Table of Content

10 January 2024, Volume 46 Issue 1

Previous Issue    Next Issue

Editorial

Epidemiological investigation of latent tuberculosis infection should be carried out systematically

He Yijun, Cheng Jun, Gao Lei

Chinese Journal of Antituberculosis. 2024, 46(1):  1-7.  doi:10.19982/j.issn.1000-6621.20230391

Abstract ( 430 )   HTML ( 40 )   PDF (1254KB) ( 344 )   Save

References | Related Articles | Metrics

China has a high burden of tuberculosis and huge population with latent tuberculosis infection (LTBI). Carrying out high-quality epidemiological investigation of LTBI is of great guiding significance for accurately understanding the epidemic characteristics of LTBI in China, assessing the incidence risks of different populations, conducting preventive treatment for high-risk populations, and exploring tuberculosis prevention strategies suitable for China’s national conditions. In this article, the author summarizes and introduces the necessity of carrying out epidemiological investigation of LTBI and the main technical aspects of epidemiological investigation of LTBI, hoping to provide reference for the systematic epidemiological investigation of LTBI in China.

Guideline·Standard·Consensus

Expert consensus on clinical monitoring and management of QTc interval prolongation caused by anti-tuberculous drugs

Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis, Beijing Chest Hospital, Capital Medical University

Chinese Journal of Antituberculosis. 2024, 46(1):  8-17.  doi:10.19982/j.issn.1000-6621.20230271

Abstract ( 2020 )   HTML ( 66 )   PDF (1793KB) ( 975 )   Save

Figures and Tables | References | Related Articles | Metrics

Bedaquiline, delamanid, clofazimine and fluoroquinolones such as levofloxacin and moxifloxacin are essential to improve the global cure rate of multidrug resistant and extensively drug-resistant tuberculosis. However, these drugs may lead to the prolongation of QTc interval corrected by electrocardiograph, which may cause serious adverse effects. Clinicians need to timely find, properly deal with and prevent adverse effects. This article aims at the common problems in clinical monitoring and management of QTc interval prolongation caused by anti-tuberculous drugs. According to the published research data and the application experience of participating experts, it was formed through discussion among many experts. Professional advice was given on the discovery, treatment and prevention of QTc interval prolongation caused by anti-tuberculous drugs, aiming at timely and standardized prevention and treatment of adverse reactions in the process of anti-tuberculous treatment.

Special Topic

MDR-Chin study analysis: prospects of using all-oral short-course treatment regimens for multidrug-resistant pulmonary tuberculosis in China

Fu Liang, Deng Guofang

Chinese Journal of Antituberculosis. 2024, 46(1):  18-22.  doi:10.19982/j.issn.1000-6621.20230325

Abstract ( 391 )   HTML ( 26 )   PDF (1145KB) ( 255 )   Save

References | Related Articles | Metrics

The global trend in the treatment of multidrug-resistant tuberculosis (MDR-TB) is to shorter treatment durations. The MDR-Chin study is China’s first cohort study to explore all-oral short-course regimens for the treatment of MDR-TB and pre-extensive drug-resistant tuberculosis (pre-XDR-TB), validating the efficacy and safety of three different treatment regimens. The results indicated that within a 12-month follow-up after the drug withdrawal, 96% of MDR-TB patients and 83.3% of pre-XDR-TB patients achieved favorable outcomes; the overall rate of favorable outcomes was 92.9%. Although grade 3 or higher adverse events (AEs) were quite common (48.1%), most were manageable and controllable, with relatively rare serious AEs (7.7%). In the study, loss-to-follow-up rate was low, the advantages of the all-oral short-course regimen were reflected and the potential for application in resource-limited settings was displayed. In this article, the author provides an overview of the MDR-Chin study, analyzesthe advantages and disadvantages, and discusses the application and future directions of clinical research for all-oral, short-course treatment regimens in China.

The role of community in tuberculosis prevention and control

Sun Huijuan, Chen Wei, Zhao Yanlin

Chinese Journal of Antituberculosis. 2024, 46(1):  23-28.  doi:10.19982/j.issn.1000-6621.20230401

Abstract ( 345 )   HTML ( 36 )   PDF (1195KB) ( 390 )   Save

References | Related Articles | Metrics

Tuberculosis is a contagious disease with insidiousness, long incubation period, long course of the disease, and repeated episodes. As the primary gateway for tuberculosis prevention and control, communities play an important role in active screening, treatment management, follow-up, and health promotion for tuberculosis. In this article, the author systematically summarizes the role of communities in tuberculosis prevention and control, analyzes the existing problems, and puts forward policy recommendations to strengthen community tuberculosis prevention and control work, with a view to providing a reference for formulating more effective community tuberculosis prevention and control strategies and policy measures, and developing the work of creating zero-TB community.

Original Articles

Latent tuberculosis infection rate and risk factors in patients with rheumatic diseases: a multi-center, cross-sectional study

Zhang Lifan, Ma Yanan, Zou Xiaoqing, Zhang Yueqiu, Zhang Fengchun, Zeng Xiaofeng, Zhao Yan, Liu Shengyun, Zuo Xiaoxia, Wu Huaxiang, Wu Lijun, Li Hongbin, Zhang Zhiyi, Chen Sheng, Zhu Ping, Zhang Miaojia, Qi Wencheng, Liu Yi, Liu Huaxiang, Shi Xiaochun, Liu Xiaoqing, the Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team

Chinese Journal of Antituberculosis. 2024, 46(1):  29-39.  doi:10.19982/j.issn.1000-6621.20230207

Abstract ( 359 )   HTML ( 33 )   PDF (909KB) ( 335 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: This study aimed to screen latent tuberculosis infection (LTBI) among patients with rheumatic diseases in China using the T-SPOT.TB assay and investigate factors affecting the results of T-SPOT.TB. Methods: Rheumatic diseases patients (n=3715) were enrolled from 13 tertiary hospitals in Eastern, Middle, and Western China from September 2014 to March 2016 and were screened by the T-SPOT.TB assay to detect LTBI. Basic information about the subjects were collected, including gender, age, region, body mass index, course of disease, smoking history, underlying disease, close contact history of tuberculosis patients, evidence of previous tuberculosis, the use of glucocorticoids, immunosuppressants and biologics, laboratory tests, and diagnosis of rheumatic disease, etc. Univariate analysis and multivariable logistic regression were performed to identify factors affecting the results of T-SPOT.TB. Results: out Of the 3715 patients, 672 were positive in T-SPOT.TB, the positive rate was 18.1% (95%CI: 16.9%-19.3%). There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with different types of rheumatic immune diseases (χ²=79.003, P<0.001), patients with Behcet’s syndrome had the highest positive rate (44.4%, 32/72), while patients with mixed connective tissue disease had the lowest positive rate (8.9%, 4/45). The positive rate of T-SPOT.TB test in male patients with rheumatic immune disease was 23.6% (168/711), which was significantly higher than that in females (16.8%, 504/3004, χ²=18.213, P<0.001). There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with rheumatic immune disease in different age groups (χ²=67.189, P<0.001), the 51-60 years old group had the highest positive rate (24.8%, 143/577), while the 16-20 years old group had the lowest positive rate (8.1%, 13/160). Multivariate logistic regression analysis showed that age≥41 years (aOR=1.81, 95%CI: 1.48-2.23), smoking ≥21 cigarettes/d (aOR=1.66, 95%CI: 1.15-2.40), previous history of tuberculosis (aOR=3.88, 95%CI: 2.71-5.57), and Behcet’s syndrome (aOR=3.00, 95%CI: 1.70-5.28) were independent related factors of T-SPOT.TB positive results; using high-dose hormones (aOR=0.67, 95%CI: 0.47-0.96) or biological agents (aOR=0.55, 95%CI: 0.36-0.84), low lymphocyte count (aOR=0.39, 95%CI: 0.25-0.62), hypoalbuminemia (aOR=0.72, 95%CI: 0.52-0.99), and multiple myositis/dermatomyositis (aOR=0.54, 95%CI: 0.29-0.99), systemic lupus erythematosus (aOR=0.75, 95%CI: 0.57-0.99) were independent correlation factors for negative T-SPOT.TB test results. Conclusion: Among patients with rheumatic diseases, the overall prevalence of LTBI is 18.1%. There is a significant difference in the positive rate of T-SPOT.TB test among different diseases. When patients are treated with high-dose glucocorticoids or biologics, have low lymphocyte counts, hypoalbuminemia, or suffer from systemic lupus erythematosus, more attention should be paid to potential false-negative results.

Analysis of the characteristics of tuberculin skin test reactions among college and high school freshmen in Beijing from 2020 to 2022

Zhao Xin, Zhang Yanan, Yan Yinsuo, Tao Liying, Li Yamin, Xu Yan, Gao Zhidong, He Xiaoxin

Chinese Journal of Antituberculosis. 2024, 46(1):  40-44.  doi:10.19982/j.issn.1000-6621.20230215

Abstract ( 318 )   HTML ( 31 )   PDF (836KB) ( 194 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the characteristics of tuberculin skin test (TST) reaction of freshmen enrolled in universities and high schools in Beijing from 2020 to 2022, and to provide basis for school tuberculosis prevention and control and epidemic situation. Methods: Based on the “Beijing New Student Tuberculosis Screening System” and the University New Student PPD Screening Registration Form report, the database of tuberculosis screening for new students enrolled in universities and high schools in Beijing was established, and 292486 new students enrolled in high schools and universities who had completed TST testing and retesting from 2020 to 2022 were selected as the survey objects. Among them, 159915 were newly admitted university students who underwent monitoring from 2020 to 2021, and 132571 were newly admitted high school students from 2021-2022. All the survey subjects underwent TST and completed retesting. Results: Of the subjects, 15.57% (45545/292486) had an average diameter of TST hard nodules ≥5 mm, 7.38% (21582/292486) had an average diameter of hard nodules ≥10 mm, and 2.94% (8599/292486) had an average diameter of hard nodules ≥15 mm. Among college freshmen, the positive rate in female students (9.27%, 6678/72038) was significantly higher than that in male students (8.93%, 7836/87708) based on the average diameter of hard nodules ≥10 mm, with a statistically significant difference (χ²=5.403, P=0.020). The positive rates of students from the western, central, and eastern regions were 10.95% (3757/34297), 10.15% (3642/35897), and 7.69% (6659/86580), respectively, with statistically significant differences (χ²=399.682, P<0.001). Taking the average diameter of hard nodules ≥5 mm as the positive standard, the positive rate of male students (17.56%, 15403/87708) was significantly higher than that of female students (17.03%, 12269/72038; χ²=7.769, P=0.005). Among high school freshmen, the positive rate of female students (5.62%, 3539/63018) was significantly higher than that of male students (5.06%, 3517/69553) based on the average diameter of hard nodules≥10 mm, with a statistically significant difference (χ²=20.523, P<0.001). The positive rate of patients with suspected symptoms of pulmonary tuberculosis was significantly higher than those without suspected symptoms of pulmonary tuberculosis (10.63% (17/160) vs. 5.32% (7039/132408), χ²=8.938, P=0.003). The positive rate of patients with close contact history of pulmonary tuberculosis (11.48%, 14/122) was higher than those without close contact history (4.76%, 5733/120501), and the difference was statistically significant (χ²=12.122, P<0.001). The positive rate of new students in urban six districts (5.70%, 4373/76713) was higher than that in non-urban six districts (4.80%, 2683/55858), and the difference was statistically significant (χ²=51.635, P<0.001). The overall tuberculosis detection rate among college freshmen was 33.96/100000 (129/379810), significantly higher than that of high school freshmen (15.09/100000 (20/132571)), with a statistically significant difference (χ²=12.047, P=0.001). Conclusion: The positive rate of TST and the detection rate of pulmonary tuberculosis of freshmen in Beijing’s university are higher than those of freshmen in senior high school. The infection rate of mycobacterium tuberculosis in female students, western student origin, students with suspected symptoms of pulmonary tuberculosis, and close contacts of pulmonary tuberculosis patients is relatively high, which suggests that the screening of pulmonary tuberculosis of freshmen in Beijing should be strengthened to improve the prevention and control of tuberculosis in schools.

Factors for discrepancy between two methods in testing latent tuberculosis infection and effect of preventive anti-tuberculosis treatment among prisoners

Zhang Guoqin, Wei Wenliang, Zhang Zhi, Zhang Yuhua, Zhong Da, Zhang Fan

Chinese Journal of Antituberculosis. 2024, 46(1):  45-53.  doi:10.19982/j.issn.1000-6621.20230290

Abstract ( 378 )   HTML ( 28 )   PDF (1295KB) ( 245 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To understand factors associated with discrepancy between interferon-γ release assay (IGRA) and Tuberculin Mantoux test (TST), and effect of preventive treatment in preventing tuberculosis incidence among prisoners. Methods: A community-based randomized controlled trail was conducted by selecting five prisons in a city, and allocating separate wards into intervention group and control group in each prison. The control group enrolled 981 participants, who underwent routine Tuberculosis control strategy; the intervention group enrolled 981 participants, who were tested for latent tuberculosis infection (LTBI) using IGRA and TST on the basis of routine tuberculosis control strategy, and the IGRA positive ones were provided preventive treatment under informed consent. All participants were interviewed for epidemiological information, and underwent regular chest X-ray examination every year. We analyzed factors associated with the discrepancy between results of IGRA and TST, and compared tuberculosis incidence in the following three years between the two groups. Results: The consistency between IGRA and TST was 77.93% (745/956). BCG scar (OR=1.477, 95%CI: 1.068-2.043) was associated with the discrepancy between the two testing methods. In the three years’ follow-up, tuberculosis incidence was 0% (0/157) among 157 IGRA positive participants who accepted and all completed preventive anti-tuberculosis treatment, and 2.05% (7/342) among those who did not take preventive treatment (χ²=3.259, P=0.071); the tuberculosis incidence was 0% (0/460) among IGRA negative participants, significantly lower than 2.05% (7/342) among the IGRA positive ones who didn’t take preventive treatment (χ²=9.498, P=0.002); overall, tuberculosis incidence was 0.71% (7/981) in the intervention group and 1.22% (12/981) in control group (χ²=1.329, P=0.249). Conclusion: Among prisoners, BCG vaccination is the key factor associated with the discrepancy between IGRA and TST; LTBI testing using IGRA followed by preventive treatment to the positive ones is an effective way to reduce tuberculosis incidence in prisons.

Screening of latent tuberculosis infection and analysis of morbidity influencing factors in household contacts of positive and sensitive pulmonary tuberculosis patients in Putuo District, Shanghai

Sun Jiaxuan, Liu Yan, Liang Pengfei, Zheng Yihui, Hu Yi, Chen Jing, Xu Biao

Chinese Journal of Antituberculosis. 2024, 46(1):  54-61.  doi:10.19982/j.issn.1000-6621.20230261

Abstract ( 363 )   HTML ( 30 )   PDF (866KB) ( 327 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analysed the screening of latent tuberculosis infection (LTBI) and the morbidity influencing factors in household contacts of positive and sensitive pulmonary tuberculosis (PTB) patients in Putuo District, Shanghai. Methods: This was a prospective study, the study subjects were the household contacts of positive and sensitive PTB patients who tested for Mycobacterium tuberculosis infection by γ-interferon release test in Putuo District from 2018 to 2021. After the first screen, the household contacts were followed up and tested for LTBI voluntarily within 3, 6, 12 months to calculate the cumulative infection rate. Binary logistic regression were used to analyze the risk factors of index cases on the LTBI of household contacts. The new cases were identified through the Tuberculosis Registration and Reporting System and short-term (end 202-12-03) incidence density of TB in household contacts were calculated. Results: From 2018 to 2021, a total of 168 PTB cases and 284 household contacts were enrolled in the study. The infection rate of the first screening test was 26.8% (76/284) and the cumulative infection rate was 34.5% (98/284) within one year. The results of multivariate analysis showed that the positive 2-month sputum examination of index cases was a risk factor for LTBI in household contacts (OR=7.167, 95%CI: 2.399-26.587, P=0.001). The short-term incidence density of 284 household contacts was 6.94/1000 person-years with 720.17 observation person-years. Five new cases were detected among and the short-term incidence density was 6.94/1000 person-years (5/720.17 person-years). There were no significant difference in the incidence density of PTB between LTBI household contacts (15.76/1000 person-years (4/253.83 person-years)) and non-infected individuals (2.14/1000 person-years (1/466.34 person-years))(χ²=2.607, P=0.106). Conclusion: The infection risk was high in household contacts of PTB patients. Index cases with positive 2-month sputum examination result had higher risks of generating LTBI. The timely diagnosis and effective treatment of smear-positive household contacts should be strengthened to effectively prevent the spread of tuberculosis in household contacts.

Phenotypic drug resistance spectrum analysis of adult patients with active pulmonary tuberculosis complicated with diabetes mellitus in Nanjing from 2019 to 2021

Guo Jing, Pang Jialei, Gao Weiwei, Cai Min, Lin Feishen, Zhang Xia

Chinese Journal of Antituberculosis. 2024, 46(1):  62-69.  doi:10.19982/j.issn.1000-6621.20230323

Abstract ( 271 )   HTML ( 22 )   PDF (880KB) ( 153 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the phenotypic drug resistance spectrum of adult patients with active pulmonary tuberculosis (PTB) complicated with diabetes mellitus in Nanjing, and to provide evidence for the prevention and control of tuberculosis. Methods: A retrospective study was conducted. The clinical isolates and data of 2089 adult PTB patients with culture positive were collected from the Second Hospital of Nanjing from 2019 to 2021. The patients were divided into PTB patients complicated with diabetes mellitus (comorbidity group; 544 cases) and non-diabetic PTB patients (non-comorbidity group; 1545 cases). After 1∶2 case matching by age, sex, body mass index (BMI), and history of anti-tuberculosis treatment, a total of 541 cases in the comorbidity group and 881 cases in the non-comorbidity group were included. The drug resistance spectrum of the two groups were analyzed, as well as the drug resistance spectrum and ranking of drug resistance in the comorbidity group with different levels of blood glucose. Results: The drug resistance rates of levofloxacin (13.1% (71/541)), rifampicin-susceptible and isoniazid-resistant tuberculosis (hr-TB, 10.5% (57/541)), and pre-extensive drug-resistant tuberculosis (pre-XDR-TB, 6.8% (37/541)) in the comorbidity group were higher than those in the non-comorbidity group (8.9% (78/881), 7.5% (66/881), and 4.1% (36/881)), and the differences were statistically significant (χ²=6.516, P=0.011; χ²=3.932, P=0.047; χ²=5.216, P=0.022). The resistance rate of hr-TB in the newly diagnosed comorbidity group (9.4% (41/436)) was higher than that in the non-comorbidity group (6.3% (45/717)), and the resistance rates of levofloxacin and pre-XDR-TB in the comorbidity group for retreatment cases (38.1% (40/105) and 25.7% (27/105)) were higher than those in the non-comorbidity group (22.6% (37/164) and 14.0% (23/164)), and the differences were statistically significant (χ²=3.842, P=0.049; χ²=7.561, P=0.006; χ²=5.781, P=0.016). The rates of isoniazid mono-resistance (12.8% (24/187)) and hr-TB (12.8% (24/187)) were higher in patients with uncontrolled fasting blood glucose than in those with controlled fasting blood glucose (6.4% (16/249) and 6.8% (17/249)) in the newly diagnosed comorbidity group, the differences were statistically significant (χ²=5.264, P=0.022; χ²=4.523, P=0.033). The drug resistance ranking in both the newly diagnosed and retreatment cases in the comorbidity group was isoniazid (15.1% (66/436) and 44.8% (47/105))>levofloxacin (7.1% (31/436) and 38.1% (40/105))>rifampicin (6.4% (28/436) and 36.2% (38/105))>ethambutol (2.1% (9/436) and 16.2% (17/105)). The drug resistance rate of hr-TB (9.4% (41/436)) in the newly diagnosed comorbidity group was higher than that of multidrug-resistant tuberculosis (MDR-TB)(5.7% (25/436)), and the difference was statistically significant (χ²=4.196, P=0.041). Conclusion: The rate of isoniazid-related resistance in adults with active PTB together with diabetes in Nanjing is increasing, especially in patients with newly diagnosed tuberculosis, and it is necessary to initiate isoniazid-resistance screening in patients with newly treated PTB complicated with diabetes mellitus and poor fasting blood glucose control as soon as possible.

Evaluation of the performance of InnowaveDX MTB/RIF in detecting Mycobacterium tuberculosis complex and rifampicin resistance

Liu Mei, Wu Xia, Gu Xu, Li Nana, Zhang Wanmin, Zhang Xiaoke, Lan Yuanbo

Chinese Journal of Antituberculosis. 2024, 46(1):  70-74.  doi:10.19982/j.issn.1000-6621.20230348

Abstract ( 377 )   HTML ( 25 )   PDF (838KB) ( 312 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the performance of InnowaveDX MTB/RIF (InnowaveDX) in detecting Mycobacterium tuberculosis complex (MTBC) and MTB rifampicin resistance. Methods: Using prospective research methods, 104 consecutive patients with tuberculosis related signs/symptoms or suspected tuberculosis according to chest X-ray from March 1 to June 30, 2023 in the Affiliated Hospital of Zunyi Medical University were included as research objects. Among them, 93 cases were diagnosed as tuberculosis (68 cases diagnosed with positive etiology and 25 cases diagnosed with negative etiology), and 11 cases were diagnosed as non-tuberculosis. Sputum, bronchoalveolar lavage fluid, urine, lymph node puncture fluid, cerebrospinal fluid, pus and pleural effusion of the subjects were collected for smear acid fast bacilli staining microscopy, culture, InnowaveDX and GeneXpert MTB/RIF (Xpert) detections, and the detection efficiency of InnowaveDX for tuberculosis and MTB rifampicin resistance was evaluated. Results: Based on etiology and clinical diagnosis, the sensitivity, specificity, consistency and Kappa value of InnowaveDX in detecting tuberculosis were 92.5% (86/93), 100.0% (11/11), 93.3% (97/104) and 0.72 respectively; and those of Xpert were 93.6% (87/93), 100.0% (11/11), 94.2% (98/104) and 0.75, respectively. The positive rates of InnowaveDX and Xpert in detecting sputum samples were both 91.5% (65/71), and the difference was not statistically significant(χ²=0.000, P=1.000); the positive rates of detecting other types of specimens (bronchoalveolar lavage fluid, urine, lymph node puncture fluid, cerebrospinal fluid, pus, and pleural effusion) were 95.5% (21/22) and 100.0% (22/22), respectively, with no statistically significant difference (Fisher’s exact probability method, P=1.000). Based on the results of Xpert testing for MTB rifampicin resistance, the sensitivity of InnowaveDX testing for MTB rifampicin resistance was 97.0% (32/33), the specificity was 92.2% (47/51), and the Kappa value was 0.88. Conclusion: InnowaveDX has good detection efficiency for MTBC and is suitable for different types of specimens. And the results of detecting MTB rifampicin resistance are consistent with Xpert.

Effects of air pollutants and greenness exposure on the mortality of newly treated tuberculosis patients in three cities, Anhui Province

Zhao Jiawen, Zhang Yongzhong, Li Zhenhua, Mao Yicheng, Zhang Jingjing, Hu Chengyang, Zhang Xiujun, Kan Xiaohong

Chinese Journal of Antituberculosis. 2024, 46(1):  75-84.  doi:10.19982/j.issn.1000-6621.20230310

Abstract ( 250 )   HTML ( 18 )   PDF (3039KB) ( 248 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To explore the effect of exposure to air pollutants and greenness on mortality during the treatment of newly treated tuberculosis patients, and to provide a scientific basis for the health management of tuberculosis patients at the environmental level. Methods: Data were collected from 29519 newly treated tuberculosis patients from January 1, 2015 to December 31, 2020 in Hefei City, Huainan City, and Huangshan City, Anhui Province. Data on atmospheric pollutants fine particulate matter (particulate matter with an aerodynamic diameter ≤2.5 μm, PM_2.5), inhalable particulate matter (particulate matter with an aerodynamic diameter ≤10 μm, PM₁₀), carbon monoxide (CO), and nitrogen dioxide (NO₂) were collected through environmental monitoring stations. Cox proportional risk model was applied to calculate the risk ratios (HR) and the 95% confidence intervals (95%CI) for all-cause mortality of air pollutant exposures and newly treated tuberculosis patients, and subgroup analyses were also performed combining with greenness exposure. Results: Of the 29519 tuberculosis patients, 369 (1.25%) died during treatment. The results of multifactorial Cox regression analyses showed that the risk of death increased by 15.6% with every 10 μg/m³ increasement in PM_2.5 (HR=1.156, 95%CI: 1.146-1.165), 18.3% with every 10 μg/m³ increasement in PM₁₀ (HR=1.183, 95%CI: 1.176-1.190); with every 0.10 mg/m³ increase in CO, the risk of death increased by 6.7% (HR=1.067, 95%CI: 1.060-1.074), and with every 10 μg/m³ increase in NO₂, the risk of death increased by 2.8% (HR=1.028, 95%CI: 1.019-1.037). After being divided into different groups based on greenness exposure from low to high by quartiles (Q₁ to Q₄), the effect of air pollutants on mortality rate gradually decreased with elevated greenness exposures (PM_2.5, for example, the HR values of normalized vegetation index on disease mortality rate in the 250 m and 500 m buffer zones were 1.218 (95%CI: 1.197-1.240) and 1.231 (95%CI: 1.210-1.253) for Q₁, respectively, and decreased to 1.125 (95%CI: 1.106-1.146) and 1.138 (95%CI: 1.118-1.159) for Q₄, respectively). Conclusion: Exposure to atmospheric pollutants is a risk factor during the treatment of newly treated tuberculosis patients, and higher levels of greenness can reduce the risk of mortality due to exposure to atmospheric pollutants.

Construction and validation of frailty risk prediction model in elderly patients with pulmonary tuberculosis

Kong Hanhan, Zhang Jiaohong, Zeng Jianfeng, Cao Jing

Chinese Journal of Antituberculosis. 2024, 46(1):  85-91.  doi:10.19982/j.issn.1000-6621.20230329

Abstract ( 418 )   HTML ( 28 )   PDF (1593KB) ( 280 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To establish and verify a nomogram model for predicting frailty risk in elderly patients with pulmonary tuberculosis. Methods: Of 448 elderly patients with pulmonary tuberculosis admitted to the Pulmonary Department of Shenzhen Third People’s Hospital from June 1, 2022 to October 28, 2022 were selected as the modeling set, and of 129 elderly patients with pulmonary tuberculosis admitted from December 1, 2022 to February 28, 2023 were selected as the validation set. General data questionnaire, FRAIL Scale, Barthel Index, Self-management scale for elderly patients with pulmonary tuberculosis, tuberculosis-related stigma Scale, patient health questionnaire-9, Perceived social support scale and Charlson Comorbidity Index were used to investigate. According to the FRAIL scale score, the patients in the modeling set were divided into frail group and non-frail group, and the indexes of patients in the two groups were compared,and the risk prediction model was established according to the results of binary logistic regression analysis. R software was used to draw the nomogram for the assessment of frailty risk in elderly patients with pulmonary tuberculosis. 1000 times Bootstrap self-sampling method and validation set data were used to conduct internal and external validation of the nomogram model. Results: The incidence of frailty in elderly patients with pulmonary tuberculosis was 50.78% (293/577). Binary logistic regression analysis showed that: age (OR=1.054, 95%CI:1.020-1.089), course of disease (OR=1.092, 95%CI:1.013-1.177), sputum status (OR=1.916, 95%CI:1.136-3.229), white blood cell count (OR=1.129,95%CI:1.031-1.235), hs-CRP (OR=1.007,95%CI:1.002-1.011), activities of daily living (ADL)(OR=0.970, 95%CI:0.958-0.982), depression (OR=1.110, 95%CI:1.064-1.159), self-management (OR=0.944, 95%CI:0.903-0.986) and Charlson Comorbidity Index (OR=1.477, 95%CI: 1.180-1.849) were independent factors of frailty in elderly patients with pulmonary tuberculosis. The AUC of the modeling set and validation set were 0.842 (95%CI: 0.807-0.876) and 0.859 (95%CI: 0.797-0.921). Conclusion: The incidence of frailty in elderly patients with pulmonary tuberculosis is higher, and the risk of frailty can be reduced by enhancing the ability of ADL and self-management. The risk of frailty increases with age, disease course, inflammatory markers, comorbidities, and depression scores, as well as sputum positive.The nomogram model based on the above factors can be used to predict the frailty of the elderly patients with pulmonary tuberculosis.

Transcriptomics and machine learning algorithm-based characterization of ferroptosis-related genes in tuberculosis

Ye Jiang’e, Fang Xuehui, Xiong Yanjun, Liu Shengsheng

Chinese Journal of Antituberculosis. 2024, 46(1):  92-99.  doi:10.19982/j.issn.1000-6621.20230273

Abstract ( 387 )   HTML ( 14 )   PDF (1364KB) ( 534 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the correlation between key genes associated with ferroptosis and the pathogenic mechanism of pulmonary tuberculosis using transcriptomics and machine learning methodologies. Methods: Two transcriptomic datasets were obtained, named as GSE153326 and GSE67589, through searching the NCBI GEO public repository (http://www.ncbi.nlm.nih.gov/geo) using keywords “pulmonary tuberculosis” and specific criteria such as sequencing type (transcriptomics) and species (HOMO sapiens). GSE153326 served as a training dataset, comprising eight blood samples from healthy individuals and 52 blood samples with positive Mycobacterium tuberculosis (MTB). GSE67589 served as the validation dataset, including 30 blood samples from healthy individuals and 27 MTB-positive samples. Data refinement and annotation were performed using R scripts. After identification of differentially expressed genes in the two transcriptomic datasets, gene expression related to ferroptosis (TBFerDEG) in the training dataset GSE153326 were obtained. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways for TBFerDEG was conducted. LASSO regression analysis and the SVM algorithm were applied to extract key genes associated with ferroptosis from TBFerDEG. ROC analysis was performed to explore the drug regulatory network related to these key genes. Finally, the key genes were incorporated into the validation dataset GSE67589 to validate the diagnostic performance of the ferroptosis-associated key genes identified in the training dataset. Results: Through bioinformatics analysis, a total of 416 TBFerDEGs were identified and 56 differentially expressed genes were obtained after filtering of non-matched genes. GO enrichment analysis revealed that biological processes related to ferroptosis in pulmonary tuberculosis include cellular response to chemical stress by autophagy regulation, mitochondrial autophagy, and mitochondrial disintegration. The implicated pathways encompassed the AMPK signaling pathway and ferroptosis. Through LASSO regression analysis and the SVM algorithm, five key genes associated with ferroptosis were ultimately identified, BID, AR, STK11, ALOX12, and SRC, with AUCs of 0.807, 0.858, 0.734, 0.840, and 0.880, respectively. Expression of AR (P=0.004) and SRC (P=0.017) in MTB-positive group were significantly different compared to the control group in the validation dataset. Conclusion: AR and SRC are key genes associated with ferroptosis in pulmonary tuberculosis, providing valuable insights for future basic research in this field.

Investigation and analysis of nutritional status and its influencing factors of adult inpatients with tuberculosis in Wenzhou City

Wu Lianpeng, Xia Dandan, Xu Ke

Chinese Journal of Antituberculosis. 2024, 46(1):  100-105.  doi:10.19982/j.issn.1000-6621.20230292

Abstract ( 289 )   HTML ( 15 )   PDF (840KB) ( 157 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the nutritional status and risk factors of adult tuberculosis inpatients in Wenzhou City, so as to provide reference for early nutritional intervention. Methods: A total of 740 patients with tuberculosis diagnosed in the Infection Department of Wenzhou Central Hospital from January 1 to July 5, 2023 were selected. Excluding 4 patients who could not get measured for weight due to usage of trolley or wheelchair, 2 patients with severe mental illness and 18 patients with incomplete laboratory data, 716 patients were included in the study. Demographic, clinical and laboratory data on admission were collected, including sex, age, diagnostic type of tuberculosis, type of treatment, complication, BMI, number of affected lung fields, detection of Mycobacterium Tuberculosis, drug resistance, nutritional risk screening-2002 (NRS-2002) results, serum total protein, albumin, prealbumin, hemoglobin, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), prognostic nutrition index (PNI), etc. The above data were statistically compared, and the occurrence and influencing factors of nutritional risk were analyzed. Results: Among the 716 patients, 231 patients with NRS 2002 score ≥3 were included in the nutritional risk group, and 485 patients with NRS 2002 score <3 were included in the non-nutritional risk group. The incidence of nutritional risk was 32.26% (231/716). Multivariate logistic regression analysis showed the affected lung fields >3 (OR (95%CI)=2.066 (1.349-3.165)), albumin <30 g/L (OR (95%CI)=4.468 (1.767-11.297)), prealbumin ≤200 g/L (100-200 g/L: OR (95%CI)=2.249 (1.377-3.674), <100 g/L: OR (95%CI)=5.585 (2.841-10.981)), hemoglobin ≤120 g/L (91-119 g/L: OR (95%CI)=2.205 (1.458-3.335), ≤90 g/L: OR (95%CI)=2.882 (1.374-6.047)) were risk factors of nutritional risk in patients. Conclusion: The incidence of nutritional risk of adult inpatients with tuberculosis in Wenzhou City is high. In the course of treatment, more attention should be paid to the nutritional status of these patients, especially those with affected lung fields >3, low albumin/prealbumin/hemoglobin.

Review Articles

Co-morbidity research progress of tuberculosis and depression

Sun Qingfeng, Li Haoran, Pang Yu, Gao Mengqiu

Chinese Journal of Antituberculosis. 2024, 46(1):  106-111.  doi:10.19982/j.issn.1000-6621.20230381

Abstract ( 376 )   HTML ( 24 )   PDF (842KB) ( 271 )   Save

Figures and Tables | References | Related Articles | Metrics

Tuberculosis and depression are both global public health concerns. There is a complex interplay between tuberculosis and depression. This review focuses on the literature on prevalence, risk factors, and mechanisms of interaction between these two diseases. We also summarize the progress on the diagnostic and therapeutic strategies for patients with both tuberculosis and depression. By reviewing the research progression in these comorbidities, we aim to extend our understanding on their underlying interaction, which is of great importance for formulating effective strategies on clinical management of these patients, and pointing out the avenues of future research.

Progress in catastrophic health expenditures for tuberculosis

Wang Jiani, Xi Mingxia

Chinese Journal of Antituberculosis. 2024, 46(1):  112-118.  doi:10.19982/j.issn.1000-6621.20230345

Abstract ( 306 )   HTML ( 15 )   PDF (920KB) ( 238 )   Save

Figures and Tables | References | Related Articles | Metrics

China is one of the countries with the highest number of tuberculosis cases and high burden in the world, and the heavy catastrophic health expenditure poses a daunting task and challenge to patients, families and society in China, making it impossible to implement tuberculosis prevention and control measures thoroughly. The authors reviewed the definition, research status, and influencing factors of catastrophic health expenditure, aiming to explore the research deficiencies in China, provide suggestions and references for future research and policy-making.

Research progress of GeneXpert MTB/RIF stool test in children tuberculosis

Li Xiaoying, Fang Yulian, Ning Jing, Xu Yongsheng

Chinese Journal of Antituberculosis. 2024, 46(1):  119-123.  doi:10.19982/j.issn.1000-6621.20230300

Abstract ( 338 )   HTML ( 16 )   PDF (839KB) ( 248 )   Save

References | Related Articles | Metrics

Difficulties in obtaining specimens and low positive rates in pathogen diagnosis exist in pediatric active tuberculosis. Xpert, a real-time fluorescence quantitative nucleic acid amplification test for Mycobacterium tuberculosis (MTB) and rifampin resistance, is rapid and provides a reliable basis for the diagnosis of tuberculosis with high sensitivity and specificity. Currently, this method has been widely used for sputum or gastric fluid test, and the application value of fecal samples in pulmonary tuberculosis diagnosis has been almost affirmed, while further research is still needed for extra-pulmonary tuberculosis. This article reviewed the use of this method for detecting MTB in fecal samples of children with tuberculosis, aiming to provide reference for the clinical application of Xpert in fecal testing for children.