Table of Content

10 May 2022, Volume 44 Issue 5

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Standard·Guide·Consensus

Expert consensus on nutritional assessment and nutritional support treatment for patients with severe tuberculosis

CHEN Zhi, LIANG Jian-qin

Chinese Journal of Antituberculosis. 2022, 44(5):  421-432.  doi:10.19982/j.issn.1000-6621.20220041

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There is a two-way relationship between tuberculosis and nutritional status, they are related to each other. Tuberculosis can lead to the occurrence of nutritional risk, and is easy to develop nutritional related diseases, such as lack of nutrition, low immune function, electrolyte imbalance and so on. And poor nutritional status can lead to lymphocytic reduction, low cellular immunity and susceptibility to tuberculosis and other infectious diseases. Malnutrition is an independent risk factor affecting the prognosis and mortality of adult patients with severe tuberculosis. However, the relevant guidance documents on nutritional assessment and nutritional support treatment for patients with severe tuberculosis is still lacking. Therefore, combined with the experience and methods of nutritional support therapy in China and the latest guidelines for enteral and parenteral nutrition in the United States and Europe, the Eighth Medical Center of Chinese PLA General Hospital and the Editorial Board of Chinese Journal of Antituberculosis jointly organized experts to draw up Expert consensus on nutrition assessment and nutritional support treatment for patients with severe tuberculosis, in order to get standardized individual nutritional assessment and nutritional support treatment for patients with severe tuberculosis, and improve the prognosis and reduce mortality. This consensus expounds the importance of nutritional assessment and nutritional support treatment for patients with severe tuberculosis, the types of commonly used nutritional agents, and gives recommendations on the principles and standards of nutritional assessment and nutritional support treatment, the types and ways of giving nutrition, the types of severe tuberculosis, the complications and the nutritional support for special populations.

Expert Note

Novel patient-oriented care to advance tuberculosis control program

LIU Er-yong, CHEN Ming-ting, ZHOU Lin, MENG Qing-lin, WANG Jing

Chinese Journal of Antituberculosis. 2022, 44(5):  433-437.  doi:10.19982/j.issn.1000-6621.20220022

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To achieve the goal of Ending tuberculosis needs to enhance the comprehensive quality of tuberculosis service, and patient care action is the key. In order to have a more comprehensive understanding of the “patient centered” tuberculosis patients’ medical service mode and enhance the level and quality of tuberculosis prevention and control service in China, this article systematically explained the meaning, progress and specific measures and significance of tuberculosis patients’ care. In order to achieve the goal of Ending tuberculosis, it is imperative to carry out the comprehensive care of tuberculosis based on the experience of past tuberculosis control.

Interpretation of Standards

Interpretation of the Procedure of tuberculin skin test-interferon-gamma release assay two-step testing

HE Yi-jun, CAO Xue-fang, GAO Lei

Chinese Journal of Antituberculosis. 2022, 44(5):  438-441.  doi:10.19982/j.issn.1000-6621.20210731

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Procedure of tuberculin skin test-interferon-gamma release assay two-step testing (T/CHATA 016-2021) is a social organization standard issued by Chinese Antituberculosis Association on July 9th, 2021. This document clarifies the related term and definitions, target populations, operation process, interpretation and disposal suggestions of detection of Mycobacterium tuberculosis (MTB) infection by tuberculin skin test-interferon-gamma release assay (TST-IGRA) two-step testing. It is applicable to disease prevention and control institutions at all levels, designated medical institutions for tuberculosis, primary medical institutions, comprehensive medical institutions and other relevant institutions in China. As a supplement to the technical specification of MTB infection detection, this article provided a detailed interpretation of the main content and precautions in the implementation, so that the TST-IGRA two-step method could be better applied to the practice of MTB infection detection by medical staff.

Original Articles

Plasma proteomics analysis of diabetic patients complicated with pulmonary tuberculosis by iTRAQ technology

WU Ming-qi, YAN Shi-chun, LIU Yu-qin, GUO Xin, WANG Mei-jie, TIAN Jing, HOU Shao-ying

Chinese Journal of Antituberculosis. 2022, 44(5):  442-449.  doi:10.19982/j.issn.1000-6621.20210659

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Objective: To analyze the difference in plasma protein mass spectrum between diabetic (DM) patients and diabetic patients complicated with pulmonary tuberculosis (DM-PTB), screen potential protein biomarkers of DM-PTB, and to provide basis for further pathogenesis exploration. Methods: A retrospective study was conducted in 16 DM and 16 DM-PTB patients from Infectious Disease Hospital of Heilongjiang Province between January 1, 2017and January 1, 2018. The plasma protein mass spectra between the two groups were analyzed by isobaric tags for relative and absolute quantitation (iTRAQ) proteomics technology. The differential proteins were screened according to the following criteria: fold of protein expression change in DM-PTB compared to DM>1.2 or <0.83, and P<0.05. The differential proteins were analyzed by bioinformatics, such as Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and so on. Results: A total of 275 differentially expressed proteins were selected out, among which 111 were up-regulated and 164 were down-regulated in DM-PTB. GO analysis showed that the biological process with the largest number of differentially expressed proteins was cellular process (92.00%, 253/275), located in organelle (87.27%, 240/275) and the molecular function was binding (90.55%, 249/275). KEGG pathway analysis showed that the differentially expressed proteins were enriched into 26 pathways (false discovery rate <0.05) and focal adhesion was the pathway with the largest number of enrichment (22 proteins). Moreover, changes were also found in PI3K-Akt signaling pathway, cholesterol metabolism, platelet activation, phagosome, complement and coagulation pathways, et al., which related to glucose and lipid metabolism and immunity. Conclusion: In this study, differentially expressed proteins of DM-PTB patients were screened by iTRAQ quantitative proteomics, and they were involved in signaling pathways related to cellular activity, glucose and lipid metabolism, and immune regulation, suggesting that the changes of pathways mentioned above may be closely related to the pathogenesis of DM-PTB.

Study on efficiency of Mycobacterium tuberculosis detection by real-time quantitative PCR with different clinical sample types and the improvement by grinding specimen with glass beads

DAI Guang-ming, WANG fen, CAO Ting-ming, CHU Hong-qian, HUANG Hai-rong, SUN Zhao-gang

Chinese Journal of Antituberculosis. 2022, 44(5):  450-454.  doi:10.19982/j.issn.1000-6621.20210584

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Objective: To explore a method with improved efficiency for quantitatively detecting Mycobacterium tuberculosis (MTB) in different type of clinical samples by combining glass beads grinding with real-time quantitative PCR (qRT-PCR). Methods: A retrospective study was performed in Beijing Chest Hospital. Data of qRT-PCR examination performed between Jan. 1st, 2008 and Dec. 31th 2016 were retrieved. The outcomes of 11570 clinical specimens collected from tuberculosis suspects of inpatients and outpatients were acquired, including 1487 sputa, 273 purulent specimens, 1391 cerebrospinal fluids (CSF), 41 bronchoalveolar lavage fluids (BALF), and 4650 blood samples. Furthermore, 82 specimens collected from pulmonary tuberculosis patients were chosen by pseudorandom function, the quantitative outcomes were compared between the procedures with or without grinding with glass beads (diameter 0.3 mm). Results: The overall positive rate of the different clinical specimen types was 12.16% (1407/11570). Among them, BALF acquired the highest positive rate (36.59% (15/41)), and the outpatients had higher positive rate (43.48% (10/23)). The second highest positive rate was among purulent specimens (35.53%(97/273)), of which the inpatients yielded higher positive rate (36.26% (95/262)). The positive rate of sputa ranked the third (30.33% (451/1487)). The positive rate of the other leftover samples ranged over 10.43% (485/4650)-15.03% (209/1391). In contrast to the method without grinding, the nucleic acid quantity of the specimen grinded by class beads increased evidently (44.45 (9.05,71.62)×10⁷ copy/ml vs. 4.03 (1.87,5.92)×10⁷ copy/ml; Z=2.120, P=0.016). Additionally, 28 (34.15%) samples produced one order of magnitude increase outcomes, 66.67% (14/21) samples from 10² copy/ml to 10³ copy/ml by using glass bead grinding. Hence, the positive rate of the selected 82 specimens increased from 60.98% (50/82) to 78.05% (64/82). Conclusion: qRT-PCR had higher detection rates in BALF, pus and sputa than other sample types. Grinding specimen by glass bead could improve the positive detection rate.

Preliminary study on serum pharmacochemistry of Niubeixiaohe extract

DUAN Li-yao, LING Yan-bo, LIANG Yan, SHI Ying-chang, WANG Lan, ZHAO Guan-ren, LIU Jun, ZHENG Yue, WU Xue-qiong

Chinese Journal of Antituberculosis. 2022, 44(5):  455-459.  doi:10.19982/j.issn.1000-6621.20210710

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Objective: Preliminary research on serum pharmacochemistry was carried out on the extract of anti-tuberculosis Chinese medicine Niubeixiaohe, and the material basis of Niubeixiaohe’s efficacy was discussed by analyzing the blood components. Methods: From April 2018 to June 2019, the standard solutions of Radix Platycodonis, Rhizoma Bletillae,Herba Houttuyniae, Fructus Arctii and the sample of Niubeixiaohe were prepared at the Tuberculosis Research Institute, the Eighth Medical Center of Chinese PLA General Hospital. 55 mice were randomly divided into 11 groups with 5 mice each group: Group 1 to 5 named Niubeixiaohe extract group were given Niubeixiaohe extract 1.25 mg·g^-1·d^-1; Group 6 to 10 named arctiin group were given arctiin 0.3 mg·g^-1·d^-1; Group 11 was the blank control group, which was given distilled water. The mice were gavaged continuously for 7 days. Blood was collected from the retroorbital venous plexus of mice at 0.5, 1, 2, 4, and 6 hours after the last administration to prepare the serum solution. The retention time of each substance in the chromatogram of the standard of traditional Chinese medicine, Niubeixiaohe extract and the serum sample solution of mice in each group after administration was analyzed by HPLC. The constituents absorbed into the blood of Niubeixiaohe extract were preliminarily identified with the reference substance. Results: The overlapping chromatograms of Niubeixiaohe extract and each medicinal standard showed that the substance corresponding to the chromatographic peak at the retention time of 7.1 min was derived from Radix Platycodonis, and the substance corresponding to the chromatographic peak at the retention time of 13.5 min, 15.5 min and 21.2 min was derived from Rhizoma Bletillae, and the substance corresponding to the chromatographic peak at the retention time of 16.3 min was derived from Fructus Arctii, which was further identified as arctiin compound. Compared with the blank control serum, the serum samples after the administration of Niubeixiaohe extract and arctiin was found the absorption peaks in 17.5-22.5 min. Conclusion: HPLC can be used as a quality control method for the extraction of Radix Platycodonis, Rhizoma Bletillae, Herba Houttuyniae, and Fructus Arctii in Niubeixiaohe. The detected constituents absorbed into the blood of Niubeixiaohe extract may be arctiin metabolites, and the trace amount of other pharmacodynamic components into the blood was not detected.

The impact of active case-finding on tuberculosis epidemic in four prefectures of Southern Xinjiang

WANG Ming-zhe, LIU Nian-qiang, Kaideliyan Abuduwaili, WANG Xin-qi, HUANG Fei

Chinese Journal of Antituberculosis. 2022, 44(5):  460-466.  doi:10.19982/j.issn.1000-6621.20210725

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Objective: To know the impact of active case-finding (ACF) on tuberculosis epidemic in Southern Xinjiang (Aksu Prefecture, Hotan Prefecture, Kashgar Prefecture and Kizilsu Kirghiz Autonomous Prefecture). Methods: By using the reported tuberculosis cases in the National Infectious Disease Reporting and Management System between 2016 and 2020, we analyzed the tuberculosis reported incidences of different age groups, sex, and proportion of case occupations, compared data of ACF period (2018-2019) and pre-ACF period (2016-2017). In addition, 77 tuberculosis prevention health care worker were surveyed to get their attitudes and suggestions about ACF and the impact of COVID-19 response on tuberculosis control by self-designed questionnaire. A total of 77 questionnaires were sent out and 77 were retrieved (100% valid). Results: The average annual incidence in Southern Xinjiang increased from 389.47/100000 (73898/18974100) in pre-ACF period to 489.64/100000 (96341/19675800) during the ACF period, the difference was statistically significant (χ²=2210.320,P<0.05). In terms of gender and age distribution, the incidence rate of male was 531.17/100000 (52304/9847000) during ACF period, which was 36.07% higher than that of the pre-ACF period (390.36/100000,37503/9607400). The incidence of female was 448.04/100000 (44037/9828800) during ACF period, which was 15.31% higher than that of the pre-ACF period (388.56/100000, 36395/9366700). The incidence rates of 15-24, 25-34, and 35-44 age groups increased by 66.30%, 50.37%, and 49.18%, respectively during ACF period. In terms of occupational distribution, the proportion of farmers, houseworkers/unemployed, and students changed from 86.14% (63646/73898), 4.83% (3571/73898), 1.17% (866/73898) to 87.40% (84201/96341), 5.40% (5202/96341), 1.68% (1623/96341) respectively. 89.61% (69/77) of respondents thought ACF can help reduce tuberculosis epidemic quickly,93.51% (72/77) of respondents thought COVID-19 responses have impacts on tuberculosis epidemic. Conclusion: ACF has detected more tuberculosis patients in southern Xinjiang, reduced the transmission of tuberculosis, and could contribute to the rapid decline of the local tuberculosis epidemic.

Study on active screening of pulmonary tuberculosis among key population in key areas of Xinmi, He’nan

JIN Xiao-wei, LI Ya-ru, DUAN Hai-xia, WEI Xiao-hui, PEI Yi-yi, LI Ying, JIN Hong-jian

Chinese Journal of Antituberculosis. 2022, 44(5):  467-472.  doi:10.19982/j.issn.1000-6621.20220027

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Objective: To evaluate the effect of active detection of pulmonary tuberculosis in key population. Methods: In 32 key administrative villages in Xinmi, He’nan, residents over 14 years old were screened for suspicious symptoms of pulmonary tuberculosis. In order to screen out pulmonary tuberculosis patients in key populations, chest digital radiography (DR) was performed on 7 key groups such as those who with suspected symptoms of pulmonary tuberculosis, diabetes patients being treated, residents over 65 years old, people with dust exposure history of more than 3 years, mental patients, residents with pulmonary tuberculosis patients in their families in recent 10 years, and migrant workers, and people who with suspicious symptoms or abnormal chest imaging were examined by sputum smear, Mycobacterium tuberculosis culture and GeneXpert MTB/RIF (Xpert) in the Municipal Tuberculosis Prevention and Control Institute. Results: A total of 7368 people in 7 categories were registered from 32 administrative villages. Among them, 7265 (98.60%) were investigated by questionnaire, 2750 (37.85%) had suspicious symptoms of pulmonary tuberculosis, 7111 (96.51%) had DR images, 456 (6.41%) had abnormalities in their lungs, 5 (0.07%) were diagnosed as pulmonary tuberculosis, 8 (0.11%) were with lung cancer, and old pulmonary tuberculosis (including old tuberculous pleurisy was found in 152 people (2.14%). The proportions of dust exposure history, aged over 65 years, tuberculosis exposure, migrant workers, pulmonary tuberculosis symptoms, diabetes and mental disease were 8.71% (75/861), 8.42% (330/3919), 7.59% (12/158), 4.23% (19/449), 3.57% (47/1315), 3.24% (28/863), 1.64% (1/61), respectively, the difference was statistically significant (χ²=68.111, P<0.001). Of the 5 detected active pulmonary tuberculosis patients, 3 were positive in Xpert. The total detection rate of active pulmonary tuberculosis was 70.31/100000 (5/7111), the highest detection rate was found in those who with dust exposure history (116.14/100000, 1/861), and the detection rates of people who aged over 65 years and those with pulmonary tuberculosis symptoms were 76.55/100000 (3/3919) and 76.05/100000 (1/1315), the difference was statistically significant (χ²=36.131, P<0.001). Conclusion: Active screening of pulmonary tuberculosis among key population is an important supplement to detect patients in referral and symptomatic visits, and therefore to improve the detection rate of tuberculosis patients.

Survey on the community treatment and management of pulmonary tuberculosis patients

HU Yuan-lian, DENG Ling, AI Ping, JIA Xue-jiao, CHEN Wei, ZHANG Dong-yan, XUE Xiao, WU Qian-yu, XIE Jun-qing

Chinese Journal of Antituberculosis. 2022, 44(5):  473-477.  doi:10.19982/j.issn.1000-6621.20210637

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Objective: To survey the status of community treatment and management of pulmonary tuberculosis patients, to provide scientific basis for further improving the regular medication rate and getting better treatment outcome. Methods: A retrospective study was conducted in 228 pulmonary tuberculosis patients registered and managed in four designated hospitals from July 1, 2017 to June 30, 2018 and followed up by 25 community health service institutions in Fengtai District, Beijing. The time of start and stop supervision by the community health service institutions, the time of start and stop treatment for patients recorded by designated hospitals, and the subsequent revisit, interruption and adverse drug response recorded by community health service institutions and designated hospitals were collected. The consistency of the above information between the community follow-up record of the community health service institutions and the medical records of the designated hospitals was analyzed. Results: All patients were followed up by the community health service institutions within 3 working days of being notified. The patients were followed up by telephone, and all the supervisors were family members. Of them, 203 cases (89.0%) were successfully treated (60 cases were cured and 143 cases finished the course of treatment). The subsequent revisit rates at the first month and 3-6 months recorded by community health service institutions were 100.0% (228/228), 99.5% (221/222), 99.1% (215/217), 99.1% (209/211) and 100.0% (209/209), respectively and were 96.9% (221/228), 96.4% (214/222), 94.9% (205/216), 95.2% (198/208) and 95.7% (198/207) recorded in the designated hospitals, the differences were statistically significant (Fisher exact probability test, P=0.016, 0.036, 0.004, 0.004 and 0.004, respectively). Nine cases (3.5%) were recorded of drug interruption in community health service institutions and 20 cases (8.3%) were recorded in designated hospitals. The difference was statistically significant (Fisher exact probability test, P=0.014). There were 41 cases (18.0%) recorded of adverse drug response in community health service institutions and 68 (29.8%) cases were recorded in designated hospitals, the difference was statistically significant (χ²=10.400, P=0.001). Of the patients, 70.2% (160/228) received the supervision from the community health service institutions within 5 days after the start of treatment in hospitals, and 76.8% (175/228) of the patients received the supervision service from the community health service institutions within 5 days after the stop of treatment in the designated hospital. Conclusion: The information of subsequent revisit, drug interruption and adverse drug reactions recorded of tuberculosis patients by community health service institutions and designated hospitals were inconsistent. It is necessary to strengthen the informatization and two-way transmission of pulmonary tuberculosis patients’ treatment and supervision management data, as well as the quality control of information input in tuberculosis specialized hospitals and designated hospitals, and patients’ follow-up in community health service institutions.

Spatial-temporal analysis of tuberculosis among students in Hu’nan Province, during 2011—2020

GONG De-hua, TANG Yi, TAN Wen-qian, WANG Qiao-zhi

Chinese Journal of Antituberculosis. 2022, 44(5):  478-483.  doi:10.19982/j.issn.1000-6621.20210700

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Objective: To analyze the spatial clustering characteristics of tuberculosis among students in Hu’nan Province from 2011 to 2020, and to provide a reference for the prevention and control of tuberculosis in schools. Methods: Medical record data of student tuberculosis patients registered from January 1, 2011 to December 31, 2020 was download from the “Tuberculosis Management Information System” which was an subsystem of the “Chinese Disease Prevention and Control Information System”. There were 17397 cases of student tuberculosis patients, and the student population data during the same period was obtained from the “Hu’nan Statistical Yearbook”. ArcGIS 10.7 was used for global and local spatial autocorrelation analysis, and SaTScan 9.5 was used for spatiotemporal aggregation analysis, and results were visualized with ArcGIS 10.7. Results: From 2011 to 2020, the registered incidence rate of tuberculosis among students in Hu’nan Province showed a downward-up-down trend. The average annual registered incidence rate was 14.04/100000 (17397/123882600). From 2011 to 2020, the registered incidence rate were 13.67/100000 (1581/11561800), 12.00/100000 (1375/11454400), and 11.92/100000 (1374/11525900), 10.74/100000 (1269/11813300), 10.16/100000 (1238/12181200), 9.22/100000 (1154/12512600), 12.23/100000 (1566/12808700), 21.97/100000 (2864/13037100), 18.97/100000 (2532/13344,800), 17.91/100000 (2444/13642800) respectively. From 2011 to 2020, the results of the global autocorrelation analysis of the registration incidence of tuberculosis among students in Hu’nan Province showed that there was spatial clustering for total (Moran I=0.316, P<0.05), and spatial clustering in 2013 (Moran I=0.379, P=0.045),2015 (Moran I=0.353,P=0.041),2019 (Moran I=0.472, P=0.007) and 2020 (Moran I=0.434, P=0.014). The results of the local spatial autocorrelation analysis showed three aggregation modes (high-high, low-low, low-high), and the high-value clustering area (high-high clustering) mainly concentrated in Zhangjiajie City. The results of spatio-temporal scanning proved spatio-temporal clustering existed with 2 spatio-temporal clustering areas. The first-level clustering area was the northwestern region of Hu’nan Province, including Zhangjiajie, Xiangxi and Changde City. The clustering time was during 2017—2020, LLR=622.22, RR=2.53, P<0.001. The secondary clustering area included 5 cities, namely Chenzhou, Hengyang, Yongzhou, Shaoyang and Zhuzhou. Conclusion: From 2011 to 2020, the registered incidence of tuberculosis among students was clustered in time and space at the city or state level. The “high-high” clustering area was mainly in the northwest of Hu’nan Province, with Zhangjiajie City as the center, and radiating to the surrounding cities (Xiangxi and Changde).

Epidemiological characteristics of MTB/HIV double infection in Changsha from 2011 to 2020

XIONG Zi, XIE Ci-fu, SONG Li-xin, WANG Xiao-jun, TIAN Bin, HUANG Zhu-lin, XU Zu-hui, ZHANG Xi-xing, BAI Li-qiong

Chinese Journal of Antituberculosis. 2022, 44(5):  484-488.  doi:10.19982/j.issn.1000-6621.20220040

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Objective: To analyze the epidemic characteristics of MTB/HIV double infection in Changsha, and to improve the prevention and control strategies. Methods: The data of MTB/HIV dual infection patients in Changsha from 2011 to 2020 were extracted from Tuberculosis Information Management System and TB/HIV Dual Infection Prevention and Management Annual Report, to establish a comprehensive database of MTB/HIV characteristics and distribution in Changsha. The detection of MTB/HIV dual infection, description of the annual change trend and the epidemic distribution characteristics in different time, gender, age and region were analyzed. Results: From 2011 to 2020, a total of 280 MTB/HIV double infection cases were found in Changsha, the patient detection rate fluctuated with the year (4.29% (12/280)-15.36% (43/280)). Among them, HIV infection were detected in 39 tuberculosis patients, with an annual detection rate of 0.10% (39/38990). The HIV positive rate showed an increasing trend of fluctuation in different years (0.03% (1/3759)-0.22% (9/4057))(Z=2.347, P=0.019). Among HIV/AIDS patients, MTB infection were detected in 241 cases, and the average annual detection rate was 0.68% (241/35381). The detection rate of tuberculosis showed a decreasing trend with fluctuation in different years (0.41% (19/4639)-2.13% (13/610))(Z=-6.126,P=0.001). The 280 MTB/HIV dual infected patients were mainly male (85.71% (240/280)); and the age was mainly at 25-44 years (46.78% (131/280)), followed by 45-64 years old (32.50% (91/280)). As to regional distribution, Liuyang City had the most cases (26.07% (73/280)), followed by Changsha County and Ningxiang City (both 16.43% (46/280)). Conclusion: The level of MTB/HIV double infection in Changsha was low, but the average annual detection rate of HIV infection among tuberculosis patients showed a fluctuating upward trend. The detection rate of MTB infection in HIV/AIDS screening showed a fluctuating downward trend. The prevention and control should be focused on male and 25-44 years age group, as well as people in areas with high prevalence of AIDS and tuberculosis.

Comparative study on results of T-cell spot test for tuberculosis infection of peripheral blood and pleural effusion in tuberculous pleurisy patients complicated with type 2 diabetes mellitus

LIU Yuan, JU Meng, ZUO Lei, ZHANG Yao-hui, HUANG Yi

Chinese Journal of Antituberculosis. 2022, 44(5):  489-493.  doi:10.19982/j.issn.1000-6621.20210642

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Objective: To investigate the effect of type 2 diabetes mellitus on the results of T-cell spot test for tuberculosis infection (T-SPOT.TB) of the peripheral blood and pleural effusion in patients with tuberculous pleurisy. Methods: According to whether complicated with type 2 diabetes mellitus, 444 tuberculous pleurisy patients from Xi’an Chest Hospital between 2016 and 2021 were divided into tuberculous pleurisy complicated with type 2 diabetes mellitus group (n=116) and tuberculous pleurisy without type 2 diabetes mellitus group (n=328). The pleural effusion and peripheral blood specimens of the two groups before medical treatment were collected for T-SPOT.TB, and the results were compared. Results: The positive rates of peripheral blood T-SPOT.TB were 46.55% (54/116) in the tuberculous pleurisy complicated with type 2 diabetes mellitus group and 56.10% (184/328) in the tuberculous pleurisy without type 2 diabetes mellitus group, respectively, and there was no significant difference between the two groups (χ²=3.140, P=0.076). The positive rate of pleural effusion T-SPOT.TB in the tuberculous pleurisy complicated with type 2 diabetes mellitus group was significantly lower than that in the tuberculous pleurisy without type 2 diabetes mellitus group (65.52% (76/116) vs. 88.41% (290/328), χ²=31.025, P<0.001). By T-SPOT.TB, the positive rates in pleural effusion were significantly higher than those in peripheral blood in both two groups (χ²=4.845, P=0.028; χ²=12.848, P<0.001). Conclusion: When tuberculous pleurisy patients complicated with type 2 diabetes mellitus, the positive rate of T-SPOT.TB in pleural effusion was decreased, but it was still higher than that in peripheral blood. Pleural effusion T-SPOT.TB detection was recommended to improve the positive detection rate.

Comparative analysis of epidemiological characteristics of pulmonary tuberculosis complicated with diabetes and simple pulmonary tuberculosis

XU Jing, LUO Ping, HE Xiao-xin

Chinese Journal of Antituberculosis. 2022, 44(5):  494-499.  doi:10.19982/j.issn.1000-6621.20220047

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Objective: To analyze the characteristics of tuberculosis patients complicated with diabetes registered in the Tuberculosis Outpatient Department of Beijing Center for Disease Prevention and Control, and to provide evidence for the prevention and treatment of tuberculosis-diabetes comorbidity. Methods: The epidemiological characteristics of 261 tuberculosis patients complicated with diabetes registered in the Tuberculosis Outpatient Department of Beijing Center for Disease Prevention and Control from 2014 to 2021 were descriptively compared with those of 1839 patients with tuberculosis alone during the same period, including gender, age, treatment classification, discovery method, positive rate of etiology, smear positive rate, culture positive rate, drug resistance rate of rifampicin, sputum smear negative conversion rate at the end of the 2nd month, treatment success rate, delay rate of visit and diagnosis,time interval of visit and diagnosis. Results: The rate of retreatment in patients with tuberculosis combined with diabetes (16.48% (43/261)) was significantly higher than that in patients with tuberculosis alone (8.70% (160/1839), χ²=15.822,P<0.001), and the proportion of active detection (7.28% (19/261)) was significantly lower than that of simple tuberculosis (13.05% (240/1839), χ²=7.040,P<0.01). The positive rate of etiology in patients with tuberculosis combined with diabetes (65.90% (172/261))was significantly higher than that in patients with tuberculosis alone (35.07% (645/1839), χ²=91.381, P<0.001). Sputum smear negative conversion rate at the end of 2nd month and treatment success rate in patients with tuberculosis combined with diabetes were lower than those of patients with simple tuberculosis (84.62% (110/130) vs. 91.15% (412/452), χ²=4.663, P=0.031; 80.46% (210/261) vs. 87.71% (1613/1839),χ²=10.495,P=0.001).There was no significant difference in the drug resistance rate of rifampicin (3.07% (8/261) vs. 1.41% (26/1839), χ²=2.945,P=0.086).The visit delay rate and the visit time of patients with tuberculosis combined with diabetes were significantly higher than those of patients with simple tuberculosis (52.87% (138/261) vs. 42.09% (774/1839), χ²=10.822, P=0.001; 16 (2, 53) d vs. 9 (0,37) d, U=2.775, P=0.006).There were no significant differences in diagnosis delay rate and diagnosis time (32.57% (85/261) vs. 31.92% (587/1839), χ²=0.044,P=0.834; 7 (0,24) d vs. 7 (1,20) d, U=0.167,P=0.867). Conclusion: Patients with tuberculosis complicated with diabetes had the characteristics of high positive rate of etiology, high retreatment rate, high delay rate in treatment, long interval between visits,low active detection rate, low sputum smear negative conversion rate and low success rate of treatment.

Review Articles

Research progress on the correlation of gut microbiota with and pulmonary tuberculosis based on the theory of exterior and interior of lung and large intestine

FEI Wan-wan, LU Zhen-hui, HUANG Xing, LI Cui, ZHANG Hui-yong, JIANG Yu-wei

Chinese Journal of Antituberculosis. 2022, 44(5):  500-504.  doi:10.19982/j.issn.1000-6621.20210582

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Pulmonary tuberculosis is a common respiratory infectious disease, and the disorder of gut microbiota is a common complication of it. The disorder of gut microbiota can aggravate the pathological damage of pulmonary tuberculosis. From the perspective of pathogenesis of Traditional Chinese Medicine, the relationship of them embodies the meridian theory, the body fluid theory and the movement theory of Qi. From the perspective of biological mechanism, gut microbiota can limit the progress of pulmonary tuberculosis by producing anti-tuberculosis metabolites through regulating the host innate immunity and adaptive immunity. The disorder of gut microbiota caused by pulmonary tuberculosis may be associated with blood circulation and lymphatic circulation, and the influence of anti-tuberculosis drug on gut microbiota may be related to the bactericidal properties of drugs. The related therapy of intestinal flora has a certain clinical value in the diagnosis and treatment of pulmonary tuberculosis. The intestinal flora can be adjusted by increasing intestinal probiotics, fecal bacteria transplantation, rational use of anti-tuberculosis drugs, improving dietary structure and so on, which has achieved the purpose of adjuvant treatment of pulmonary tuberculosis. In this paper, the author will review the previous literature.

Research progress of exhaled volatile organic compounds on the diagnosis of pulmonary infectious diseases

WU Chao-ling, DENG Guo-fang, FU Liang, YUAN Xiao-liang

Chinese Journal of Antituberculosis. 2022, 44(5):  505-511.  doi:10.19982/j.issn.1000-6621.20210693

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Current diagnostic methods for pulmonary infectious diseases are usually invasive and require specific laboratories and technologies. Therefore, it is necessary to develop novel non-invasive diagnostic tools. The detection method based on exhaled volatile organic compounds (VOC) has shown the potential as an alternative tool for traditional diagnostic and can be used to identify various pathogens quickly and in real time. VOC is derived from multiple endogenous metabolism processes in an organism, including lipid oxidation, carbohydrate, and fatty acids catabolism. Gaseous metabolites and decomposition products from these processes are transported through the circulatory system and be discharged quickly via the lungs. Therefore, they may become potential non-invasive metabolic biomarkers for diagnosing and monitoring pulmonary infectious diseases. The principle and common techniques of VOC detection, the collection method, the research status and problems of VOC in pulmonary infectious diseases are reviewed, and the VOC analysis method based on exhalation is prospected in this paper.

Research progress of innate immunity and adaptive immune response in diabetic patients complicated with tuberculosis infection

LI Yu-jie, YANG Yu-ting, YANG Guo-ping

Chinese Journal of Antituberculosis. 2022, 44(5):  512-516.  doi:10.19982/j.issn.1000-6621.20210686

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Diabetes is one of the risk factors for tuberculosis or progression to severe tuberculosis. The inflammatory environment caused by high glucose can lead to the damage of phagocytosis of innate immune cells and delayed presentation of related antigen presenting cells. Then the abnormal differentiation induced by adaptive immune response will affect the anti-Mycobacterium tuberculosis infection of CD4⁺ and CD8⁺T cells, lead to abnormal secretion of related cytokines and eventually cause immune dysfunction and accelerate the process of tuberculosis infection. Therefore, the research progress on the innate immune mechanism and adaptive immune response of diabetes to anti-tuberculosis infection were reviewed, in order to provide the basis for the anti-inflammatory treatment of diabetic patients and the formulation of reasonable immunotherapy strategies.

Progress in clinical research of gastrointestinal tuberculosis and its characteristics under endoscopy

YANG Ge-rile, LI Yan-mei, ZHAO Li-ping

Chinese Journal of Antituberculosis. 2022, 44(5):  517-521.  doi:10.19982/j.issn.1000-6621.20210729

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Gastrointestinal tuberculosis (GITB) is one of the common forms of extrapulmonary tuberculosis (EPTB), and can affect any part of the digestive tract. Diagnosis is challenging since the clinical manifestations may be similar with other digestive diseases or malignancies, and endoscopy and histology generally show non-specific inflammatory alterations. We reviewed the research progress in China and abroad on the clinical and endoscopic characteristics of gastrointestinal tuberculosis, to raise awareness of clinicians on such diseases to avoid misdiagnosis and missed diagnosis.