Table of Content

10 April 2009, Volume 31 Issue 4

Previous Issue    Next Issue

Optimum cutoff value of the sICAM-1, sIL-2R level for the diagnosis of the pulmonary tuberculosis

Zhang Jin¹, Hong Zhiqiang², Huang Huiliang², Cui Xiwen², Shen Yueping³

Chinese Journal of Antituberculosis. 2009, 31(4):  181-184. 

Abstract ( 1319 )   PDF (3175KB) ( 556 )   Save

References | Related Articles | Metrics

ObjectiveTo explore the correlation between the serum level of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble interleukin-2 receptor (sIL-2R) in the smear-positive, -negative patients with pulmonary tuberculosis (TB) and health control, and to develop the optimum cutoff values of sICAM-1 and sIL-2R for the diagnosis of the TB patients. MethodELISA assay was used to measure the serum level of sICAM-1, sIL-2R in 97 newly diagnosed TB cases (containing 53 smear-positive cases, 44 smear-negative cases) aged 20 to 60 years old and being treated in Kunshan first people hospital and the township-level hospitals, Jiangsu province and 93 health controls matched by ages (±3 yrs) and sex. The pearson correlation coefficient r was estimated between the sICAM-1 and sIL-2R level among the smear-positive, smear-negative and control groups. ROC curve was used to explore the optimum cutoff value of sICAM-1, sIL-2R for the diagnosis of the TB. Resultsthe serum level of sICAM-1 was positively associated with level of sIL-2R in the smear-negative cases（r=0.4639, P=0.0017）. No significant linear correlations were found between the two indexes among the smear-positive TB patients and control population (r₁=0.0472, P=0.7397, r₂=-0.0077, P=0.9419). When the cutoff value of sICAM-1 level was higher than 364.04ng/ml, its sensitivity and specificity for the diagnosis of TB were 83.0% and 83.9%, respectively. For sIL-2R with cutoff value lower than 2.49ng/ml, the sensitivity and specificity were 63.9% and 64.8%, respectively. ConclusionThe sICAM-1 level higher than 364.04ng/ml could be regarded as the clinical diagnosis reference value for TB.

Analysis on surgical treatment in 48 patients with unilateral tuberculous destroyed lung

Liao Yong, Xu Jianrong, Wei Ming, Tang Jifu, Huang Xifeng, Liu Wei, Cai Qing, Zhao Naikang

Chinese Journal of Antituberculosis. 2009, 31(4):  185-188. 

Abstract ( 1444 )   PDF (3780KB) ( 703 )   Save

References | Related Articles | Metrics

ObjectiveTo summarize the experience of surgical treatment for unilateral tuberculous destroyed lung. MethodsForty-eight patients with unilateral tuberculous destroyed lung were treated by pneumonectomy,and the clinical data was analyzed retrospectively.ResultsPneumonectomies in 48 cases were successful, and pleuropneumonectomies in 36 cases were performed.The peri-operative bleeding amount ranged from 500ml to 5300ml.Postoperative short-term complications occured in 12 cases(25%),including 3 acute pulmonary oedema,4 respiratory failure, 3 empyema,and 2 mediastinal flutter. Postoperative long-term complication was constrictive pericarditis in 1 case (2.1%).Forty-five cases were cured(93.8%), 2 cases died(4.2%).ConclusionThe patients with unilateral tuberculous destroyed lung whose medical therapy is failed should be performed surgical treatment if their cardio-pulmonary function are compensative. The rate of complication and mortality are acceptable.

Analysis on chest X-ray screening in family contacts exposed to patients with smear positive pulmonary tuberculosis

Du Yuhua, Su Ruzhao, Fan Liying, Yu Haining, Song Tao, Liu Yumei

Chinese Journal of Antituberculosis. 2009, 31(4):  189-191. 

Abstract ( 1752 )   PDF (2365KB) ( 565 )   Save

References | Related Articles | Metrics

ObjectiveTo investigate active pulmonary tuberculosis detection situation in family close contacts exposed to patients with smear positive pulmonary tuberculosis.MethodsAmong 771 close contacts, children less than 15 years old received tuberculin skin test(TST), and X-ray was carried out for children whose TST was no less than 10mm or less than 10mm with blister, and for people aged no less than 15 years old sputum smear and culture were carried out for patients with suspectable X-ray shadow. ResultsOf close contacts exposed to patients with smear positive in family, the detection rate of patients with active pulmonary tuberculosis and with smear positive were 3.8% and 0.8% respectively. The detection rate was high in close contacts exposed to patients with pulmonary cavity and high bacterial load in family. The detection rate in group of contacts aged 60 years older was also higher than those age ranged from 15 to 60 years old with statistically significant difference. ConclusionsIt is helpful to increase TB case detection rate via X-ray screening in close contacts exposed to family patients with smear positive. This is an effective way to find new case of pulmonary tuberculosis.

Clinical analysis on 362 hematogenous disseminated pulmonary tuberculosis

Zhou Wenlin, Tian Jingfang

Chinese Journal of Antituberculosis. 2009, 31(4):  192-194. 

Abstract ( 1464 )   PDF (3417KB) ( 876 )   Save

References | Related Articles | Metrics

ObjectiveTo analyse clinical characteristics of hematogenous disseminated pulmonary tuberculosis. MethodsWe analyzed retrospectively the data of clinical features, treatment and prognosis of 362 patients with hematogenous disseminated pulmonary tuberculosis who hospitalized in our hospital from 1998 to 2007. ResultsMost patients with hematogenous disseminated pulmonary tuberculosis were young and they accounted for 62.0%. The elderly patients showed an upward tendency and they accounted for 21.0%. The fever accounted for 86.1% in clinical symptom. The respiratory symptom mainly included cough, fatigue, tachypnea, night sweat and chest pain. The symptoms of headache, nausea and vomiting would be seen patients complicated with tubercular meningitis. The time of clinical confirmed diagnosis: patients confirmed diagnosis within 30 days accounted for 50.3%, a few patients were diagnosed over four months. The rate of sputum bacilli positive was 37.8%,the positive reaction of PPD test 58.6%, the positive rate of serum antitubercular antibody 44.8%. The patients with acute hematogenous disseminated pulmonary tuberculosis accounted for 68.5%, the patients with subacute and chronic hematogenous disseminated pulmonary tuberculosis 31.5%. Those patients with typical military nodes in X-ray accounted for 68.5%, the patients complicated with extrapulmonary tuberculosis 40.0%. The non-tuberculosis complication accounted for 68.2%. Antituberculosis treatment with 4 or 5 drugs and the treatment for non-tuberculosis complication were given at the same time.Except two deaths due to cerebral hernia, most patients were improved. ConclusionsHematogenous disseminated pulmonary tuberculosis is a kind of critical pulmonary tuberculosis with serious symptom, especially when complicated with tuberculosis in other viscera. The effective antituberculosis treatment should be given in time for those patients with hematogenous disseminated pulmonary tuberculosis and extraplumoary tuberculosis. Treatment for non-tuberculosis complication is also performed properly. Adjuvant and supportive care including immunopotentiators maybe improve symptoms for these patients.

The morphological characteristic about 530 strains of culture-positive mycobacteria by BACTEC 960

Zou Shenghua，Dai Lamei，Zhang Lishui

Chinese Journal of Antituberculosis. 2009, 31(4):  195-198. 

Abstract ( 1695 )   PDF (3327KB) ( 560 )   Save

References | Related Articles | Metrics

ObjectiveTo study the growth characteristic of mycobacteria cultured by BACTEC 960 and the patterns of smear and acid-fast staining, to provide initial comments on the identification of mycobacterium. MethodsThe clinical samples were collected from the hospital, and cultured by BACTEC 960. Five handred and thirty culture-positive isolates were performed direct smear and acid-fast staining，species identification and drug susceptibility testing. ResultsMycobacterium tuberculosis growing in the MGIT culture tube presented as the floc precipitation， showed the rope-like arrangement by smear and microscopic examination. Whereas, non-tuberculosis mycobacterium (NTM) presented as the turbid growth， showed dispersive，the regiment granular， massive， debris and loose fascicular，and other irregular arrangement under the microscope. ConclusionMycobacterium tuberculosis cultured in BACTEC 960 has the characteristic of the winding，which is very easy to be identified under the microscope, provide a primary screening role on the identification of mycobacteria.

Study on the relationship between polymorphism of BTNL2 gene and susceptibility of tuberculosis in Chinese population

Lian Yuanyuan, Yue Jun, Han Min, Liu Jianfang, Liu Lirong

Chinese Journal of Antituberculosis. 2009, 31(4):  199-205. 

Abstract ( 1827 )   PDF (4821KB) ( 662 )   Save

References | Related Articles | Metrics

ObjectiveTo investigate the genetic polymorphisms of BTNL2 gene in Chinese, and to study the possible correlation of BTNL2 polymorphism and the susceptibility to tuberculosis. MethodsBlood samples from 94 tuberculosis cases and 95 controls were collected for a case-control study in Chinese. DNAs of the subjects were extracted and amplified by polymerase chain reaction (PCR). The single nucleotide polymorphisms (SNPs) of BTNL2 were determined by SNaPshot SNP genotype techniques. The genotype and haplotype frequencies were compared between tuberculosis cases and controls using SHEsis software. ResultNo correlation was detected between any of the single SNPs locus studied and disease. However, the C-A-T-G-C-G and C-G-T-G-C-G haplotype groups were present a significant correlation with susceptibility to tuberculosis, with the OR (95% CI) to be 0.39 (0.19～0.79) and 3.50 (0.93～13.18) respectively. ConclusionThe single SNP in polymorphisms of BTNL2 gene might not be correlated with the susceptibility to tuberculosis in Chinese. But, the haplotype of BTNL2 gene may be correlated with tuberculosis.

Analysis of anti-TB drug resistance surveillance in Linxia, Ganan and Dingxi in Gansu province

Si Hongyan¹, Li Qing1, Mu Taojun¹, Liang Chengzhi², Yang Qiaoling³, Xie Zhongke⁴, Ma Ling¹

Chinese Journal of Antituberculosis. 2009, 31(4):  206-209. 

Abstract ( 1477 )   PDF (3427KB) ( 528 )   Save

References | Related Articles | Metrics

ObjectiveTo find out the status of drug resistance (DR) of Mycobacterium tuberculosis and multi drug-resistance tuberculosis (MDR-TB) situation in Linxia, Gannan and Dingxi in Gansu province, and to provide scientific evidence for TB control in minority and poor area. MethodsAccording to the guidelines for Surveillance of Drug Resistance in Tuberculosis (WHO/ IUATLD), all new smear positive cases and new registered retreatment smear positive cases in one year in survey area were the cases for surveillance. A total of 909 isolated strains of Mycobacterium tuberculosis were tested for drug susceptibility by the absolute concentration method. ResultsThe overall drug resistance was 26.0%, the primary drug resistance was 21.0% and the acquired drug resistance was 50.0%; multi-drug resistance was 10.1%, the rates were 7% and 24.1% respectively for primary multi-drug resistance and acquired multi-drug resistance; 70.8% RFP-resistant strains were MDR-TB strains. ConclusionThe incidence of drug resistance of Mycobacterium tuberculosis in minority in Gansu province is high, health administrative department and TB control institute at each level should pay attention to drug resistance.

Analysis on the midterm evaluation of Shanxi tuberculosis prevention and control programme

Zhang Tianhua, Guo Liujia, Ai Xianqin, Zhang Hongwei, Liu Weiping

Chinese Journal of Antituberculosis. 2009, 31(4):  210-214. 

Abstract ( 1525 )   PDF (4182KB) ( 521 )   Save

References | Related Articles | Metrics

ObjectiveTo evaluate the implementation of Shanxi Tuberculosis (TB) Prevention and Control Programme (2002—2010) (Programme for short) and assess achievements of midterm goal, to sum up the experience and deficiencies obtained, and to put forward measures for improvement. MethodsUniform scheme and questionnaires applied in national Programme evaluation were used to investigate and verify the implementation of Programme at provincial, prefecture and district level. Data were entered and analyzed with Epidata 3.1. ResultsThe governments at all levels have developed TB prevention and control programme, established leadership groups, set up and perfected TB prevention and control institutes, 77.45 million yuan has been used in TB prevention and control. DOTS coverage has reached 100%. Accumulatively 131.5% target task of case detection appointed in Programme has been achieved and the cure rate of new smear positive cases arrives at 89.0%. The implementations of training, supervision and health education have met the requirement in Programme. ConclusionsThe implementation of Programme is in smooth progress and the midterm goal has been achieved in time. However, the government promise, capability building of TB prevention and control institutes and the quality of DOTS still need to be enhanced in future.

Application of MRI in differential diagnosis of spinal tuberculosis

You Kun, He Baoming

Chinese Journal of Antituberculosis. 2009, 31(4):  216-217. 

Abstract ( 1291 )   PDF (1711KB) ( 535 )   Save

References | Related Articles | Metrics

ObjectiveTo investigate the clinical value of MRI in differential diagnosis of spinal tuberculosis. MethodWe analyzed retrospectively 45 patients with spinal tuberculosis and 34 patients with spinal tumor whose diagnosis were confirmed by surgical operation and histopathology. ResultsOf 45 cases of spinal tuberculosis,MRI showed destroyed vertebral body and intervertebral discs, narrow intervertebral spaces and paravertebral soft tissue swelling.The lesions showed low signal intensity in T1W, and a little bitter high signal intensity in T2W, and high signal in short-tau inversion recovery(STIR). In 34 cases of vertebral tumor, MRI showed that the vertebral spaces were normal,both vertebral bodies and pedicles were involved in 15 cases,only pedicles were involved in 2 cases. ConclusionMRI is a useful tool in differential diagnosis of spinal tuberculosis, especially STIR images are very clear.

Analysis of the status and risk factors of drug resistant tuberculosis in Chaoyang district in Beijing

Zhang Hong, Zhang Aijie, Zhao Ping, Zhang Shihuai, Zhang Shufang, Li Hongmin

Chinese Journal of Antituberculosis. 2009, 31(4):  218-222. 

Abstract ( 1441 )   PDF (3512KB) ( 525 )   Save

References | Related Articles | Metrics

ObjectiveTo find out the status and risk factors of drug-resistant tuberculosis in Chaoyang district, and to provide evidence for tuberculosis control in future. MethodsAll new and previously treated cases with positive sputum culture registered at Chaoyang TB control institute from 2006 to 2007 were enrolled as study population. Drug susceptibility of Mycobacterium tuberculosis to isoniazid (H), rifampicin (R), streptomycin (S) and ethambutol (E) was tested by the absolute concentration method before treatment. ResultsThe overall drug resistance of 430 strains was 15.6% (67/430), the multi-drug resistance (MDR) was 3.0% (13/430); the primary drug resistance and multi-drug resistance were 12.3% (47/381) and 1.8% (7/381); the acquired drug resistance and multi-drug resistance were 40.8% (20/49) and 12.2% (6/49). The drug resistance and multi-drug resistance were higher in previously treated cases than in new cases, which was significant difference (P<0.001). The overall drug resistance to four anti-tuberculosis drugs which sorted in descending order were S (12.6%), H（8.4%）, R（5.8%）and E（0.9%）; the primary drug resistance were S (10.0%), H（6.3%）, R（3.7%）and E（0.8%）; the acquired drug resistance were S (32.7%), H（24.5%）, R（22.4%）and E（2.0%）. Resistance to a single drug was main in new cases, while to 2 drugs was main in previously treated cases. Multivariate non-conditional logistic regression analysis showed that the history of previous treatment was the most significantly factor with drug resistance, drug resistance among previously treated cases was significantly higher than that among new cases (OR=4.9, 95%CI 2.6～9.4, P<0.001). The differences of age, gender, cavity and diabetes were not significantly correlated with drug resistance（P>0.05）. The main reason of drug resistance for the previously treated cases was the irregular treatment (OR=5.8, 95%CI 1.5～23.5, P<0.05). ConclusionsThe drug resistance was lower in Chaoyang district compared with the nationwide. Strengthening the treatment and management of new cases and reducing irregular treatment is the key to control drug resistance.

The value of high-sensitive C-reactive protein (hs-CRP) and adnosine deaminase(ADA) in the diagnosis of tuberculous pleuritis

Yuan Baodong, Wang Tingping,Xiao Yong, Zhang Yanlin

Chinese Journal of Antituberculosis. 2009, 31(4):  223-225. 

Abstract ( 1812 )   PDF (2347KB) ( 709 )   Save

References | Related Articles | Metrics

ObjectiveTo study the value of high-sensitive C-reactive protein (hs-CRP) and adnosine deaminase(ADA) in the diagnosis of tuberculous pleuritis. MethodsWe studied 116 consecutive cases with pleural fluid admitted in 2007. The patients with pleural fluid were divided into two groups: tuberculosis（TB），non-TB. The hs-CRP and ADA were detected, respectively, and included in receiver operating characteristic curve, which was used to determine cutoff values with the highest sensitivity and specificity. Results The level of hs-CRP and ADA in the TB group were (56.76±16.62) mg/L and (47.89±12.97) IU/L, respectively.they in non-TB group were (22.72±5.04) mg/L and (21.61±5.97) IU/L, respectively. The sensitivity and specificity of hs-CRP and ADA in the TB group were 98.6%, 97.6% and 95.9%, 95.2%, respectively. The area under the curve both hs-CRP and ADA was 0.999(0.998-1.001,95%CI), 0.993(0.982-1.003,95%CI), respectively. The sensitivity and specificity of the detection combined hs-CRP with ADA were 90.5% and 98.7%, respectively. ConclusionThe detection of hs-CRP and ADA in pleural fluid have important value for the diagnosis of tuberculous pleuritis.

The clinical value of Tb-DNA in BALF detected by FQ-PCR in diagnosing smear-negative pulmonary tuberculosis

Zhang Hongman, Li Zhihui, Zhao Jie, Liu Pengchong, Geng Shujun, Li Yi, Song Tao

Chinese Journal of Antituberculosis. 2009, 31(4):  227-229. 

Abstract ( 1630 )   PDF (2377KB) ( 667 )   Save

References | Related Articles | Metrics

ObjectiveTo study the value of M.tuberculosis (MTB) DNA(MTB-DNA) in bronchoalveolar lavage fluid (BALF) detected by fluorescence quantitative polymerase chain reaction (FQ-PCR) in diagnosing smear-negative pulmonary tuberculosis.MethodsFQ-PCR was uesd to detect the MTB-DNA in BALF from 300 smear-negative pulmonary TB patients,178 smear-positive pulmonary TB patients and 119 patients with pneumonia or lung cancer.ResultsThe positive rates of MTB-DNA in 3 groups patients mentioned above were 74.3%（223/300）, 94.9%（169/178）, and 17.6%（21/119）, respectively. ConclusionDetecting MTB-DNA in BALF by FQ-PCR could significantly improve the sensitivity of the diagnosis of TB, might become a helpful method for the diagnosis of TB.

The study on the imbalance between oxidation and anti-oxidation in the patients with pulmonary tuberculosis

Liang Qingtao，Li Qi，Zhang Zongde，Cao Min, Ma Yu

Chinese Journal of Antituberculosis. 2009, 31(4):  230-233. 

Abstract ( 1529 )   PDF (3209KB) ( 438 )   Save

References | Related Articles | Metrics

ObjectiveTo study the characteristic and influential factors of imbalance between oxidation and anti-oxidation of pulmonary tuberculosis(TB). MethodsThe superoxide dismutase (SOD)，glutathione peroxidase (GPX) and malonaldehyde(MDA) were detected in the sera from 20 healthy controls and 120 patients with pulmonary TB. Results1. Compared with the healthy controls, the level of SOD，GPX decreased and MDA increased in pulmonary TB group(P＜0.01). 2. The SOD，GPX decreased more obviously in the pulmonary TB patients with cavity or fibrosis and in the patients of faster erythrocyte sedimentation rate(P＜0.01)，but no difference of MDA was observed between them. 3.Through the chi-square test and logistic regression, we found that the loss of SOD and GPX was associated with TB lesion’s imageological characteristic and the patients’ESR. ConclusionsThe patients with TB have the imbalance between oxidation and anti-oxidation， the loss of SOD and GPX was associated with TB lesion’s imageological characteristic and the patients’ESR.