint regression model was used to evaluate long-term trends, with annual percent change (APC) and average annual percent change (AAPC) used to quantify variations in each indicator. Results: From 2000 to 2021, the mean annual age-standardized incidence, infection, mortality, and DALYs rates for tuberculosis among individuals aged ≤24 in China were 53.51/100000, 29889.73/100000, 4.92/100000, and 180.04/100000, respectively. These indicators declined by 54.16%, 5.75%, 81.46%, and 79.67%, all demonstrating significant downward trends (AAPC=-3.639%, -0.301%, -7.745%, and -7.317%). The age-standardized infection rate decreased the least and showed two periods of temporary increase: 2005-2010 and 2015-2019 (rising from 29446.97/100000 in 2005 to 30057.59/100000 in 2010, with an APC value of 0.587%; and from 27918.13/100000 in 2015 to 30567.83/100000 in 2019, with an APC value of 2.483%). In terms of age group, the 0-4-year-old group exhibited the most significant declines in age-standardized incidence, mortality, and DALYs rates (72.58%, 95.79% and 94.20%, with corresponding AAPCs of -5.970%, -14.058%, and -12.670%). In contrast, the 20-24-year-old group showed the smallest declines (AAPC=-2.378%, -8.174%, and -5.709%). Tuberculosis infection rates in the 5-9, 10-14, 15-19, and 20-24 age groups showed a phased upward trend between 2005—2010 (increasing from 7010.40/100000, 11768.47/100000, 24312.79/100000, and 32324.53/100000 in 2005 to 7334.07/100000, 12575.43/100000, 24748.90/100000, and 33308.53/100000 in 2010, with APC values of 0.913%, 1.685%, 0.560%, and 0.812%, respectively) and between 2015—2019 (increasing from 6966.83/100000, 11735.23/100000, 22668.91/100000, and 30001.30/100000 in 2015 to 8937.86/100000, 15005.36/100000, 25357.04/100000, and 32830.45/100000 in 2019, with APC values of 6.852%, 6.767%, 3.071%, and 2.464%, respectively). In terms of gender, the mean annual age-standardized incidence, infection, mortality, and DALYs rates of male tuberculosis patients (67.83/100000, 31082.59/100000, 7.03/100000, 241.34/100000, respectively) are higher than that of female patients (40.14/100000, 28673.12/100000, 3.07/100000, 121.48/100000, respectively). Although both genders exhibited significant downward trend (male AAPC=-3.396%, -0.288%, -7.221%, -6.724%; female AAPC=-4.082%, -0.317%, -8.880%, and -8.452%), the overall decline rates of male patients (51.74%, 5.55%, 79.08%, 76.83% respectively) was lower than that of female patients (58.25%, 6.02%, 85.67%, 84.23% respectively). Notably, age-standardized infection rates for both genders showed a phased upward trend between 2005—2010 (increasing from 30740.24/100000 and 28126.36/100000 in 2005 to 31252.77/100000 and 28842.19/100000 in 2010, with APC values of 0.492% and 0.696%, respectively) and between 2015—2019 (increasing from 29110.34/100000 and 26708.01/100000 in 2015 to 31696.74/100000 and 29408.98/100000 in 2019, with APC values of 2.332% and 2.637%, respectively). Conclusion: From 2000 to 2021, the tuberculosis burden among individuals aged ≤24 in China declined substaintially. However, tuberculosis infection rate remains high and is decreasing slowly. Although the females had lower tuberculosis burden than males, they experienced faster declines in all indicators. The 20-24 age group bears the highest TB burden, followed by the 0-4 age group. Strengthen the prevention and control of tuberculosis and develop more targeted epidemic prevention and control strategies are needed to further reduce tuberculosis infection and disease burden in this population.

The disease burden and changing trends of HIV/AIDS-associated drug-susceptible tuberculosis in the elderly population aged 60 above of China from 1990 to 2021

Zhu Qingdong, Zhao Chunyan, Huang Aichun, Zeng Chunmei, Gong Chunming, Xu Chaoyan, Jian Shasha, Li Weiwen, Song Chang

Chinese Journal of Antituberculosis. 2026, 48(1):  34-40.  doi:10.19982/j.issn.1000-6621.20250265

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Objective: To analyze the trends in disability-adjusted life years (DALYs), deaths, incidence, and prevalence of HIV/AIDS co-infected with drug-susceptible tuberculosis (DS-TB) among the elderly aged 60 above in China from 1990 to 2021, and to provide reference for the formulation of prevention and control strategies. Methods: Data on DALYs, deaths, incidence, and prevalence of HIV/AIDS co-infected with DS-TB among individuals aged ≥60 years in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) database. The estimated annual percentage change (EAPC) and its 95% confidence interval (CI) were used to describe the dynamic trends of each indicator. Results: From 1990 to 2021, the prevalence and incidence of HIV/AIDS co-infected with DS-TB among the elderly in China continued to rise, with the most pronounced increase observed in the 80-84 age group, recording an EAPC of 3.77% (95%CI: 2.33%-5.22%). Mortality and DALYs showed heterogeneous trends: while mortality declined in those aged ≥80, DALYs increased in absolute terms across all age groups except the 90-94 cohort, with the fastest growth in the 70-74 age group (EAPC=1.71%, 95%CI: 0.27%-3.18%). In 2021, the 65-69 age group bore the heaviest disease burden, ranking highest across all indicators—DALYs, deaths, incidence, and prevalence. Among males, these were 45.6757 million person-years, 1.516 million deaths, 11.074 million incident cases, and 23.3058 million prevalent cases, respectively; among females, they were 16.4134 million person-years, 0.5264 million deaths, 4.2574 million incident cases, and 9.051 million prevalent cases. All indicators were significantly higher in males than in females. Beyond this age group, all four indicators declined with advancing age. Attributable mortality due to behavioral risks and unsafe sex among males increased with age, reaching 86.22/100000 and 83.38/100000, respectively, in those ≥95 years. Among females, attributable mortality from both behavioral risks and unsafe sex exceeded 90/100000. Conclusion: The disease burden of HIV/AIDS co-infected with DS-TB among the elderly in China is steadily increasing, with causes involving behavior, drugs, and violence. Greater attention should be paid to the very old and to sex-specific differences in future prevention and control efforts.

Analysis of epidemiological characteristics and influencing factors of pulmonary tuberculosis recurrence in Guangdong Province

Huang Shanshan, Dong Xiaowei, Zhou Fangjing, Feng Huiying, Li Jianwei, Chen Yuhui

Chinese Journal of Antituberculosis. 2026, 48(1):  41-48.  doi:10.19982/j.issn.1000-6621.20250353

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Objective: To analyze the epidemiological characteristics and associated risk factors for recurrence of pulmonary tuberculosis (PTB) following successful treatment among patients in Guangdong Province. Methods: A retrospective cohort study was conducted using data from the China Disease Prevention and Control Information System. According to setting inclusion criteria, the clinical information of active PTB patients with etiological confirmation or clinical diagnosis, who were registered in Guangdong Province from January 1 to December 31, 2017 and whose treatment outcomes were “cured” or “completed course”, was automatically matched with all registered PTB cases reported from January 1, 2018 to June 30, 2023. Patients who were matched successfully and met the recurrence definition were selected as study subjects. Clinical data for all recurrent cases was collected and analyzed for its epidemiological characteristics and influencing factors associated with these recurrence by the single factor and multivariable Cox proportional hazards regression models. Results: A total of 1417 recurrent cases meeting the predefined criteria were identified. The crude recurrence rate was 2.67% (1417/53047), and the Kaplan-Meier estimated cumulative recurrence rate was 2.83%. The recurrence incidence density was 0.50 per 100 person-years (1417 recurrences over 283429.25 person-years). Among recurrent cases, the median (IQR) time to recurrence was 1.85 (0.88-3.34) years, with 52.51% (744/1417) of recurrences occurring within the first two years after successful treatment completion. Multivariable Cox regression analysis, based on patient characteristics at the initial PTB diagnosis in 2017, identified the following independent risk factors for recurrence: male sex (adjusted hazard ratio (aHR) =1.380, 95%CI: 1.207-1.578), occupation as farmer or herdsman (aHR=1.587, 95%CI: 1.029-2.450), comorbid diabetes mellitus (aHR=1.287, 95%CI: 1.024-1.616), detected from passive case finding (aHR=1.738, 95%CI: 1.003-3.009), delayed case finding (aHR=1.142, 95%CI: 1.025-1.271), and positive etiological test results (aHR=2.099, 95%CI: 1.886-2.337), while using fixed-dose combination (FDC) drugs (aHR=0.802, 95%CI: 0.717-0.897) and residence in the Pearl River Delta region (aHR=0.665, 95%CI: 0.585-0.755) were identified as protective factors. Conclusion: PTB patients in Guangdong Province remain at risk of recurrence within five years after successful treatment, with over half of the recurrences occurring within the first two years. Enhanced post-treatment follow-up and management are recommended, special attention should be paid to high-risk groups such as males, farmers/herdsmen, patients with comorbid diabetes mellitus and positive for etiology. Active case-finding strategies and standardized use of FDC regimens should be promoted to facilitate early detection, reduce the risk of recurrence, and improve long-term treatment outcomes.

Analysis of the willingness and influencing factors of receiving active pulmonary tuberculosis screening among the aged 65 and above in ethnic minority areas of Yunnan Province

Tang Shunding, Xu Lin, Li Ling, Cun Dejiao, Yang Rui

Chinese Journal of Antituberculosis. 2026, 48(1):  49-56.  doi:10.19982/j.issn.1000-6621.20250337

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Objective: This study aims to evaluate the willingness to accept pulmonary tuberculosis (PTB) screening and its influencing factors under the active screening strategy for PTB among the elderly (aged 65 and above) in ethnic minority areas of Yunnan Province, and to provide suggestions for improving quality of active screening in the future. Methods: From January 1 to December 31, 2023, a stratified random sampling questionnaire survey was conducted on the willingness to accept active PTB screening among the elderly aged 65 and above in 12 towns/communities of 6 counties (cities) in 3 ethnic areas of Yunnan Province. A total of 1399 pieces of questionnaire were distributed, and 1395 valid pieces were retrieved, with a valid rate of 99.71%. Results: 92.62% (1292/1395) of the elderly were willing to take PTB symptom screening, 94.27% (1315/1395) were willing to undergo PTB-related examinations, and 90.18% (1258/1395) were willing to accept both. The willingness to accept active PTB screening was presented as follows: The willingness of non-farmers to accept active screening was 9.157 (95%CI: 1.242-67.495) times of that of farmers. The willingness of those who purchased other medical insurance for active screening was 4.098 times of that of those who purchased the medical insurance for urban and rural residents (95%CI: 1.762-9.531). Individuals with at least one disease had a willingness to be screened that was 1.767 (95%CI: 1.198-2.604) times of that of individuals with no diseases. Those who knew that “the elderly are more prone to tuberculosis” had 3.110 (95%CI: 2.101-4.603) times of willingness to actively undergo screening compared with those who were unaware. The willingness for active screening of families with annual per capita medical expenditure less than OR equal to the average level was lower than that of families with annual per capita medical expenditure greater than the average level (OR=0.459, 95%CI: 0.313-0.674). Conclusion: Under the current policy, the willingness of the elderly aged 65 and above in ethnic minority areas of Yunnan Province to undergo active PTB screening is high. Active PTB screening among the elderly should continue to be carried out in combination with The National Basic Public Health Service Project to improve the quality and efficiency of screening and thereby improve the level of patient detection.

Analysis of case detection and anti-tuberculosis treatment outcomes in Mycobacterium tuberculosis/HIV co-infected patients in Ningxia from 2015 to 2023

Tian Xiaomei, Jiang Xuefeng, Yang Xia, Sha Xiaolan, Lei Juan, Wang Xiaowei, Liu Jing

Chinese Journal of Antituberculosis. 2026, 48(1):  57-63.  doi:10.19982/j.issn.1000-6621.20250264

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Objective: To understand and analyze the bidirectional screening of tuberculosis (TB) patients and people living with HIV/AIDS (PLHIV) as well as the anti-tuberculosis treatment status of patients with MTB/HIV coinfection in Ningxia, so as to provide a reliable basis for formulating prevention and control measures for MTB/HIV coinfection. Methods: Data on tuberculosis-related examinations received by PLHIV in Ningxia from 2015 to 2023 was collected through the Annual Report Form on the Prevention and Control Management of MTB/HIV Coinfection; Registration information of patients with MTB/HIV coinfection and the total population data from 2015 to 2023 were obtained via the “Surveillance Report Management System” and “Comprehensive Disease Control and Prevention Management System”, which are subsystems of the “China Information System for Disease Control and Prevention”. Bidirectional screening was conducted among tuberculosis (TB) and HIV/AIDS patients, and the status of anti-tuberculosis treatment for patients with MTB/HIV coinfection was analyzed. Results: From 2015 to 2023, the rate of newly registered and followed-up PLHIV in Ningxia receiving chest X-ray or sputum examination was 90.66% (16630/18343). Specifically, the rate was 85.29% (574/673) in 2015 and 94.50% (2923/3093) in 2023, and the rates showed a fluctuating upward trend over the years, with a statistically significant difference ({\chi }_{trend}^2=435.673, P<0.01). A total of 53 tuberculosis (TB) cases were diagnosed, with a detection rate of 0.32% (53/16630). Among them, the rate of chest X-ray or sputum examination among newly registered PLHIV was 88.98% (2552/2868), and 26 TB cases were identified, resulting in a TB detection rate of 1.02% (26/2552). For previously followed-up PLHIV, the rate of chest X-ray or sputum examination was 90.97% (14078/15475), with 27 TB cases detected (TB detection rate: 0.19%, 27/14078). The TB detection rate was 0.76% (3/397) in 2015 and 0.19% (5/2596) in 2023, showing a fluctuating downward trend over the years with a statistically significant difference ({\chi }_{trend}^2=17.439,P<0.05). In 2015, the rate of HIV antibody test among TB patients was 42.22% (1097/2598), with no HIV-positive cases detected. In 2023, the rate was 59.49% (1317/2214), and the HIV detection rate was 0.30% (4/1317). There was a statistically significant difference across different years (χ²=246.475, P<0.01). A total of 10427 TB patients underwent HIV test, with an HIV-positive detection rate of 0.14% (15/10427). The registration rate of MTB/HIV coinfection increased from 0.05/100000 (3/6615400) in 2015 to 0.19/100000 (14/7283400) in 2023, showing a fluctuating upward trend over the years with a statistically significant difference ({\chi }_{trend}^2=20.186, P<0.01). Among MTB/HIV coinfected patients, the treatment success rate was 69.12% (47/68), other outcomes accounted for 5.88% (4/68), transfer to rifampicin-resistant TB treatment accounted for 7.35% (5/68), and the mortality rate was 17.65% (12/68). Conclusion: From 2015 to 2023, the MTB screening rate among PLHIV in Ningxia was relatively high. However, the HIV test rate among tuberculosis (TB) patients and the anti-tuberculosis treatment success rate for patients with MTB/HIV coinfection need to be further improved.

The epidemic trend of pulmonary tuberculosis in Shandong Province from 2005 to 2023

Shangguan Shichao, Wang Ke, Wang Liansen, Duan Xi, Huang Pengxiang, Yao Mingxiao, Lou Lei

Chinese Journal of Antituberculosis. 2026, 48(1):  64-72.  doi:10.19982/j.issn.1000-6621.20250330

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Objective: To systematically describe and analyze the reported incidence and epidemic trends of pulmonary tuberculosis (PTB) in Shandong Province from 2005 to 2023, thereby providing a scientific basis for the formulation and enhancement of regional TB prevention and control strategies. Methods: The epidemic data of PTB in Shandong Province from 2005 to 2023 were collected from the Infectious Disease Surveillance System of China Information System for Disease Control and Prevention. Population data were obtained from Shandong Statistical Yearbook. The national population distribution released by the National Bureau of Statistics based on the Seventh National Population Census in 2020 was adopted as the standard population for calculating the age-standardized reported incidence rate. Joinpoint regression and heat map were employed to analyze the epidemic trends of PTB. Results: From 2005 to 2023, a total of 632763 PTB cases were reported in Shandong Province, the average reported incidence rate was 34.06/100000. The overall reported incidence rate decreased by 51.09% from 2005 (43014 cases, 46.51/100000) to 2023 (23027 cases, 22.75/100000). The top six regions reporting the number of cases were Liaocheng (2693 cases, 46.11/100000), Linyi (4191 cases, 40.57/100000), Heze (3393 cases, 40.08/100000), Dezhou (2129 cases, 37.93/100000), Tai’an (2029 cases, 36.84/100000) and Ji’nan (2646 cases, 35.15/100000). Weifang (2214 cases, 24.12/100000), Dongying (576 cases, 27.47/100000) and Qingdao (2608 cases, 28.51/100000) exhibited relatively lower average reported incidence rate. From 2005 to 2023, the standardized reported incidence rate in Shandong Province demonstrated an overall downward trend (AAPC=-4.25, 95%CI: -5.15--3.33, t=-8.936, P<0.001). Among the cities, Binzhou (AAPC=-6.45, 95%CI: -9.58--3.22, t=-3.843, P<0.001), Tai’an (AAPC=-6.20, 95%CI: -8.41--3.93, t=-5.247, P<0.001), Jinan (AAPC=-5.82, 95%CI: -6.83--4.80, t=-10.867, P<0.001), Dongying (AAPC=-5.74, 95%CI: -6.58--4.89, t=-13.893, P<0.001), Dezhou (AAPC=-5.66, 95%CI: -6.31--5.01, t=-17.788, P<0.001), Linyi (AAPC=-5.33, 95%CI: -7.24--3.39, t=-5.238, P<0.001) experienced the fastest decline, while the decline rates in Yantai (AAPC=-1.63, 95%CI: -2.73--0.52, t=-2.878, P=0.004), Qingdao (AAPC=-1.96, 95%CI: -2.52--1.40, t=-7.312, P<0.001), Weihai (AAPC=-2.55, 95%CI: -3.87--1.20, t=-3.688, P<0.001), Weifang (AAPC=-3.61, 95%CI: -4.16--3.07, t=-13.732, P<0.001), Heze (AAPC=-4.22, 95%CI: -5.48--2.94, t=-6.357, P<0.001) were lower than the average level of Shandong Province. Conclusion: Since 2005, the reported incidence of PTB in Shandong Province has shown a continuous downward trend, reflecting the success of the TB prevention and control strategies implemented during various periods. The TB epidemic situation exhibits significant regional disparities in Shandong Province. Therefore, it is essential to conduct an in-depth analysis of the influencing factors and develop targeted prevention and control policies tailored to the specific characteristics of each region.

Meta-analysis of diagnostic delay rate among Chinese students patients with pulmonary tuberculosis

Wang Na, Wan Bin, Zhao Xia, He Ting, Zhang Miao, Yao Rong, Yang Xiaoyi

Chinese Journal of Antituberculosis. 2026, 48(1):  73-83.  doi:10.19982/j.issn.1000-6621.20250334

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Objective: To systematically evaluate the diagnostic delay of pulmonary tuberculosis (PTB) among Chinese students. Methods: Cross-sectional studies related to diagnostic delay of PTB in students from China (excluding Hong Kong, Macao, and Taiwan) were collected by searching electronic databases including Web of Science, PubMed, Embase, The Cochrane Library, CBM, CNKI, VIP, and WanFang Data from inception of each database to July 2025. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using Stata 15.0 software. Results: A total of 36 cross-sectional studies were included, involving 101473 subjects and 24906 student PTB patients with diagnostic delay, the overall diagnostic delay rate was 25.54%. The risk of bias assessment indicated that 14 studies were of high quality and 22 were of moderate quality. Meta-analysis results showed that the pooled rate of diagnostic delay among Chinese student PTB patients was 25.47% (95%CI: 21.16%-29.79%). Specifically, the diagnostic delay rates were 26.41% and 27.20% for male and female patients, respectively; 24.50%, 23.80%, and 28.00% for students from eastern, central, and western regions of China, respectively; and 23.41%, 28.09%, 21.90%, and 27.08% for students with educational levels of primary school and below, junior high school, senior high school, and college and above, respectively. The diagnostic delay rates for patients detected via symptomatic visit/recommendation, referral, tracking, health check-up, and other methods were 22.10%, 28.91%, 24.20%, 18.83%, and 30.09%, respectively. The rates were 21.20% and 17.31% for Han Chinese and ethnic minority patients, 21.90% and 28.60% for new and retreatment patients, 25.00% and 14.22% for patients with negative and positive etiological test results, and 19.60% and 20.62% for local and non-local residents, respectively. Meta-analysis of seven influencing factors revealed that female gender was a protective factor against diagnosis delay (OR=0.758, 95%CI: 0.617-0.931), while non-local household registration was a risk factor for diagnosis delay (OR=1.550, 95%CI: 1.039-2.295). Conclusion: The diagnostic delay rate among Chinese student PTB patients is high. Although it has shown a yearly declining trend since 2018, significant variations in the diagnostic delay persist due to factors such as gender, region, education level, detection method, etiological test results, and ethnicity, indicating that the epidemic prevention and control situation remains severe.

Latent profiles of fear of disease progression and associated factors in young and middle-aged adults with pulmonary tuberculosis

Chen Weiwei, Zou Shengqiang, Yuan Jia, Wu Rongzhen, Shi Lingyan

Chinese Journal of Antituberculosis. 2026, 48(1):  84-93.  doi:10.19982/j.issn.1000-6621.20250284

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Objective: To identify latent profile categories of fear of disease progression in young and middle-aged tuberculosis patients and to analyze the influencing factors associated with these categories. Methods: A convenience sampling approach was employed to select 312 young and middle-aged tuberculosis patients hospitalized in the Fifth People’s Hospital of Suzhou from January 2025 to June 2025. Data were collected using a general information questionnaire, the Simplified Fear of Disease Progression Scale, the General Self-Efficacy Scale, the Comprehensive Scoring Scale for Financial Toxicity Functional Assessment of Chronic Illness Therapy, the Perceived Social Support Scale, and the Tuberculosis Stigma Perception Scale. Latent profile analysis was performed to identify distinct categories of fear of disease progression. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors. Results: The fear of disease progression in young and middle-aged tuberculosis patients was classified into two latent profile categories: the “Low Fear Risk-Disease Adaptation Group” (n=184, 58.97%) with a mean score of (28.19±5.41) on the Simplified Fear of Disease Progression Scale, and the “High Fear Risk-Dysfunction Group” (n=128, 41.03%) with a mean score of (41.65±5.20). Multivariate logistic regression analysis revealed that economic security (OR=0.894, 95%CI: 0.808-0.989) and family support (OR=0.900, 95%CI: 0.835-0.970) were protective factors against fear of disease progression, while being married (OR=2.410, 95%CI: 1.101-5.275), participation in the New Rural Cooperative Medical System (OR=2.436, 95%CI: 1.083-5.481), treatment duration of 3 to 6 months (OR=2.628, 95%CI: 1.316-5.251), treatment duration >6 months (OR=4.621, 95%CI: 1.979-10.789), economic pressure and burden (OR=1.200, 95%CI: 1.081-1.331), future economic concerns (OR=1.157, 95%CI: 1.034-1.295), and negative self-feelings (OR=1.086, 95%CI: 1.026-1.150) were risk factors leading patients to the high fear risk group. Conclusion: The fear of disease progression in young and middle-aged tuberculosis patients exhibits significant heterogeneity. Tailored interventions based on identified profile categories are essential to address the varying needs of these patients effectively.

To construct a risk prediction model for adult chronic kidney disease complicated with active tuberculosis based on logistic regression, decision tree, and neural network

Chen Depan, Li Xiang, Zhang Kaiyi, Li Min, Xia Jiawei, Gao ChuYi, Yang Yatao, Zhang Le

Chinese Journal of Antituberculosis. 2026, 48(1):  94-105.  doi:10.19982/j.issn.1000-6621.20250311

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Objective: To evaluate the application value of logistic regression model, decision tree model, and neural network model in predicting active tuberculosis among patients with chronic kidney disease (CKD). Methods: A retrospective analysis was conducted on 392 CKD patients admitted to the Third People’s Hospital of Kunming between January 2021 and January 2024. Among them, 266 patients with active tuberculosis were included in the observation group, and 126 patients without active tuberculosis were included in the control group. Clinical data and laboratory indicators were collected for both groups. Logistic regression, decision tree and neural network models were used to identify influencing factors and construct the risk prediction models. The model performance was compared using receiver operating characteristic (ROC) curve. Results: The area under the curve (AUC) of the logistic regression model was 0.726 (95%CI: 0.766-0.777), with a sensitivity of 45.1% and a specificity of 92.1%. Alcohol consumption, hemoptysis, low lymphocyte count, low hematocrit, high uric acid, high fibrinogen degradation products, and low IL-10 level were identified as independent predictors (all P values <0.05). The AUC of the decision tree model was 0.825 (95%CI: 0.783-0.868), with a sensitivity of 62.0% and a specificity of 82.5%. Fibrinogen degradation products served as the primary stratification variable, and further included variables such as CD4⁺ T lymphocytes, lymphocyte count, hematocrit, loss of appetite, and uric acid to construct a decision path. The neural network model demonstrated the best predictive performance, with an AUC of 0.876 (95%CI: 0.843-0.909), a sensitivity of 60.9%, and a specificity of 98.4%. Feature importance analysis indicated that IL-10, hematocrit, fibrinogen degradation products, and CD4⁺ T lymphocytes were the top four predictors. Conclusion: The neural network model exhibited the best predictive ability for detecting CKD patients with active tuberculosis. Key predictors identified in this study—such as low lymphocyte count, low CD4⁺ T lymphocyte count, and high fibrinogen degradation product—may help define the key population for screening. The three models provide complementary strenghths and may be applied synergistically applied in clinical practice. Enhanced tuberculosis screening is warrented for CKD patients with immunosuppression (e.g., low lymphocyte count, CD4⁺ T lymphocyte count), activation of coagulation and fibrinolysis (e.g., increased fibrinogen degradation products), or hemoptysis.

Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease

Shang Yuanyuan, Nie Wenjuan, Chu Naihui

Chinese Journal of Antituberculosis. 2026, 48(1):  106-112.  doi:10.19982/j.issn.1000-6621.20250411

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Objective: To compare the clinical characteristics and drug resistance profiles between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease (MAB-PD), and to analyze the prognostic factors influencing treatment outcomes. Methods: A total of 123 patients diagnosed with MAB-PD at Beijing Chest Hospital, Capital Medical University, from January 1, 2021, to May 31, 2023, were enrolled and divided into an elderly group (48 patients, age ≥65 years) and a non-elderly group (75 patients, age <65 years). Clinical data, drug susceptibility testing results, and treatment outcomes were collected. The clinical features of the two groups were compared, and prognostic factors associated with treatment outcomes were analyzed. Results: The incidence of cavitary lesions was significantly higher in elderly MAB-PD patients (41.7% (20/48)) compared to non-elderly patients (24.0% (18/75)). The proportion of patients with pleural adhesion was also significantly greater in the elderly group (66.7% (32/48)) than in the non-elderly group (46.7% (35/75)) (χ²=4.279, P=0.039; χ²=4.721, P=0.030, respectively). Multivariate logistic analysis identified age ≥65 years (OR=2.532, 95%CI: 1.048-6.120), BMI<18.5 kg/m² (OR=4.379, 95%CI: 1.758-10.905), and the presence of pleural adhesion (OR=3.566, 95%CI: 1.420-8.955) as independent risk factors for treatment failure. Conclusion: Elderly patients with MAB-PD are more likely to present with pulmonary cavities and pleural adhesions. Advanced age, low BMI, and pleural adhesion are significant risk factors for treatment failure in MAB-PD patients. Individualized management strategies should be considered for elderly patients, those with malnutrition, and those exhibiting pleural adhesions on imaging.

Analysis of current status of self-discipline of pulmonary tuberculosis patients and its influencing factors

Chen Lina, Ding Liqi, He Yan, Chen Danping

Chinese Journal of Antituberculosis. 2026, 48(1):  113-120.  doi:10.19982/j.issn.1000-6621.20250280

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Objective: To investigate the current status of self-discipline among pulmonary tuberculosis patients, analyze the associated influencing factors, and establish an evidence-based foundation for developing interventions about improving self-discipline behaviors in this population. Methods: Using a convenience sampling method, a total of 571 pulmonary tuberculosis patients hospitalized in the Department of Tuberculosis at Shanghai Pulmonary Hospital, Affiliated to Tongji University, from March to June 2025 were selected. Data were collected using a sociodemographic questionnaire, the Pulmonary Tuberculosis Self-Discipline Scale, the Tuberculosis Self-Efficacy Scale, the Perceived Social Support Scale, and the Perceived Tuberculosis Stigma Scale. Results: A total of 551 pulmonary tuberculosis patients were included. Their mean total self-discipline score was (112.40±14.71). Correlation analysis revealed that self-discipline was positively correlated with tuberculosis self-efficacy (r=0.645, P<0.001) and perceived social support (r=0.389, P<0.001), while negatively correlated with perceived tuberculosis stigma (r=-0.089, P<0.05). Regression analysis indicated that female (β=3.598,95%CI:1.652-5.544,P<0.001), educational attainment at junior/senior high school or technical secondary school level (β=3.480,95%CI:0.210-6.750,P=0.037), educational attainment at college level or above (β=10.016,95%CI:6.295-13.738,P<0.001), rural residence (β=-2.387,95%CI:-4.593--0.182,P=0.034), tuberculosis self-efficacy (β=0.792,95%CI:0.689-0.896,P<0.001), and perceived tuberculosis stigma (β=0.094,95%CI:0.017-0.171,P=0.017) were significant influencing factors of self-discipline in pulmonary tuberculosis patients. Conclusion: The current level of self-discipline among pulmonary tuberculosis patients requires further enhancement. Factors influencing their self-discipline include gender, educational level, place of residence, self-efficacy regarding tuberculosis, and perceived stigma associated with the disease.

Causal effects of gut microbiota on non-tuberculous mycobacterial lung infection: a bidirectional two-sample mendelian randomization study

Tan Xiao, Li Fangping, Zhang Qian, Zhang Meijia

Chinese Journal of Antituberculosis. 2026, 48(1):  121-130.  doi:10.19982/j.issn.1000-6621.20250292

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Objective: To assess the causal direction between gut microbiota and non-tuberculous mycobacteria lung infection (NTM-LI). Methods: This study used a bidirectional two-sample Mendelian randomization (MR). Genome-wide association studies (GWAS) data of gut microbiota and NTM-LI were obtained from the GWAS Catalog and the FinnGen databases, respectively. Instrumental variables (IV) were selected based on genome-wide significance thresholds, linkage disequilibrium analysis, and weak instrumental variable screening. The primary causal effect assessed using the inverse-variance weighted (IVW) method, supplemented by using MR-Egger, weighted median, simple mode, and weighted mode methods. Heterogeneity, sensitivity, and horizontal pleiotropy were evaluated using Cochran’s Q test, leave-one-out analysis, MR-Egger intercept test, and MR-PRESSO, respectively. Reverse MR analysis followed the same protocol. Results: IVW analysis revealed that changes in the abundance of specific gut microbiota taxa were significantly associated with the risk of NTM-LI. Odoribacter laneus (OR=1.798, 95%CI: 1.017-3.180, P=0.044), Desulfovibrio piger (OR=1.508, 95%CI: 1.069-2.128, P=0.019) and Blautia hansenii (OR=2.487, 95%CI: 1.222-5.062, P=0.012) could increase the risk of NTM-LI. Conversely, Turicibacteraceae (OR=0.570, 95%CI: 0.343-0.949, P=0.031), RUG420 sp900317985 (OR=0.153, 95%CI: 0.036-0.649, P=0.011), Firmicutes E (OR=0.084, 95%CI: 0.009-0.814, P=0.033), Enteroscipio (OR=0.386, 95%CI: 0.197-0.756, P=0.006), and CAG-145 sp000435615 (OR=0.575, 95%CI: 0.357-0.927, P=0.023) could reduce the risk of NTM-LI. No significant heterogeneity, horizontal pleiotropy, and outlier interference was detected. Furthermore, reverse MR analysis did not support effect of NTM-LI on gut microbiota composition. Conclusion: This MR analysis reveals a potential causal relationship between specific gut microbiota and NTM-LI. Targeted modulation of these specific gut microbial taxa holds promise as a novel intervention strategy for the prevention and treatment of NTM-LI.

Hirudin ameliorates tuberculous pleural fibrosis in mice by regulating the Nrf2/HO-1 signaling pathway

Yu Zhou, Chen Lina, Yang Rongjing, Shang Xuan, Xiao Guosu, Zhang Xianming, Huang Niwen

Chinese Journal of Antituberculosis. 2026, 48(1):  131-138.  doi:10.19982/j.issn.1000-6621.20250310

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Objective: To investigate the effect of hirudin on tuberculous pleural fibrosis in mice by regulating the nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway. Methods: Sixty male C57 mice weighing 20-25 g were randomly divided into the following groups: control group, model group, low-dose hirudin group (L group), medium-dose hirudin group (M group), high-dose hirudin group (H group), and high-dose hirudin+ML385 (an Nrf2 transcription inhibitor) group (H+ML385 group). Except for the control group, all other groups were established as models by injection of a bacillus Calmette-Guérin (BCG) suspension. After 28 days, the distribution of pleural effusion was observed in each group, and the volume of pleural effusion was collected and recorded. Pleural adhesion was observed; the adhesiveness of pleural effusion was assessed using fibrinogen (FBG) levels and the score of pleural adhesive bands number. Pleural thickness was measured. Histopathological changes of pleural tissues were observed by hematoxylin-eosin (HE) staining. The protein expressions of Nrf2 and HO-1 in pleural tissues were detected by western blot. The contents of matrix metalloproteinases (MMP-1, MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) in pleural tissues were measured by enzyme-linked immunosorbent assay (ELISA). Results: After 28 days, the H group showed significantly lower values compared to the model group in the following parameters: pleural effusion volume ((666.00±87.62) μl vs. (1144.00±15.00) μl), pleural thickness ((16.50±1.17) μm vs. (21.11±2.98) μm), pleural adhesion band score (2.60±0.51 vs. 3.90±0.31), FBG ((0.30±0.07) g/L vs. (0.48±0.07) g/L), MDA ((74.51±6.53) mmol/mg vs. (102.70±14.06) mmol/mg), MMP-1 ((14.08±0.85) μg/L vs. (18.54±1.20) μg/L), MMP-9 ((4.84±0.38) μg/L vs. (7.65±1.02) μg/L), and TIMP-1 ((2.63±0.13) μg/L vs. (3.62±0.36) μg/L). Conversely, SOD ((134.00±8.07) U/mg vs. (90.79±4.68) U/mg) and GSH ((350.80±15.73) nmol/g vs. (247.30±22.28) nmol/g) levels were significantly higher in the H group than those in the model group. All these differences were statistically significant (t=8.48, P<0.001; t=4.54, P<0.001; t=6.79, P<0.001; t=5.53, P<0.001; t=5.73, P<0.001; t=9.57, P<0.001; t=8.16, P<0.001; t=8.10, P<0.001; t=14.64, P<0.001; t=12.00, P<0.001, respectively). HE staining revealed that hirudin intervention groups (especially in the high-dose group) markedly alleviated pathological fibrotic changes in the pleura compared with the model group. Western blot results indicated that Nrf2 protein expression in the H group (0.83±0.07) was significantly higher than that in the model group (0.57±0.06) and also significantly higher than that in the H+ML385 group (0.67±0.50) (t=8.36, P<0.001; t=4.09, P=0.017, respectively). HO-1 protein expression in the H group (0.72±0.03) was significantly higher than that in the model group (0.31±0.02), with a statistically significant difference (t=8.36, P<0.001). Conclusion: hirudin can ameliorate tuberculous pleural fibrosis by inhibiting oxidative stress through the regulation of the Nrf2/HO-1 signaling pathway.

Identification of efferocytosis-related core genes in active tuberculosis patients based on GEO database

Fan Weixiao, Zhou Ke, Liu Jiayun

Chinese Journal of Antituberculosis. 2026, 48(1):  139-147.  doi:10.19982/j.issn.1000-6621.20250352

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Objective: To screen efferocytosis-related genes as biomarkers for distinguishing active tuberculosis (ATB) and latent tuberculosis infection (LTBI) in human patients. Methods: The microarray dataset GSE28623, comprising peripheral blood samples from 46 ATB patients and 25 LTBI individuals, was downloaded from the GEO database. The R package limma was used to screen out differentially expressed genes (DEGs). Immune infiltration analysis was performed using CIBERSORT to evaluate the immune microenvironment status in patients with ATB and LTBI; subsequent GO and KEGG pathway enrichment analysis were conducted on the upregulated DEGs identified in ATB patients. Efferocytosis-related DEGs (EF-DEGs) were identified by intersecting the DEGs with an efferocytosis-related gene set. LASSO regression and SVM-RFE machine learning algorithms were then applied to screen for key ATB genes. Finally, dataset GSE101705 was used to further validate the expression levels of the key genes. ROC curves were plotted to evaluate the discriminatory performance of these key genes in distinguishing ATB from LTBI. Results: Differential analysis identified 460 upregulated DEGs and 991 downregulated DEGs. Immune infiltration analysis indicated that ATB patients exhibited significantly increased proportions of neutrophils (P=1.45×10^-7) and M0 macrophages (P=7.55×10^-6), while the proportions of naive CD4⁺ T cells (P=0.003), CD8⁺ T cells (P=1.45×10^-7) and naive B cells (P=0.026) were significantly decreased. GO enrichment analysis revealed significant enrichment of upregulated DEGs in ATB across three ontologies: biological processes for responses to molecules of bacterial origin, response to lipopolysaccharide, and myeloid leukocyte activation; cellular components including secretory granule lumen, cytoplasmic vesicle lumen, and vesicle lumen; molecular functions involving immune receptor activity, pattern recognition receptor activity, and lipopolysaccharide binding. KEGG pathway analysis further demonstrated that these ATB-upregulated DEGs were prominently involved in lipid and atherosclerosis, efferocytosis, and the NOD-like receptor signaling pathway. Thirteen EF-DEGs (PROS1, SIAH2, CD274, WDFY3, SCARF1, ABCA1, DYNLT1, FPR2, CLU, IL1B, TNFSF13B, ITGB3, PLAUR) were identified through intersecting the upregulated DEGs with the efferocytosis-related gene set. Through LASSO regression and SVM-RFE machine learning algorithms, CD274, PROS1, and SIAH2 were identified as key genes associated with ATB. External validation using dataset GSE101705 confirmed that the expression levels of CD274, PROS1, and SIAH2 were significantly higher in the peripheral blood of ATB patients compared to LTBI individuals. The AUC values for discriminating ATB were 89.5% (95%CI: 79.9%-99.1%), 88.4% (95%CI: 78.7%-98.1%), and 79.0% (95%CI: 64.6%-93.5%) for CD274, PROS1 and SIAH2, respectively. The combined discriminatory AUC value for the three genes reached 93.6% (95%CI: 86.5%-100.0%). Conclusion: Based on the analysis of public database peripheral blood gene expression profiles from ATB and LTBI patients, this study identified CD274, PROS1 and SIAH2 as potential biomarkers with good discriminatory value for ATB.

Review Articles

Research progress in drug-susceptible pulmonary tuberculosis treatment regimens for children

Fu Yanan, Yang Xiaotao, Liu Xiaomei, Shen Adong

Chinese Journal of Antituberculosis. 2026, 48(1):  148-152.  doi:10.19982/j.issn.1000-6621.20250358

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Drug-susceptible pulmonary tuberculosis (DS-PTB) exhibits a high incidence rate among paediatric populations. With the progressive advancement of clinical research, treatment regimens are continually being updated and optimised towards shorter durations and greater precision. This paper aims to review the developmental trajectory, optimisation, and innovation of treatment regimens for DS-PTB in children and adolescents, with a view to providing reference for proposing scientific and standardized DS-PTB treatment protocols applicable to children and adolescents in China.

Research progress on the impact of malnutrition on the treatment outcomes of tuberculosis patients

Reyihanguli Aken, Fan Lin

Chinese Journal of Antituberculosis. 2026, 48(1):  153-159.  doi:10.19982/j.issn.1000-6621.20250287

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Tuberculosis is a chronic consumptive infectious disease intrinsically associated with malnutrition. In patients with tuberculosis, malnutrition can result from multiple pathways including chronic inflammatory responses, gastrointestinal malabsorption, and multi-organ involvement. Such nutritional impairment further compromises host immune defenses through various mechanisms, thereby adversely affecting treatment outcomes. Thus, malnutrition not only worsens tuberculosis prognosis but also elevates the risk of disease development. Individualized nutritional interventions-particularly high-protein, high-calorie diets and micronutrient supplementation-have been shown to significantly improve clinical outcomes in tuberculosis patients. This review systematically summarizes the bidirectional vicious cycle between malnutrition and tuberculosis, detailing the pathophysiological processes by which tuberculosis induces malnutrition, and elucidates the molecular mechanisms through which malnutrition impairs treatment outcomes via diminished cellular immunity, disrupted metabolic homeostasis, and exacerbated chronic inflammation. It further evaluates clinical evidence supporting nutritional strategies-such as high-protein, high-calorie diets, vitamin D and trace element supplementation, and specific fatty acid interventions-in improving body weight, immune function, and treatment outcomes in tuberculosis patients. The overarching aim of this article is to provide a scientific rationale for nutritional support in tuberculosis management and to inform evidence-based clinical practice and public health strategies.