Table of Content

10 February 2026, Volume 48 Issue 2

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Guideline·Standard·Consensus

Expert consensus on therapy and drug monitoring clinical application of anti-tuberculosis drug (updated in 2025)

Pharmaceutical Professional Branch of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2026, 48(2):  167-187.  doi:10.19982/j.issn.1000-6621.20250435

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Therapeutic drug monitoring (TDM) is a method to develop individualized dosing regimens for patients based on the measurement of drug exposure pharmacological biomarkers, or efficacy indicators in the body, using quantitative pharmacological models and taking the drug treatment window as the benchmark. Its core is individualized drug therapy. In order to further guide and standardize the TDM work of anti-tuberculosis drugs in Chinese medical institutions, ensuring scientific rigor, ethical practice, and standardized procedures for maximal patient benefit, Pharmaceutical Professional Branch of Chinese Antituberculosis Association, in conjunction with Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute systematically updated the indications, monitoring methods, dose adjustment, and application in special populations of TDM on the basis of the 2021 Expert consensus on clinical application of therapeutic drug monitoring for anti-tuberculosis drugs. This consensus is registered on the international practice guidelines platform, and the formulation process follows the principles of methodology. Drawing on the collaborative expertise of tuberculosis pharmaceutical and clinical experts, along with the latest evidence-based research and practical experience, this consensus will provide scientific and feasible guidance for the clinical implementation of TDM.

Special Topic

Imaging manifestations of male reproductive system tuberculosis

Fu Xuwen, He Weiyaozhen, Li Xiang

Chinese Journal of Antituberculosis. 2026, 48(2):  188-196.  doi:10.19982/j.issn.1000-6621.20250302

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Male genital tuberculosis (MGTB) can occur in various organs of male reproductive system, which could be with atypical clinical symptoms or asymptomatic, thus easy to cause missed diagnosis and misdiagnosis. With the development of medical imaging technology, it plays an important role in the diagnosis and differential diagnosis of MGTB. The authors aim to systematically summarize the ultrasound, CT and MRI manifestations of tuberculosis in various organs of male reproductive system, to improve understanding and clinical diagnosis of MGTB.

Original Articles

Survival status and influencing factors analysis of patients with rifampicin-resistant pulmonary tuberculosis in Kashgar Prefecture, Xinjiang Uygur Autonomous Region, 2013—2022

Su Wei, Bai Xinyu, Maiwulajiang Yimamu, Keyoumu Wubulikasimu, Diermulati Tusun, Lai Fuli, Mirenisha Abudurexiti, Xirizhati Mamuti, Zhou Linjun, Huang Fei

Chinese Journal of Antituberculosis. 2026, 48(2):  197-205.  doi:10.19982/j.issn.1000-6621.20250366

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Objective: To analyze the survival status and influencing factors of patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) in Kashgar Prefecture, Xinjiang Uygur Autonomous Region, and to provide a scientific basis for optimizing the prevention and control strategies of drug-resistant tuberculosis. Methods: A retrospective analysis was performed on the survival status of RR-PTB patients diagnosed in Kashgar Prefecture since the initiation of standardized diagnosis and treatment for drug-resistant tuberculosis in 2013, up to the end of 2022. The life table method was used to analyze the death probability, survival probability and cumulative survival rate of the patients; the Kaplan-Meier method was used to calculate the median survival time and draw the survival curve, and the Log-rank test was performed; univariate and multivariate Cox proportional hazards regression models were applied to analyze the risk factors affecting the survival of RR-PTB patients. Results: A total of 782 RR-PTB patients were included in the analysis, with a maximum follow-up duration of 9.9 years. During the follow-up period, 40.0% (313/782) of the patients died, with deaths predominantly concentrated in the first year after diagnosis (121 cases), particularly within 2 months after diagnosis (31 cases, accounting for 25.6%). The overall mortality density was 4.4/100 person-years, showing a decreasing trend. The median survival time of the patients was 80.9 (95%CI: 61.3-100.5) months, and cumulative survival rates at the 12th, 36th, and 60th months were 74.2%, 61.5%, and 52.2%, respectively. The average survival times of patients who presented with the three adverse treatment outcomes of treatment failure, loss to follow-up, and unevaluated were (67.9±7.9), (67.4±3.8), and (71.1±3.6) months, respectively, and the difference in survival times between the groups was statistically significant by the Log-rank test (χ²=27.631, P<0.001). Multifactorial Cox proportional risk model analysis revealed that non-treatment (compared to the treated patients, HR=2.642,95%CI: 2.018-3.458), retreatment (compared to the new patients, HR=1.779, 95%CI: 1.359-2.329) and low education(compared to the primary school or below group, the junior high school group: HR=0.652, 95%CI: 0.443-0.959)were factors affecting the survival time of patients. Conclusion: RR-PTB patients in Kashgar Prefecture have a notably high mortality rate and bear a heavy disease burden. Non-treatment, retreatment and low education level are risk factors affecting the survival of patients, and patients with adverse treatment outcomes such as treatment failure have a prolonged infectious period. It is recommended to promote rapid drug susceptibility testing technology and short-course treatment regimens, ensure that all eligible patients receive treatment, provide appropriate health education, and strengthen patient care and support, so as to reduce the risk of death and alleviate the disease burden.

Analysis on the prognostic outcome model of elderly pulmonary tuberculosis patients with comorbidities based on the Chinese multimorbidity-weighted index

Wu Xiaoying, He Gang, Cai Xiaoting, He Liqian, Deng Hong, He Liyan

Chinese Journal of Antituberculosis. 2026, 48(2):  206-216.  doi:10.19982/j.issn.1000-6621.20250360

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Objective: Using the Chinese Multimorbidity-weighted Index (CMWI), a model for predicting the prognosis of elderly pulmonary tuberculosis patients with comorbidities was established, to provide a reference basis for formulating prevention and treatment strategies for comorbidities of pulmonary tuberculosis in the elderly. Methods: A retrospective cohort study was conducted on 1423 elderly pulmonary tuberculosis patients with comorbidities admitted to Guangzhou Chest Hospital from January 1, 2016 to December 31, 2023. The study started from the date of diagnosis of pulmonary tuberculosis, and the follow-up observation period was 18 months, taking prognosis of study subjects as final outcomes. Information of the subjects was collected from the “TB Information Management System” of the “China Disease Control and Prevention Information System”, medical records, the “tuberculosis patient treatment record card of Guangzhou”, and the “tuberculosis patient treatment management registration card of Guangzhou”. Characteristics and prognosis of patients were analyzed using descriptive methods, followed by logistic regression analysis to identify influencing factors and establish a predictive model. Results: Among 1423 elderly pulmonary tuberculosis patients with comorbidities, 1205 cases (84.68%) got treatment success, and 218 cases (15.32%) got unfavorable outcomes. Higher age (HR=1.054,95%CI:1.033-1.076), non-local-registered residence (HR=1.655,95%CI:1.058-2.621), clinical symptoms (HR=2.216,95%CI:1.333-3.683), positive etiological examination result (HR=3.802,95%CI:2.512-5.754), severe pulmonary tuberculosis (HR=4.628,95%CI:2.968-7.216), and high CMWI (Chinese multimorbidity-weighted index,CMWI)(HR=1.301,95%CI:1.196-1.415) were risk factors for adverse treatment outcomes; regular treatment (HR=0.285,95%CI: 0.180-0.451) was a protective factor. We established a predictive model as logit P=-8.136+0.053X₁+0.510X₂+0.796X₃+1.335X₆+1.532X₉-1.254X₁₀+0.263X₁₁. The goodness of fit test showed that the model fit well (χ²=8.055, P=0.428). The total accuracy using backtesting and interaction verification methods were 87.70% and 88.19%, respectively, indicating good prediction accuracy. The diagnostic performance of the model was as follows: area under the curve (AUC) was 0.870 (95%CI: 0.844-0.896), optimal critical point was 0.189, sensitivity was 73.53%, missed diagnosis rate was 26.47%, specificity was 86.98%, misdiagnosis rate was 13.02%, and Jordan index was 0.605, showing the model having made good performance. A decision tree model was constructed using machine learning algorithms which consisted of 3 layers, 11 nodes, and 4 explanatory variables, with regular treatment as the root node, followed by severe tuberculosis, etiological examination result, and CMWI as child nodes. The probability of getting treatment success was highest (96.36%) for patients with regular treatment, non-severe pulmonary tuberculosis, and CMWI≤3.2. ROC curve for this model showed: area under the curve (AUC) was 0.843 (95%CI: 0.812-0.875), optimal critical point was 0.134, sensitivity was 77.98%, missed diagnosis rate was 22.02%, specificity was 79.34%, misdiagnosis rate was 20.66%, and Jordan index was 0.573. Brier score was 0.089. Calibration curve indicated good predictive accuracy. Decision curve demonstrated good clinical applicability. Conclusion: The prognostic outcome predictive model for elderly pulmonary tuberculosis patients with comorbidities based on the CMWI has good application value and provides scientific basis for exploring the management of comorbidities of pulmonary tuberculosis in the elderly.

Research on the construction of social support indicator system for tuberculosis based on Delphi method

Zhu Shiyu, Song Canlei, Zhang Rui, Hao Yanxing, Zhu Weitao, Gao Xia

Chinese Journal of Antituberculosis. 2026, 48(2):  217-222.  doi:10.19982/j.issn.1000-6621.20250375

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Objective: To construct an indicator system for the tuberculosis social support system, and provide a reference for the scientific implementation of “Zero Tuberculosis Community” development. Methods: Based on a literature review, a preliminary indicator system for tuberculosis social support was constructed through group discussions. The Delphi method was adopted to invite 12 experts in related fields to conduct two rounds of consultations, aiming to evaluate the importance and feasibility of each item in the indicator system for the tuberculosis social support system. Results: The expert positive coefficient for both rounds of consultations was 100.0%, with a mean expert authority coefficient of 0.91. The Kendall’s W test for items at all levels showed statistically significant differences (Ps<0.001). The consistency coefficients (W values) for the importance of indicators in the two rounds of expert consultation were 0.187 and 0.203, respectively, while those for feasibility were 0.280 and 0.256. The final constructed indicator system for tuberculosis social support included 3 first-level indicators (institutional support, community support, and family support), 10 second-level indicators, and 55 third-level indicators. The mean scores for importance and feasibility of each item were all greater than 3.5, with coefficients of variation all less than 0.25. Conclusion: The indicator system for tuberculosis social support system initially established using the Delphi method has certain reliability and scientificity. It can provide a basis and assistance for the construction of “Zero Tuberculosis Community”. Further research is needed to verify and improve the indicator system.

A qualitative study on motivational factors and barriers to pulmonary tuberculosis treatment among initial treated smear-positive pulmonary tuberculosis patients and their families based on the Health Belief Model

Xu Liangrun, Yang Mingying, Guo Yingwu, Wang Yun, Xu Jingjing, Hou Juyan, Ma Yunhong

Chinese Journal of Antituberculosis. 2026, 48(2):  223-229.  doi:10.19982/j.issn.1000-6621.20250244

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Objective: Based on the Health Belief Model, with qualitative interviews, this study is to explore the health beliefs of initial treated smear-positive pulmonary tuberculosis patients and their families: motivational factors and barriers. Methods: Based on the Health Belief Model theory, a descriptive qualitative study was conducted. Using purposive sampling, 10 initial treated smear-positive pulmonary tuberculosis patients hospitalized in the Third People’s Hospital of Kunming from November to December 2022 and their 9 family members (including 2 parents, 5 spouses, and 2 children), were selected as the study subjects. In-depth and semi-structured interviews were conducted based on the interview outline, and the interview data were organized and analyzed using targeted content analysis. Results: The study identified six health belief themes among initial treated smear-positive pulmonary tuberculosis patients and their families: blind spots in pulmonary tuberculosis-related knowledge, concerns about pulmonary tuberculosis transmission, the ability to return to social activities after being cured, barriers to the treatment of pulmonary tuberculosis, confidence in being cured from pulmonary tuberculosis, and support for pulmonary tuberculosis treatment needs. These six themes were categorized into motivating factors and barriers. The motivating factors were the ability to return to social activities after being cured, confidence in being cured from pulmonary tuberculosis, and support for treatment needs; Barriers included blind spots in pulmonary tuberculosis-related knowledge, concerns about pulmonary tuberculosis transmission, and barriers to pulmonary tuberculosis treatment (general barriers and specific barriers for both patients and their families). General barriers for patients included treatment costs, schooling suspension, and work suspension. Specific barriers included inconvenient transportation. General barriers for family members included treatment costs, while the specific barriers included the absence of caregivers for patients. Conclusion: The ability to return to social activities after being cured, confidence in being cured from pulmonary tuberculosis, and support for treatment needs are the healthbeliefs that serve as motivational factors for the initial treated smear-positive pulmonary tuberculosis patients and their families, while blind spots in pulmonary tuberculosis-related knowledge, concerns about pulmonary tuberculosis transmission, and treatment barriers (costs, suspension of schooling and work, transportation inconvenience, and lack of caregivers) are the health beliefs that hinder the treatment for initial smear-positive pulmonary tuberculosis patients and their families.

Analysis of close contacts screening situation and time changing trends of pulmonary tuberculosis patients in Chongqing from 2015 to 2024

Liu Shuya, Zhang Ting, Wang Qingya, Fan Jun, Wang Ni

Chinese Journal of Antituberculosis. 2026, 48(2):  230-237.  doi:10.19982/j.issn.1000-6621.20250344

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Objective: To analyze the screening situation of close contacts and time changing trends of pulmonary tuberculosis (PTB) patients in Chongqing from 2015 to 2024, and to provide a basis for improving the efficiency of PTB detection and the standardized management of close contacts. Methods: Data on all registered active PTB patients and etiologically-positive PTB patients in Chongqing from January 1, 2015, to December 31, 2024, as well as data from three times of follow-up screening of close contacts (at initial diagnosis, 6 months, and 1 year), were collected from the China Information System for Disease Control and Prevention. Joinpoint regression was used to analyze the temporal trends of average number of close contacts registered per index case, tuberculosis examination rate, detection rate of active PTB among close contacts, and contribution rate of close contact screening to PTB patient discovery, using Annual Average Percent Change (AAPC) and Annual Percent Change (APC). Results: From 2015 to 2024, a total of 161163 cases of PTB cases, 81280 PTB index cases and 210311 close contacts were registered in Chongqing. Among them, household contacts accounted for 69.72% (146624/210311), and non-household contacts accounted for 30.28% (63687/210311), with an average of 2.59 close contacts registered per index case. A total of 206067 close contacts were screened for suspicious PTB symptoms, with a screening rate of 97.98%; however, only 6.44% (13265/206067) were found to have suspicious symptoms. A total of 152991 close contacts underwent tuberculosis examinations, representing an examination rate of 72.75%. In total, 1501 active PTB patients were detected, yielding a detection rate of 0.98% (1501/152991). The contribution rate of close contact screening to overall PTB patient discovery was 0.93% (1501/161163). Joinpoint trend analysis indicated that the average number of registered close contacts per index case showed an upward trend from 2015 to 2024 (AAPC=12.287%, 95%CI: 7.800% to 15.508%, P<0.001), with a significant increase observed from 2021 to 2024 (APC=41.482%, 95%CI: 21.084% to 76.752%, P<0.001). Conversely, both the tuberculosis examination rate and the detection rate of active PTB among close contacts showed downward trends (AAPC=-6.631%, 95%CI: -10.722% to-2.017%, P=0.004; AAPC=-27.791%, 95%CI:-46.442% to -2.882%, P=0.032), with the examination rate declining significantly from 2021 to 2024 (APC=-18.192%, 95%CI:-36.210% to -7.334%, P=0.002). Conclusion: From 2015 to 2024, the average number of close contacts registered for each index case in Chongqing showed an upward trend, while the tuberculosis screening rate and the detection rate of PTB patients among close contacts decreased. The contribution of close contacts screening to case detection was relatively low. It is recommended to further standardize the close contacts screening work, increase the tuberculosis screening rate, so as to enhance the detection rate of PTB patients and the contribution of close contacts screening to case detection.

Construction of a discharge preparation service protocol for new drug-susceptible pulmonary tuberculosis patients based on the Timing Theory

Cai Liping, Chen Danping, Tang Jing, Jiang Sisi, Wu Ying, Wang Xiaomei

Chinese Journal of Antituberculosis. 2026, 48(2):  238-246.  doi:10.19982/j.issn.1000-6621.20250389

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Objective: To develop a discharge preparation service protocol for new drug-susceptible pulmonary tuberculosis patients based on the Timing Theory, providing a practical pathway reference for clinicians delivering discharge planning services. Methods: A preliminary draft was developed through literature review and group discussions. Two rounds of expert consultation via the Delphi method were then conducted for further refinement, and the final discharge preparation service protocol for new drug-susceptible pulmonary tuberculosis patients was determined. Results: The response rates of experts in both rounds of Delphi consultation were 100.0%, the expert authority coefficients of 0.912, respectively. In the first round, the Kendall’s W coefficients for the importance and operability of the items were 0.186 and 0.225 (χ²=319.349 and 385.936, both P<0.001), and those in the second round were 0.212 and 0.271 (χ²=353.771 and 452.208, both P<0.001). The final protocol comprised 5 primary indicators, 24 secondary indicators, and 70 tertiary indicators, spanning the period from the patient admission to 6 months post-discharge. Conclusion: The discharge preparation service protocol for newly diagnosed drug-susceptible tuberculosis patients, developed based on the Timing Theory, is scientifically validated and reliable, and can provide valuable reference for clinical discharge planning.

Analysis of drug resistance patterns in 241 patients with lymph node tuberculosis

Lin Weibing, Shi Yiheng, Guo Yanling, Ma Shang, Yang Bin, Long Sibo, Zheng Maike, Sun Yong, Zhao Yan, Wang Guirong

Chinese Journal of Antituberculosis. 2026, 48(2):  247-255.  doi:10.19982/j.issn.1000-6621.20250309

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Objective: To analyze the drug resistance characteristics of 241 hospitalized patients with lymph node tuberculosis to guide individualized treatment. Methods: A retrospective analysis was conducted on the clinical data of 241 hospitalized patients with lymph node tuberculosis treated at Beijing Chest Hospital, Capital Medical University, from January 2016 to January 2024. The Mycobacterium microplate drug susceptibility testing technique was used to test and analyze the drug susceptibility test results of Mycobacterium tuberculosis isolated from 241 patients to 16 anti-tuberculosis drugs, including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), rifapentine (Rft), rifabutin (Rfb), levofloxacin (Lfx), moxifloxacin (Mfx), kanamycin (Km), amikacin (Am), capreomycin (Cm), prothionamide (Pto), para-aminosalicylic acid (PAS), para-aminosalicylic acid isoniazid (Pa), clarithromycin (Clr), and clofazimine (Cfz), as well as the differences in drug resistance patterns between primary and retreatment patients. Results: Among 241 patients, the overall drug resistance, monoresistance, multidrug resistance (MDR), polydrug resistance and pre-extensively drug-resistant (pre-XDR) rates to 16 anti-tuberculosis drugs were 51.87% (125/241), 8.30% (20/241), 24.07% (58/241), 12.86% (31/241) and 10.37% (25/241), respectively. The overall resistance rate (62.50%,95/152), MDR rate (34.21%,52/152) and pre-XDR rate (16.45%,25/152) in retreatment patients were all significantly higher than those in primary patients (33.71% (30/89), 6.74% (6/89) and 0.00% (0/89), respectively), with χ² values of 18.639, 23.177 and 14.611 (continuity-corrected), all P<0.001. Among the 16 anti-tuberculosis drugs, drugs with highest resistance rates were INH (34.44%, 83/241), Sm (32.78%, 79/241), Rft (30.71%, 74/241), RFP (26.14%, 63/241), Pa (24.48%, 59/241), Rfb (22.41%, 54/241) and PAS (17.43%, 42/241). Among 58 patients with MDR-TB, the resistance rates to fluoroquinolones and second-line injectable anti-tuberculosis drugs were 43.10% (25/58) and 89.66% (52/58), respectively, and 24 patients (41.38%) were resistant to both classes simultaneously. In this subgroup, the resistance rate to fluoroquinolones (48.08%, 25/52)) and the rate of concomitant resistance to both fluoroquinolones and second-line injectable drugs (46.15%, 24/52)) in retreatment patients were significantly higher than those in primary patients (0/6 for both), with statistically significant differences by Fisher’s exact test (P=0.032 and 0.037, respectively). The cross-resistance rates among Rft, Rfb and RFP ranged from 72.97% (54/74) to 100.00% (54/54). A total of 44 MDR resistance combination patterns and 25 polydrug-resistance combination patterns were identified; the highest frequencies of individual MDR and polydrug-resistance pattern were 2.90% (7/241) and 2.07% (5/241), respectively, whereas 37 other MDR patterns and 22 polydrug-resistance patterns each had a frequency of 0.41% (1/241). Conclusion: Patients with lymph node tuberculosis exhibit a high overall rate of drug resistance; INH, Sm and rifamycin-class drug are the main drugs to which resistance occurs, and the patterns of multidrug and polydrug resistance are complex. These findings indicate a severe drug-resistance situation in lymph node tuberculosis, and clinical treatment should rely fully on drug susceptibility test to develop individualized and standardized anti-tuberculosis regimen.

The CT imaging features of Mycobacterium avium-intracellulare pneumonia and the diagnostic evaluation of in non-tuberculous mycobacterium pneumonia

Ji Yuanfei, Yu Xia, Wang Jue, Sun Mengyan, He Wei, Lyu Yan, Hou Dailun, Li Chenghai

Chinese Journal of Antituberculosis. 2026, 48(2):  256-263.  doi:10.19982/j.issn.1000-6621.20250417

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Objective: To compare and analyze the differences in computed tomography (CT) imaging findings between pulmonary disease caused by the Mycobacterium avium-intracellulare complex (MAC) and pulmonary disease caused by other non-tuberculous mycobacterial (NTM) species, to explore the CT imaging characteristics of MAC pulmonary disease, and to improve the CT diagnostic accuracy for MAC pulmonary disease. Methods: With the retrospective study, the clinical data of 259 patients with confirmed NTM pulmonary diseases admitted to Beijing Chest Hospital, Capital Medical University from January 1, 2013 to August 31, 2021 were collected based on the inclusion criteria. Among them, 138 patients had MAC pulmonary disease (MAC group), and 121 patients had pulmonary disease caused by other NTM species (other NTM group). Univariate and multivariate binary logistic regression models were used to analyze the imaging features (including patchy opacities, ground-glass opacities, interstitial changes, thin-walled cavities, thick-walled cavities, mixed cavities, localized adjacent pleural thickening, bronchial wall thickening, extensive pleural thickening, emphysema, etc.) of the two groups. The diagnostic performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), and the DeLong test was employed to compare the differences in AUC values between the combined prediction and individual imaging signs. Results: The median age (interquartile range) of the MAC group was 61.00 (54.75, 68.25) years, which was higher than that of the other NTM group (52.00 (42.50, 61.00) years), with a statistically significant difference (Z=5.246,P<0.001). The proportions of CT imaging findings such as patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities in the MAC group (97.10% (134/138), 19.57% (27/138), 65.22% (90/138), and 44.20% (61/138), respectively) were significantly higher than those in the other NTM group (89.26% (108/121), 4.96% (6/121), 35.54% (43/121), and 31.40% (38/121), respectively), with statistically significant differences (χ²=6.470, P=0.011; χ²=12.372, P<0.001; χ²=22.734, P<0.001; χ²=4.472, P=0.034). Multivariate binary logistic regression analysis showed that interstitial changes and thick-walled cavities were positively correlated with MAC pulmonary disease (β=1.045, OR (95%CI)=2.843 (1.023-7.900); β=2.239, OR (95%CI)=9.381 (2.845-30.937)), while mixed cavities were negatively correlated with MAC pulmonary disease (β=-1.452, OR (95%CI)=0.234 (0.076-0.721)). ROC curve analysis revealed that the AUC values for predicting MAC pulmonary disease using patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities individually, as well as the combined detection of these four imaging signs, were 0.539 (95%CI: 0.469-0.610), 0.573 (95%CI: 0.504-0.642), 0.648 (95%CI: 0.581-0.716), 0.564 (95%CI: 0.494-0.634), and 0.705 (95%CI: 0.643-0.768), respectively. The DeLong test showed that the diagnostic performance of thick-walled cavities for MAC pulmonary disease was second only to that of the combined detection (Z=-3.117, P=0.002) and was significantly higher than that of patchy opacities, interstitial changes, and mixed cavities (Z=-3.337, P=0.001; Z=-2.296, P=0.022; Z=4.300, P<0.001). Conclusion: The combined model of patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities demonstrates certain diagnostic efficacy in predicting MAC pulmonary disease, with thick-walled cavities being the imaging finding with the highest diagnostic value among them.

Functional annotation of single nucleotide polymorphisms and analysis of drug resistance-related pathways in Mycobacterium abscessus strains resistant to Sudapyridine

Shang Yuanyuan, Wang Xueyu, Wang Yujin, Yu Xia, Huang Hairong, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(2):  264-273.  doi:10.19982/j.issn.1000-6621.20250346

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Objective: To induce Mycobacterium abscessus strain ATCC 19977 resistant to sudapyridine (WX-081) and to perform the functional annotation of resistance-associated single nucleotide polymorphism (SNP) along with related pathways. Methods: The standard strain Mycobacterium abscessus ATCC19977 was subjected to incrementally increasing WX-081 exposure in liquid medium to select resistant mutants. Genomic DNA was extracted from the WX-081-resistant strains for whole-genome sequencing to identify SNP. Sequence alignment was performed using BLAST against multiple databases, such as evolutionary genealogy of genes: non-supervised orthologous (eggNOG), gene ontology (GO), kyoto encyclopedia of genes and genomes (KEGG), non-redundant (Nr), protein families (Pfam), swiss-prot protein sequence (swiss-prot) for functional annotation, followed by GO, eggNOG, and KEGG pathway enrichment analyses. Results: Comparative genomic analysis identified 187 SNP in coding regions between the parental ATCC19977 and WX-081-resistant strains, of which 62 met quality thresholds. Among these, 43 were homozygous SNP (12 synonymous and 31 missense mutations). SNP in the coding regions accounted for 9.14% (187/2047), of the total, with stop-gained variants (nonsense mutations) being the least frequent (0.05%, 1/2047). In contrast, 90.86% (1860/2047) of SNP were located in non-coding regions, predominantly in downstream (51.83%, 1061/2047) and upstream (39.03%, 799/2047) regions.GO annotation identified 8 biological processes (BP), 5 cellular components (CC), and 4 molecular functions (MF). eggNOG functional prediction classified the variant genes as follows: 7 with unknown function, 3 involved in amino acid transport and metabolism, 1 in nucleotide transport and metabolism, 2 in lipid transport and metabolism, 1 in transcription, 2 in cell wall/membrane and/envelope biogenesis, 1 in post-translational modification, protein turnover, chaperones, 2 in inorganic ion transport and metabolism, 2 in secondary metabolite biosynthesis, transport and catabolism, and 1 in signal transduction mechanisms. KEGG pathway analysis identified 1 pathway each related to membrane transport, amino acid metabolism, and carbohydrate metabolism, 3 pathways in global and overview maps, and 4 pathways associated with lipid metabolism. Conclusion: The genome of WX-081-resistant Mycobacterium abscessus exhibited predominantly non-coding SNP, while 31 missense mutations in coding regions may directly contribute to drug resistance. Metabolic pathway analysis revealed significant enrichment of genes related to lipid metabolism, cell wall synthesis, and amino acid transport, suggesting that membrane/wall structural remodeling and metabolic reprogramming are key resistance mechanisms.

Analysis of usage characteristics of traditional Chinese medicine compound prescriptions for treating pulmonary tuberculosis based on the Chinese Patent Publication and Announcement Network

Su Ben, Qiu Lei, Zhou Rui, Chen Tao, Chen Yuxian, Cui Jie, Xia Liuyuan, Zhang Shaoyan, Lu Zhenhui

Chinese Journal of Antituberculosis. 2026, 48(2):  274-281.  doi:10.19982/j.issn.1000-6621.20250307

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Objective: To statistically analyze the usage characteristics of traditional Chinese medicine (TCM) compound prescriptions for treating pulmonary tuberculosis from the Chinese Patent Publication and Announcement Network, to provide references for clinical rational drug use and new drug development. Methods: Information on drug composition, effectiveness, nature, taste, and meridian tropism of TCM compound prescriptions for treating pulmonary tuberculosis was collected from the Chinese Patent Publication and Announcement Network, and a database was established. Frequency analysis was conducted using Excel 2019 software, association rule analysis and drug correlation analysis were performed on the database using R studio software through the R environment. Cluster analysis of high-frequency drugs was conducted using SPSS 26.0 software, and a complex network of core drug co-occurrence was constructed using Cytoscape 3.10. Results: A total of 305 TCM compound prescription patents were included, involving 905 TCM drugs. The top five drugs in terms of frequency of use were Baibu (135 times), Baiji (107 times), Gancao (107 times), Maidong (103 times), and Baihe (84 times). Their main drug functions were tonifying (770 times), expectorant and cough/asthma-relieving (417 times), and heat-clearing (302 times). The main tastes were sweet (1946 times), bitter (1492 times), and pungent (543 times), and the main natures were cold (1363 times), warm (788 times), and neutral (633 times). The drugs were mostly attributed to the lung meridian (2027 times), liver meridian (1022 times), heart meridian (967 times), and kidney meridian (872 times). The association rule analysis of high-frequency drugs revealed common drug pairs such as Ejiao-Maidong, Shengdihuang-Maidong, and Tiandong-Baibu, and common drug triplets such as Baibu-Shengdihuang-Maidong, Baiji-Maidong-Baibu, and Baihe-Maidong-Baibu. The cluster analysis of high-frequency drugs identified 9 drug combinations: (1) Maidong, Shengdihuang, Ejiao, and Shudihuang; (2) Chuanbeimu and Xuan Shen; (3) Danggui and Baishao; (4) Baibu and Baiji; (5) Baihe and Jiegeng; (6) Huangqi, Dangshen, and Baizhu; (7) Fuling and Shanyao; (8) Kuxingren and Ziwan; (9) Digupi and Zhimu. The drug correlation analysis indicated that Fuling-Shanyao, Ejiao-Maidong, Maidong-Shengdihuang, and Digupi-Zhimu were closely related. The core drug co-occurrence network suggested that Baibu-Baiji, Baibu-Maidong, Baibu-Baihe, Baibu-Gancao, and Baibu-Huangqi might be the core drugs in the treatment of pulmonary tuberculosis. Conclusion: The TCM compound prescriptions for treating pulmonary tuberculosis on the Chinese Patent Publication and Announcement Network have significant clinical value and broad application prospect. In clinical practice, relevant drug combinations should be used rationally based on syndrome differentiation and treatment to improve clinical effectiveness.

Association analysis between anti-interferon-γ auto-antibodies and interferon-gamma release assay results

Yu Haiwei, Li Qian, Feng Fengquan, Li Sha

Chinese Journal of Antituberculosis. 2026, 48(2):  282-288.  doi:10.19982/j.issn.1000-6621.20250376

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Objective: To explore whether there is a correlation between anti-interferon-gamma (IFN-γ) auto-antibodies and indeterminate results of the IFN-γ release assay (IGRA-ELISA). Methods: We collected data of 82 non-HIV patients with opportunistic infections who underwent both anti-IFN-γ auto-antibody testing and IGRA-ELISA at the Fourth People’s Hospital of Nanning between March 2020 and February 2025. Based on the anti-IFN-γ auto-antibody results, the patients were divided into a positive group (29 patients) and a negative group (53 patients). First, intergroup differences were statistically analyzed. Subsequently, factors possessing potential independent predictive value for the auto-antibodies were incorporated into a Firth penalized logistic regression model, with the ultimate goal of identifying their key predictors. Results: In the positive group, main opportunistic pathogens were nontuberculous mycobacteria (37.9%, 11/29) and Talaromyces marneffei (27.6%, 8/29). Firth penalized logistic regression demonstrated that the indeterminate IGRA-ELISA result was a significant predictor of anti-IFN-γ auto-antibody positivity (OR=56.317, 95%CI: 3.062-1.020×10¹¹, P<0.01). Conclusion: When patients with opportunistic infections present with an indeterminate IGRA-ELISA result, anti-IFN-γ auto-antibodies may be present in patients.

Evaluation of the diagnostic efficacy of AIMTB-fluorescent immunochromatography for screening latent tuberculosis infection

Zhou Cang, Li Guoli, Jiang Hui, Shao Yan, Song Honghuan, Xue Hao, Ning Jingxian, Pan Yuchen, Fei Xinru, Sun Zheng, Chen Cheng, Zhu Limei, Liu Qiao

Chinese Journal of Antituberculosis. 2026, 48(2):  289-298.  doi:10.19982/j.issn.1000-6621.20250300

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Objective: To evaluate the diagnostic performance of the AIMTB-fluorescent immunoassay ( AIMTB-FIA) for screening latent tuberculosis infection (LTBI) in different populations. Methods: A cross-sectional study was conducted. Participants were enrolled according to inclusion criteria from a welfare institution in Zhenjiang City and community healthcare workers in Yancheng City, Jiangsu Province, in March-Apirl, 2025. QuantiFERON-TB Gold Plus (QFT-Plus) assay was used as the reference standard. Consistency and diagnostic efficacy of AIMTB-FIA relative to QFT-Plus were assessed by calculating the Kappa coefficient, overall agreement rate, and the area under the receiver operating characteristic curve (AUC). Subgroup analyses were further performed to compare the diagnostic performance of AIMTB-FIA across different population sources (welfare institution residents vs. community healthcare workers) and age groups (≥65 years vs. <65 years). Results: A total of 396 participants were enrolled, including 239 from welfare institution and 157 community healthcare workers. The positivity rate of QFT-Plus was 11.62% (46/396), while that of AIMTB-FIA was 17.93% (71/396). Using QFT-Plus as the reference standard, the AIMTB-FIA demonstrated a sensitivity of 97.80% (45/46), specificity of 92.60% (324/350), overall agreement rate of 93.20%, Kappa value of 0.731, and an AUC of 0.988. Subgroup analyses revealed that the Kappa values ranged from 0.628 to 0.879, and AUCs ranged from 0.977 to 0.992 across different populations and age groups, indicating consistently robust diagnostic performance. Spearman’s correlation analysis showed a moderate positive correlations between the T-N values of the AIMTB-FIA and the interferon-gamma (IFN-γ) levels of TB1-Nil and TB2-Nil of the QFT-Plus assay (r=0.631, 0.638; Ps<0.001). Conclusion: As an optimized interferon-gamma release assay, AIMTB-FIA exhibits high concordance with QFT-Plus, with advantages of simplified operation and reduced detection time. It has potential as a reliable alternative for LTBI screening in primary healthcare settings.

Review Articles

Research progress on the anti-Mycobacterium tuberculosis activity of sitafloxacin

Wang Xueyu, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(2):  299-303.  doi:10.19982/j.issn.1000-6621.20250295

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The global tuberculosis epidemic remains severe, and China continues to be classified among the tuberculosis high-burden countries. Conventional fluoroquinolones are increasingly limited by cross-resistance and adverse-event profiles. Sitafloxacin, distinguished by its dual-target mechanism and good tissue penetration (The ratio of alveolar lining fluid concentration to plasma concentration is 54%), exhibits potent bactericidal activity against multidrug-resistant, rifampicin-resistant, pre-extensively drug-resistant, and extensively drug-resistant Mycobacterium tuberculosis strains. Comparative studies indicate that its early bactericidal activity surpasses that of levofloxacin and moxifloxacin, while its safety profile remains acceptable. Notably, the first documented case of pre-extensively drug-resistant tuberculosis has been successfully treated with sitafloxacin-based regimens. This review synthesizes recent advances in the use of sitafloxacin for tuberculosis therapy, aiming to provide an evidence-based reference for its clinical application.