Table of Content

10 November 2009, Volume 31 Issue 11

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Study on the new tuberculosis treatment management model in the universities of Tianjin

Zhong DaZhang YuhuaFu Yanyong¹, Chen Shengyu¹, Yang Guangwei¹,Yao Ying², Liu Shuqin³, Li Rongxin⁴, Yu Hongye⁵, Wu Peihong⁵, Yang Xu⁶

Chinese Journal of Antituberculosis. 2009, 31(11):  623-626. 

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ObjectiveTo evaluate the effectiveness of the new tuberculosis treatment management model pilot in universities of Tianjin, and to lay a good foundation for future spread to all universities of Tianjin. MethodsThe TB patients in four pilot unversities were managed with new model and the TB patients in other universities were managed with DOTS in TB control institutions, the effectiveness of these two models were compared. ResultsRegular treatment rate, regular sputum examination rate, treatment completion rate of sputum smear negative and systematic management rate were 90.9%, 89.1%, 95.8% and 87.3% respectively, which were much more than the others in other universities (71.6%, 70.3%, 81.0% and 66.2%). There were statistically significant differences between two groups（P<0.05）.The cure rate of sputum smear positive cases was 85.7%, which was higher than 81.8% of the compared group, but there was no statistical significant difference（P>0.05）. ConclusionsThe new tuberculosis treatment management model was successfully implemented in the four pilot universities. It is valuable to promote in all universities of Tianjin.

Bibliometric analysis of multidrug-resistant tuberculosis literatures in Web of Science

Huo Jinrong

Chinese Journal of Antituberculosis. 2009, 31(11):  628-632. 

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ObjectiveTo understand the progress in multidrug-resistant tuberculosis (MDR-TB) research over the last 10 years through a bibliometric approach. MethodsLiteratures about MDR-TB（1999—2008） were searched from Web of Science citation database. The searching Results were analyzed concerning the article numbers and the frequency of citations by countries, institutes and authors, MDR-TB periodical distribution, and MDR-TB research subject distribution. ResultsOverall 1521 papers were found and distributed in 337 types of periodicals. The number of papers has increased apparently over the last five years. World Health Organization，USA，Belgium have played important roles in the MDR-TB research in the world. The MDR-TB research subjects mostly focused on infectious diseases, respiratory diseases, microbiology, pharmacy and so on. ConclusionsThe prevalence of MDR-TB has been a threat to global public health security. This problem has attracted more and more attention. As a MDR-TB high-burden country, China should improve the level of investment and research on MDR-TB.

Study on compliance of new smear positive pulmonary tuberculosis patients in rural area with directly observed treatment conducted by family member

Liu Xun, Xiong Changfu, Yang Chengfeng, Luo Junmin, Wang Xiaojing, Zhao Dingyuan, Hou Shuangyi, Li Guoming, Zhou Liping, Li Aiguo

Chinese Journal of Antituberculosis. 2009, 31(11):  633-636. 

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ObjectiveTo explore the effect to improve treatment compliance of new smear positive (NSP) tuberculosis patients with directly observed treatment by family member. MethodsThe epidemiological, experimental study was utilized. From June 2006 to April 2007, NSP cases registered in Hanchuan, Yidu, Xianfeng, Zigui and Jianshi counties were randomly allocated to two groups using SAS software. Experimental group (Group 1) received Directly Observed Treatment Short-term (DOTS) conducted by family member and control group (Group2) by village doctor. The treatment compliance and cure rate between 2 groups were evaluated. EpiData V3.02 software, EpiData Analysis V2.0.3.129 software and SAS 8.0 software were adopted for data entry, analyzing and χ² analysis. ResultsOf total 532 TB cases registered in five counties, 270 were allocated in group 1 and 262 in group 2. The sputum examination rate after 2, 5,6 months’ treatment were 95.9%, 93.0% and 92.6% respectively in group 1, and 95.8%, 89.7% and 88.9% in group 2. There was significant difference between 2 groups on sputum examination rate after 6 months’ treatment (χ²=6.9350,P<0.05); 24300 does should be taken and 23126 were taken actually in group 1. 23580 does should be taken and 22045 were taken actually in group 2. The drug-taking compliance rate in group 1 (95.2%) was significantly higher than that in group 2 （93.5%, χ²=63.1636, P<0.01）. The sputum conversion rate after 2 months treatment and cure rate were 95.6% and 92.6% in groups 1 and 95.4%, 88.9% in group 2. There was no significant difference between 2 groups on sputum conversion rate and cure rate. ConclusionsIt is possible to increase treatment compliance of new smear-positive TB patients and DOTS implement quality by encouraging educated, trained and responsible family member or volunteer as family supervisor in rural areas.

Analysis on the effect of TB prevention and control among floating population in Suzhou

Mu Weiming¹, Xu Weiguo²

Chinese Journal of Antituberculosis. 2009, 31(11):  637-640. 

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ObjectiveTo analyze the effect of TB prevention and control among floating population in Suzhou. MethodsTB prevention and control project in floating population of China Global Fund TB Program Round 5 (phaseⅠ) was implemented in Suzhou. The data of the TB cases in floating population were collected and analyzed. They were compared with the National “Five rates” and the indexes of resident population. ResultsIn the floating population, the accomplishment ratio of case detection task of new smear positive tuberculosis was 110.0%, the reporting rate、referring rate、cure rate of patients and examination rate of close contact of smear positive tuberculosis patients were up to par. The arrival rate after referring、arrival rate after tracing、overall arrival rate were above the national average level, while most of them were lower than that in the resident population. ConclusionsThe effect of TB prevention and control among floating population in Suzhou is good. But it is poor in the floating population, comparing with the resident population. The result of preventing and controlling TB in the floating population is affected by many uncertain factors. It is suitable to evaluate the work of tuberculosis prevention and control in the floating population and in the resident population separately in different areas.

The analysis and evaluation of GF-5 TB/HIV co-infection control project-The first implementation period in Guangxi

Xu Guangbao¹, Zhou Changming², Cui Zhezhe², Wang Haitao¹, Liu Feiying²

Chinese Journal of Antituberculosis. 2009, 31(11):  641-644. 

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ObjectiveTo analyze and evaluate the Results of GF-5 TB/HIV co-infection control project in Guangxi, and also to provide theoretical evidence for formulating the framework of TB/HIV co-infection control in Guangxi. MethodsStatistical analysis was conducted in the data of quarterly report forms, special surveys, on-site monitoring and examination. ResultsSince the project was conducted, special funds of 5.1128 million Yuan were utilized. HIV testing and counseling was provided for 8379 tuberculosis patients, with positive rate 2.4%. Tuberculosis screening was provided for 10016 HIV/AIDS, with positive rate 10.1%. Among the 1207 HIV/TB co-infection patients, 928 received anti-tuberculosis treatment, 629 received anti-virus treatment and 793 received CPT. ConclusionsThrough the project implementation and the application of scientific Methods of TB/HIV co-infection control strategy, the incidence and death of TB/HIV co-infection patients in project areas decreased

The preliminary study on rifampicin-resistant mechanism of Mycobacterium tuberculosis

Li Hongmin, Zhang Guangyu, Yang Nan, Zhang Xia, Liu Yinping, Yang Kunli, Kong Xiangrui

Chinese Journal of Antituberculosis. 2009, 31(11):  646-648. 

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ObjectiveTo study the mechanism of drug resistance in M. tuberculosis. MethodsM. tuberculosis virulent strain (H₃₇Rv) that was cultured in the different levels of rifampicin and 36 isolated strains with the Results of drug resistance were analyzed by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and sequence analysis. ResultsThe 7th generation of strain H₃₇Rv had abnormal PCR-SSCP profile, was confirmed rpoB gene mutation at codon 513 by DNA sequencing. Of 36 clinical isolates, 63.9% strains (23/36) had rpoB mutations. The mutation sites of 5 clinical isolates were the same as that of induced strains H₃₇Rv. Conclusions Stimulating constantly tubercle bacillus with rifampicin is an important reason that cause rifampicin-resistant tuberculosis.

Therapeutic effects of DNA vaccines in a mouse model of multi-drug resistant Mycobacterium tuberculosis infection

Liang Yan¹，Wu Xueqiong¹， Li Zhongming²,Zhang Junxian¹,Li Ning¹,Yang Yourong¹,Yu Qi¹,Bai Xuejuan¹,Song Jingying¹,Wang Lan¹,Shi Yingchang¹,Liu Jie¹,Liu Chenglong¹,Zhu Yan¹,Xu Xueyu¹

Chinese Journal of Antituberculosis. 2009, 31(11):  649-652. 

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ObjectiveTo evaluate the therapeutic effects of DNA vaccines in mouse models of M. tuberculosis infection to establish new immunotherapeutic agents to treat MDR-TB. Methods60 female BALB/C mice were infected intravenously via the tail vein with 220000 CFU of clinical isolate M. tuberculosis HB361 which was resistant to RFP and INH, then randomly divided into 6 groups and treated as follow at the third day after infection for 60 days: saline, plasmid vector, rifampin, HSP65 plasmid DNA, Ag85A plasmid DNA vaccines，Ag85A/ESAT-6 chimeric plasmid DNA vaccines. DNA vaccines were injected intramuscularly 5 times at 15 days intervals. The lungs and spleens from the mice were taken and their pathological changes, weight and number of mycobacterial colony were examined at 3 weeks after the end of treatment. ResultsThe histopathological changes of lung showed that the lung lesions were slight and limited, there were relatively clear profile and normal structure of the alveoli in the treatment groups compared with the control groups. Compared with vector group, HSP65, Ag85A, Ag85A/ESAT-6 DNA vaccines groups reduced the pulmonary bacterial loads by 0.30, 0.50, 0.26 logs, and reduced the splenic bacterial loads by 0.37, 0.46, and 0.28 logs (P<0.05 or P<0.01), respectively. ConclusionThe immunotherapeutic effects of Ag85A DNA was significantly stronger than that of chimeric Ag85A/ESAT6 DNA，HSP65 DNA vaccine in the mouse model of multi-drug resistant tuberculosis.

Clinical features of Multidrug-resistant and extensively drug-resistant pulmonary tuberculosis

Lou Hai,Xiao Heping,Zhang Qing,Yan Liping,Yue Jun

Chinese Journal of Antituberculosis. 2009, 31(11):  653-656. 

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ObjectiveTo investigate the clinical features of multidrug-resistant(MDR) and extensively drug-resistant(XDR) tuberculosis. MethodsData of drug susceptible test, history of anti-TB treatment, scopes of disease，and complications in 148 patients with MDR-TB and XDR-TB was retrospectively analyzed. Chi-square test was used for statistic analysis. ResultsThe percentage of XDR-TB was 33.1%（49/148）.The ratio of men to wowen was 0.88 to 1. The proportion of drug resistance to 4 or 5 drugs was 82.8% in MDR-TB, and Ofloxacin-resistant rate was 66.7%.The initial drug-resistance rates of XDR and MDR were 30.6%（15/49）and 16.2%（16/99）respectively (χ²=4.13，P=0.04). The proportion of patients with lung lesions involved with more than 4 lung fields in XDR-TB and MDR-TB group were 81.6% (40/49) and 65.7%(56/99）respectively (χ²=4.06，P=0.04). The proportion of patients with complications in both groups was higher than 60%. Diabetes mellitus was the most common complication,especially in XDR-TB, with rates of 28.6% and 20.2% in XDR and MDR respectively. ConclusionsThis study showed that the rate of XDR was increasing obviously. More cases of initial drug-resistance emerging in MDR, especially in XDR group indicated that the management for these patients may be too weak. The severity of Ofloxacin-resistant further showed that both the difficulty of the treatment for MDR and the possibility of MDR developing into XDR were increasing. And the phenomenon many patients complicated with diabetes mellitus might provide clues for the prevention and treatment for MDR and XDR.

A clinical study on chemotherapy in 218 cases of Silicotuberculosis in different stages

Yu Zhongying，Wang Ting, Liu Yaosong，Wang Wenbin.

Chinese Journal of Antituberculosis. 2009, 31(11):  657-659. 

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ObjectiveTo investigate the short-term and long-term therapeutic effects of different chemotherapeutic regimens for silicosis patients with initial smear positive pulmonary tuberculosis in different stages. MethodsAccording to silicosis stages and lesions distribution, 218 initial treated smear-positive Silicotuberculosis patients were divided into four groups (A1, A2, B1, B2) and received different chemotherapeutic regimens. All patients were supervised to finish chemotherapy and then followed up for 5 years. The rates of sputum negative conversion and relapse were observed. ResultsAt the end of full treatment courses, the sputum negative conversion rates in all groups were 100%. During the five-year follow-up, the sputum re-positive rates in A1 group、A2 group、B1 group、B2 group were 14.3%, 3.8%, 11.4% and 4.7% respectively. ConclusionsThe chemotherapeutic regimen with 3HRZS(E)/6HRZ/9HRE fits to treat Silicotuberculosis in stageⅠ-Ⅱ.The chemotherapeutic regimen with 3HRZS(E)/9HRZ/12HRE fits to treat Silicotuberculosis in stage Ⅲ, and the long-term effect of this group's chemotherapy is satisfactory.

A short-term efficacy on aerosolizing inhalation recombinant human gamma interferon in multidrug-resistant pulmonary tuberculosis

Yang Zhiyi，Wang Lin, Guo Liren,Lin Minfang,Chen Xiaohong.

Chinese Journal of Antituberculosis. 2009, 31(11):  660-663. 

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ObjectiveTo observe and evaluate the clinical efficacy of recombinant human IFN-γ in multidrug-resistant pulmonary tuberculosis(MDR-TB).MethodsSisty cases with MDR-TB were randomized into a treatment group(30 cases treated with 3SPPZETH+(2)IFN-γ/9SPPE) and a control group（30 cases treated with 3SpPaZETH/9SpPaE）. IFN-γ was used by aerosilizing inhalation in initial phase of the treatment group for two months. Results28 cases in the treatment group and 29 cases in the control group completed the treatment course.The sputum negative conversion rate in the treatment group（82.1%）was higher than that in the control group（58.6%）(P<0.05).The rate of radiographic improvement in the treatment group(92.9%) was higher than that in the control group(P<0.01).CD4 T cells count and the ratio of CD4/CD8 in the treatment group were higher than that in the control group at the 3nd month of therapy (P<0.05). There was no severe adverse effects of IFN-γ therapy. ConclusionsAs an effective and relatively safe biological agent, IFN-γ can be used to adjuvant therapy in multidrug-resistant pulmonary tuberculosis.