Table of Content

10 December 2025, Volume 47 Issue 12

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Special Topic

Exploring pathogenesis and treatment of Lao Zhai (Traditional Chinese Medicine) from the perspective of “fire”

Zhang Xuyang, Mu Tingting, Ma Yan, Cai Qiujie

Chinese Journal of Antituberculosis. 2025, 47(12):  1535-1540.  doi:10.19982/j.issn.1000-6621.20250328

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Lao Zhai is an infectious and chronic consumptive disease, mainly characterized by symptoms such as cough, hemoptysis, hectic fever, night sweat, and gradual weight loss. It is equivalent to the narrow sense of tuberculosis in modern medicine. Traditional Chinese Medicine (TCM) has a long history in the treatment of tuberculosis. TCM physicians of successive dynasties believed that its occurrence and development are closely related to “Fire”. The authors explored TCM pathogenesis and syndrome differentiation and treatment of tuberculosis from the perspective of “Fire”, combed understandings of physicians in successive dynasties, explained the pathogenic characteristics of different types of “Fire”, and clarified that the “Fire” in the pathogenesis of tuberculosis could be divided into four types: deficiency fire, ministerial fire, phlegm-fire, and fire transformed from long-term blood stasis, and identified deficiency fire as the main type in clinic, accompanied by other types. The thinking of syndrome differentiation and treatment of tuberculosis can take “fire” as the core, then combining with typical clinically proven cases, clarify pathogenesis changes of relevant syndrome types, adjust treatment according to symptoms, to provide references and ideas for improving TCM clinical treatment of tuberculosis.

Interpretation of Standards

Strengthening the foundation, improving quality and efficiency, and promoting the implementation of National Tuberculosis Control Program—Interpretation of Tuberculosis health education standard in primary medical and health institutions

Wan Ying, Wu Huizhong, Qu Yan, Zhang Fan

Chinese Journal of Antituberculosis. 2025, 47(12):  1541-1546.  doi:10.19982/j.issn.1000-6621.20250278

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Primary healthcare institutions are an important part of Chinese tuberculosis (TB) prevention and control service system, serving as the foundational units in TB prevention and control. Health education runs through the whole TB prevention and treatment, and is an important work responsibility that they should undertake. The ability and service quality of primary healthcare institutions to carry out TB health education are crucial to the effectiveness of TB epidemic control. The National Tuberculosis Prevention and Control Plan (2024—2030) clearly states that it is necessary to strengthen the responsibilities of primary healthcare institutions and comprehensively enhance the quality and level of TB prevention and control services. On April 2, 2025, the social organization standard Tuberculosis health education standard in primary medical and health institutions (T/CHATA 048—2025) was officially released and implemented on the same day. This standard provides normative guidance on work safeguards, content and methods, as well as evaluation and application of TB health education in primary healthcare institutions. This article interprets the core points of the standard to facilitate its scientific application by primary healthcare institutions nationwide, standardize TB health education practices, and support the high-quality implementation of measures outlined in the national plan.

Original Articles

Analysis of influencing factors of treatment outcomes among pulmonary tuberculosis patients comorbid with diabetes, China, 2019—2023

Tian Feifei, Li Yuhong, Li Xue, Wang Jia, Li Tao, Du Xin, Zhao Yanlin, Zhang Hui, Liu Xiaoqiu

Chinese Journal of Antituberculosis. 2025, 47(12):  1547-1555.  doi:10.19982/j.issn.1000-6621.20250275

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Objective: To assess the epidemiological characteristics and the influencing factors of treatment outcomes among PTB patients comorbid with DM (PTB-DM) in China from 2019 to 2023. Methods: Notified PTB cases from 2019 to 2023 were extracted from the National Tuberculosis Management Information System. Chi-square tests were utilized to compare the characteristics of PTB patients with and without DM. A two-level logistic model with patient as level 1 and provinces as level 2, was used to analyze the influencing factors of treatment outcomes among PTB-DM patients. Results: From 2019 to 2023 in China, a total of 189664 PTB-DM patients were notified, accounted for 6.16% of the total PTB patients (3077951 cases). The proportion of PTB-DM increased during 2019—2023, the annual increase rate of PTB-DM proportion was 24.91% (Z=2.200, P=0.027). Among the PTB-DM patients, male accounted for 77.95% (147848/189664), ≥65 years accounted for 32.69% (62002/189664), retirees/houseworker/job seekers accounted for 31.52% (59780/189664), floating patients accounted for 27.07% (51343/189664), Han nationality accounted for 89.92% (170554/189664), pathogen-positive accounted for 74.95% (142150/189664), previously treated accounted for 12.11% (22977/189664), culture-positive at the end of 2nd month of treatment accounted for 4.34% (8238/189664), irregular medication rate was 15.15% (26134/172497), significantly higher than PTB patients without DM (68.08% (1966270/2888287), 27.55% (795676/2888287), 20.52% (592653/2888287), 26.07% (752894/2888287), 83.91% (2423534/2888287), 54.80% (1583015/2888287), 8.62% (249014/2888287), 1.76% (50820/2888287), 6.85% (190277/2777768), χ²=8069.084, 48737.054, 22271.353, 92.769, 4860.105, 29447.614, 2695.229, 69998.258, 16462.024, all P<0.001). The success treatment rate in PTB-DM patients (88.57% (152780/172497)) was lower than PTB patients without DM (93.37% (2593733/2777768), χ²=5831.725, P<0.001). The two-level logistic model analysis revealed that, among PTB-DM patients, aged ≥65 years (OR=1.669, 95%CI: 1.527-1.825), retirees/houseworker/job seekers (OR=1.827, 95%CI: 1.097-3.042), pathogen-positive (OR=1.435, 95%CI: 1.024-2.011), previously treated (OR=4.937, 95%CI: 4.554-5.353), irregular medication (OR=178.119, 95%CI: 154.968-204.728) patients had higher risks of adverse outcomes, while female (OR=0.771, 95%CI: 0.722-0.824), pathogen-negative (OR=0.683, 95%CI: 0.485-0.961) patients had lower risks of adverse outcomes. Conclusion: The number and proportion of PTB-DM among notified PTB patients in China have been increasing year by year. Attention should be paid to PTB-DM patients who are male, over 65 years old, retired/houseworker/unemployed, pathogen-positive, previously treated, and irregular medication. It is needed to strengthen targeted prevention, treatment and management strategies for PTB-DM patients to improve treatment success rates and reduce the risk of adverse outcomes.

Prevalence of latent tuberculosis infection and willingness for preventive treatment among Chinese students:A Meta-analysis and systematic review

Ming Yao, Chen Minghui, Wang Fang, Hu Feifei, Wang Zhi

Chinese Journal of Antituberculosis. 2025, 47(12):  1556-1565.  doi:10.19982/j.issn.1000-6621.20250257

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Objective: To determine the prevalence of latent tuberculosis infection (LTBI) and the willingness to accept tuberculosis preventive treatment among Chinese students through a meta-analysis. Methods: Systematic searches were conducted in databases including CNKI, Wanfang Database, VIP Database, PubMed, Embase, Cochrane Library, and Web of Science, with the search period spanning from the inception of each database to April 23, 2025. The literature consisted of publicly published Chinese and English articles. Two researchers independently screened the literature, extracted data from the included studies, and assessed the quality of the literature. Meta-analysis was performed using Stata 15.1 software. Results: A total of 44 Chinese and English articles were included. The pooled prevalence of LTBI among Chinese students was 6.7% (95%CI: 5.9%-7.5%), and the acceptance rate for TPT was 41.5% (95%CI: 27.0%-56.0%). Subgroup analyses revealed lower latent tuberculosis infection rates in the following groups: tuberculin skin test (6.3% (95%CI: 5.4%-7.1%)), North China region (3.6% (95%CI: 1.7%-5.4%)), primary school students (3.2% (95%CI:1.9%-4.5%)), studies with a sample size of ≥10000 (4.5% (95%CI: 3.4%-5.5%)), studies conducted before 2017 (6.0% (95%CI: 4.9%-7.1%)), and non-close contacts (6.1% (95%CI: 5.4%-6.8%)). In contrast, higher latent tuberculosis infection rates were observed in the following subgroups: other diagnostic criteria (including interferon-gamma release assay, T-cell spot test for tuberculosis infection, and recombinant Mycobacterium tuberculosis fusion protein skin test) (9.2% (95%CI: 6.1%-12.2%)), East China region (10.1% (95%CI: 7.8%-12.3%)), middle school students (6.6% (95%CI: 5.6%-7.7%)), studies with a sample size of <10000 (8.7% (95%CI: 7.0%-10.3%)), studies conducted after 2017 (6.8% (95%CI: 5.8%-7.7%)), and close contacts (8.3% (95%CI: 6.2%-10.3%)). Conclusion: The prevalence of LTBI among Chinese students remains relatively high, while the willingness to accept TPT is comparatively low.

Analysis on current status and influencing factors of latent tuberculosis infection among school tuberculosis epidemic contacts of pulmonary tuberculosis patients in Ganzhou City

Xie Tian, Wang Meng, Peng Xiaomei, Yuan Zhiping, Wang Yongqiang, Feng De'an, Guo Huiying, Chen Lixia

Chinese Journal of Antituberculosis. 2025, 47(12):  1566-1572.  doi:10.19982/j.issn.1000-6621.20250282

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Objective: To analyze the current status and influencing factors of latent tuberculosis infection (LTBI) among school tuberculosis (TB) epidemic contacts of pulmonary tuberculosis (PTB) patients in Ganzhou City, and to provide a basis for optimizing TB prevention and control measures in school settings. Methods: A retrospective study was conducted utilizing clinical data collected from TB prevention and control institutions across all counties (cities and districts) of Ganzhou City between July 2022 and July 2023. Data included gender, age, presence of suspected TB symptoms, screening time, and results of the recombinant Mycobacterium tuberculosis fusion protein (EC) test among school contacts of PTB patients. The prevalence of LTBI and associated risk factors were analyzed among contacts with varying characteristics. Results: From July 2022 to July 2023, EC-based TB infection screening was conducted among contacts from 111 school TB outbreaks in Ganzhou City, involving 6748 identified contacts. Of these, 6613 (98.00%) underwent EC testing, which identified 6 active TB cases and 259 LTBI cases during the first round. Two hundred and eighty initially EC-negative contacts from classes with three or more TB cases were re-tested three months later, yielding 7 additional LTBI cases. Finally, the LTBI detection rate of the screened individuals was 4.03% (266/6607) after excluding 6 tuberculosis patients. Multivariate logistic regression analysis of 6607 screened individuals indicated that the risk of LTBI increased with age, with odds ratios (OR (95%CI)) of 2.865 (1.528-5.372) for ages 15-19, 4.174 (1.762-9.891) for ages 20-24, 14.301 (2.649-77.201) for ages 25-34, 25.674 (4.788-137.656) for ages 35-44, 39.642 (7.018-223.909) for ages 45-54, and 37.745 (6.435-221.387) for ages 55-69. Contacts of patients with positive bacteriological results had a significantly higher risk of LTBI compared with those in contact with bacteriologically negative patients (OR (95%CI)=1.468 (1.110-1.940)). Conclusion: Contact with etiologically positive tuberculosis patients is a significant risk factor for LTBI among school contacts, and the LTBI prevalence increases with age. Strengthening dynamic surveillance of latent infections and implementing sustained follow-up measures are essential to prevent and control clustered outbreaks, particularly among high-risk groups.

Analysis of the epidemiological characteristics and influencing factors of treatment outcomes in patients with pulmonary tuberculosis complicated by diabetes in Kashgar Prefecture, 2018—2023

Maiweilanjiang Abulimiti, Abudukelimu Tawakuli, Gulimina Abulimiti, Huang Fei

Chinese Journal of Antituberculosis. 2025, 47(12):  1573-1582.  doi:10.19982/j.issn.1000-6621.20250228

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Objective: To analyze the epidemiological characteristics of patients with pulmonary tuberculosis complicated by diabetes mellitus (PTB-DM) and the influencing factors of treatment outcomes in Kashgar Prefecture, Xinjiang Uygur Autonomous Region. Methods: Through the “Tuberculosis Management Information System” subsystem of the “China Disease Prevention and Control Information System”, data on pulmonary tuberculosis patients registered and treated in Kashgar Prefecture, Xinjiang Uygur Autonomous Region from 2018 to 2023 were collected. Descriptive analysis was employed to compare the characteristics of PTB-DM patients with those of non-diabetic pulmonary tuberculosis patients managed during the same period. Regression analysis was conducted to examine the factors influencing the treatment outcomes of PTB-DM patients. Results: From 2018 to 2023, a total of 82990 patients with active pulmonary tuberculosis were registered in Kashgar, including 81048 patients without diabetes and 1942 PTB-DM patients. The annual registration rate of pulmonary tuberculosis decreased from 806.70/100000 (32851 cases) in 2018 to 154.80/100000 (7150 cases) in 2023, showing a downward trend (APC=-33.10%, {\chi }_{trend}^2=45.320, P<0.05). However, the annual registration rate of PTB-DM had increased from 2.70/100000 (110 cases) in 2018 to 14.72/100000 (680 cases) in 2023, showing a year-on-year upward trend (APC=48.00%, {\chi }_{trend}^2=6.280, P<0.05). There were significant differences in the distribution of gender, age, nationality, occupation, source of patients, pathogenic detection results and other characteristics between PTB-DM group and non-combined diabetes group. Among 1942 PTB-DM patients, 1701 achieved successful treatment, with a success rate of 87.59%. In 81048 pulmonary tuberculosis patients without diabetes, 74896 achieved successful treatment, with a success rate of 92.41%. Multivariate logistic regression analysis of influencing factors on treatment outcomes in PTB-DM patients revealed that occupations as farmers (OR=2.101, 95%CI: 1.560-2.821), patients undergoing retreatment (OR=2.277, 95%CI: 1.812-2.861), 45-54 years old (OR=2.080, 95%CI: 1.161-3.750), 55-64 years old (OR=3.360, 95%CI:1.910-5.911), 65-74 years old (OR=4.891, 95%CI: 2.820-8.482), ≥75 years old (OR=8.202, 95%CI: 4.201-16.023), positive pathogen results (OR=1.484, 95%CI: 1.147-1.920), referral/follow-up patients (OR=1.534, 95%CI: 1.116-2.109; OR=1.898, 95%CI: 1.275-2.826) had a higher risk of developing adverse treatment outcomes; patients from Yecheng County and Yuepuhu County (OR=0.148, 95%CI: 0.031-0.710; OR=0.110, 95%CI: 0.019-0.625) had a lower risk of adverse treatment outcomes. Conclusion: The registration rate of PTB-DM patients in Kashgar Region has been increasing year by year. PTB-DM patients are mainly farmers, elderly people, pathogen positive, and retreated patients, and the main sources of patients are referral and tracking; these factors are also the main risk factors for adverse treatment outcomes.

Analysis of latent tuberculosis infection status and influencing factors among elderly aged 65 and above in Haizhu District, Guangzhou City

Cai Xiaoting, Su Bihui, He Liqian, Deng Hong, Wu Xiaoying

Chinese Journal of Antituberculosis. 2025, 47(12):  1583-1589.  doi:10.19982/j.issn.1000-6621.20250249

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Objective: To analyze the status and influencing factors of latent tuberculosis infection (LTBI) among the elderly aged 65 and above in Haizhu District, Guangzhou City, and to provide a scientific basis for precise prevention and control of pulmonary tuberculosis in the elderly. Methods: A prospective study and stratified random sampling method were adopted. From January to December 2024, publicity points were set up at community health checkup sites in 18 streets of Haizhu District, Guangzhou City. According to the proportion of permanent residents aged 65 and above in each street, the sample size for inclusion was allocated. At each publicity point, elderly people who met the inclusion criteria and were willing to participate in the interferon-gamma release assay (IGRA) were invited on-site to complete information registration and blood sample collection. The blood samples were then promptly sent to the Laboratory Department of Guangzhou Chest Hospital for IGRA testing. Other clinical data were obtained from the health management records of the elderly, including health examination reports, demographic characteristics, blood routine, and liver and kidney function information. Univariate and multivariate logistic regression models were used to analyze the influencing factors related to the occurrence of LTBI. Results: A total of 1987 elderly people aged 65 and above who met the inclusion criteria in Haizhu District were enrolled in the study, and the infection rate of LTBI was 38.70% (769/1987). Multivariate logistic regression analysis showed that current smokers were 1.485 times more likely to be diagnosed with LTBI than non-smokers (OR=1.485, 95%CI: 1.002-2.201), and for each 1 mmol/L increase in fasting blood glucose, the risk of LTBI increased by 5.5% (OR=1.055, 95%CI:1.002-1.110). Those who mainly followed a vegetarian diet were 10.871 times more likely to be diagnosed with LTBI than those with a balanced diet (OR=10.871, 95%CI: 1.294-91.331). On the other hand, for each 1-unit increase in blood urea nitrogen, the risk of LTBI decreased by 5.8% (OR=0.942, 95%CI: 0.892-0.995). Conclusion: The infection rate of LTBI among the elderly aged 65 and above in Haizhu District, Guangzhou City is relatively high. Special attention should be paid to high-risk groups such as smokers, those with abnormal fasting blood glucose, and those with malnutrition. It is recommended to implement comprehensive prevention and control strategies including smoking cessation intervention, blood glucose monitoring, and personalized nutritional support.

Research on the inpatient expense standards for pulmonary tuberculosis patients based on Diagnosis-Related Groups

Yu Haiying, Li Shengjie, Yu Honghong

Chinese Journal of Antituberculosis. 2025, 47(12):  1590-1600.  doi:10.19982/j.issn.1000-6621.20250268

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Objective: To explore case mix classification schemes and cost standards for hospitalization expenses of pulmonary tuberculosis based on Diagnosis-Related Group (DRG), providing reference for optimizing payment reform schemes for pulmonary tuberculosis. Methods: A retrospective study was conducted. Medical record information from 17829 pulmonary tuberculosis patients treated at the Shandong Provincial Public Health Clinical Center affiliated to Shandong University between January 2022 and December 2024 was collected according to inclusion criteria. Data included gender, age, medical insurance type, length of hospital stay, hospitalization costs, primary diagnosis, and other diagnoses. Univariate nonparametric tests, multiple linear regression analysis, and quantile regression analysis were performed on the hospitalization costs to identify cost thresholds. A decision tree model was then used to construct the DRG grouping scheme. Results: The average hospitalization expenses per case for the 17829 pulmonary tuberculosis inpatients ranged from 1310.91 to 86513.88 yuan, with a median (interquartile range) of 11068.43 (6932.57, 12758.35) yuan. Multivariate linear regression analysis revealed that gender, age, length of hospital stay, presence of comorbidities or complications, and drug-resistant tuberculosis status all influenced hospitalization costs. Specifically, for each additional day of hospitalization,expenses increased by 0.410 (95%CI: 0.403 to 0.418) units; hospitalization costs for non-drug-resistant tuberculosis patients were 0.664 (95%CI: -0.679 to -0.647) units lower than those for drug-resistant patients; for each one-year increase in age, costs increased by 0.052 (95%CI: 0.047 to 0.056) units; patients without comorbidities or complications incurred costs 0.086 (95%CI: -0.097 to -0.075) units lower than those with comorbidities or complications; and costs for female patients were 0.042 (95%CI: -0.052 to -0.033) units lower than those for male patients. Drug-resistant tuberculosis status, age, and length of stay were incorporated into the decision tree model, yielding a total of 14 DRG combinations and corresponding hospitalization cost standards. Among these, DRG1 (drug-resistant pulmonary tuberculosis, hospitalization duration >15 days) had the highest median standard cost of 32658.46 yuan, while DRG14 (non-drug-resistant pulmonary tuberculosis, hospitalization duration 2-7 days, age ≤30 years) had the lowest median standard cost of 6769.86 yuan. A total of 450 patients (2.52%) exceeded the upper limit of standard cost, consuming 5.12% (10106372.41/197339038.50) of medical resources, with DRG1 having the highest weight (2.98). Conclusion: The decision tree model effectively grouped inpatient costs for pulmonary tuberculosis patients, with stratification nodes consistent with regression analysis results. This cost-based grouping scheme provides a reference for controlling inpatient expenses, reducing resource consumption, and alleviating the pressure on medical insurance funds.

Development and application of a high-performance liquid chromatography method for simultaneous determination of isoniazid, pyrazinamide, rifapentine or rifampicin in human plasma

Ji Deqian, He Tian, Li Wei, Xu Manyi, Liu Miaona, Lu Yu

Chinese Journal of Antituberculosis. 2025, 47(12):  1601-1608.  doi:10.19982/j.issn.1000-6621.20250274

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Objective: To establish a high-performance liquid chromatography (HPLC) method for the simultaneous determination of isoniazid (INH), pyrazinamide (PZA), and either rifapentine (RFT) or rifampicin (RFP) in plasma from tuberculosis patients. Methods: Chromatographic separation was performed on a StarCore Amide column (4.6 mm×100 mm, 2.6 μm) maintained at 20 ℃ with a ternary gradient elution system (A: 20 mmol/L ammonium acetate, pH 4.7; B: acetonitrile; C: ultrapure water; 0-3 min 97% B/3% C; 3-4 min 30% A/70% B; 4-7 min 50% A/50% B; 7-9 min 50% B/50% C; 9-15 min 97% B/3% C) at a flow rate of 1.2 ml/min. UV detection was set at 260 nm, and the injection volume was 30 μl. RFT or RFP was used as the internal standard. After full method validation, 147 plasma samples collected consecutively from tuberculosis patients undergoing therapeutic drug monitoring (TDM) were analyzed in parallel by the proposed HPLC-UV method and liquid chromatography-tandem mass spectrometry (LC-MS/MS) to evaluate clinical applicability. Results: Under the specified conditions, INH, PZA, and RFT (or RFP) achieved baseline separation within 15 minutes, with no interfering peaks from blank serum. When RFP was used as the internal standard, the linear ranges were 0.6-15 mg/L (R²=0.999) for INH, 2-100 mg/L (R²=0.999) for PZA, and 0.8-40 mg/L (R²=0.999) for RFT. Both intra-day and inter-day precision (relative standard deviation) were ≤12.14%, extraction recoveries ranged from 95.85% to 107.22%, and stability deviations under room temperature or refrigeration conditions were within ±15% of the nominal concentrations. When RFT was employed as the internal standard, the linear ranges of all analytes were consistent with their retention times (RFP: 3.39 min), demonstrating good specificity. Validation with clinical patient plasma samples showed high agreement with LC-MS/MS results (Bland-Altman bias <5%), confirming the reliability of the method. Conclusion: We developed a simple, specific, and sensitive HPLC method capable of simultaneously quantifying three first-line anti-tuberculosis drugs in plasma. It can be applied to TDM of the core agents in both the standard 6-month regimen and the 4-month short-course chemotherapy, thereby facilitating individualized dosing in tuberculosis patients.

First isolation, identification and characterization of Mycobacteriophages in Yunnan Province

Du Yu, Zhang Haipeng, Liu Kejun, Shi Liyuan, Tan Hongli, Wang Peng

Chinese Journal of Antituberculosis. 2025, 47(12):  1609-1615.  doi:10.19982/j.issn.1000-6621.20250248

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Objective: To isolate Mycobacteriophages from Yunnan Province and elucidate their phenotypic and genomic characteristics. Methods: Hospital sewage samples, soil samples, and fecal samples were collected in Kunming, Dali, Nujiang, Dehong, Yuxi, Lincang, Pu'er, Zhaotong, and Baoshan cities in Yunnan Province. Using Mycobacterium smegmatis mc²155 as the host bacterium, direct and enrichment methods were used to isolate Mycobacteriophages from the sample. The isolated Mycobacteriophages were subjected to biological characterization, whole genome sequencing, and genome analysis. Results: Three Mycobacteriophages were isolated from 186 samples, and one strain named YN1 was selected for the further study. The results showed that the optimal multiple number of YN1 infection was 0.1, and the growth incubation period was about 330 minutes. Environmental factors such as temperature, pH, UV and ethanol had certain effects on YN1.Genomic analysis showed that YN1 belongs to the linear double stranded DNA virus, while comparative genomics indicated that YN1 belongs to the mycobacterial Ⅰ cluster bacteriophage in taxonomy. Conclusion: This study isolated Mycobacteriophages from Yunnan Province for the first time. After identification and characterization, YN1 was identified as a new mycobacterial cluster Ⅰ bacteriophage, enriching the domestic mycobacterial bacteriophage library and providing a basis for further development and utilization of Mycobacteriophages.

The early diagnostic value of fluorescence quantitative PCR in bronchoalveolar lavage fluid for sputum smear-negative pulmonary tuberculosis

Chen Lei, He Xiaoying, Yang Guang, Yu Chunqi, Han Aizhen, Zheng Weijie, Yin Xiangyu, Han Shouhua

Chinese Journal of Antituberculosis. 2025, 47(12):  1616-1620.  doi:10.19982/j.issn.1000-6621.20250279

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Objective: To evaluate the early diagnostic efficacy of the fluorescence quantitative PCR (DiagMed qPCR, abbreviated as “qPCR”) in detecting sputum smear-negative pulmonary tuberculosis using bronchoalveolar lavage fluid. Methods: A prospective study was conducted, enrolling consecutive suspected pulmonary tuberculosis patients with sputum smear-negative results who met the inclusion criteria and were treated at the Second People's Hospital of Weifang from July to November 2024 as the study subjects. The bronchoalveolar lavage fluid samples submitted by the research subjects were subjected to smear acid fast bacteria staining microscopy, MGIT 960 liquid culture (referred to as “liquid culture”), GeneXpert MTB/RIF (referred to as “Xpert”), and qPCR detection. The results of liquid culture and clinical comprehensive diagnosis were used as reference standards to evaluate the diagnostic value of qPCR technology in detecting bronchoalveolar lavage fluid for sputum smear-negative pulmonary tuberculosis. Results: Finally, 168 study subjects were included. The positive rate of acid fast bacteria staining in bronchoalveolar lavage fluid smear microscopy was 19.05% (32/168), the positive rate of liquid culture was 32.74% (55/168), the positive rate of Xpert detection was 37.50% (63/168), and the positive rate of qPCR detection was 42.26% (71/168). There was no statistically significant difference in the positive rate of qPCR detection compared to Xpert detection and liquid culture (χ²=3.251, P=0.071; χ²=0.836, P=0.361). Using liquid culture results as a reference standard, the sensitivity and specificity of qPCR detection were 96.36% (53/55) and 84.07% (95/113), respectively; the sensitivity and specificity of Xpert detection were 94.55% (52/55) and 90.27% (102/113), respectively. Based on clinical diagnostic results, the sensitivity and specificity of qPCR detection were 63.06% (70/111) and 98.25% (56/57), respectively; the sensitivity and specificity of Xpert detection were 56.76% (63/111) and 100.00% (57/57), respectively; the sensitivity of qPCR detection was significantly higher than that of Xpert detection, and the difference was statistically significant (χ²=65.298, P<0.05). Conclusion: qPCR detection of bronchoalveolar lavage fluid showed good efficacy in the diagnosis of sputum smear-negative pulmonary tuberculosis, providing an important means for early diagnosis of pulmonary tuberculosis in primary medical institutions using molecular biology technology.

Investigation into the impact of Rv2048c gene knockout on the drug susceptibility of Mycobacterium tuberculosis

Li Nana, Wang Hong, Tian Peng, Wen Jixiu, Yang Dan, Wu Xia, Lan Yuanbo

Chinese Journal of Antituberculosis. 2025, 47(12):  1621-1628.  doi:10.19982/j.issn.1000-6621.20250429

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Objective: To investigate the effect of Rv2048c gene knockout on the drug susceptibility of Mycobacterium tuberculosis (MTB). Methods: In this study, the MTB standard strain (H37Rv-WT) was used as a template to construct the Rv2048c gene knockout strain (H37RvΔRv2048c) via homologous recombination principle. Colony morphology, cell size, and cell wall integrity were evaluated through solid culture, acid-fast staining, and scanning electron microscopy. A growth curve was plotted to evaluate the growth rate. The minimum inhibitory concentration (MIC) was determined using the microplate method for drug susceptibility testing. Cell wall permeability was assessed using ethidium bromide staining. The biological characteristics, anti-tuberculosis drug susceptibility, and cell wall permeability of H37Rv-WT and H37RvΔRv2048c were systematically compared. Subsequently, the influence of the Rv2048c gene on MTB drug susceptibility and its potential mechanism were analyzed. Results: H37RvΔRv2048c was successfully constructed. Colony morphology transitioned from the rough type (R type) in H37RV-WT to the smooth type (S type) in H37RvΔRv2048c. Both strains exhibited rod-like structures with comparable cell wall compositions; however, the bacterial length of H37RvΔRv2048c was significantly shorter. The MIC of ethionamide (Eto) against H37RvΔRv2048c (1.25 μg/ml) was 1/4 of the MIC of Eto against H37Rv-WT (5.00 μg/ml); the MIC of amikacin (Am) against H37RvΔRv2048c (0.25 μg/ml) was 1/4 of the MIC of Am against H37Rv-WT (1.00 μg/ml). After ethidium bromide staining, the fluorescence intensity of H37RvΔRv2048c (1.526 RFU) was significantly higher than that of H37Rv-WT (0.924 RFU)(t=16.960, P<0.001). Conclusion: Deletion of the Rv2048c gene results in reduced MIC values for Eto and Am. This gene may modulate MTB susceptibility to Eto and Am by altering cell wall permeability. This study provides new insights into MTB drug resistance mechanisms and identifies potential targets for enhancing the effectiveness of Eto and Am.

Clinical analysis of 12 patients with tuberculosis complicated with hemophagocytic syndrome

Xue Yu, Liu Yan, Lei Xuan, Li Wensheng, Li Huan, Zhang Jing, Zhao Lingjuan, Guo Shubin, Wen Li

Chinese Journal of Antituberculosis. 2025, 47(12):  1629-1634.  doi:10.19982/j.issn.1000-6621.20250288

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Objective: To understand the clinical manifestations, laboratory findings, and treatment options of patients with hemophagocytic syndrome (HPS) induced by tuberculosis, and to improve understanding of this disease for early diagnosis and treatment. Methods: A retrospective analysis was performed on clinical data of 12 patients with tuberculosis complicated with HPS in Beijing Chest Hospital, Capital Medical University from January 2015 to January 2025. Demographic data, clinical features, laboratory results, treatment regimens, and prognosis were collected. Results: Among the 12 patients with tuberculosis complicated with HPS, only one case was over 65 years old (86-year-old). There were 11 cases of pulmonary tuberculosis, including 5 cases of miliary pulmonary tuberculosis (hematogenous disseminated type); 1 case of extrapulmonary tuberculosis (lymph node tuberculosis). All 12 patients presented with high fever (temperature>38.5 ℃) and elevated ferritin; 10 cases had varying degrees of cytopenia; 9 cases had splenomegaly, elevated plasma soluble CD25, and decreased NK cell activity, respectively; 6 cases showed hemophagocytosis in bone marrow smears; 4 cases had decreased fibrinogen; 1 case had elevated triglycerides; 7 cases had underlying tumors or immune diseases. All patients received active anti-tuberculosis treatment combined with HPS-specific therapy. Five patients died, with the time from HPS diagnosis to death ranging from 4 to 53 days (median, 22 days). Conclusion: Tuberculosis-induced HPS predominantly affects young and immunosuppressed populations, commonly with miliary pulmonary tuberculosis and all patients get high fever. Given its high mortality, aggressive treatment for HPS is necessary in conjunction with anti-tuberculosis therapy.

Meta-analysis on effectiveness of comprehensive nursing care on pulmonary tuberculosis patients

Wu Dengzhu, Shen Lingfen, Zheng Jun, Lu Tianqi, Zheng Yi, Pan Lei, Yan Chenxi

Chinese Journal of Antituberculosis. 2025, 47(12):  1635-1643.  doi:10.19982/j.issn.1000-6621.20250281

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Objective: To systematically evaluate the effectiveness of comprehensive nursing on the treatment outcome of patients with pulmonary tuberculosis. Methods: A systematic search was conducted in CNKI, PubMed and Embase databases for randomized controlled trials that met certain criteria. The effectiveness of comprehensive nursing on the treatment outcomes of pulmonary tuberculosis patients, including treatment compliance, self-management ability and mental health indicators, was evaluated. The search period was from January 1, 2010 to July 1, 2025. Two researchers independently conducted literature screening, data extraction and quality evaluation. Meta-analysis was performed using RevMan 5.4 software. Results: A total of 16 articles were included in the study. The meta-analysis results showed that compared with conventional treatment, comprehensive care significantly increased the treatment compliance rate of tuberculosis patients (OR=4.87, 95%CI: 3.36-7.06, P<0.01). In meta-analysis of self-management ability assessment scales of the two groups, the observation group scored significantly higher than the conventional care group in self-concept (MD=5.24, 95%CI: 4.69-5.79, P<0.01), self-responsibility (MD=5.08, 95%CI: 2.09-8.08, P<0.01), self-care skills (MD=7.85, 95%CI: 7.16-8.54, P<0.01), and health knowledge level (MD=8.00, 95%CI: 7.13-8.87, P<0.01). Compared with conventional care, the observation group had significantly lower SAS scores (MD=-7.09, 95%CI: -9.67 - -4.51, P<0.01) and SDS scores (MD=-7.17, 95%CI: -9.13 --5.21, P<0.01). Conclusion: Comprehensive nursing significantly enhanced treatment compliance, self-management ability of patients with pulmonary tuberculosis, and improved their mental health indicators. Medical staff can strengthen comprehensive nursing based on individual characteristics of tuberculosis patients to improve the treatment outcome.

Review Articles

Research advances in tuberculosis care for key populations

Liang Xuefang, Wang Zhiying, Zhu Zhipeng

Chinese Journal of Antituberculosis. 2025, 47(12):  1644-1650.  doi:10.19982/j.issn.1000-6621.20250251

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Tuberculosis (TB) remains a major global public health threat, disproportionately affecting key populations such as the elderly, children, migrants, individuals with drug-resistant TB, and those living with HIV. These groups often face structural and physiological vulnerabilities, including limited access to healthcare services and heightened social stigma, which hinder effective disease management. Tailored, patient-centered care is therefore essential to improving outcomes. Despite global progress in TB control, significant gaps persist in the delivery of equitable care for these high-risk populations. This review offers a comprehensive analysis of the current landscape, persistent barriers, and strategic directions for enhancing TB care in key populations. It proposes an integrated framework that emphasizes policy innovation, technological advancement, and multisectoral collaboration. These insights aim to support the development of more effective, inclusive care strategies and accelerate progress toward TB elimination.

Research progress of social isolation in tuberculosis patients

Chen Yao, Xing Luyan, Liu Ting, Luo Jia

Chinese Journal of Antituberculosis. 2025, 47(12):  1651-1657.  doi:10.19982/j.issn.1000-6621.20250240

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To introduce concept and measurement tools of social isolation in tuberculosis patients, expound status quo and influencing factors of social isolation, and put forward targeted strategies and suggestions for management. It's aimed at providing references for the related work of social isolation in tuberculosis patients in the future, and helping tuberculosis patients to reintegrate into community as much as possible, and improving their quality of life.

Immunomodulatory effects of Mycobacterium vaccae on allergic diseases: advances and mechanisms

Wang Yiwen, Qi Yunfeng, Nie Wenjuan

Chinese Journal of Antituberculosis. 2025, 47(12):  1658-1662.  doi:10.19982/j.issn.1000-6621.20250293

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Mycobacterium vaccae, a non-pathogenic mycobacterial species, exhibits unique potential in immunomodulation of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis. Its immunomodulation effects are mediated through coordinated multicellular interactions—enhancing macrophage activity, promoting dendritic cell maturation, and inducing a Th1-polarized immune profile—while expanding regulatory T cells to suppress Th2-dominant hyperactivity, thereby correcting immune dysregulation. Preclinical evidence has demonstrated that this bacterium significantly alleviates allergic symptoms, including reduced airway hyperresponsiveness in asthma, mitigated mucosal inflammation in allergic rhinitis, improved skin lesions in atopic dermatitis, and further supports its significant therapeutic efficacy and favorable safety profile in asthma and allergic rhinitis; however, optimization of administration routes and dynamic immune biomarker monitoring require refinement. Future research necessitates multidisciplinary approaches to elucidate immunomodulatory mechanisms of Mycobacterium vaccae and to advance its clinical translation, provides a novel immunomodulatory strategy for allergic diseases with broad research prospects.