Chinese Journal of Antituberculosis

Expert consensus on the diagnosis and treatment of Brucella spondylitis

The Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, The Western China Bone Tuberculosis Union, The North China Union of Bone Tuberculosis

Chinese Journal of Antituberculosis. 2022, 44(6): 531-538. doi:10.19982/j.issn.1000-6621.20220138

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Brucellosis spondylitis has been increasing in recent years, because of the low early diagnosis rate, there is often the possibility of misdiagnosis and mistreatment, resulting in the difficulty of later treatment and disability of patients. In order to standardize the diagnosis and treatment process of patients with Brucella spondylitis, help more specialist to get the treatment details of such disease, and have evidence in the treatment, the Expert consensus on the diagnosis and treatment of Brucella spondylitis was jointly formulated by the Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, the Western China Bone Tuberculosis Union, the North China Union of Bone Tuberculosis. This consensus starts from the epidemiological characteristics of Brucella spondylitis, deeply expounds and discusses its common clinical manifestations, laboratory examination and diagnostic criteria, therapeutic drugs, surgical treatment methods, prognosis and so on.

Interpretation of immunoadjuvant therapy in Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition)

AN Hui-ru, WU Xue-qiong

Chinese Journal of Antituberculosis. 2022, 44(6): 539-543. doi:10.19982/j.issn.1000-6621.20220066

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The occurrence, development and prognosis of tuberculosis (TB) are closely related to anti-TB immune function. TB patients often have anti-TB immune function abnormalities, the immune intervention using immune agents can improve the cure rate and reduced the recurrence rate. However, there is no consensus on the immune intervention and selection of immune agents for active TB. Expert consensus on immune function assessment and immunotherapy in patients with active tuberculosis (2021 Edition) published in No.1 of 2022 in Chinese Journal of Antituberculosis proposed specific suggestions and reached consensus on anti-TB immunotherapy. The factors of immune abnormality in TB patients, the concept of immunoadjuvant therapy for active TB, the clinical application of the immune intervention were further interpreted in this paper, to provide the reference of TB clinical workers in China.

Effect of enhanced recovery after surgery management in the surgical treatment of knee joint tuberculosis

YAN Guang-xuan, DONG Wei-jie, LAN Ting-long, FAN Jun, TANG Kai, LI Yuan, WANG Heng, QIN Shi-bing

Chinese Journal of Antituberculosis. 2022, 44(6): 544-548. doi:10.19982/j.issn.1000-6621.20220051

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Objective: To evaluate the clinical effect of enhanced recovery after surgery (ERAS) management model in patients undergoing surgery for debriding knee joint tuberculosis lesion. Methods: A retrospective analysis was performed on clinical data of 35 patients who underwent knee joint tuberculosis debridement surgery under ERAS management (ERAS group) in the Department of Orthopedics of the Capital Medical University Affiliated Beijing Chest Hospital from January 2018 to October 2020. A control group was established with 35 knee joint tuberculosis debridement surgery patients who underwent non-ERAS management (non-ERAS group) consecutively enrolled from December 2015 to December 2017. The amount of blood loss, postoperative total drainage flow, postoperative deep vein thrombosis in lower extremities, first-stage incision healing and length of hospital stay were compared. Visual analogue scale (VAS) and hospital of special surgery (HSS) knee score were used to evaluate the degree of pain and knee function before and 8 weeks after surgery. Results: The average amount of blood loss in ERAS group ((65.0±12.2) ml) was significantly lower than that in non-ERAS group ((125.8±35.0) ml), the total postoperative drainage in ERAS group ((212.9±32.2) ml) was significantly lower than that in non-ERAS group ((408.6±51.9) ml),the hospitalization length in ERAS group ((19.1±2.4) days) was significantly shorter than that in non-ERAS group ((28.5±9.7) days), and the differences were all statistically significant (t were -5.085, -11.203 and -3.278, respectively,all P values <0.05). No postoperative lower extremity deep vein thrombosis occurred in ERAS group, and 2 cases occurred in non-ERAS group. First-stage healing occurred in 35 cases in ERAS group and 31 cases in non-ERAS group. At 8 weeks after surgery, average VAS score in ERAS group (2.6±0.8) was significantly lower than that before surgery (7.7±0.7), and average HSS score (77.4±3.8) was significantly higher than that before surgery (36.5±4.1), with statistically significant differences (t were 18.419 and -29.654, respectively, both P values <0.05). There were significant differences between the two scores before and after operation in the non-ERAS group (t were 14.807 and -12.771, respectively, all P values <0.05). At 8 weeks after surgery, average VAS score in ERAS group (2.6±0.8) was significantly lower than that in non-ERAS group (3.9±1.0), and average HSS score in ERAS group (77.4±3.8) was significantly higher than that in non-ERAS group (68.3±5.0), with statistically significant differences (t were -2.751 and 4.502, respectively,both P values <0.05). Conclusion: Appling the ERAS management in perioperative period for patients taking knee joint tuberculosis debridement surgery can alleviate postoperative symptoms, improve joint function, reduce blood loss and drainage, and shorten hospitalization time. ERAS management model can promote rapid recovery, reduce complications for patients.

Value of nutrition management under the concept of enhanced recovery after surgery in perioperative patients with spinal tuberculosis

CHEN Yang, LI Zhuo, JIAO Mei, MA Jiao-jie

Chinese Journal of Antituberculosis. 2022, 44(6): 549-554. doi:10.19982/j.issn.1000-6621.20220052

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Objective: To explore the value of nutrition management under the concept of enhanced recovery after surgery (ERAS) in perioperative patients with spinal tuberculosis. Methods: A total of 79 patients with spinal tuberculosis who were hospitalized and operated in the Department of Orthopaedics in the Beijing Chest Hospital during January to December 2021 were chosen and were randomly allocated into observation group (42 cases) and control group (37 cases) using random number table. Two cases in the observation group withdrew from the experiment halfway which left the group with 40 patients finally. Patients in the observation group were given perioperative nutrition management under ERAS concept, while those in the control group were given routine operation management. The nutritional risks of these two groups were observed at the time of admission, the 6th and 13th day after operation. Differences of serological test results at admission, the 1st, 6th and 13th day after operation were compared, as well as the differences of intraoperative and postoperative blood loss, drainage, extubation time, time of first gas and defecation. Results: On the 6th and 13th day after operation, among the observation group,70.0% (28/40) and 57.1% (20/35) had nutritional risk, which were lower than that in the control group (94.6% (35/37) and 81.8% (27/33), χ²=7.816, P=0.005; χ²=4.845,P=0.028). On the 1st day after operation, the average amount of WBC among the observation group was (9.99±3.12)×10⁹/L, which was lower than that of the control group ((11.69±2.74) ×10⁹/L, t=2.529, P=0.014). On the 6th day after operation, the average blood albumin in the observation group was (33.48±4.47)g/L, which was higher than that in the control group ((31.35±3.51)g/L, t=-2.310,P=0.024).The average uric acid level of the observation group was (274.67±116.91)μmol/L, lower than that in the control group ((339.19±115.79)μmol/L, t=2.416,P=0.018). The median (IQR) blood loss during operation in the observation group was 300.0 (175.0,500.0) ml, which was less than that in the control group (400.0 (250.0,600.0) ml, Z=2.098,P=0.036). Median (IQR) postoperative exhaust time and average defecation time in the observation group were 25.5 (15.5,37.5)h and (95.7±46.9)h, both of which were shorter than that in the control group (30.7 (21.5,44.5)h, (117.3±38.8)h, Z=2.050,P=0.040;t=2.140,P=0.036). Conclusion: The nutrition management under ERAS concept can effectively improve the nutritional status of patients with spinal tuberculosis and promote the recovery of gastrointestinal function thus help patients recover quickly.

Analysis of the effect of enhanced recovery after surgery in perioperative nursing of spinal tuberculosis

JIANG Yan, LONG Ya-qin, WANG Rui-lan, TIAN Li-ying, ZHAO Ming-wei, LIU Jia-hong

Chinese Journal of Antituberculosis. 2022, 44(6): 555-558. doi:10.19982/j.issn.1000-6621.20220054

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Objective: To analyze the effect of enhanced recovery after surgery (ERAS) concept in perioperative nursing of spinal tuberculosis. Methods: A total of 147 patients with spinal tuberculosis treated in the Department of Surgical of Qingdao Chest Hospital from July 2017 to June 2020 were collected. Of them, 68 cases treated from July 2017 to December 2018 received routine nursing during the perioperative period (control group); 79 cases from January 2019 to June 2020 who underwent surgery were treated with the ERAS concept on the basis of routine nursing measures (ERAS group). The time of drainage tube extraction, first getting out of bed for functional exercise and initial spontaneous urination, pain score 72 hours after operation (using visual analog scoring (VAS) method), the length of hospital stay, the incidence of nausea and vomiting, the incidence of lung infection and drug-induced liver damage, and the patient's satisfaction were observed and compared between the two groups. Results: Compared with the control group, the drainage tube removal time, the initial time to get out of bed for functional exercise, the initial spontaneous urination time, VAS score 72 h after operation and the length of hospital stay in the observation group were all significantly shorter than those in the control group (6.00(4.00,8.00) d vs. 8.00 (7.00,8.00) d, W=4321.000, P<0.001; 2.00 (2.00,4.00) d vs. 5.50 (4.25,6.00) d, W=3376.000, P<0.001; 5.00 (3.00, 6.00) h vs. 9.00 (7.00, 9.00) h, W=3369.000, P<0.001; 3.00 (2.00, 4.00) vs. 5.00 (5.00, 6.00), W=4078.500, P<0.001; 19.00 (18.00, 21.00) d vs. 22.00(19.00,27.00) d, W=4791.500,P<0.001, respectively). The incidences of postoperative nausea and vomiting and pulmonary infection, and drug-induced liver damage in the observation group were significantly lower than those in the control group (7.6% (6/79) vs. 19.1% (13/68), χ²=4.311,P=0.038; 2.5% (2/79) vs. 11.8% (8/68), χ²=4.914, P=0.027; and 1.3% (1/79) vs. 13.2% (9/68), χ²=8.258, P=0.004, respectively). The patient satisfaction in the observation group was significantly higher than that in the control group (96.2% (76/79) vs. 85.3% (58/68), χ²=7.100, P=0.008). Conclusion: The application of ERAS concept in perioperative nursing of spinal tuberculosis can speed up the recovery, reduce the occurrence of complications, and improve the satisfaction.

Analysis of effectiveness of short-course preoperative chemotherapy in rapid recovery of patients with single-segment spinal tuberculosis anterior surgery

DONG Zhao-liang, YAO Li-ming, WANG Lian-bo, JIA Chen-guang, YAO Xiao-wei, LIU Shu-ren, LIU Feng-sheng, WANG Shuai

Chinese Journal of Antituberculosis. 2022, 44(6): 559-564. doi:10.19982/j.issn.1000-6621.20210733

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Objective: To explore the application value of preoperative short-term chemotherapy in the rapid recovery of patients taking single-segment spinal tuberculosis anterior surgery. Methods: Fifty-six patients with spinal tuberculosis treated in the Department of Orthopedics of Hebei Chest Hospital from June 2017 to May 2019 were selected, including 28 males and 28 females, aged from 21 to 85 years. The diseased segment: there were 2 cases of cervical spine, 21 cases of thoracic spine, 28 cases of lumbar spine, and 5 cases of lumbosacral spine. All patients were given short-course chemotherapy before surgery, and H-R-Z-E quadruple anti-tuberculosis drugs were given routinely lasting 1-10 days, with an average of (6.90±1.35) days. The symptoms of systemic poisoning were improved, and the general condition of the whole body could tolerate the operation. After surgery, dynamic observations of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) changes, pain relief, nerve recovery, bone fusion, spinal tuberculosis cure rate, and complications were made. Results: Of the 56 patients enrolled, 1 case did not get early wound healing, but was healed after routine dressing change; 1 case got sinus formed, and the wound healed after sinus curettage. The remaining 54 cases all had wounds healed at first stage with level A healing. ESR ((20.96±7.97)mm/1h) at the 3rd week after operation were significantly lower than that before operation ((40.74±14.35) mm/1h), and the difference was statistically significant (t=23.198, P=0.000); CRP at the 3rd week after operation ((27.57±8.98) mg/L) was significantly lower than that before operation ((45.83±9.57)mg/L), and the difference was statistically significant (t=8.807, P=0.000); visual analogue scale (VAS) scores (3 (2,4)) at the 3rd week after operation was decreased significantly compared with the score before operation (6 (6,8)), and the difference was statistically significant (Z=-6.543,P=0.000). There were 29 patients with neurological impairment. At the end of follow-up, 2 patients with grade B impairment improved to grade D and 1 improved to grade E; within 10 patients with grade C impairment, 8 cases improved to grade E, and the others improved to grade D; all 17 patients with grade D impairment got improved to grade E. The positive rate of tuberculosis bacteria culture with samples collected from tuberculosis lesions during the operation was 44.6%(25/56), of which 1.8% (1/56) were single-drug-resistant, 3.6% (2/56) were multi-drug-resistant, and 1.8% (1/56) were poly-drug-resistant. 4-11 months after operation, 91.1% (51/56) of the 56 patients with intervertebral bone grafts achieved grade Ⅰ fusion, and 8.9% (5/56) of which achieved grade Ⅱ fusion according to Bridwell standards. Conclusion: For spine tuberculosis with indications, it is feasible to take a short course of preoperative chemotherapy before anterior debridement, bone graft fusion and internal fixation.

Effect evaluation of intravenous and local application of tranexamic acid in perioperative period of lumbar tuberculosis

ZHOU Wei-dong, LIU Jie-qing, LIU Zhao-yang, ZHAO Ming-wei

Chinese Journal of Antituberculosis. 2022, 44(6): 565-569. doi:10.19982/j.issn.1000-6621.20220037

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Objective: To investigate the clinical value of intravenous and local application of tranexamic acid (TXA) in perioperative period of lumbar tuberculosis. Methods: A total of 92 lumbar tuberculosis patients admitted to Qingdao Chest Hospital from January 2019 to January 2022 were prospectively analyzed. They were randomly divided into observation group (n=46) and control group (n=46). In the observation group, 0.5 g (5 ml) TXA was injected intravenously before operation, and 0.5 g of TXA was given once within 12 hours after operation. During the operation, 0.5 g of TXA was sprayed in each cavity (including small incision of lumbar posterior approach, oblique anterior incision of lumbar spine and incision of iliac bone extraction area). In the control group, 0.5 g TXA was injected intravenously before operation, and 0.5 g was given intravenously before surgery and 0.5 g intravenously within 12 hours after surgery. Patients in both groups underwent lumbar obliquely anterior approach diseased vertebra removal and iliac bone grafting fusion. The intraoperative bleeding volume, operation duration, drainage volume 24 hours and 72 hours after operation, hematocrit 3 days after operation, hemoglobin decrease 3 days after surgery, blood D-dimer (D-D) level 1 week after surgery, coagulation function (prothrombin time, activated partial thrombin time) and other related indicators were compared between the two groups. Results: All the 92 patients successfully completed the operation and no deep vein thrombosis was found by color Doppler ultrasonography of lower extremity veins. There was no significant difference in operation duration and intraoperative bleeding between the two groups ((149.0±23.8) min vs. (145.0±26.3) min, t=0.765, P=0.443; (344.0±120.0) ml vs. (360.0±134.0) ml, t=0.603,P=0.402). The drainage volume 24 hours and 72 hours after operation, and the decrease of hemoglobin 3 days after operation in the observation group were significantly lower than those in the control group ((64.0±23.3) ml vs. (77.0±33.1) ml, t=2.178, P=0.042; (159.0±25.2) ml vs. (174.0±27.2) ml, t=2.743, P=0.032; (28.2±8.1)g/L vs. (32.5±9.6)g/L, t=2.324, P=0.037, respectively). The erythrocyte specific volume in the observation group [(32.1±8.3) %] was higher than that in the control group ((28.2±10.2) %), the difference was statistically significant (t=2.014, P=0.048). There was no significant difference in the incidence of gastrointestinal reactions, prothrombin time 3 days after surgery, activated partial prothrombin time and blood D-D level 1 week after surgery between the two groups (8.7% (4/46) vs. 10.9% (5/46), χ²=0.123, P=0.212; (13.1±3.2) s vs. (12.6±2.9) s, t=0.835, P=0.517; (36.1±6.1) s vs. (34.6±5.6) s, t=1.229, P=0.224; (0.9±0.2) mg/L vs. (0.9±0.3) mg/L, t=0.366, P=0.712, respectively). Conclusion: Intravenous and local application of TXA could effectively reduce the blooding volume in the operation of lumbar tuberculosis, reduce the amount of blooding after surgery, and not increase the risk of postoperative thrombosis, so that patients could achieve the goal of rapid rehabilitation.

Analysis of influencing factors of postoperative exhaust time in patients with spinal tuberculosis

ZHANG Ya-chao, LI Zhuo, CHEN Yang, MA Jiao-jie, LEI Guo-hua

Chinese Journal of Antituberculosis. 2022, 44(6): 570-575. doi:10.19982/j.issn.1000-6621.20220150

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Objective: To explore the influencing factors of postoperative exhaust time in patients with spinal tuberculosis. Methods: A prospective cross-sectional study was conducted in 75 newly admitted patients with spinal tuberculosis from the Orthopedics Department of Beijing Chest Hospital, Capital Medical University between February and December 2021. All the patients met the inclusion criteria. The basic information of patients, routine blood test and blood biochemistry on the next day after admission and the next day after surgery, the procedure and duration of surgery, the management of pain, postoperative thirst scores, intraoperative bleeding and blood transfusion, etc., as well as whether or not participate in nutritional management were collected by the case report form. Univariate correlation analysis and multiple stepwise regression analysis were performed to explore the potential influencing factors of exhaust time of patients with spinal tuberculosis. Results: The postoperative exhaust time of 75 patients with spinal tuberculosis ranged from 0.5 to 98.0 hours, and the median time was 27.0 (19.0, 40.0) hours. There were only 29 patients with exhaust time of ≤24 hours (38.7%). The results of univariate correlation analysis showed that the postoperative exhaust time in patients with spinal tuberculosis was negatively correlated with the concentration of hemoglobin at admission ((124.1±17.2)g/L) (r=-0.289, P=0.012) and positively correlated with the thirst score 2 hours after surgery (5.0 (4.0, 6.0)) (r=0.258, P=0.025), but not significantly correlated with other factors. For example, the postoperative exhaust time in patients was not significantly correlated with nutrition management (26.0 (16.0,38.0) h and 30.8 (21.3, 45.3) h) (Z=-1.915,P=0.056) or pain score 24 hours after surgery (4.0 (3.0, 6.0) score)(r=0.171, P=0.143). The results of the multiple stepwise regression showed that the concentration of hemoglobin at admission (β=-0.349, P=0.002), pain score 24 hours after surgery (β=3.143, P=0.003), and nutritional management (β=-10.312, P=0.008) were the influencing factors for exhaust time in these patients, the postoperative exhaust time might shorten with the increasement of the concentration of hemoglobin and the improvement of nutrition management, and might prolong with the increase of pain score 24 hours after surgery. Conclusion: The postoperative exhaust recovery time of patients with spinal tuberculosis is long. Clinical medical staffs should pay more attention to the patients with anemia at admission, those who lack of whole-process nutrition management during hospitalization, and high pain score 24 hours after surgery.

Clinical analysis of six cases of Brucella spondylitis misdiagnosed as lumbar tuberculosis

LIU Xin, GUO Le, LI Jun-xiao, CHEN Qi-liang, WU Qian-hong

Chinese Journal of Antituberculosis. 2022, 44(6): 576-581. doi:10.19982/j.issn.1000-6621.20210648

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Objective: To analyze the patients with Brucella spondylitis misdiagnosed as lumbar tuberculosis and explore the treatment outcome of Brucella spondylitis. Methods: The clinical data of Brucella spondylitis patients misdiagnosed as lumbar tuberculosis from Shaanxi Tuberculosis Control Hospital between June 2018 and June 2021 were collected, and the clinical symptoms, laboratory examination results, imaging findings, treatment methods and follow-up results were analyzed. Results: Among the 6 patients, 4 were male and 2 were female, with the mean age of (63.00±10.15) years (ranged from 54 to 81 years); 2 had contact history of Brucella, 3 had contact history of pastoral area and cattle and sheep, 1 had unknown contact history; 1 complicated with old pulmonary tuberculosis, and 1 with epidural abscess and underwent surgery. The course of disease ranged from 20 days to 1 year, with an average of (4.17±1.32) months. The duration of misdiagnosis was 7-24 days, with an average of (15.66±5.53) days. The lesion sites were as follows: 2 cases of lumbar 2-3, 1 case of lumbar 3-4, 2 cases of lumbar 4-5, and 1 case of lumbar 5-sacral 1 complicated with epidural abscess. As to imaging findings, all the 6 patients showed intervertebral space stenosis, marginal bone destruction of the vertebral body, which appeared alternately with hyperplasia and sclerosis, and the formation of adjacent intervertebral bone bridges. One case had high fever of >39℃, and the type was undulating fever, while the other 5 cases had normal body temperature. Tuberculin purified protein derivative (PPD) skin test was weakly positive in 2 cases, and generally positive in 3 cases; tuberculosis antibody was positive in 3 cases, LAM antibody and T-SPOT. TB test were positive in 2 cases. All the patients were diagnosed as Brucellosis spondylitis through the positive preliminary screening of Rose-Bengal plate agglutination test and tube agglutination test. They were treated with doxycycline hydrochloride and rifampicin for 12 weeks and followed up for 6 months. Finally, 4 patients were cured and 2 patients improved without recurrence. Conclusion: Brucella spondylitis usually has a history of disease exposure, which can be confirmed by fever type and laboratory examination. The overall prognosis of most Brucella spondylitis patients is good.

The efficacy and safety of regimen containing bedaquiline in the treatment of elderly drug-resistant tuberculosis patients

XUE Yu, ZHANG Jing, NIE Wen-juan

Chinese Journal of Antituberculosis. 2022, 44(6): 582-586. doi:10.19982/j.issn.1000-6621.20220019

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Objective: To evaluate the early efficacy and safety of regimen containing bedaquiline in the treatment of elderly drug-resistant tuberculosis (TB) patients. Methods: From April 2020 to July 2021, 20 elderly patients over 65 years old with drug-resistant TB who used bedaquiline regimen in Beijing Chest Hospital were enrolled, including 2 (10.0%) with rifampicin-resistant (RR), 6 (30.0%) with multidrug-resistant (MDR), 11 (55.0%) with pre-extensively drug-resistant (pre-XDR) and 1 (5.0%) with extensively drug-resistant TB (XDR-TB), respectively. TB culture conversion rate and lesions absorption within 24 weeks were analyzed to assess the early treatment efficacy. The adverse events and QTc were recorded to assess the treatment safety. Results: Twelve (60.0%) cases achieved culture conversion within 24 weeks, 7 showed significant absorption in Chest CT scan, 5 showed partial absorption. Among 6 patients with lung cavities, 5 showed cavities reducing and 1 showed cavity closing, 4 (20.0%) cases died, and the reason of death was respiratory failure caused by severe infection, 1 (5.0%) patient stopped bedaquiline due to the happening of left anterior bundle branch block. QTc value >450 ms was found in 5 (25.0%) patients, with 1 (5.0%) >500 ms, 2 (10.0%) were 473 ms and 490 ms, respectively, and bedaquiline was stopped. The other 2 patients with QTc 479 ms and 452 ms persisted took bedaquiline until the end of 24 weeks. 2 patients (10.0%) with gastrointestinal reactions continuing regimen until the end of 24 weeks, including 1 (5.0%) with liver injury. Conclusion: The regimen containing bedaquiline can achieve high culture conversion rates in patients with drug-resistant TB, and the safety is also well in the elderly TB patients.

Study on the significance of immune intervention and influencing factors of peripheral blood CD4⁺T lymphocytopenia in HIV-negative pulmonary tuberculosis patients

LIU Sheng-sheng, YANG Juan, ZHA Zhao-yu, ZHANG Chao, XU Zi-wei, TANG Shen-jie, LIN Wen-hong

Chinese Journal of Antituberculosis. 2022, 44(6): 587-594. doi:10.19982/j.issn.1000-6621.20220087

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Objective: To investigate the incidence, immune intervention value, and influencing factors of peripheral blood CD4⁺T lymphocytopenia in HIV-negative pulmonary tuberculosis (PTB) patients. Methods: The clinical data of 213 cases with HIV-negative PTB in Anhui Chest Hospital from December 2020 to July 2021 were analyzed, retrospectively. According to the CD4⁺T lymphocytes counts, 213 cases were divided into CD4⁺T lymphopenia group (count <410 cells/μl) and control group (count ≥410 cells/μl). The patients with CD4⁺T lymphopenia were divided into the immune intervention group and non-intervention group according to whether they received immune intervention. Demographic characteristics (gender, age, occupation, and education level), smoking, drinking, number of symptoms, treatment classifications, comorbid diseases, drug resistance, imaging, and laboratory test results were collected. Efficacy analysis between groups was compared using the Chi-square test. Multivariate logistic regression analysis was used after filtrating by univariate analysis to explore the influencing factors of peripheral blood CD4⁺T lymphocytopenia in HIV-negative PTB patients. Results: The incidence of CD4⁺T lymphopenia was 28.6% (61/213). The efficacy analysis showed that after 2-4 months of treatment, the negative rate of sputum smear in the immunological intervention group was 93.9%, higher than 75.0% in the non-intervention group (χ²=4.320, P<0.05). After 5-7 months of treatment, the absorption rate of lesions in the immunological intervention group was 51.5%, which was higher than 25.0% in the non-intervention group (χ²=4.462,P<0.05). Univariate analysis showed that in the CD4⁺T lymphopenia group, male, age ≥60 years, farming, illiterate culture, number of symptoms ≥4, complicated with extrapulmonary tuberculosis, involving 4-6 lung fields, pulmonary cavity, hemoglobin <110 g/L, platelet <125×10⁹/L, albumin <35 g/L, CD8⁺T lymphocyte count <190/μl (77.0%, 44.3%, 36.1%, 26.2%, 36.1%, 34.4%, 77.0%, 55.7%, 45.9%, 18.0%, 68.9%, 29.5%) were significantly higher than that of control group (60.5%, 11.2%, 19.7%, 10.5%, 19.7%, 21.1%, 38.2%, 40.8%, 25.7%, 5.3%, 44.7%, 7.9%), the differences were statistically significant (χ² values were 5.242, 29.060, 10.095, 13.650, 6.290, 4.165, 26.342, 3.929, 8.274, 8.738, 10.137, and 16.805, respectively, all P values <0.05). Multivariate logistic regression analysis showed that age ≥60 years old, lesion involvement of 4-6 lung fields, platelet <125×10⁹/L, CD8⁺T lymphocytes count <190 cells/μl (OR=4.816,95%CI:1.650-14.052; OR=3.669,95%CI:1.548-8.696; OR=3.753,95%CI:1.069-13.173; OR=3.908,95%CI:1.394-10.954) were the risk factors of CD4⁺T lymphocytopenia. Conclusion: HIV-negative pulmonary tuberculosis patients were prone to a decrease in CD4⁺T lymphocytes, and immune intervention therapy had positive significance for improving the efficacy of this population. Old age, a wide range of lesions involved, thrombocytopenia, and CD8⁺T lymphocytopenia were the independent risk factors for CD4⁺T lymphocytopenia in HIV-negative PTB patients.

Influence of malnutrition on positive rate of interferon gamma release assay (IGRA) in patients with tuberculosis

LA Ba, ZHANG Meng-meng, WANG Ming-gui, HE Jian-qing

Chinese Journal of Antituberculosis. 2022, 44(6): 595-599. doi:10.19982/j.issn.1000-6621.20210709

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Objective: To investigate whether malnutrition affects the positive rate of γ-interferon release assay (IGRA) in patients with tuberculosis. Methods: From January 2015 to November 2018, 443 patients with tuberculosis who were admitted to the Department of Respiratory and Critical Care Medicine, West China Hospital were included by reviewing electronic medical record. According to body mass index (BMI), they were divided into malnutrition group (BMI <18.5; 136) and no-malnutrition group (BMI ≥18.5; 307). Enzyme linked immunosorbent assay was used to measure the concentration of interferon-γ in fresh heparinized whole blood stimulated by tuberculosis specific antigen in vitro. The positive rate of IGRA in the two groups was compared. Results: A total of 443 patients, the positive rate of IGRA was 76.47% (104/136) in the malnourished group and 78.18% (240/307) in the no-malnutrition group, there was no significant difference between the two groups (χ²=0.158,P=0.712). Among the bacterium-confirmed tuberculosis patients, the positive rate of IGRA was 75.61% (31/41) in the malnutrition group and 80.65% (50/62) in the no-malnutrition group, there was no significant difference between the two groups (χ²=0.373,P=0.542). Conclusion: Malnutrition does not affect the positive rate of IGRA in patients with tuberculosis.

Analysis of adverse treatment outcomes and influencing factors of drug-resistant tuberculosis patients in Guangzhou from 2016 to 2020

LI Zhi-wei, LAI Keng, LI Tie-gang, LIANG Zi-chao, DU Yu-hua, ZHANG Jin-xin

Chinese Journal of Antituberculosis. 2022, 44(6): 600-607. doi:10.19982/j.issn.1000-6621.20220020

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Objective: To analyze the status of adverse treatment outcomes and influencing factors of drug-resistant tuberculosis patients in Guangzhou. Methods: A retrospective cohort study was conducted in 677 drug-resistant tuberculosis patients registered and treated in Guangzhou Chest Hospital from January 1, 2016 to December 31, 2020. The medical record of them were from the China Tuberculosis Management Information System. And the occurrence and influencing factors of adverse treatment outcomes were analyzed. Results: Of the 677 patients, 193 (28.5%) were successfully treated, 280 (41.4%) were under treatment, 204 (30.1%) had adverse treatment outcomes (13 stopped treatment adverse reactions, 9 failed, 32 died, and 150 failed to be followed up), and the median survival time for patients with adverse treatment outcomes was 729 days. Multivariate Cox model analysis showed that non-Guangzhou registration, complicated with diabetes, interprovincial mobility and older age were risk factors of adverse treatment outcomes in drug-resistant TB patients (HR (95%CI)=1.74 (1.21-2.49), P=0.002; HR (95%CI)=1.59 (1.10-2.32), P=0.015; HR (95%CI)=2.29 (1.26-4.18), P=0.007; HR (95%CI)=1.01 (1.00-1.03), P=0.011, respectively), and multidrug resistance was a protective factor (HR (95%CI)=0.53 (0.36-0.79), P=0.002). Conclusion: The incidence of adverse treatment outcomes in drug-resistant tuberculosis patients was high, and the treatment and long-term management of drug-resistant tuberculosis patients should be strengthened, especially those who complicated with diabetes, moved from other provinces, had an older age and could not enjoy preferential medical treatment in the city due to registered residence registrations.

Knowledge, attitude and practice and influencing factors of practice towards tuberculosis prevention and control among parents of new students in Beijing

XU Yan, QIN Li, ZHAO Yao, SUN Shan-hua, ZHANG Hong-wei, GAO Zhi-dong, LI Bo

Chinese Journal of Antituberculosis. 2022, 44(6): 608-616. doi:10.19982/j.issn.1000-6621.20220083

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Objective: To understand the knowledge, attitude and practice of tuberculosis prevention and control among parents of senior high school and below students in Beijing, and to analyze the influencing factors of practice, so as to provide reference for carrying out health education for tuberculosis prevention and control on campus. Methods: During August to September, 2021, the parents of new students of senior high school and below in Beijing, whose children were screened by “Beijing New Student Tuberculosis Screening Program”, were selected to participate in an online survey about knowledge, attitude and practice towards tuberculosis prevention and control with informed consent. Statistical analysis and logistic regression analysis were used to analyze the status and the influencing factors. Results: A total of 51142 questionnaires were obtained, among which 29571 were filled by parents who took more than 60 seconds to answer, thus were included in analysis. The median (interquartile range) of total score, knowledge score, attitude score, behavior score of the parents were 25.0 (20.0, 27.0), 4.0 (3.0, 5.0), 8.0 (6.0, 8.0), 13.0 (10.0, 15.0) respectively, and the pass rate of them were 75.87% (22435/29571), 80.19% (23712/29571), 86.42% (25556/29571), and 64.42% (19051/29571), respectively. Multivariate logistic regression analysis showed that, for tuberculosis prevention behavior score, compared with fathers, pass rate of mothers was higher (OR (95%CI): 0.90 (0.85-0.96)); compared with the parents of students in primary school and below, unpass rate of the parents of junior and senior middle school students was higher (OR (95%CI): 1.63 (1.52-1.75) and OR(95%CI): 1.43 (1.32-1.55)); compared with parents with junior middle school education and below, parents with college education and above had higher pass rate (OR (95%CI)=0.72 (0.63-0.81)); compared with parents working for government/institutions/enterprises, parents working in agricultural sector/military or retired had lower pass rate (OR (95%CI): 3.48 (3.18-3.82)); compared with the parents having the first child in school, the parents having non-first child in school had lower pass rate (OR(95%CI): 1.15 (1.08-1.23)); compared with parents who failed in knowledge and attitude scores, the parents who got passed had higher pass rate in behavior score (OR(95%CI): 0.16 (0.15-0.18), OR(95%CI): 0.08 (0.07-0.09)). Conclusion: The parents of new students in Beijing had certain knowledge about tuberculosis control, and had a positive attitude towards tuberculosis control in campus. However, there were still incorrect tuberculosis prevention behaviors. We should conduct targeted health education and behavior guidance for parents who are father, having junior high school education and below, working in agricultural sector/military or retired, parents whose first child are about to enter junior and senior school, and parents with a lack of knowledge and attitude towards tuberculosis.

Investigation on the implementation of tuberculosis prevention and control measures in some pension institutions in Shanghai

CHEN Jing, RAO Li-xin, XIAO Xiao, WU Zhe-yuan, SHEN Xin

Chinese Journal of Antituberculosis. 2022, 44(6): 617-624. doi:10.19982/j.issn.1000-6621.20220039

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Objective: To investigate the implementation of tuberculosis (TB) prevention and control measures and the staff's knowledge of core information of TB in pension institutions in Shanghai, so as to provide basis for improving TB prevention and control measures. Methods: A questionnaire survey was conducted in 84 pension institutions (30 located in urban arears and 54 located in suburban areas) and 858 staff from 21 pension institutions of them in seven districts in Shanghai (234 from urban areas and 624 from suburban areas) from January to April, 2019. The implementation of chest X-ray for the staff and the elderly before and after entering the pension institutions,TB and other infectious diseases prevention and control measures, as well as the training for staff on infectious diseases and their knowledge of the core information of TB prevention and control were analyzed. Results: The proportions of regular chest X-ray test before and after entering pension institutions were 76.2% (64/84) and 79.8% (67/84) of the staff, and 98.8% (83/84) and 73.8% (62/84) of the elderly. The proportions of implementing daily round of checking, infectious diseases report, disinfection and isolation of epidemic and training of infectious diseases (including TB) were 97.6% (82/84), 89.3%(75/84), 91.7% (77/84) and 81.0% (68/84), respectively. The proportions of chest X-ray test for the staff before and after entering pension institutions, and for the elderly after entering pension institutions were 93.3% (28/30), 86.7% (26/30), and 93.3% (28/30) in urban areas, which were significantly higher than those in suburban areas (66.7% (36/54), χ²=9.179, P=0.010; 75.9% (41/54), χ²=6.579, P=0.037; 63.0% (34/54), χ²=11.580, P=0.003, respectively), and so were the infectious diseases report (100.0% (30/30) vs. 83.3% (45/54), χ²=5.600, P=0.018), disinfection and isolation of epidemic (100.0% (30/30) vs. 87.0% (47/54), χ²=4.242, P=0.039) and training of infectious diseases (including TB)(96.7% (29/30) vs. 72.2% (39/54), χ²=7.474, P=0.006). Among the 858 staff, those who in urban areas had significantly higher proportion of receiving training on infectious diseases both before and after entering nursing home than those in suburban areas (76.5% (179/234) vs. 63.0% (393/624), χ²=13.988, P<0.001; (79.9% (187/234) vs. 69.2% (432/624), χ²=9.666, P=0.002, respectively).In staff from urban areas, the proportions of awareness rate of cough over 2 weeks (88.5% (201/227) vs. 71.3% (427/599), χ²=26.911, P<0.001), expectoration (74.9% (170/227) vs. 64.3% (385/599), χ²=8.416,P=0.004), suspected symptoms of fever (49.3% (112/227) vs. 41.1% (246/599), χ²=4.586,P=0.032), and TB is a respiratory infectious disease (95.2% (216/227) vs. 84.8% (508/599), χ²=16.280, P<0.001) were significantly higher than those in suburban areas. Conclusion: Chest X-ray for the staff before and after entering pension institution, and for the elderly after entering pension institution, as well as trainings on infectious diseases (including TB) to the staff should be further strengthened, especially in suburban areas.

Distribution characteristics of N-acetyltransferase-2 genotypes and comparison methods of different genotyping in Chinese population

WANG Ning, ZHENG Lu-yao, MENG Xiu-juan, LIU Hai-ting, DING Yang-ming, YAO Rong, GUO Shao-chen, LU Yu

Chinese Journal of Antituberculosis. 2022, 44(6): 625-634. doi:10.19982/j.issn.1000-6621.20210737

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Objective: To analyze the distribution characteristics of N-acetyltransferase-2 (NAT2) genotypes and the effectiveness of different genotyping methods in Chinese population. Methods: The literatures containing NAT2 gene polymorphism data of Chinese population were retrieved in Medline, PubMed, Embase, China Science and Technology Journal Database, China National Knowledge Internet, and Wanfang database. The retrieval time limit was from the establishment of the database to December 1, 2021, with the English search words of NAT2, N-acetyltransferase, polymorphism, China or Chinese, etc., and Chinese search words of NAT2, gene polymorphism, China, etc.. Newcastle Ottawa scale (NOS) was used to evaluate the quality and bias risk of the included literature. The NAT2 genotype and allele data in the literature were extracted, the NAT2 genotype database of single study was reconstructed, and the haplotype and diplotype were reconstructed and verified by phase 2.1 software. The NAT2 genotype of the control group in the literature were extracted to construct the NAT2 genotype distribution database of Chinese population, and the distribution characteristics of NAT2 alleles and genotypes were analyzed. Based on the constructed NAT2 genotype database, the efficiency of different NAT2 genotyping panels was evaluated. Results: Through literature retrieval and screening, the results of 10 studies were included. The genotype data in the control group of 4010 individuals were summarized. The overall frequencies of NAT2 fast, intermediate and slow metabolism genotype were 25.79% (1034/4010), 50.87% (2040/4010) and 23.34% (936/4010), respectively, the total frequency of NAT2 non-slow metabolism genotype was 76.66% (3074/4010); the total frequencies of NAT2 fast and slow metabolism alleles were 51.19% (4096/8002) and 48.81% (3906/8002), respectively. Using 3SNP method, the sensitivity and specificity of NAT2 slow metabolism genotype inferring were 99.92% (1249/1250) and 99.81% (4190/4198), and were 100.00% (1484/1484) and 99.92% (3961/3964) in NAT2 fast metabolism genotype inferring. Using 2SNP method, the sensitivity and specificity of in NAT2 slow metabolism genotype inferring were 99.52% (1194/1250)and 98.36% (4129/4198); and in NAT2 fast metabolism genotype inferring were 93.19% (1383/1484) and 96.01% (3806/3964). There was no significant difference in the sensitivity of NAT2 slow metabolism genotypes inferred by 3SNP and 2SNP method (χ²=0.189, P=0.664), and there was high consistency between the two methods (Kappa=0.932). The sensitivity of 3SNP method in inferring of NAT2 fast metabolism genotype was higher than that of 2SNP method (χ²=10.973, P=0.001). Conclusion: Non-slow metabolic genotypes constitute the majority of NAT2 metabolic genotypes in Chinese population, and the efficiency of 3SNP method was better than 2SNP method in inferring of NAT2 genotypes.

Analysis of clinical characteristics of tuberculosis patients in vagrants and beggars in Hangzhou from 2016 to 2020

LIN Li-hua, CHEN Yuan-yuan, FANG Hang-dan

Chinese Journal of Antituberculosis. 2022, 44(6): 635-637. doi:10.19982/j.issn.1000-6621.20210669

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In order to analyze the clinical characteristics of tuberculosis patients in vagrants and beggars, the clinical data of 82 tuberculosis patients in vagrants and beggars admitted to the Tuberculosis Diagnosis and Treatment Center of Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine from January 2016 to December 2020 were collected for a retrospective study. Of the 82 cases, it was found that 76 (92.68%) were male and 6 (7.32%) were female with the average age of (41.04±12.93) years old; 54 cases (65.85%) were of initial treatment and 28 cases (34.15%) were of retreatment; drug-resistant was found in 6 cases (7.32%), all of whom were retreatment patients; bacterial positive pulmonary tuberculosis was found in 61 cases (74.39%), and 21 (25.61%) were bacterial-negative pulmonary tuberculosis; 25 cases (30.49%) complicated with extrapulmonary tuberculosis. Of the 82 patients, 64 (78.05%) complicated with pulmonary infection, 14 (17.07%) complicated with HIV/hepatitis B/syphilis, 60 (73.17%) complicated with hypoalbuminemia, 44 (53.66%) complicated with anemia, 18 (21.95%) complicated with mental disorder/intellectual disability, 19 (23.17%) complicated with diabetes, 18 (21.95%) complicated with organ failure, 9 (10.98%) complicated with shock. The results showed that the pulmonary tuberculosis patients in vagrants and beggars had high rates of positive bacteria and retreatment, in addition, poor nutritional status, many complications, and serious illnesses were also found.

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