Table of Content

10 April 2022, Volume 44 Issue 4

Previous Issue    Next Issue

Expert Note

Systematic tuberculosis prevention and control strategy in miners should be urgently implemented

CHENG Jun, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2022, 44(4):  310-314.  doi:10.19982/j.issn.1000-6621.20210664

Abstract ( 444 )   HTML ( 20 )   PDF (1030KB) ( 474 )   Save

References | Related Articles | Metrics

Silica-exposed workers and pneumoconiosis patients are at high risk of developing tuberculosis (TB). There is a huge population in mining industry in China, however, no specific TB prevention and control measurements for them. Authors review both TB epidemic and the current domestic and international strategies of TB prevention and control in miners and pneumoconiosis patients, and suggest that cooperation between TB prevention and control system, and occupational disease prevention and control system should be established. The relevant investigations and researches should be carried out to implement all TB prevention and control measurements in miners.

Original Articles

CT imaging of inactive tuberculous pleurisy and active tuberculous pleurisy

HE Wei, LYU Ping-xin, LYU Yan, WANG Dong-po, LI Cheng-hai, ZHOU Zhen, NING Feng-gang, LI Fang, WANG Yue, SUN Meng-yan, WANG Yi-chuan

Chinese Journal of Antituberculosis. 2022, 44(4):  315-321.  doi:10.19982/j.issn.1000-6621.20210728

Abstract ( 1274 )   HTML ( 21 )   PDF (1529KB) ( 549 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate computed tomography (CT) features of inactive and active tuberculous pleurisy. Methods: A total of 68 patients with pure inactive tuberculous pleurisy admitted to Beijing Chest Hospital affiliated to Capital Medical University from June 1, 2012 to March 30, 2021 were analyzed retrospectively, and compared with the CT findings of 44 patients with active tuberculous pleurisy during the same period. Results: (1)The CT findings of inactive tuberculous pleurisy (68 cases):pleural adhesion 62 cases (91.2%), pleural calcification was 28 cases (41.2%), interlobular fissure involvment in 22 cases (32.4%), pleural effusion 12 cases (17.6%), and encapsulated effusion 8 cases (11.8%). (2)The CT findings of active tuberculous 44 cases: pleural adhesion 30 cases (68.2%), no pleural calcification was observed, pleurisy interlobular fissure involvement 32 cases (72.7%), pleural effusion 43 cases (97.7%),and encapsulated effusion 26 cases (59.1%). (3) Comparison of CT scan images of inactive and active tuberculous pleurisy: the incidence of pleural adhesion and pleural calcification were higher, with statistical significance (χ²=9.630,P=0.002;χ²=23.737,P=0.000, respectively); the incidence of interlobar fissure involvement, pleural effusion and encapsulated pleural effusion was lower, and the differences were statistically significant (χ²=12.692,P=0.000;χ²=68.548,P=0.000;χ²=28.301,P=0.000,respectively). Conclusion: In comparison of CT scan images of inactive and active tuberculous pleurisy,the incidence of pleural adhesion and pleural calcification of inactive tuberculous pleurisy was higher but the incidence of pleural effusion, encapsulated effusion, and interlobar fissure involvement was lower. The identification of CT scan features of inactive and active tuberculous pleurisy is helpful to guide clinical treatment of patients.

Analysis of clinical manifestations and imaging features of inactive central tracheobronchial tuberculosis using microscope

GUO Yang, QIN Lin, XU Hui-fang, ZHAO Ying, WANG Wen-jie, FU Wen-xia, WANG Guo-chun, CHUAI Jun-wei, DING Wei-min, FU Yu

Chinese Journal of Antituberculosis. 2022, 44(4):  322-328.  doi:10.19982/j.issn.1000-6621.20210722

Abstract ( 608 )   HTML ( 19 )   PDF (2831KB) ( 489 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the features of inactive central tracheobronchial tuberculosis (tracheobronchial tuberculosis) using different types of microscopes. Methods: The clinical manifestations, imaging features, and bronchoscopic findings of 267 tracheobronchial tuberculosis patients admitted to Beijing Chest Hospital from January 2017 to December 2020 were retrospectively analyzed. Results: Of the 267 cases, 79 were male and 188 were female, the ratio of male to female was 1∶2.38; and the patients were mainly 20-40 years old (55.43%, 148/267). Common symptoms were dyspnea (221 cases, 82.77%), cough and sputum (166 cases, 62.17%), fever (35 cases, 13.11%), hemoptysis (15 cases, 5.62%), and non-symptoms (20 cases, 7.49%). The main involved parts of inactive tracheobronchial tuberculosis were left principal bronchus (124 cases, 46.44%), right intermediate bronchus (69 cases, 25.84%), right principal bronchus (48 cases, 17.98%), trachea (26 cases, 9.74%), the ratio of left to right was 1∶0.94 (124∶117). Among the total 267 cases, 21 were soft type (7.87%), 198 were stenotic type (74.16%), 15 were occlusion type (5.62%), 33 were frequent retraction type (12.36%); 169 complicated with atelectasis (63.30%), 116 complicated with pulmonary cavitation (43.45%), and pulmonary multiple niduses was found in 195 cases (73.03%). The coincidence rate of bronchial luminal stenosis between CT scan and bronchoscope was 98.13% (262/267). Conclusion: Inactive tracheobronchial tuberculosis is common in women, middle-aged and young people. The most common symptoms are dyspnea, cough and sputum. The coincidence rate of CT scan is high, and CT scan is an important diagnostic method before bronchoscopy.

CT features in patients with inactive and active pulmonary tuberculosis

LI Chun-hua, LIU Xue-yan, TANG Guang-xiao, SHU Wei-qiang, WANG Yao, WANG Jia-nan, ZHENG Jiao-feng, LI Yong-mei, LYU Sheng-xiu

Chinese Journal of Antituberculosis. 2022, 44(4):  329-335.  doi:10.19982/j.issn.1000-6621.20210713

Abstract ( 1230 )   HTML ( 34 )   PDF (1761KB) ( 518 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the CT features in patients with inactive pulmonary tuberculosis and active pulmonary tuberculosis. Methods: All of 181 patients with inactive pulmonary tuberculosis (inactive group) and 166 patients with active pulmonary tuberculosis (active group) diagnosed and treated in Chongqing Public Health Medical Center from August 2020 to July 2021 were retrospectively collected, and CT manifestations in the two groups were analyzed. Results: The percentages of lesions involving one lobe (19.9% (36/181)) and two lobes (25.4% (46/181)) in the inactive group were significantly higher than that in the active group (10.8% (18/166) and 13.3% (22/166), respectively)(χ²=5.392 and 8.128 respectively, and P=0.020 and 0.004, respectively). The percentage of lesions involving 5 lobes (21.5% (39/181)) was significantly lower than that in the active group (48.2% (80/166))(χ ²=27.283, P=0.000). The percentages of lesions in the right middle lobe and lower lobe as well as the left lower lobe (38.7% (70/181), 45.3% (82/181) and 46.4% (84/181), respectively) were also significantly lower than those in the active group (69.9% (116/166), 77.1% (128/166) and 68.7% (114/166))(χ ²=33.903, 36.657, 17.520; Ps=0.000). CT findings: the incidences of patchy consolidation (22.1%, 40/181), caseous lesions (0.6%, 1/181), cavity (16.6%, 30/181), pleural effusion (0.6%, 1/181), lymphadenopathy (18.8%, 34/181) and tree-in-bud signs (18.2%, 33/181) in the inactive group were significantly lower than those in the active group (80.1% (133/166), 7.2% (12/166), 27.1% (45/166), 31.9% (53/166), 53.6% (89/166), 66.9% (111/166))(χ ²=116.598, 10.703, 5.671, 64.868, 45.906 and 84.365, respectively, and P=0.000, 0.001, 0.017, 0.000, 0.000, 0.000, respectively). The incidences of bronchiectasis (61.3%, 111/181), parenchyma cavity (12.2%, 22/181), pleural calcification (10.5%, 19/181), calcified nodules (34.8%, 63/181), sclerosis (37.0%, 67/181) and fibrosclerosis (91.7%, 166/181) in the inactive group were significantly higher than those in the active group (44.0% (73/166), 4.2% (7/166), 3.6% (6/166), 16.9% (28/166), 0.6% (1/166), 27.7% (46/166))(χ ²=10.464, 7.124, 6.135, 14.403, 70.576 and 149.222 respectively, and P=0.001, 0.008, 0.013, 0.000, 0.000 and 0.000, respectively). Conclusion: The lesions of inactive pulmonary tuberculosis in the lower lobe are less distributed, and fibrosclerosis, bronchiectasis, sclerosis, calcified nodules and pleural calcification are more common signs on CT. CT scanning plays an important role in assessing the activity of pulmonary tuberculosis.

CT features of residual inactive tuberculosis lesions in cured patients of pulmonary tuberculosis

QIN Li-yi, LYU Yan, YANG Yang, JIA Jun-nan, HUO Feng-min, LI Wei-min, LYU Ping-xin

Chinese Journal of Antituberculosis. 2022, 44(4):  336-342.  doi:10.19982/j.issn.1000-6621.20210734

Abstract ( 901 )   HTML ( 14 )   PDF (1568KB) ( 323 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the distribution, CT characterization and evolution of stable inactive tuberculosis lesions in cured patients without medical intervention for a long time. Methods: A retrospective cohort study of 100 patients who met the inclusion criteria from May 2017 to July 2020 at Beijing Chest Hospital, Capital Medical University was conducted. The distribution, CT-morphological characterization, and evolutionary features of inactive intrapulmonary lesions were summarized and analyzed from two groups of follow-up data. Results: The most common signs of inactive intrapulmonary lesions in 100 cured patients were fibrous stripes (88.0%), nodules (67.0%), and patchy opacity (63.0%). 6.5 (1.0,8.3) of nodular lesions and 1.6 (1.0,2.0) of patchy lesions were detected per capita. Nodules, patchy opacity, and strips opacity with visible calcification, pleural adhesions, and poorly defined edges of fibrous stripes on the margins were 92.6% (403/435), 52.9% (54/102) and 81.0% (17/21), 72.2% (314/435), 93.1% (95/102) and 100.0% (21/21), 76.6% (333/435), 96.1% (98/102) and 100.0% (21/21), respectively. Compared with the result of pre- and post-follow-up examination, nodules, patchy opacity, and strips opacity were significantly reduced (Z=-10.289, P<0.001; Z=-3.658, P<0.001; Z=-2.312, P=0.021; Z=-7.524, P<0.001; Z=-3.334, P=0.001; Z=-2.194, P=0.028) in cross-sectional maximum diameter (6.97 (5.44, 10.47) mm and 6.72 (4.87, 9.67) mm, 18.30 (10.67, 30.46) mm and 16.00 (9.59, 30.76) mm, 42.30 (21.63, 74.90) mm and 41.75 (18.75, 73.37) mm), and lesion volume (18.03 (14.86, 77.89) mm³ and 16.10 (14.02, 55.04) mm³, 201.57 (61.02, 633.55) mm³ and 144.29 (58.68, 612.75) mm³, 3224.00 (410.50, 5265.00) mm³ and 3138.25 (302.08, 3865.50) mm³). In the contrary, the mean CT values in nodules and patchy opacity (157.01 (126.24, 236.77) HU and 211.22 (144.96, 342.05) HU, 19.79 (17.22, 45.89) HU and 31.15 (16.16, 64.08) HU) were significantly increased (Z=-10.342, P<0.001; Z=-4.094, P<0.001). Conclusion: The most common signs of inactive intrapulmonary lesions in cured patients with pulmonary tuberculosis were fibrous stripes, nodules, and patchy opacity, and most of them presented as calcification, pleural adhesions, and poorly defined edges of fibrous stripes. Two follow-up data suggested a reduction in volume and elevation in density of incomplete calcification and fibrous lesions, and this finding was significant for determining the activity of pulmonary tuberculosis lesions.

Three cases of anti-tuberculosis therapy-associated acute liver failure in tuberculosis children and literature review

LIANG Li, ZOU Li-ping, XIE Fang-hui, CHEN Qing, WU Gui-hui

Chinese Journal of Antituberculosis. 2022, 44(4):  343-348.  doi:10.19982/j.issn.1000-6621.20210639

Abstract ( 624 )   HTML ( 28 )   PDF (829KB) ( 551 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the clinical features, therapeutic measures and prognosis of anti-tuberculosis therapy-associated acute liver failure in children with tuberculosis. Methods: The clinical manifestations, examination results, therapeutic measures and prognosis of three children with anti-tuberculosis therapy-associated acute liver failure were reported. Literatures were reviewed on the published reports between January 1980 and December 2021 by searching with the key words of “acute liver failure, tuberculosis, child/children” in Wanfang, WPCS, CNKI and PubMed. Information was collected, including the patient’s age, anti-tuberculosis treatment plan, duration of taking anti-tuberculosis drug, usage of other drugs that can cause liver injury, and treatment outcome, etc. Cases of liver failure caused by tuberculosis preventive treatment were excluded. Results: Three patients were admitted to our hospital, including 1 boy and 2 girls.Tuberculosis was involved in thoracic, abdominal cavity in 3 children and involved in central nervous system in in 2 children. All the three cases had hypoproteinemia. After treatment, 2 died and 1 survived. Through literature review, the data of 6 cases were obtained. The total number of subjects was 9 cases, including three cases reported above. The age of 9 cases ranged from 0.25 to 12.80 years, and the median age (quartile) was 10.70 (5.02, 12.70) years. Four cases were treated with H-R-E-Z (H: isoniazid, R: rifampin, E: ethambutol, Z: pyrazinamide) regimen, and the other five were treated with H-R (2 cases), H-R-Z (2 cases), and H-R-E-S (S: streptomycin; 1 case). In this study, four cases survived and five died. Of the three cases aged <10 years old, two died and one who received liver transplantation survived. Conclusion: Anti-tuberculosis therapy-associated acute liver failure in children mainly occurred within 1 months after taking anti-tuberculous drugs. The younger the case, the worse the prognosis of liver failure.

Characterization of rifampin resistance determining region mutations in tuberculosis patients with GeneXpert MTB/RIF positive RNA polymerase β subunit gene mutation

SUN Qing, LIAO Xin-lei, WANG Chen-qian, JIANG Guang-lu, DONG Ling-ling, WANG Fen, ZHAO Li-ping, HUANG Hai-rong, WANG Gui-rong

Chinese Journal of Antituberculosis. 2022, 44(4):  349-353.  doi:10.19982/j.issn.1000-6621.20210635

Abstract ( 1042 )   HTML ( 29 )   PDF (821KB) ( 393 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the mutation distribution and frequency of RNA polymerase β subunit (rpoB) gene probe in tuberculosis (TB) patients with GeneXpert MTB/RIF (Xpert) positive rpoB gene mutation, and to elucidate the mutation characteristics of rifampicin resistance determining region. Methods: A total of 682 consecutive TB patients with positive Xpert test and rpoB gene mutation who visited Beijing Chest Hospital, Capital Medical University from June 2019 to June 2020 were involved, including 618 pulmonary TB (PTB) cases and 64 extrapulmonary TB (EPTB) cases. Clinical examination samples, including 465 sputum, 153 bronchoalveolar lavage fluid, 37 pus, 19 pleural effusion, 7 stool and 1 cerebrospinal fluid, were collected from patients. All Xpert positive specimens were analyzed for semi-quantitative results of Mycobacterium tuberculosis (MTB) and mutation distribution of the rpoB gene probe. Results: Of the 682 samples, 6.45% (44/682) were high, 25.07% (171/682) were medium, 25.51% (174/682) were low, and 42.96% (293/682) were very low in MTB semi-quantitative. The proportion of very low levels of MTB semi-quantitative was significantly higher in EPTB samples than in PTB samples (64.06% (41/64) vs. 40.78% (252/618), χ ²=12.83, P<0.001). Smear positive rates were 84.62% (33/39), 64.02% (105/164), 27.27% (42/154), and 7.84% (20/255) in semiquantitatively high, medium, low, and very low levels of MTB specimens, respectively. The mutation rate of the rpoB gene was 92.82% (633/682) for single probe, 6.89% (47/682) for double probe, and 0.29% (2/682) for triple probe. The mutation rate of probe E was the highest in specimens with single probe mutation (74.34%, 507/682), followed by probe D (8.80%, 60/682); the mutation rate of probe D+E was the highest in specimens with double probe mutation (4.25%, 29/682), followed by probe A+B (1.76%, 12/682); and all three probe mutations were probe A+D+E (2 cases). Conclusion: Single probe mutation is predominant in Xpert positive rpoB gene mutation MTB, and the most common mutation probes in PTB and EPTB are probe E and probe D.

Analysis of gene mutation characteristics of isoniazid-resistant Mycobacterium tuberculosis in China

TIAN Li, ZHOU Wei, HUANG Xing, WU Xian-wei, ZHANG Hui-yong, LU Zhen-hui, ZHANG Shao-yan

Chinese Journal of Antituberculosis. 2022, 44(4):  354-361.  doi:10.19982/j.issn.1000-6621.20210573

Abstract ( 1086 )   HTML ( 33 )   PDF (1074KB) ( 610 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To clarify the gene mutation characteristics of isoniazid (INH)-resistant Mycobacterium tuberculosis in China. Methods: We searched for literatures on INH-resistant gene mutations of Mycobacterium tuberculosis in China in PubMed, CNKI, Wanfang, and Weipu databases, and then conducted integrated analysis on mutation points and types of mutations, and numbers of amino acid changes reported in the literatures. Results: A total of 69 Chinese and English literatures were included with data of 6393 strains of isoniazid-resistant Mycobacterium tuberculosis within which 95.71% (6119/6393) had gene mutations or deletions. Among them, katG, inhA, and ahpC were most frequently observed mutation genes, accounting for 77.57% (4959/6393), 15.20% (972/6393), 3.69% (236/6393) of all strains respectively. Single gene single point mutations accounted for 87.80% (5613/6393), and combined mutations accounted for 12.20% (780/6393). katG315, katG463 and inhA15 mutations accounted for 56.22% (3594/6393), 10.03% (641/6393) and 10.10% (646/6393) of all strains respectively. The most common form of mutation was C→T, accounting for about 10.03% (641/6393). Conclusion: The most common mutated genes of isoniazid-resistant Mycobacterium tuberculosis were katG, inhA, ahpC, while the most mutated codons were katG315, katG463, inhA15 in China.

Study on the diagnostic efficacy of different bacteriological and pathological examination techniques for osteoarticular tuberculosis

SU Dan, CHE Nan-ying, OU Xi-chao, ZHAO Ying-li, LI Kun, CHEN Xue-jing, LIN Hai-feng, MU Jing, HUANG Hai-rong

Chinese Journal of Antituberculosis. 2022, 44(4):  362-367.  doi:10.19982/j.issn.1000-6621. 20210675

Abstract ( 622 )   HTML ( 13 )   PDF (1109KB) ( 328 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: The efficacy of bacteriological technology for pus specimens and pathological technology for tissue specimens in the diagnosis of osteoarticular tuberculosis was retrospectively analyzed. Methods: The 213 suspected osteoarticular tuberculosis patients hospitalized in Beijing Chest Hospital from January 2016 to December 2018 were selected as the research objects. Pus and tissue specimens specimens of them were submitted at the same site for test. Fresh pus specimens were tested with smear staining microscopic examination, GeneXpert MTB/RIF, FQ-PCR and BACTEC MGIT 960 liquid culture test; tissue specimens were embedded in paraffin and then subjected to acid-fast staining microscopic examination and FQ-PCR. Results: According to the composite reference standard (CRS), 186 patients were diagnosed as osteoarticular tuberculosis, of which 124 were confirmed tuberculosis cases, 23 were highly suspected tuberculosis cases, 39 were suspected tuberculosis cases, 27 patients were excluded from osteoarticular tuberculosis. Compare to CRS, the sensitivities of smear microscopy, MGIT 960 liquid culture, FQ-PCR, GeneXpert MTB/RIF for pus specimens, and acid-fast staining and FQ-PCR detection for tissue specimens were 28.7% (49/171), 49.0% (48/98), 58.1% (25/43), 87.5% (161/184), 48.6% (90/185) and 85.4% (146/171); the specificities were 100.0% (26/26), 11/11, 8/9, 96.2% (25/26), 96.3% (26/27) and 100.0% (27/27). Conclusion: GeneXpert MTB/RIF examination for pus specimens and FQ-PCR examination for tissue specimens had high sensitivity and short turn-around time, they could be used for early diagnosis of osteoarticular tuberculosis.

Analysis of the effect of strengthening tuberculosis etiological examination on hospitalized patients from respiratory department of general hospital in Longhua of Shenzhen between 2018 and 2020

WANG Yan, FANG Hong-xia, ZHENG Kai-qiao, TAN Xiao-ping, HUANG Dong-sheng, SU Lian-hui, LIU Chang-wei

Chinese Journal of Antituberculosis. 2022, 44(4):  368-374.  doi:10.19982/j.issn.1000-6621.20210682

Abstract ( 607 )   HTML ( 31 )   PDF (822KB) ( 365 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the status of discovery of pulmonary tuberculosis with positive etiology among unknown pulmonary tuberculosis and suspected patients hospitalized in the respiratory department of a general hospital in Longhua, Shenzhen from 2018 to 2020, and explore the mode of early detection of pulmonary tuberculosis among hospitalized patients in the respiratory department. Methods: From January 2018 to December 2020, a sputum retention room was set up in a general hospital in Longhua, equipped with full-time personnel for sputum retention education to collect sputum from unknown pulmonary tuberculosis and suspected patients who had suspected symptoms or other hospitalized patients with pulmonary tuberculosis could not be excluded clinically (n=342)(or collecting bronchoalveolar lavage fluid or pleural effusion by medical staff). Smear, culture and GeneXpert MTB/RIF (“GeneXpert”) test were conducted at the same time to detect the pulmonary tuberculosis patients with positive etiology, and the value of different test strategies in the detection of patients with positive etiology was analyzed. Results: Of the 342 patients, etiology was positive in 73 (21.3%). With single test method, 24 patients (32.9%, 24/73) were found positive by smears, 52 (71.2%,52/73) by culture, and 54 (74.0%, 54/73) by GeneXpert. With combination of test methods, 53 patients (72.6%, 53/73) were found positive by sputum smear+sputum culture test, 58 patients (79.5%, 58/73) were found positive by sputum smear+GeneXpert test, and 73 patients (100.0%, 73/73) were found positive by sputum culture+GeneXpert. The positive rate of pathogens was the highest in 2020 (27.7%, 38/137), followed by 2018 (20.6%, 20/97) and 2019 (13.9%, 15/108), with statistical significance (χ²=6.941, P=0.031). Conclusion: Among the inpatients in the respiratory department of general hospitals, beside those who with known pulmonary tuberculosis and those who with pulmonary tuberculosis-related images indicated by chest imaging examination, pulmonary tuberculosis patients with positive etiology still existed. It was suggested that the general hospital cooperate with local institutions with detection ability to keep sputum for examination before diagnostic treatment, so as to move forward the detection of pulmonary tuberculosis patients with positive etiology.

Establishment and prediction of autoregressive integrated moving average model of monthly reported deaths of pulmonary tuberculosis in China

ZHUANG Li, LU Zhen-hui, CEN Jun, MA Zi-feng, LI Cui, JIANG Yu-wei, ZHANG Hui-yong, ZHANG Shun-xian

Chinese Journal of Antituberculosis. 2022, 44(4):  375-380.  doi:10.19982/j.issn.1000-6621.20210574

Abstract ( 643 )   HTML ( 21 )   PDF (1108KB) ( 412 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analysis the trend of monthly reported deaths of pulmonary tuberculosis in China, to establish and determine the optimal autoregressive integrated moving average model (ARIMA). Methods: Monthly reported deaths of pulmonary tuberculosis in China (excluding Hong Kong, Macao and Taiwan) reported on Disease Surveillance from 2010 to 2020 was collected, and the total number was 21055.Date from 2010 to 2018 were used as modeling databases to form the time series and fit the ARIMA model. The actual date monthly reported in 2019 and 2020 were used as verification database to screen and evaluate the ARIMA models, then the optimal model was selected and used to predict monthly reported deaths of pulmonary tuberculosis from January 2021 to December 2021 in China. Results: The model was constructed based on the number of monthly reported deaths of pulmonary tuberculosis in China from 2010 to 2018, and three alternative models were preliminarily screened out through parameter evaluation and overall diagnosis; they were ARIMA (0,1,1) (1,1,0)₁₂ with the maximum stationary R-square (R ²=0.589), ARIMA(0,1,2) with the minimum root mean squared error (RMSE=24.572) and ARIMA (0,1,1) with the minimum value of standardized Bayesian information criterion (NBIC=6.517), respectively. The alternative model was used to predict the number of monthly reported deaths of pulmonary tuberculosis in China from 2019 to 2020. Compared with the actual data, ARIMA (0,1,1) was the optimal prediction model, and the relative errors of the predicted data in 2019 and 2020 were 6.56% (147/2241) and 58.52% (910/1555), respectively. ARIMA (0,1,1) model was used to predict the monthly reported deaths of pulmonary tuberculosis in China, the total number from January 2021 to December 2021 would be about 2542, with average of 212 cases monthly. Conclusion: ARIMA model had a good short-term prediction effect and could be used to predict the number of monthly reported deaths of pulmonary tuberculosis in China; however, it was not effective in predicting long-term or year date affected by some large factors.

Research on the equity and service capability of human resources allocation in departments of medical institutions based on diagnosis related groups

YAO Peng-tao, YANG Nan, MA Li, MA Qian-hui, XIE Na

Chinese Journal of Antituberculosis. 2022, 44(4):  381-389.  doi:10.19982/j.issn.1000-6621.20210599

Abstract ( 508 )   HTML ( 14 )   PDF (4194KB) ( 340 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the fairness and service capacity of human resources allocation among hospital departments based on diagnosis related groups (DRG). Methods: The DRG-related data such as service amount and DRG weight of the main departments (tuberculosis department, oncology department, thoracic surgery department) of Beijing Chest Hospital Affiliated to Capital Medical University from 2017 to 2019 were collected from “Hospital Inpatient Medical Records” and “Beijing Regional Inpatient Medical Service Performance Evaluation Platform”. A retrospective study method was used to evaluate the fairness and service capacity of inter-departmental physician human resource allocation by using indicators such as health resources agglomeration degree (≥1 indicates that the fairness of health human resources is relatively high and human resources are relatively sufficient), concentration index (“positive value” indicates physician manpower DRG indicators such as resources are distributed in departments with high service amount), carrying capacity coefficient (>1 means that medical institutions are overloaded and have strong service capabilities). Results: From 2017 to 2019, the inpatient service amount of tuberculosis department, oncology department and thoracic surgery department were 12505, 16831 and 12137, respectively, and the total weights were 14690.60, 13904.75 and 14638.01, respectively. The number of physician person-month were 1039.5, 1219.8, and 892.0, respectively. According to the service amount, the concentration of human resources of tuberculosis physicians was >1; from the perspective of DRG weight, the concentration of human resources of oncologists was >1. The concentration index of the three types of departments was less than 0 from the analysis of two dimensions. The number of hospitalizations per capita in the tuberculosis department was 144.36 cases, which was slightly lower than that in the oncology department (165.58 cases), thoracic surgery department (163.28 cases). The per capita DRG weight of oncology department was the lowest (136.79), followed by tuberculosis department (169.59), and thoracic surgery department was the highest (196.92). Conclusion: The results of human resource allocation analysis based on the two dimensions of inpatient service amount and DRG weight were significantly different, and the DRG weight of patients admitted by the department was significantly affected. According to the DRG payment principle, the efficiency of human resource allocation in departments with less patient weight could be improved by improving patient turnover efficiency and controlling unreasonable expenses.

Analysis of economic burden of pulmonary tuberculosis patients in four districts and counties of Chongqing

WU Bo, LIU Ying, LIAO Wen-pin, ZHENG Yi, QIN Bo, YANG Jing, XIE Hui-man, YU Ya

Chinese Journal of Antituberculosis. 2022, 44(4):  390-396.  doi:10.19982/j.issn.1000-6621.20210633

Abstract ( 573 )   HTML ( 32 )   PDF (836KB) ( 389 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the economic burden of pulmonary tuberculosis patients in less developed districts and counties of Chongqing, and to provide data support for optimizing the medical insurance policy for tuberculosis patients. Methods: A cross-sectional study was conducted in 326 active pulmonary tuberculosis patients registered in Qianjiang district, Fengdu county, Kaizhou district and Wushan county of Chongqing from June 2019 to June 2020. The expenses and personal burden of patients due to illness were analyzed through questionnaire survey and diagnosis and treatment information and medical expenses collected from hospital information system. Results: Of the 326 cases, the average course of treatment was 180.0 (178.0,210.0) days, the direct medical cost before and after diagnosis were RMB 1600.0 (920.0,3500.0) yuan and RMB 2479.0 (1218.9,5709.6) yuan, respectively. Direct non-medical expenses after illness were RMB 1300.0 (400.0,3000.0) yuan, the indirect lost because of tuberculosis treatment was RMB 3850.0 (500.0,15000.0) yuan, and the total medical cost was RMB 14156.8 (6904.7,28133.9) yuan; 80.98% (264/326) of patients had family catastrophic expenditure for the treatment of pulmonary tuberculosis. Conclusion: The economic burden of tuberculosis patients in less developed areas of Chongqing is heavy. The current medical insurance reimbursement policy can not completely alleviate the economic burden of patients. The reimbursement policy for tuberculosis medical insurance in Chongqing should be further improved, and the disastrous expenses should be reduced.

A survey on TB screening among four high-risk groups in general medical institutions in Tianjin City

GAO Li, PANG Xue-wen, WAN Ying, YANG Guang-wei, LI Dan, ZHANG Wen-qian, CHEN Sheng-yu

Chinese Journal of Antituberculosis. 2022, 44(4):  397-402.  doi:10.19982/j.issn.1000-6621.20220018

Abstract ( 634 )   HTML ( 14 )   PDF (826KB) ( 293 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the current status of tuberculosis screening in inpatients with unilateral pleural effusion, hemoptysis and inpatients prescribed with immunosuppressant or long-term glucocorticoid in general medical institutions of Tianjin City. Methods: Convenient sampling was used to select 31 general medical institutions with large number of TB cases in Tianjin City as study sites, then 10 inpatients’ medical records were selected from designated department of each medical institution, a total of 1240 patients were included and finally records of 419 patients meeting definition of the 4 high-risk groups were extracted as research objects, including 164, 97, 86 and 72 patients for each of the unilateral pleural effusion group, hemoptysis group, immunosuppressant group and long-term glucocorticoid group. Results: The 31 general medical institutions were mainly tertiary hospitals, accounting for 80.6% (25/31).46.1% (193/419) of the 4 high-risk groups completed examination for TB diagnosis. 57.3% (94/164), 52.6% (51/97), 29.1% (25/86), 31.9% (23/72) of inpatients completed the examination for each of the unilateral pleural effusion group, hemoptysis group, immunosuppressant group and long-term glucocorticoid group.The proportions of patients taking smear, culture, GeneXpert, TST, IGRA and tuberculosis antibody examination were 64.8% (125/193), 16.6% (32/193), 10.9% (21/193), 8.3% (16/193), 18.1% (35/193) and 34.2% (66/193), respectively. The proportion of IGRA examination was 21.1% (35/66) in tertiary general medical institutions, higher than 0.0% (0/27) in secondary general medical institutions with statistically significant difference (χ²=6.954, P=0.005), while the proportion of tuberculosis antibody examination was 31.3% (52/166) in tertiary institutions, lower than that of secondary institutions(51.9%, 14/27), the difference was statistically significant (χ ²=4.348, P=0.049) too. Conclusion: In Tianjin City, the proportion of high-risk population undergoing tuberculosis examinations in general medical institutions was quite low which should be further improved.

Analysis of drug resistance among tuberculosis patients in Hebei Province in 2020

XIE Bing-jie, JIN Fei, ZHANG Jun-li, XU Hua, CHEN Hai-feng, ZHANG Hui-min

Chinese Journal of Antituberculosis. 2022, 44(4):  403-408.  doi:10.19982/j.issn.1000-6621.20210638

Abstract ( 684 )   HTML ( 43 )   PDF (868KB) ( 346 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To understand the epidemic situation and trend of multi-drug resistant tuberculosis (MDR-TB) in Hebei Province,providing scientific evidence for formulating suitable strategies for MDR-TB prevention and control for the province. Methods: A total of 14 surveillance counties (districts) in Hebei province were selected as drug resistance surveillance sites by simple random sampling.A total of 424 culture positive TB patients were selected from those surveillance sites in 2020. Isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), ofloxacin (Ofx), capreomycin (Cm), prothioisinamide (Pto),and sodium P-aminosalicylate (PAS) were tested for drug resistance with the proportional drug susceptibility test. Results: (1) Overall drug resistance: rate of resistance to INH was the highest in newly treated patients (9.19% (35/381)), rate of resistance to RFP was the highest in re-treated patients (13.95% (6/43)). Overall INH resistance rate was (9.43% (40/424)).(2) Monoresistance: the rate of monoresistance to RFP was the highest in newly treated patients, re-treated patients and all patients (1.84% (7/381), 6.98% (3/43), 2.36% (10/424), respectively). (3) Polydrug resistance: the INH+Sm resistance rate was the highest in newly treated patients (0.79% (3/381)), INH+Sm and INH+EMB+Sm resistance rate were the highest in retreated patients (both were 2.33% (1/43)), and INH+Sm resistance rate was the highest among all patients (0.94% (4/424)). (4) Multidrug resistance:INH+RFP and INH+RFP+Km+Ofx resistance rate were the highest in newly treated patients (both were 1.31% (5/381)), and INH+RFP+EMB resistance rate was the highest in retreated patients (4.65% (2/43)). The INH+RFP and INH+RFP+Km+Ofx resistance rates were the highest (both were 1.18% (5/424)) among all patients.The overall drug resistance rate was 34.20% (145/424), 33.07% (126/381) in newly treated patients and 44.19% (19/43) in retreated patients.The overall rate of multidrug resistance was 5.42% (23/424), 5.25% (20/381) in newly treated patients and 6.98% (3/43) in retreated patients. Conclusion: The situation of tuberculosis resistance in Hebei is serious in 2020.We should pay more attention on standardized use of first-line and second-line drugs, especially for Km and Ofx, to reduce drug resistance rate.

Review Articles

Value of PET-CT in the evaluation of pulmonary tuberculosis activity

LI Duo, LYU Ping-xin

Chinese Journal of Antituberculosis. 2022, 44(4):  409-411.  doi:10.19982/j.issn.1000-6621.20210712

Abstract ( 513 )   HTML ( 14 )   PDF (790KB) ( 362 )   Save

References | Related Articles | Metrics

Imaging plays an important role in the evaluation of tuberculosis activity. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET-CT provides both metabolic and morphology information of tuberculosis. ¹⁸F-FDG-PET-CT can indicate the degree of glucose metabolism of cells, which could be used to comprehensively evaluate the activity of tuberculosis combined with morphological features. ¹⁸F-FDG-PET-CT may identify subclinical pulmonary tuberculosis in patients with latent tuberculosis infection. Patients with obsolete pulmonary tuberculosis without ¹⁸F-FDG uptake have low risk of recurrence. ¹⁸F-FDG-PET-CT can early evaluate the effect of anti-tuberculosis treatment, the decrease of standard uptake value (SUV) indicates effective treatment, and no ¹⁸F-FDG uptake may indicate that the Mycobacterium tuberculosis have been killed because of the treatment. ¹⁸F-FDG PET-CT may be used as an examination method to evaluate the efficacy of new anti-tuberculosis drugs and determine the endpoint of treatment time. This paper reviews the application and value of ¹⁸F-FDG PET-CT in identifying latent tuberculosis infection and evaluating the efficacy and prognosis of anti-tuberculous therapy in tuberculosis patients.