Table of Content

10 November 2012, Volume 34 Issue 11

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The optimized anti-tuberculous drugs and chemotherapy regimens in the future

SHA Wei，XIAO He-ping

Chinese Journal of Antituberculosis. 2012, 34(11):  693-696. 

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The impact of tuberculosis diagnosis-delay on the disease economic burden

BAI Li-qiong, XIAO Shui-yuan, LI Yan-hong, TANG Yi, GONG De-hua, TAN Zhen, FAN Jiang-jing, WAN Yan-ping, XIAO Tao

Chinese Journal of Antituberculosis. 2012, 34(11):  697-703. 

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Objective  To investigate the influence of TB timely diagnosis on TB patients, family, government and social economic burden.   Methods  386 active pulmonary tuberculosis patients, which were obtained by stratified random cluster sampling method from 6 different poverty level country/district institutions of TB Prevention and Control in Hunan, were given the TB economic burden questionnaire surveys including seven indicators: the diagnosis and treatment of TB, medical expenses, and so on. We totally issued 386 questionnaires took 381 back and acquired 354 effective questionnaires. We compared the difference of TB patients, family, government and social direct and indirect economic burden before and after TB diagnosed by t test. Ordered univariate logistic regression was used to analyze the influence of TB timely diagnosis on TB economic burden.   Results  The total family disease economic burden of 354 patients was 829 524.5 Yuan, 478 435 Yuan (57.68%) and 351 089.5 Yuan (42.32%) derived from before and after confirmed diagnosis respectively. For the direct economic burden of patients’ families (300 989 Yuan before diagnosis, 215 795 Yuan after diagnosis), the direct medical costs of patients (265 299 Yuan before diagnosis,183 321 Yuan after diagnosis), direct non-medical costs (35 690 Yuan before diagnosis, 32 474 Yuan after diagnosis), lost income of patients (161 882.5 Yuan before diagnosis, 126 182.5 Yuan after diagnosis) and the loss income of their accompanies (15 563.5 Yuan before diagnosis,9112 Yuan after diagnosis),the after diagnosis costs are higher than before diagnosis,and the difference was statistically significant(t=3.6879, 3.7278, 2.1429, 1.9902, 5.995, P<0.05).Hunan provincial government invested 145 140 Yuan of direct medical cost within 1 year after the illness, among which 74 340 Yuan and 70 800 Yuan before and after the diagnosis respectively. The total disease’s social economic burden of Hunan province was 160 742 351.7 Yuan. 88 813 229.25 Yuan and 71 929 122.45Yuan respectively before and after the confirmed diagnosis. Days of diagnosis-delay, diagnosis delay or not, and number of times that patient visit the doctor before confirmed diagnosis were positively correlated with family economic burden of TB (β=0.604, 0.815, 0.662; Wald χ²=7.574,10.234,8.215;OR=1.829,2.259,1.939; 95%CI=3.004-5.709，1.519-3.36，1.311-2.863). That the first visit of Tuberculosis Prevention and Control institutions has a negative correlation with family economic burden (β=－1.98, Wald χ²=21.429，OR=0.138，95%CI＝0.058-0.327).   Conclusion  The economic burden of TB (including the patient’s family, government and society)whether direct or indirect economic burden were mainly derived from the period before the confirmed diagnosis. The timeliness of patient visiting a doctor and the therapy level of hospital are the main factors affecting TB economic burden.

The study of drug resistance of retreatment tuberculosis patients in Beijing 2009—2010

LUO Ping, ZHANG Tian-hao, GAO Zhi-dong, XING Qing, ZHAO Yao, YI Jun-li, WANG Su-min

Chinese Journal of Antituberculosis. 2012, 34(11):  704-707. 

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Objective  To understand the drug resistance of retreatment tuberculosis patients in Beijing, and to provide evidence for Beijing TB control.  Methods  One hundred and ninty-five retreatment tuberculosis patients registered in TB control organizations from 2009 to 2010 that had performed both the 1st-line and 2nd-line drug susceptibility tests were collected and analyzed. Chi-square test was used for comparing difference of drug resistant rate,  α=0.05.     Results  The resistance rate of 1st-line anti-TB drugs was 56.4%（110/195）, for 2nd-line anti-TB drug resistance rate was 63.6%（124/195）, multi-drug resistant(MDR) rate was 28.2%（55/195）,extensively-drug resistant(XDR) rate was 3.1%（6/195）. Drug resistance rate in the top 5 of the 9 drugs tested were Pto 57.9%(113/195), INH 42.6%(83/195), EMB 36.4%(71/195), S 34.9%(68/195) and RFP 33.8%(66/195).There were no significant difference of drug resistance in different gender［male 788%(119/151)，female 79.5% (35/44)，χ²=0.011, P>0.05］, age group［“15～years old” 82.9%(34/41), “30～years old” 83.8%(57/68), “45～years old” 79.2%(38/48), “60～years old”  65.8%(25/38)，χ²=5.328, P>0.05］, region［local census register,79.2%(103/130),Nonlocal census register 78.5% (51/65)，χ²=0.015, P>0.05］and patient classification ［relapse 77.7%(122/157), initial treatment failure 84.6%(11/13),other retreatment 840%(21/25), χ²=0.824, P>0.05］.  Conclusion  The drug resistance of retreatment tuberculosis is serious in Beijing. We should strengthen the research on existing treatment methods in TB control in order to meet the evolving needs of capital tuberculosis control under the new situation.

Analysis on the hospital for tuberculosis diagnosis and treatment in China

MI Feng-ling, MA Yan，DU Jian，GAO Jing-tao, YUE Shu-min, JIANG Xiao-ying，LI Liang

Chinese Journal of Antituberculosis. 2012, 34(11):  708-711. 

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Objective  To investigate the basic information of the hospital for tuberculosis (TB) control, and to make use of the priorities to serve the national TB control program.  Methods  The questionnaire was designed by Administration Office of Clinical Center on TB, Beijing Tuberculosis and Thoracic Tumor Research Institute. Ministry of Health gave an official notification to 31 provinces (municipality, autonomous region) (not including Taiwan,Hongkong and Macao) and Xinjiang Production and Construction Corps, the hospital at provincial and prefecture level, which have 30 TB beds or above, filled in the questionnaire and reported to the higher administrative levels, the results were inputted into the EpiData database, SPSS 11.0 software was used for analysis.   Results  In 2009, there were 203 hospitals for TB control with 30 TB beds or above in China. Among of them, 12.8%(26/203) were at provincial level, 87.2%(177/203) at prefecture level; 45.8%(93/203) were located in eastern area，41.4%(84/203) in middle area and 12.8%(26/203) in western area. 17.2% (35/203) were full allocation institutions, 64.5%(131/203) were balance allocation institution and 9.4%(19/203) were self-supporting unit, others were 8.9%(18/203). There are 18 899 staff engaged in TB control, among of whom 14 456 were professional personnel. 3.7%(528/14 456) had master degree or above，37.7%(5456/14 456) had bachelor degree，35.1%(5078/14 456) had junior college degree and 23.5%(3394/14 456) had technical secondary school degree or below；3.5%(508/14 456) were senior title，10.0%(1448/14 456) were vice senior title，32.6%(4711/14 456) were middle title，50.5%(7300/14 456) were primary title or below, and 3.4%(489/14 456)had no title. There were 24.0 thousands TB beds, outpatient amount was 2.5 million and inpatient amount was 1.3 million in all hospitals for TB control. The average hospitalization time of TB patients was 27 days, the average hospitalization expenses was 6631 Yuan, bed utilization rate was 87.0%.    Conclusion  The hospital of TB control has many advantages such as the human recourses, tuberculosis wards, diagnosis and treatment capacity etc. It is suggested that the hospital for TB diagnosis and treatment should be involved into the national tuberculosis control program as soon as possible，and provide supports for new tuberculosis control system.

Analysis on geographical distribution of migrant tuberculosis patients in China

JIA Lei, LI Xue, LI Jun, LIU Xiao-qiu, JIANG Shi-wen

Chinese Journal of Antituberculosis. 2012, 34(11):  712-720. 

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Objective  To describe the spatial distribution and concentration of migrant tuberculosis (TB) patients in China, in order to provide scientific evidence for TB control among migrant population.  Methods  The data of TB patients registered in National TB Information Management System (not including Taiwan, Hong Kong and Macao) in 2010 and 2011 was used. The numbers of active pulmonary TB cases were 74 062 and 73 635 respectively among migrant population in 2010 and 2011, and 857 401 and 831 708 among permanent residents. Excel and ArcGIS 9.3 software were applied for analysis.  Results  (1) The notification rate of migrant TB patients in 2010 and 2011 were 7.95%（74 062/931 463） and 8.13% (73 635/905 343)respectively. (2) The proportions of migrant TB patients in eastern area were 76.12% (56 379/74 062) and 76.21% (56 117/73 635) in 2010 and 2011. (3) The number of migrant TB patients registered in western area increased 1.29% ((1254/24 369-1029/26 708)×100%) in Xinjiang Uygur Autonomous Region, 2.77% ((235/3598-128/3403)×100%) in Tibet and 1.14% ((1396/24 421-1026/22 409)×100%) in Yunnan provinces. (4) The registration numbers of migrant TB patients were more in Shanghai, Zhejiang, Guangdong, Fujian and adjacent areas. In 2011 Z-score for Shanghai was 24.88, 9.27 for Hangzhou, 69.94 for Guangzhou, 46.44 for Shenzhen and 7.44 for Xiamen. While the registration number of Beijing and Chongqing was more just within the municipality, Z-scores were -3.30 and -2.87 respectively in 2011. (5) There was a positive correlation between migrant TB patients’ registration and GDP per capita, y=107 027x+23 371, the square of related coefficient was 0.6287.  Conclusion  Most of migrant TB patients accumulate in eastern coastal areas, while the incidence has been increasing year by year in western area in the recent two years. So it is very important to pay attention to TB control in western areas.

Evaluation on image quality of children’s pulmonary tuberculosis with low-dose spirial CT

ZHOU Chun-hua, WANG Wei-hua, YU Hui-shan, LI Bao-xue, TIAN Kui, YU Qiong, SHA Jin-lu

Chinese Journal of Antituberculosis. 2012, 34(11):  721-726. 

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Objective  To evaluate the image quality of children’s pulmonary tuberculosis (CPTB)with low-dose spirial CT scanning.   Methods  One hundred and fifty new initial treated children diagnosed with CPTB about 0-15 years old have been randomly recruited. Routine dose using AECT (automatic exposure control technique) and low-dose using CCCT (constant current control technique)spirial CT scanning were performed in 150 children with CPTB prospectively. Two imaging quality were evaluated by the double-blind method. GroupⅠwas 0- years olds scanned by AECT 100 mA and CCCT 20 mA; groupⅡ was 6- years olds scanned by AECT 150 mA and CCCT 30 mA; groupⅢ was 11-15 years olds scanned by AECT 150 mA and CCCT 40 mA.  Results  The results with different low-dose spirial CT scanning were as follows: (1)The contents of imaging quality controlling including range, density, resolution, details and noise of lesions in lung window were as below: the average scores of CCCT 20 mA and AECT with 100 mA in groupⅠwere 88.8 (22.2±1.5) and 95.1 (23.7±0.8) with significant difference(t=7.9, P<0.001). The average scores of CCCT 30 mA and AECT with 150 mA in group Ⅱ were 97.2(24.2±0.9) and 98.7(24.7±0.5) with no significant difference (t=2.9, P>0.05). The average scores of CCCT 40 mA and AECT with 150 mA in group Ⅲ were 98.3(24.6±0.6) and 99.0(24.7±0.5) with no significant difference (t=1.7, P>0.05). (2)The contents of imaging quality controlling including muscle and ribs and fat, hilum and main vessels, esophagus and surrounding tissue contrast in mediastinum, atrium and ventricle, inferior vena cava in mediastinum window were as below: the average scores of CCCT 20 mA and AECT with 100 mA in groupⅠwere 87.8(21.9±1.5) and  95.4 (23.8±1.1) with significant difference(t=7.2, P<0.001). The average scores of CCCT  30 mA and AECT with 150 mA in group Ⅱ were 97.0（24.2±0.8）and 98.7（24.5±0.5） with no significant difference(t=2.2，P＞0.05). The average scores of CCCT 40 mA and AECT with 150 mA in group Ⅲ were 97.6(24.4±0.7) and 98.9(24.7±0.4) with significant difference (t=2.7, P>0.05). (3) The imaging quality of lesions of CPTB were as below: the average scores of CCCT 20 mA and AECT with 100 mA in groupⅠwere 85.6(3.72±0.73) and 95.3 (4.66±0.66) with significant difference(t=9.34, P<0.001). The average scores of CCCT 30 mA and AECT with 150 mA in group Ⅱ were 96.0(4.56±0.54) and 98.8 (4.74±0.44) with no significant difference (t=1.99, P>0.05). The average scores of CCCT 40 mA and AECT with 150 mA in group Ⅲ were 97.6(4.72±0.45) and 99.2(4.84±0.37) without significant difference (t=1.66, P>0.05).  Conclusion  The imaging got with low-dose spirial CT scanning could be used to diagnose CPTB.

Efficacy of combination of surgery with drug therapy for 16 cases with cervical tuberculosis

WEI Ren-qian,CAO Xing-hai,TU Da-hua

Chinese Journal of Antituberculosis. 2012, 34(11):  727-730. 

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Objective  To evaluate the clinical effects of surgery combined with drug therapy for cervical tuberculosis.  Methods  From May 2007 to March 2010, 16 cases who suffered from cervical tuberculosis were treated by surgery combined with drug and the data of treatment and efficacy were retrospectively analyzed.  Results  The mean followed-up time was 21 months.All cases’ tuberculosis lesions were cured, bone graft got fusion,and clinical symptoms such as neck pain disappeared or was significantly improved. The muscle strength of 10 cases recovered in one week after operation, the sensory and motor function of 6 cases gradually improved in one month after operation, the bowel and bladder function of all patients were improved within one month after surgery. Their nerve symptoms were greatly improved. The level were improved from 1 to 3 grades in Frankel grading system. One patient with Frankel B was improved to D and another one was improved from C to D.The others with different Frankel grades were improved totally to E.  Conclusion  Surgery combined with drug therapy for cervical tuberculosis with quadriplegia are satisfactory in early stage. The long-term efficacy remains to be seen due to the short time of the clinical application.

Pulmonary tuberculosis incidence and its influencing factors in rural areas of Xiangtan county，Hunan province

ZHANG Chuan-fang, ZHANG Yi-rui, CHEN Tian-zhu, GONG De-hua, ZHAO Pei-an, ZENG Zheng-biao, TANG Yi, BAI Li-qiong

Chinese Journal of Antituberculosis. 2012, 34(11):  731-735. 

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Objective  To study the pulmonary tuberculosis incidence and risk factors among  rural areas.  Methods  A nested case-control study was conducted based on cohort of 72 859 subjects in Xiangtan county of Hunan province. The case group was composed of 80 cases of new tuberculosis patients detected during the 1 year follow-up program. Four hundred nontuberculosis subjects were selected by simple random sampling method from the cohort as controls. Univariate analysis and mutivariate nonconditional logistic regression were used to analyze associations between the exposure factors and pulmonary tuberculosis. Results  The incidence of pulmonary tuberculosis was 109 80 per 100 000（80/72 859） within one year, the incidence of male and female was 168.11（63/37 476），48.05 per 100 000 （17/35 383） respectively. The results of univariate analysis showed that age (Wald χ²=22.251，P<0.001，OR=1.759), gender (Wald χ²=16.145，P<0.001，OR=0.310), educational level (Wald χ²=21.937，P<0.001，OR=0.468), marital status (Wald χ²=8.320，P=0.004，OR=0.358), occupation (Wald χ²=10.297，P=0.001，OR=0.377), history of TB exposure (Wald χ²=7.535，P=0.006，OR=4.166), history of tuberculosis (Wald χ²=14.637，P<0.001，OR=57.000), smoking history (Wald χ²=4.525，P=0.033，OR=1.730), suspicious symptoms (Wald χ²=46.630，P<0.001，OR=12.758) were significantly associated with TB incidence; multivariate analysis showed that gender (β=-1.142，Wald χ²=12.904，OR=0.319，95% CI=0.171-0.595), education level (β=-0.743，Wald χ²=14.355，OR=0.476，95% CI=0.324-0.699), marital status (β=-1.138，Wald χ²=7.537，OR=0.320，95%CI=0.142-0.722), history of tuberculosis (β=2.852，Wald χ²=5.563，OR=17.329，95%CI=1.619-185.441), suspicious symptoms (β=1.728，Wald χ²=16.333，OR=5.630，95%CI=2.435-13.016) were significantly associated with TB incidence.  Conclusion  Women, high education level and single were protective factors of TB incidence while history of tuberculosis and suspicious symptoms of tuberculosis were risk factors of TB incidence.

Analysis of Mycobacterium tuberculosis drug-resistance situation of sputum culture positive patients visiting Tai’an Tuberculosis Prevention and Treatment Hospital in 2011

MENG Fan-liang，LIU Qing-fu，LI Jian-zhi，WANG Gui-mei，LV Shi-qin

Chinese Journal of Antituberculosis. 2012, 34(11):  736-739. 

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Objective  To analyze the Mycobacterium tuberculosis drug-resistance situation of sputum culture positive patients visiting Tai’an TB Prevention and Treatment Hospital.   Methods  From January 2011 to December 2011,  a total of 233 sputum culture positive patients visited Tai’an TB Prevention and Treatment Hospital, we analyzed their drug susceptibility situation for 6 kinds of anti-TB drugs, namely S, Km, INH, RFP, EMB and PAS and their resistance pattern. According to the treatment history, patients were divided into new patients group (171 cases) and retreatment group (62 cases). Chi-square test was used to analyze if the difference is statistically significant (P<0.05).   Results  The overall drug-resistant rate of 233 sputum culture patients was 52.36% (122/233), with 51.46% (88/171) in new patients and 54.84% (34/62) in retreatment patients. Sputum culture positive patients had high drug susceptibility rate to first line drugs, with the highest of INH (30.04%,70/233), followed by S (24.46%,57/233), EMB (23.18%,54/233) and RFP(16.74%,39/233). In terms of resistance pattern, the majority was multi-drug resistant  TB (50.00% 61/122), followed by single-drug resistant  TB (28.69%,35/122) and multi-drug resistant (MDR) TB (21.31%,26/122). The overall MDR-TB rate was 11.16% (26/233), with 19.35%(12/62) in new patients and 8.19%(14/171) in new patients, the difference between two groups is statistically significant(χ²=5.724，P<0.05). The MDR-TB rate (23.08%,6/26) in patients ever used anti-TB drugs was higher than those never taken anti-TB drugs before (5.52%,8/145), and the difference is statistically significant(χ²=6.699，P<0.05). Conclusion  The overall drug-resistance rate of Mycobacterium tuberculosis and INH, S, EMB, RFP drug-resistance rates are high in sputum culturepositive patients visiting Tai’an TB Prevention and Treatment Hospital, and the retreatment and new patients who had taken anti-TB drugs before are more likely to develop MDR-TB.

Recommendations for the production of domestic tuberculosis serological detection reagents based on the results of a large-scale background investigation

Chinese Journal of Antituberculosis. 2012, 34(11):  740-742. 

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According to the “active tuberculosis detection means” policy recommendations published by WHO，State Food and Drug Administration (SFDA) issued a notice named Guideline on further strengthening the supervision of tuberculosis serological diagnostic reagent. The notification required SFDA to conduct a background investigation of the domestic tuberculosis serological diagnostic products. The main purpose is to give some useful recommendations based on the evaluation of quality control in the production process of the domestic tuberculosis serological diagnostic reagents and to study the problems in the clinical evaluation. These recommendations will be served as the reference for the production，researches and clinical evaluation of tuberculosis serological diagnostic reagents.

Risk communication and tuberculosis control in university settings

Chinese Journal of Antituberculosis. 2012, 34(11):  743-745. 

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Tuberculosis (TB) is a serious health threat to China’s population. The TB epidemics in university have attracted increasing public attention. As a key measure of public health emergency response, risk communication aims to narrow the gap of risk perception and to lead establishment of public reason, which will play an important role in TB control in university. Risk communication is the process to exchange information and views among individuals, groups, and school management at all levels, consequently promote confidence building among stakeholders, and ultimately affect the outcome of TB epidemic control. Communication targets should be defined according to the extent to which the epidemic affects, so do the communication frequency and depth. Daily risk communication should be implemented well for the preparation of unexpected TB epidemic. Risk communication in TB emergency response should involve public participation, release of epidemic information in time， monitor public opinions, pay attention to the intensity of information dissemination, launching variety of promotion activities, and balancing between timeliness and accuracy,  scientificalness and popularity of information.