Table of Content

10 March 2018, Volume 40 Issue 3

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Interpretation of Health Industry Standards

Comprehensive interpretation of the Classification of tuberculosis (WS 196-2017)

Er-yong LIU,Lin ZHOU,Li-xia WANG

Chinese Journal of Antituberculosis. 2018, 40(3):  234-238.  doi:10.3969/j.issn.1000-6621.2018.03.003

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In order to meet the needs of the current tuberculosis prevention and control work in China,the National Health and Family Planning Commission (NHFPC) released the health industry standard for the Classification of tuberculosis (WS 196-2017) on November 9, 2017. The new classification standards are based on the etiology, epidemiological characteristics, clinical manifestations, laboratory tests and differential diagnosis of tuberculosis. Amendments mainly focus on active TB, and it is in line with the characteristics of the change and development of tuberculosis. The trachea and bronchial tuberculosis and tuberculous pleurisy are incorporated into pulmonary tuberculosis. And the molecular and bacteriological examination result are defined as pathogenic examination. At the same time, the results of drug susceptibility test are included in the active tuberculosis classification. This standard also cover Mycobacterium tuberculosis latent infection and inactive pulmonary tuberculosis. The clear definition of the two groups are more conducive to the key prevention and control of tuberculosis. Increasing the drug resistance classification is beneficial to understand the status of drug-resistant tuberculosis and to evaluate the epidemic status of drug-resistant tuberculosis scientifically and objectively. The Classification of tuberculosis (WS 196-2017) will provide a strong technical support for the realization of the goal of ending tuberculosis prevention and control in China in 2035.

Interpretation of new health industry standards diagnostic cretia for tuberculous pleurisy

Xiao-you CHEN

Chinese Journal of Antituberculosis. 2018, 40(3):  239-242.  doi:10.3969/j.issn.1000-6621.2018.03.004

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The diagnosis of tuberculous pleurisy is difficult due to the low positive rate of etiology in pleural effusion and atypical clinical symptoms. The new health industry standards criteria(WS 288-2017) issued for tuberculous pleurisy will be helpful to diagnose systematically in practice. This paper focused on interpretation of tuberculous pleurisy from the new national standards for readers to understand it better.

Interpretation of clinical diagnosed pulmonary tuberculosis case in new national diagnostic standard on pulmonary tuberculosis

Meng-qiu GAO

Chinese Journal of Antituberculosis. 2018, 40(3):  243-246.  doi:10.3969/j.issn.1000-6621.2018.03.005

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Clinical diagnosed pulmonary tuberculosis (TB), known as TB cases without pathogenic evidence. Because of lacking typical clinical symptoms, misdiagnosis is not rare in clinical practice. The newly released national standard on Diagnosis for pulmonary tuberculosis (WS 288-2017) sets up a new criteria for clinical diagnosed TB case with consideration of current new diagnostic tools. This paper aims to interpret the new national standard on clinical diagnosed TB case, and provide guidance to clinicians’ routine practice.

Pay attention to comprehensive diagnosis and treatment of tracheobronchial tuberculosis—Reading the Classification of tuberculosis (WS 196-2017)

Ming-gui LIN

Chinese Journal of Antituberculosis. 2018, 40(3):  247-250.  doi:10.3969/j.issn.1000-6621.2018.03.006

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On November 9, 2017, the National Health and Family Planning Commission of the People’s Republic of China issued a new health standard for the Classification of tuberculosis (WS 196-2017), which will be formally implemented on May 1, 2018. By the introduction of tracheobronchial tuberculosis incidence, clinical features, diagnosis, classification and treatment methods in WS 196-2017 standard, this paper focuses on the clinical diagnosis of tracheobronchial tuberculosis and especially provides a feasible reference for the key roles of bronchoscopy in the diagnosis and interventional treatment of tracheobronchial tuberculosis.

Imaging evaluation of non-active pulmonary tuberculosis

Xin-hua ZHOU,Bu-dong CHEN,Yan LYU,Wei HE

Chinese Journal of Antituberculosis. 2018, 40(3):  251-254.  doi:10.3969/j.issn.1000-6621.2018.03.007

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The Classification of tuberculosis (WS 196-2017) was released in 2017, increased the types of non-active tuberculosis. The author summarized the imaging features of inactive pulmonary tuberculosis. On the basis of analyzing the imaging manifestations of pulmonary tuberculosis, the imaging manifestations of active and inactive pulmonary tuberculosis were compared and analyzed and to summarized the imaging features of inactive pulmonary tuberculosis. The imaging evaluation methods of inactive pulmonary tuberculosis were discussed from chest X-ray and CT images.

Clinical application and research on strengthening pathological diagnosis of tuberculosis

Wen CHEN,Ning LI

Chinese Journal of Antituberculosis. 2018, 40(3):  255-258.  doi:10.3969/j.issn.1000-6621.2018.03.008

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Tuberculosis is a kind of infectious disease caused by Mycobacterium tuberculosis complex group, which seriously endangers human health. On November 9, 2017, the National Health and Family Planning Commission issued the two mandatory health industry standards for Classification of tuberculosis (WS 196-2017) and Diagnosis for pulmonary tuberculosis (WS 288-2017), and will implement on May 1, 2018. At the same time, “Classification of tuberculosis (WS 196-2001)” and “Diagnosis for pulmonary tuberculosis (WS 288-2008)” will be abolished. In the standard of Diagnosis for pulmonary tuberculosis (WS 288-2017), the status of pathological diagnosis in tuberculosis diagnosis and precision treatment is significantly improved. Pulmonary tuberculosis can be diagnosed by pathological diagnosis. The findings of the imaging examination support the diagnosis of tuberculosis, while patients with positive molecular biology can also be diagnosed with tuberculosis. PCR technology can quickly diagnose Mycobacterium tuberculosis infection, the nucleic acid hybridization technique can quickly detect the mutation site of the gene and determine the type of drug resistance of Mycobacterium tuberculosis. Further study and implementation of the standard of Diagnosis for pulmonary tuberculosis (WS 288-2017) is of great importance to clarify and understand the role of pathological diagnosis in the clinical diagnosis and precise treatment of tuberculosis.

Advances in the diagnosis of childhood pulmonary tuberculosis

Hui-min LI,Shun-ying ZHAO

Chinese Journal of Antituberculosis. 2018, 40(3):  259-262.  doi:10.3969/j.issn.1000-6621.2018.03.009

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On November 9, 2017, the health standard of the People’s Republic of China “Diagnosis for pulmonary tuberculosis (WS 288-2017)” was introduced. The author would like to explain and analyze the new standard, focusing on several issues of children’s tuberculosis, combined with the literature to discuss the advances in the diagnosis of tuberculosis in children. Clinical manifestations, imaging findings, a history of close contact with tuberculosis patients and Tuberculin Skin Test are the main basis for the clinical diagnosis of tuberculosis in children. Gamma-interferon release assay has better specificity than the tuberculin skin test. When pulmonary tuberculosis is suspected in children, efforts should be taken to keep two or more specimens including gastric juice, sputum or nasopharyngeal aspirate for smear microscopy, solid and liquid culture and molecular test to increase the positive rate of the pathogen. Bronchoscopy should be performed when airway involvement is suspected. Xpert MTB/RIF positive results can be used as the etiological basis for the diagnosis of pediatric pulmonary tuberculosis.

Original Articles

Association of IL-2-330T/G and IL-6-174G/C polymorphisms with tuberculosis susceptibility: a Meta-analysis

Yan-lin LI,Liang LI,Xiu-fang TANG,Xiu-juan WU

Chinese Journal of Antituberculosis. 2018, 40(3):  263-268.  doi:10.3969/j.issn.1000-6621.2018.03.010

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Objective To investigate the relationship between interleukin-2 (IL-2-330T/G) and interleukin-6 (IL-6-174G/C) gene polymorphisms and susceptibility of tuberculosis (TB).Methods Relevant English and Chinese publications were identified by a literature search in the PubMed, Medline, EMBase, Web of Science, Elsevier Science Direct, Wanfang Data, CNKI and Weipu databases from January 1990 to June 2017. Two investigators screened 573 articles, and 12 articles were finally included according to the inclusion and exclusion criteria. Meta-analysis was performed on the original data by using Stata 12.0.Results In all, eight studies containing 971 cases and 1519 controls were used to assess the potential influence of the IL-2-330T/G polymorphism with TB susceptibility. This Meta-analysis indicates that the TB risk in Europeans with gene T was 45% lower than those with gene G (T vs. G: OR=0.55, 95%CI=0.31-0.98, P=0.042). As for IL-6-174G/C, nine studies containing 1445 cases and 1955 controls were involved. The TB risk in Americans with gene G was 1.65 times higher than those with gene C (G vs. C: OR=1.65, 95%CI=1.28-2.13, P<0.01), and the TB risk in Asians with gene G was 1.4 times higher than those with gene C (G vs. C: OR=1.40, 95%CI=1.13-1.72, P=0.002).Conclusion This Meta-analysis indicates that the IL-2-330T/G polymorphism is associated with decrease in TB risk in Europeans, and IL-6-174G/C polymorphism is associated with increase in TB risk in Americans and Asians.

Large sequence polymorphisms of the Mycobacterium tuberculosis Beijing genotype strains

Tong XIE,Rui SUN,Han-fang JU,Chun-hua WANG,Cheng MU,Zhi-rui WANG,Hui ZHAO

Chinese Journal of Antituberculosis. 2018, 40(3):  269-273.  doi:10.3969/j.issn.1000-6621.2018.03.011

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Objective To clarify the evolutionary pathway of Beijing genotype of Mycobacterium tuberculosis (MTB) and to elucidate the sublineages of Beijing strains.Methods The Beijing genotype isolates were identified from the 567 MTB isolates, which collected from the patients with pulmonary tuberculosis from Jan. 2014 to Apr. 2016 in Tianjin, China, by analyzing the deletion of regions of difference 207 (RD207). Large sequence polymorphism (LSP) of the Beijing strains were determined based on the presence or absence of RD105, RD181, RD150 and RD142. The insertion sequence 6110 (IS6110) insertion in noise transfer function (NTF) region was also analyzed.Results Of the 567 clinical isolates, 517 (91.2%) were identified as Beijing genotype. Among these Beijing strains, 447 (86.5%) belonged to modern Beijing strains that possessed IS6110 insertion in NTF region, whereas 70 (13.5%) belonged to ancient Beijing strains that had no IS6110 insertion in NTF region. Based on the LSP analy-sis, all 517 Beijing strains were further divided into five sublineages. 22 (4.3%) were RD181(+), and all these RD181(+) strains belonged to ancient Beijing genotype. 41 (7.9%) and 7 (1.4%) were RD181(-)/RD150(+) and RD181(-)/RD150(-) ancient Beijing strain, respectively. Of the 447 modern Beijing strains, there were 404 RD181(-)/RD150(+) and 43 RD181(-)/RD150(-) strains, accounting for 78.1% and 8.3% of the Beijing isolates, respectively.Conclusion Modern Beijing strains are the most predominant in Tianjin, China. Based on the LSP analysis, the Beijing genotype strains have evolved five sublineages and the majority of isolates is the RD181(-)/RD150(+) modern sublineage.

Treatment effect of Shenqi Eleven Granules on leuccytopenia caused by antituberculosis drugs

Cun-bing GUO,Hui LI,Shu-lan ZHENG

Chinese Journal of Antituberculosis. 2018, 40(3):  274-279.  doi:10.3969/j.issn.1000-6621.2018.03.012

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Objective To evaluate the treatment effect of Shenqi Eleven Granules on treating leukopenia caused by antituberculosis drugs.Methods A total of 158 patients who were complicated by leukopenia after first standard anti-TB drug treatment were collected from Tuberculosis Prevention and Control Agency, Xuchang City, He’nan Province from September 2015 to February 2017. According to the table of random number, patients were divided into two groups: taking Shenqi Eleven Flavor Granule for “A group”(n=79) and taking Leucogen for B group (n=79). Peripheral blood leukocyte count, main symptoms associated with leucopenia, and adverse drug reactions were observed and recorded.Results The total effective rate of leukopenia (94.44% (68/72)) and WBC in peripheral blood (5.12±0.76)×10 ⁹/L) in A group were significantly higher than those in B group (72.97% (54/74), (4.09±1.02)×10 ⁹/L) (χ ²=10.14, P=0.021; t=4.38, P=0.017). The WBC of peripheral blood in group A and B after treatment were significantly higher than that before treatment ((3.26±1.02)×10 ⁹/L and (3.18±0.82)×10 ⁹/L)) (t=5.79, P=0.010; t=4.15, P=0.018). Dizziness (8.33% (6/72), 9.46% (7/74)), low fever (2.78% (2/72), 2.70% (2/74)), weakness (5.56% (4/72), 4.05% (3/74)) in both groups were than those before treatment (27.78% (20/72), 28.38% (21/74); 15.28% (11/72), 16.22% (12/74)); 40.28% (29/72), 41.89% (31/74)) (χ ²=12.34, P=0.008; χ ²=12.09, P=0.008; χ ²=8.83, P=0.011;χ ²=8.16,P=0.010; χ ²=17.26, P=0.020; χ ²=18.09, P=0.020). However, there was no significant difference between the two groups in the improvement of the main symptoms such as dizziness, fever and fatigue (χ ²=1.43, P=0.437; χ ²=2.62, P=0.406; χ ²=1.95, P=0.410). The incidence of ADR in group A was not significantly different from that in group B (83.33% (60/72)) compared with 86.49% (64/74) in group B (χ ²=3.03, P=0.382). Conclusion Shenqi Eleven Flavor Granules has a better clinic effect on leukopenia caused by anti-tuberculosis drugs and higher safety.

Analysis on the effect of surgical treatment for stable pulmonary tuberculosis associated with lower esophageal carcinoma

Cun-hong LIN

Chinese Journal of Antituberculosis. 2018, 40(3):  280-285.  doi:10.3969/j.issn.1000-6621.2018.03.013

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Objective To investigate the feasibility and safety of surgical treatment for patients who have stable pulmonary tuberculosis associated with lower Methods The clinical data of surgical treatment for 34 cases of stable pulmonary tuberculosis associated with lower esophageal carcinoma (Group A) and 310 cases of lower esophageal carcinoma alone (Group B) from March 2009 to March 2014 in Taian Tumor (Tuberculosis) Hospital was collected. All the patients received routine surgical treatment for lower esophageal carcinoma. The difference between both groups in operation lasting time, blood loss, resection rate, postoperative hypoxemia, delayed fever, cardiac arrhythmia, pulmonary complications, wound healing, anastomotic leakage, operative mortality and survival rate was retrospectively analyzed. DPS 10.0 was used for statistical analysis. The measurement data was expressed as “ \bar{x} ±s”, and t test was used. The count data was small sample data, and the corrected χ ² test was used. P<0.05 was regarded as statistically significant. Results There was no statistically difference (P>0.05) between the two groups in operation lasting time (A: (3.4±0.4)h, B: (3.1±0.4)h. t=1.77, P=0.055), intraoperative blood loss (A: (181.0±71.4)ml, B: (165.0±80.5)ml. t=0.73, P=0.241) and the resection rate (A: 94.1% (32/34), B:93.5% (290/310). χ ²=0.06, P=0.810). The incidence rate of postoperative hypoxemia (17.6%, 6/34), surgical delayed fever (32.4%, 11/34) and pulmonary complications (23.5%, 8/34) in Group A was significantly higher than that in Group B (6.5%, 20/310; 16.1%, 50/310; 10.3%, 32/310) (χ ²=4.01, P=0.045; χ ²=4.47, P=0.034; χ ²=3.99, P=0.045); but there was no statistically difference (P>0.05) between the two groups in the incidence rate of cardiac arrhythmia (A: 8.8% (3/34), B: 6.1% (19/310); χ ²=0.06, P=0.810), difficult healing wound (A: 2.9% (1/34), B: 2.9% (9/310); χ ²=0.28, P=0.599), anastomotic leakage rate (A: 5.9% (2/34), B: 3.9%(12/310); χ ²=0.01, P=0.915), and operative mortality (A: 2.9% (1/34), B: 1.0% (3/310); χ ²=0.03, P=0.860). There was no significant difference between the two groups in 1-year survival rate (A: 94.1% (32/34), B: 93.9% (291/310); χ ²=0.10, P=0.748) and 2-year survival rate (A: 67.7% (23/34), B: 74.8% (232/310); χ ²=0.49, P=0.482), but the 3-year survival rate in Group A was significantly lower than that in Group B (A: 20.6% (7/34), B: 42.9% (133/310); χ ²=5.43, P=0.019). No postoperative progression and dissemination of tuberculosis were found in Group A. Conclusion The feasibility and safety of surgical treatment for patients who have stable pulmonary tuberculosis associated with lower esophageal carcinoma are good, and there is no progression and dissemination of tuberculosis, suggesting that surgical treatment is still the primary and effective treatment for these patients.

Prognosis of different regimens in pulmonary tuberculosis patients with mono-resistance to isoniazid and rifampicin

Mao-jun WANG,Bing-qian MA,Jun-ling HAO,Zhi-hua FU,Shu-min DONG,Yan-zhu CAO

Chinese Journal of Antituberculosis. 2018, 40(3):  286-291.  doi:10.3969/j.issn.1000-6621.2018.03.014

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Objective To analyze the prevalence of multidrug-resistant tuberculosis (MDR-TB) after treatment with different regimens in patients with mono-resistance to isoniazid (H) and rifampicin (R), in order to guide rational drug use in clinical settings.Methods From January 2010 to December 2014, 332 pulmonary tuberculosis patients with mono-resistance to H and 114 pulmonary patients with mono-resistance to R identified by the drug resistance surveillance project in Puyang City, He’nan Province were enrolled as the study subjects. The subjects were randomized (through simple randomization among patients with mono-resistance to H and R respectively) into standard chemotherapy group (a total of 222 cases on regimens according to the standardized chemotherapy for na?ve and retreated patients, referred to as “standard group”); and the levofloxacin chemotherapy group (a total of 224 cases on regimens based on the drug sensitivity test results, containing levofloxacin chemotherapy, referred to as “levofloxacin group”). The incidence of MDR-TB after treatment in both groups was observed. SPSS 20.0 statistical software package was used for statistical analysis, and the group comparison was performed using χ ² test. P<0.05 was considered statistically significant. Results The incidence of MDR-TB was 11.7% (26/222) in the standard group, and 4.9% (11/224) in the levofloxacin group and the difference was statistically significant (χ ²=6.779, P=0.009). Among the newly diagnosed patients, the incidence of MDR-TB was 4.4% (8/180) in the standard group and 2.2% (4/185) in the levofloxacin group, with no significant difference between the two (χ ²=1.495,P=0.222). Among the retreated patients, the incidence of MDR-TB was 42.9% (18/42) in the standard group and 17.9% (7/39) in the levofloxacin group, with statistical difference (χ ²=5.880, P=0.015). Among the patients with mono-resistance to R, the incidence of MDR-TB was 37.5% (21/56) in the standard group and 17.2% (10/58) in the levofloxacin group, with the difference being statistical significance (χ ²=5.906, P=0.015). Among the retreated patients with mono-resistance to R, the incidence of MDR-TB was 56.5% (13/23) in the standard group, and 27.3% (6/22) in the levofloxacin group, and the difference was statistically significant (χ ²=3.493, P=0.047). Conclusion Among naive patients with mono-resistance to H and R, standard chemotherapy does not increase the risk of developing MDR-TB. Pulmonary tuberculosis patients with mono-resistance to R are more prone to develop MDR-TB, compared with those with mono-resistance to H, especially those retreated patients with mono-resistance to R.

Analysis of drug resistance to anti-tuberculosis drugs of 115 retreatment smear-positive pulmonary tuberculosis

Lin ZHANG,Jian KANG,Xiao-ping XIAN

Chinese Journal of Antituberculosis. 2018, 40(3):  292-295.  doi:10.3969/j.issn.1000-6621.2018.03.015

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Objective To investigate the status of drug resistance of 115 retreatment smear-positive tuberculosis patients and to analyze the causes of drug resistance.Methods We collected 115 retreatment smear-positive tuberculosis patients from Shaanxi Tuberculosis Prevention and Treatment Institute and newly registered outpatients from Xijing Hospital, and did the Mycobacterium isolation and strain identification with their sputum specimens. After strain culture, 97 Mycobacterium were isolated, of which 93 has obtained drug susceptibility testing (referred to as “susceptibility testing”) results. Mycoplasma strains were identified as 2 non- and 91 Mycobacterium tuberculosis. We took these 91 tuberculosis patients as research object, and did the susceptibility testing with six kinds of anti-TB drugs (rifampicin (RFP), isoniazid (INH), streptomycin (Sm), ethambutol (EMB), levofloxacin (Lfx), Kanamycin (Km)). We analyzed the status of drug resistance and further investigated the causes of drug resistance formation.Results For the 91 retreatment smear-positive tuberculosis patients, the total drug resistance rate was 42.86% (39/91), single-drug resistant rate was 30.77% (28/91), multi-drug resistant rate was 6.59% (6/91), the multidrug-resistant rate (MDR) was 4.40% (4/91) and the extensively drug resistant rate (XDR) was 1.10% (1/91). Single-drug resistant rates from high to low were: Lfx (12.09%, 11/91), Sm (7.69%, 7/91), RFP (5.49%, 5/91), INH (2.20%, 2/91), EMB (2.20%, 2/91), Km (1.10%, 1/91). Drug resistance analysis found, that medical factors accounted for 57.14% (16/28), patient’s own factors accounted for 28.57% (8/28), and the drug factors accounted for 14.29% (4/28).Conclusion The total drug resistant rate is relatively high for the 115 retreatment smear-positive tuberculosis patients, and the non-standard anti-TB drug treatment is the main cause for drug resistance.

Analysis of the medical intention of TB and its influencing factors among floating population in six provinces in China

Sheng-lan LIU,Yu-hui SHI,Yang SHEN,Huan HE,Qing-qi ZENG,Chun CHANG

Chinese Journal of Antituberculosis. 2018, 40(3):  296-301.  doi:10.3969/j.issn.1000-6621.2018.03.016

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Objective This study aims to demonstrate the treatment intention of the floating population in the presence of suspicious symptoms of tuberculosis, and to analyze the influencing factors of delayed treatment intention, and to provide scientific basis for the prevention and control of TB in floating population.Methods During May to September in 2015, PPS sampling method was used to select 2 provinces respectively from eastern, central and western regions of China. In these provinces, based on convenience sampling method, a total of 3300 floating people from 3 main types of work place which contains factories, construction sites and service business in 12 cities were chosen to complete the survey, and 3294 valid questionnaires were collected (the effective rate was 99.8%). The questionnaire was designed based on the health belief model (HBM). The medical intention of objectives with different characters were analyzed, and the scores of each HBM module of people with different treatment intentions were calculated and compared, too.Results The proportion of delayed treatment intention of people with mild and moderate tuberculosis symptoms was 22.8% (751/3294) and 14.9% (491/3294), respectively. In both mild or moderate symptom groups, the highest proportion of delay was in the construction industry, namely, 29.7% (341/1149) and 22.2% (255/1149); people aged 41-50, 25.6% (212/829) and 18.9% (157/829); the western region,32.7% (342/1046) and 23.0% (241/1046). The delayed treatment rates in both mild and moderate TB symptoms groups were higher in those who did not receive the education for TB promotion, which was 26.2% (553/2111) and 16.5% (348/2111), respectively, while in those who once received, the proportions were 16.7% (192/1153) and 11.7% (135/1153) respectively. The average score of knowledge was (8.51±3.37); perceived TB threat, (12.28±2.62); perceived value of medical treatment, (14.27±1.89); perception of barriers, (13.03±1.12), prompt factor, (6.45±1.12).Conclusion The proportion of delayed treatment intention was high in floating population. It is necessary to enhance health education among the floating people, especially construction workers and people in the western region. The education should be designed based on the health belief model, include the benefits and barriers of timely medical treatment into the publicity.

Investigation on public awareness in key messages of tuberculosis prevention and control in Beijing

Ya-min LI,Zhi-dong GAO,Xiao-xin HE,Yan XU,Xi CHEN,Yao ZHAO

Chinese Journal of Antituberculosis. 2018, 40(3):  302-306.  doi:10.3969/j.issn.1000-6621.2018.03.017

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Objective To understand the current status of public awareness in key messages of tuberculosis (TB) prevention and control in Beijing, so as to provide direction and focus to further promote health education on TB.Methods The multi-stage stratified clustered random sampling method was applied to select 17274 residents who were 15 years old and above in January to October 2015 among all communities and townships of 16 districts in Beijing. All of the subjects were interviewed face-to-face with the standard questionnaire designed by the expert group of the Awareness Survey through literature search and expert consultation. A total of 16519 valid questionnaires were received and the effective rate was 95.6%. The interview was carried out to take the basic demographic characteristics, the awareness rate of TB key message and the main channel for the subjects to get TB knowledge and information. A database was set up, and then the overall awareness rate of TB key messages was calculated. The way and the will of obtaining the knowledge were analyzed.Results The overall awareness rate of key messages on TB prevention and control among surveyed people was 75.0% (61944/82595), and that of women (75.7%, 37413/49445) was higher than that of men (74.0%, 24531/33150)(χ ²=29.37, P<0.01). The awareness of population of Beijing registered residence (76.0%, 49446/65050) was significantly higher than that of non-household population (71.2%, 12498/17545) (χ ²=168.25, P<0.01). The awareness rate of the age group 30-44 (76.4%, 24005/31435) was higher than other age groups. In this study, only a few subjects (26.1%, 4308/16519) knew all the five key messages. The main channels for the subjects to get TB knowledge and information were TV (62.4%, 10303/16519) and health lectures (44.9%, 7413/16519), and the materials which contained pictures and texts were the most popular form (33.6%, 5543/16519). Conclusion The awareness rate on TB key know-ledge of the public in Beijing is lower than the requirement of the National TB Control Programme. For the important population, TB control health education activities with popular form and materials should be applied to further promote the awareness on TB.

The knowledge, attitude and practice and its influencing factors of Uyghur tuberculosis patients in Kashgar

,Guo-fang MA,Yu-jian ZHENG

Chinese Journal of Antituberculosis. 2018, 40(3):  307-314.  doi:10.3969/j.issn.1000-6621.2018.03.018

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Objective To analyze predominantly Muslim Uyghur’s tuberculosis (TB) knowledge, attitude and practice and its influencing factors, and to provide references and suggestions on the development of TB patients health education strategies and measures in Kashgar.Methods One hundred and seventy one Uyghur TB patients who were registered and treated in Tuberculosis Information Management System in China from 1 January 2017 to 1 April 2017 in Kashgar were investigated using questionnaires in Uyghur language. The questionnaire was designed according to the brochure of TB prevention and control knowledge in Kashgar. One hundred and seventy one questionnaires were issued and 171 were actually recovered. The response rate was 100.0%. There were 171 valid questionnaires and the effective response rate was 100.0%. Among 171 patients, 91 were males and 80 were females, and the ratio of male to female was 1.14∶1. The number of patients aged 60 and above accounted for 69.0% (118/171). Primary school was the main education level, accounting for 61.4% (105/171). Farmer was the main occupation, accounting for 84.2% (144/171). The new cases accounted for 87.1% (149/171). EpiData 3.1 software was used to input data, the quantitative data acquired through the questionnaire survey were statistically analyzed by SPSS 17.0 software, count data were analyzed by variance analysis, univariate analysis and multiple linear regression analysis were used to analyze the influencing factors. P<0.05 was considered statistically significant.Results The overall awareness rate of 171 PTB cases was 72.4% (1609/2223), and those of 8 items (1, 5-11) were higher (>80%, 138/171-166/171), and those for the rest 3 items (2-4) of the basic knowledge were lower (<60%, 86/171-101/171). In terms of correct cognition of the prevention and treatment, the total accuracy rate was only 20.8% (278/855), and the accuracy of the first item was 94.7% (162/171), while those of the remaining four items (no. 2-5) were less than 40% (2/171-66/171). Single factor analysis showed that there was a correlation between TB awareness level and patients with chronic disease (t=12.113, P<0.05) and patient type (t=4.960, P<0.05). Through multiple linear regression analysis, there was no correlation between patients’ general information (i.e., gender, age, registered permanent residence, education level, whether suffering from chronic diseases, patient type) and the behavior level on TB prevention and control (t=-1.417—-0.399, Ps>0.05), while there was a correlation between chronic disease and basic knowledge of TB control (t=3.069, P<0.05) (t=2.716, P<0.05).Conclusion The awareness of Uygur Tb patients on TB prevention and control is not high, and the right prevention and control behavior need to be developed. It is urgent to take various forms and targeted activities to strengthen TB control health education.

Review Articles

Advances in safety assessment of enhanced CT and MRI scanning in tuberculosis patients complicated with chronic kidney disease

Tao JIN

Chinese Journal of Antituberculosis. 2018, 40(3):  315-319.  doi:10.3969/j.issn.1000-6621.2018.03.019

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Patients with tuberculosis (or suspected tuberculosis) or lung cancer complicated with chronic kidney disease (CKD) are increasing. Some special adverse reactions may appear during enhanced CT or MRI scanning, which require clinicians’ attention. Contrast-induced nephropathy (CIN) is the most serious adverse reaction by iodine contrast medium that is used during enhanced CT scanning. CIN can be prevented and treated. Properly selecting appropriate contrast medium type and dosage, discontinuing nephrotoxic drugs, and receiving hydration therapy before and after examination can minimize the occurrence of CIN in CKD and other high risk patients. Nephropathy systemic fibrosis (NSF) is the most serious adverse reaction by gadolinium contrast medium that is used during enhanced MRI scanning. NSF can be prevented but is difficult to be treated. Patients with stage 4 or 5 CKD, acute kidney injury or undergoing dialysis should avoid the use of gadolinium contrast medium.

Current situation and progress of cerebrospinal fluid-based laboratory tests in patients with tuberculous meningitis

Xue-lian LI,Meng-qiu GAO

Chinese Journal of Antituberculosis. 2018, 40(3):  320-324.  doi:10.3969/j.issn.1000-6621.2018.03.020

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Tuberculous meningitis (TBM) is one of the most common extra-pulmonary tuberculosis (TB), accounting for about 1% among all types of TB cases. The death rate of TBM can reach 26.8%, while the death usually occurs in the first six months. Early diagnosis and treatment are the important factors to improve the prognosis of TBM. Clinically, the diagnosis of TBM is made based on a comprehensive analysis by evaluating the clinical features, cerebrospinal fluid (CSF) tests, cerebral imaging features and the evidences of extra-cranial TB. The results of CSF-based tests are the important diagnostic indicators for TBM diagnosis. Detection of Mycobacterium tuberculosis and its specific markers in cerebrospinal fluid is extremely helpful for TBM diagnosis.

The research progress on the application of mobile medical treatment in tuberculosis management

Rong-rong ZHAO,Su-yan CHEN

Chinese Journal of Antituberculosis. 2018, 40(3):  325-327.  doi:10.3969/j.issn.1000-6621.2018.03.021

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Tuberculosis is a chronic respiratory infectious disease which seriously endangers human health and threatens human life. It is of great significance to do a good job of education on tuberculosis knowledge and behavior intervention for the public to reduce the incidence of new tuberculosis and to reduce the spread of tuberculosis. Through the literature review, we found that mobile communication technology can break through the limitation of traditional medical services in time and space, strengthen the information communication between medical staffs and patients and reduce the patients in emergency and hospitalization, so as to reduce the overall cost of treatment, relieve the psychological pressure of patients and improve the treatment compliance of patients. Therefore, mobile medical treatment can play an important role in the clinical treatment of tuberculosis patients. The purpose of this paper is to introduce the development of mobile medical treatment and its application in tuberculosis management and health promotion, providing reference for tuberculosis prevention and control workers.

Short Articles

One stage anterior debridement, titanium mesh-bone graft and posterior internal fixation for the treatment of thoracolumbar tuberculosis

Hua MA,Lin MENG,Qing-gang ZENG,Jian-hua MA

Chinese Journal of Antituberculosis. 2018, 40(3):  328-332.  doi:10.3969/j.issn.1000-6621.2018.03.022

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From January 2006 to January 2015, 45 patients with thoracolumbar tuberculosis treated with one stage anterior debridement, titanium mesh-bone graft fusion and posterior internal fixation in the First People’s Hospital of Yidu in Hubei province were included in this analysis. Among them, 20 cases were males, and 25 were females. They aged from 23 to 72 years old, with an average age of (46.02±10.13) years. There were 20 cases with thoracic tuberculosis, 10 cases with thoracolumbar spinal tuberculosis, 8 case with lumbar vertebral tuberculosis, and 7 cases with lumbosacral tuberculosis. The operation time, intraoperative blood loss, visual analogue scale (VAS) score, Frankel grade, angle of kyphosis, and erythrocyte sedimentation rate (ESR) before and after surgery were evaluated, as well as complications and bone graft fusion status. The average operation time of the 45 patients was (230.27±15.86)min, and the intraoperative hemorrhage was (489.89±35.87)ml. The preoperative VAS score was (7.50±1.13), and it decreased to (0.89±1.67) 3months after operation. The difference was statistically significant (t=22.23, P<0.001). As to postoperative neurological improvement, of the 7 cases with Frankel grade B before surgery, 4 cases recovered to grade E and 3 cases recovered to grade D; of the 8 cases with grade C and 15 cases with grade D before operation, all recovered to grade E. Preoperative kyphosis angle was (33.93±7.01)°, while the kyphosis angle was reduced to (15.07±3.45)° 3months after the operation; the difference was statistically significant (t=16.20, P<0.001). ESR decreased from (69.75±14.62)mm/1h before surgery to (13.16±5.27)mm/1h 3months after surgery; the difference was statistically significant (t=23.81, P<0.001). The 45 patients were followed up for 24-70months. No serious complications occurred after operation, bone graft was fused in all patients, and no internal fixation loosening and fracture appeared. Hence, we concluded that the one stage anterior debridement, titanium mesh-bone graft combined with posterior internal fixation for patients thoracolumbar spinal tuberculosis can effectively correct spinal deformity, reconstruct spinal stability, and improve the cure rate of spinal tuberculosis.

The clinical features and misdiagnosis analysis of 19 cases with bronchial tuberculosis in children

Chun-mei HU,Chun-yang YIN,Xiao-yan GU,Gang FANG,Xia ZHANG

Chinese Journal of Antituberculosis. 2018, 40(3):  333-335.  doi:10.3969/j.issn.1000-6621.2018.03.023

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The chest imaging findings, lesions location, and bronchoscopy manifestations were retrospectively analyzed of 19 children with bronchial tuberculosis from January 2010 to December 2016 in Department of Tuberculosis, Nanjing Chest Hospital. All of the children were misdiagnosed before admission. The misdiagnosis was also summarized. Among the 19 cases, 10 cases showed a large high-density shadow in pulmonary on chest CT, and 9 cases showed spot patchy shadow. Performances under bronchoscope indicated 8 cases with ulcers necrosis, 6 cases with inflammation infiltration, 3 cases with scar type, and 2 cases with proliferative granulation. According to bronchoscopy for the most serious region, there were 10 cases with bronchial tuberculosis lesions located in the upper lobe, 4 cases in the basal segment of the lower, 3 cases in the dorsal segmental, and 2 cases in the left main bronchus. The main symptom of 17 cases was chronic cough, and 11 cases had complaint of chest tightness and discomfort. Due to these atypical symptoms, 19 children were misdiagnosed as bronchitis (n=7), cough allergic asthma (n=4), mycoplasma pneumonia (n=3), bronchial asthma (n=2), upper airway cough syndrome (n=2) or cough after infection (n=1) before admitted to our hospital. We conclude that the clinical characteristics of bronchial tuberculosis in children are lack of specificity, and can easily be misdiagnosed in clinical. Thus, we need to be more cautious in order to diagnose bronchial tuberculosis by timely using bronchoscopy.

Analysis of diagnosis and clinical characters of 369 suspected asymptomatic tuberculosis patients

Zong-xin FENG

Chinese Journal of Antituberculosis. 2018, 40(3):  336-339.  doi:10.3969/j.issn.1000-6621.2018.03.024

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Diagnosis and clinical characters of 369 suspected asymptomatic tuberculosis patients without any symptoms from the Fifth People’s Hospital in Puyang, Henan, between January 2011 and January 2016 were retrospectively analyzed. Of the 369 patients, 267 (72.36%) were suspected active TB, and 102 (27.64%) were suspected non-active TB; 275 were male (74.53%), 94 were female (25.47%); and mainly at the age of 13-40 years (68.83% (254/369)). The diagnosis methods were as follows: the physical examination after the entrance examination (49.32% (182/369)), the lung examination because of other diseases (20.60% (76/369)), the Staff Physical Examination (18.70% (69/369)), the Prisoners’ Physical Examination (11.38% (42/369)). According to CT scan, single small patchy, sprouts, nodular shadows and nodular, punctate calcification shadows were 55.83% (206/369), the unilateral shadow was 67.21% (248/369), the upper lung shadow was 73.98% (273/369), and the patchy and hole shadow was 7.59% (28/369). Patients with positive sputum smear acid-fast bacillus (AFB) accounted for 8.67% (32/369), smear-negative and culture-negative cases were 329 (89.16%), smear-positive and culture-positive cases were 32 (8.67%), and smear-negative and culture-positive cases were 8 (2.17%). Non-TB mycobacteria and drug-resistant bacteria were not found. Secondary TB accounted for 73.98% (273/369). There was no hematogenous disseminated pulmonary TB. The 267 patients diagnosed as suspected active TB and 26 (25.49% (26/102)) patients diagnosed as suspected non-active TB were diagnosed as active TB after a chest CT re-examination. The 293 patients were treated with normative anti-tuberculosis drugs, after 2 months, the lesions were clearly absorbed and the cavity reducton rate was 57.68% (169/293), and the conversion rate from smear-positive to smear-negative was 82.35% (28/34), the conversion rate from culture-positive to culture-negative was 77.50% (31/40); after 6 months, 47.78% (140/293) of the lesions were fully absorbed and the cavity closure rate was 100.00% (28/28), the conversion rate of smear-positive to smear-negative was 100.00% (34/34). with Asymptomatic pulmonary tuberculosis patientswere mainly diagnosed based on physical examination. The chest CT scan plays a certain part in diagnosing and judging whether the lesions changes for better or not after treatment.