Table of Content

10 January 2025, Volume 47 Issue 1

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Guideline·Standard·Consensus

Expert consensus on diagnosis and treatment of spinal tuberculosis with HIV/AIDS (2nd Edition)

Expert Consensus on the Diagnosis and Treatment of Spinal Tuberculosis Combined with HIV/AIDS Patients Group, Combined with HIV/AIDS Patients Group Chinese Antituberculosis Association, Chinese Antituberculosis Association of STD and AIDS Prevention and Control, the Western China Bone Tuberculosis Alliance, the North China Bone the North China Bone

Chinese Journal of Antituberculosis. 2025, 47(1):  1-11.  doi:10.19982/j.issn.1000-6621.20240411

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Patients with spinal tuberculosis co-infected with HIV/AIDS are profoundly immunocompromised, significantly complicating their clinical management. To establish standardized protocols for diagnosing and treating this dual pathology, thereby enhancing clinical understanding and providing evidence-based treatment guidelines, the Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, in collaboration with the Western China Bone Tuberculosis Alliance, the North China Bone Tuberculosis Alliance, and the Editorial Board of Chinese Journal of Antituberculosis, formulated and released the Expert consensus on the diagnosis and treatment of patients with spinal tuberculosis complicated with HIV/AIDS in May 2020. The consensus opens with an overview of the epidemiological context of spinal tuberculosis complicated by HIV/AIDS. It provides a detailed discussion on the common clinical manifestations, laboratory diagnostic criteria, as well as pharmacological and surgical treatment options. Furthermore, it addresses critical aspects such as occupational exposures, necessary precautions during surgery, and outlines future research directions for the management of spinal tuberculosis complicated by HIV/AIDS. Building upon the first edition of the consensus, and incorporating both the clinical experience and diagnostic and therapeutic approaches for spinal tuberculosis complicated by HIV/AIDS in China, as well as relevant international research findings, the consensus writing group has jointly developed the second edition of the Expert consensus on diagnosis and treatment of spinal tuberculosis with HIV/AIDS. This updated version highlights recent epidemiological trends over the past five years, advances in preoperative antiviral therapy, and the evolving anti-tuberculosis treatment regimens for drug-resistant tuberculosis. The consensus also discusses the advancements in minimally invasive surgery for the treatment of spinal tuberculosis complicated by HIV/AIDS, as well as the potential application of accelerated recovery surgery principles in the management of these patients. The aim is to provide clinicians with a comprehensive framework for accurate diagnosis and evidence-based treatment of spinal tuberculosis complicated by HIV/AIDS.

Special Topic

Implementation update of strategy for the control of tuberculosis and HIV/AIDS co-infection in China

Zhang Guoqin, Qu Ting, Meng Qinglin, Zhou Lin, Liu Eryong

Chinese Journal of Antituberculosis. 2025, 47(1):  12-17.  doi:10.19982/j.issn.1000-6621.20240331

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Tuberculosis (TB) and AIDS are both serious infectious diseases in the world. TB is a commonly opportunistic infection and the major cause of death among HIV/AIDS patients, and meanwhile the HIV/AIDS dramatically increases risk of TB incidence. The TB-HIV/AIDS co-infection mutually exacerbates progression of the diseases, making it a serious threat to public health globally. The author made a review to the prevalence and control strategy of TB-HIV/AIDS co-infection, and proposed the main problems and countermeasures.

Construction, application and prospect of integrated management information system for tuberculosis prevention and control in Shanghai

Rao Lixin, Wu Zheyuan, Chen Jing, Mao Dan, Liu Xinghang, Shen Xin, Chen Xin

Chinese Journal of Antituberculosis. 2025, 47(1):  18-21.  doi:10.19982/j.issn.1000-6621.20240307

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Information system plays an increasingly important role in the prevention and control of infectious diseases owing to the rapid development of information technology and the widespread popularization of the internet. Shanghai Tuberculosis Management Information System has been prepared since 2010, and in 2015 it was officially put into use and accomplished data interchange with National Tuberculosis Management Information System. The authors summarized the experience and practice of tuberculosis information construction in Shanghai, comprehensively introduces the overall planning of Shanghai Tuberculosis Management Information System, reviewed the system construction, transformation and application in more than ten years, and prospects the subsequent function expansion and intelligent application of the system.

Original Articles

Prevalence of active tuberculosis in Chinese patients with rheumatic diseases: A multicenter cross-sectional subgroup analysis

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

Chinese Journal of Antituberculosis. 2025, 47(1):  22-28.  doi:10.19982/j.issn.1000-6621.20240283

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Objective: This study aimed to investigate the prevalence of active tuberculosis (ATB) among patients with rheumatic diseases (RD) in China. Methods: Using a stratified multi-stage cluster sampling method, a total of 13550 RD patients who underwent ATB screening from 13 tertiary hospitals in the eastern, central, and western regions of China between September 2014 and March 2016 were included in the survey. Participants underwent screening for ATB, and the prevalence of ATB was calculated. Subgroup analyses were performed based on RD subtype, age, and sex. Results: Among the 13550 surveyed subjects, 105 case diagnosed with ATB, 48 (45.7%) exhibited no classical symptoms such as cough, sputum production, fever, night sweats, or weight loss. Of those with microbiological and/or pathological confirmation of ATB, 35.3% (12/34) were asymptomatic, while the asymptomatic rate was 30.8% (8/26) among patients with bacteriologically confirmed pulmonary tuberculosis (PTB). Extrapulmonary tuberculosis (EPTB) was identified in 41 cases (39.0%), with 28 cases (68.3%) being exclusively EPTB and 13 cases (31.7%) involving combined pulmonary and extrapulmonary disease. The highest prevalence of ATB was observed in patients with systemic vasculitis syndrome, reaching 1915/100000 (13/679; 95%CI: 881/100000-2948/100000), followed by patients with diffuse connective tissue diseases, at 1002/100000 (58/5789; 95%CI: 745/100000-1259/100000). Among RD patients, the 16-34 age group exhibited the highest ATB prevalence, recorded at 1162/100000 (43/3700; 95%CI: 817/100000-1508/100000). Males demonstrated a higher prevalence (919/100000, 30/3264; 95%CI: 592/100000-1247/100000) compared to females (729/100000, 75/10286; 95%CI: 565/100000-894/100000). Conclusion: Patients with RD in China carry a substantial burden of subclinical TB, EPTB, and disseminated TB. The prevalence of ATB shows marked differences across RD subtypes, age groups, and genders.

The epidemiological characteristics and trends of tuberculosis among children aged 0-14 years in Hunan Province from 2014 to 2023

Liang Linlong, Pei Yi, Zhou Haiyi, Xie Qifang, Zhang Feng, Jiang Jie, Liu Fuqiang

Chinese Journal of Antituberculosis. 2025, 47(1):  29-35.  doi:10.19982/j.issn.1000-6621.20240341

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Objective: To analyze the epidemiological characteristics and trends of tuberculosis among children aged 0-14 years in Hunan Province from 2014 to 2023, and to provide references for the formulation and adjustment of pediatric tuberculosis prevention and control policies. Methods: The surveillance data of tuberculosis among children aged 0-14 years in Hunan Province from 2014 to 2023 were collected from the Infectious Disease Surveillance System. The epidemiological characteristics of tuberculosis among children aged 0-14 years were analyzed during the study period, and the incidence trend was analyzed using Joinpoint regression model. Results: From 2014 to 2023, a total of 3350 cases of tuberculosis among children aged 0-14 were reported cumulatively in Hunan Province, with an average annual reported incidence rate of 2.64/100000, and the reported incidence rate increased from 1.80/100000 (220 cases) in 2014 to 3.19/100000 (384 cases) in 2023, with an overall upward trend ($\chi_{\text {trend }}^{2}$=82.928, P<0.001). The average annual incidence was 2.46/100000 (1691 cases) in boys and 2.85/100000 (1659 cases) in girls, and the reported incidence for girls was higher than those for boys, with a statistically significant difference (χ²=17.870, P<0.001). The reported incidence of tuberculosis among children aged 0-14 in Hunan Province from 2014 to 2023 showed an overall upward trend in Joinpoint regression analysis, with an average annual increase of 5.759% (AAPC=5.759%, 95%CI: 0.245%-11.577%, t=2.411, P=0.042). The variation tendency of girls was similar to that of all children, with an average annual increase of 7.511% (AAPC=7.511%, 95%CI: 0.471%-15.044%, t=2.466, P=0.039), and there was no statistically significant difference in the trend for boys (AAPC=4.066%, 95%CI: ―0.548%-8.893%, t=2.027, P=0.077). A total of 1030 cases with positive etiological test were reported, accounting for 30.75% (1030/3350) of all reported pediatric tuberculosis cases. The proportion of etiology positive tests increased from 21.82% in 2014 (48/220) to 41.41% in 2023 (159/384), showing a yearly increasing trend ($\chi_{\text {trend }}^{2}$=139.436, P<0.001). The most cases were reported in October (12.21%, 409/3350), and the cases reported throughout the year were mainly concentrated in July-October (44.99%, 1507/3350). Conclusion: From 2014 to 2023, the reported incidence of tuberculosis among children aged 0-14 years in Hunan Province generally showed an upward trend, and the number of cases with etiology positive also increased year by year. The active surveillance efforts should be continued, and the prevention and control strategies should be adjusted in combination with the actual incidence of tuberculosis among children in various regions.

Characteristics and treatment outcome analysis of MTB/HIV dual infection patients in Guizhou Province from 2018 to 2023

Li Fudong, Ma Xiaoxue, Zhou Jian, Wang Dafu, Zhang Yueying, Gong Tingting, Rao Wen, Hong Feng, Li Shijun, Li Jinlan

Chinese Journal of Antituberculosis. 2025, 47(1):  36-43.  doi:10.19982/j.issn.1000-6621.20240317

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Objective: Analyze characteristics and treatment data of rifampicin sensitive MTB/HIV dual infection patients in Guizhou Province from 2018 to 2023, providing reference basis for optimizing tuberculosis prevention and control measures of Guizhou Province. Methods: The registration information of rifampicin sensitive MTB/HIV dual infection patients in Guizhou Province from 2018 to 2023 was obtained through the “Tuberculosis Information Management System”, a subsystem of the “China Disease Prevention and Control Information System”, and their characteristics and treatment outcomes were analyzed. Results: From 2018 to 2023, there were a total of 2021 rifampicin sensitive MTB/HIV dual infection cases in Guizhou Province. Age, gender, ethnicity, and occupation were related to MTB/HIV dual infection, with 50.32% (1017/2021) cases aged 40-59, 79.76% (1612/2021) being male, 69.12% (1397/2021) being Han, and 77.29% (1562/2021) being farmers; 1663 cases were successfully treated, with an overall success rate of 82.29% (1663/2021). The successful treatment rates of year 2021 to 2023 showed a downward trend ($\chi_{\text {trend }}^{2}$=7.232, P=0.007), with the proportion of cured cases increasing from 48.79% (161/330) in 2021 to 53.20% (183/344) in 2023, and the proportion of non-tuberculosis deaths increasing from 10.61% (35/330) in 2021 to 17.44% (60/344) in 2023. The results of multivariable logistic regression analysis showed that compared with new patients, the risk of adverse outcomes was higher for retreatment patients who had experienced a treatment failure previously (OR=5.386,95%CI:1.656-17.516); compared with patients taking 2H-R-Z-E/10H-R-E as primary treatment regime, the risks of adverse outcomes were lower for patients taking 2H-R-Z-E/4H-R (OR=0.433,95%CI:0.309-0.606) and 2H-R-Z-E/7-10H-R-E (OR=0.497,95%CI: 0.302-0.818). Conclusion: From 2018 to 2023, the majority of patients with rifampicin sensitive MTB/HIV dual infection in Guizhou Province were male, Han, farmers, and aged 40 to 59. During treatment, attention should be paid to treating opportunistic infections and managing complications, improving treatment compliance and regularity according to the course of treatment, to increase the treatment success rate of patients.

Analysis of mortality trend of pulmonary tuberculosis cases with an age-period-cohort model in Guangzhou City, 2011—2020

Li Xueqiu, Liu Qun, Tang Ke, Wu Di

Chinese Journal of Antituberculosis. 2025, 47(1):  44-50.  doi:10.19982/j.issn.1000-6621.20240323

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Objective: Analyze pulmonary tuberculosis caused mortality rate and its changing trend in Guangzhou City from 2011 to 2020, in order to provide a scientific basis for formulating prevention and control strategies and measures. Methods: The Joinpoint regression model was used to analyze the change trend of tuberculosis mortality rates in all age groups in Guangzhou from 2011 to 2020. Annual percent change (APC) and average annual percent change (AAPC) were calculated. Age-period-cohort model was used to analyze the age, period and cohort effects on risk of pulmonary tuberculosis caused death in 20-85 years old populations in Guangzhou. Results: From 2011 to 2020, 2144 cases died of pulmonary tuberculosis were reported in Guangzhou, with an average annual standardized mortality rate of 2.57/100000. The standardized mortality rate of male was 4.19/100000, about 4.4 times of that of females (0.96/100000). The age-standardized mortality rates showed a decreasing trend in the past 10 years, AAPC was ―4.15% (95%CI: ―6.41%-―1.85%, P=0.003). The mortality rates decreased faster in females (AAPC=―6.72%, 95%CI: ―10.38%-―2.92%, P=0.004) than in males (―3.55%, 95%CI: ―6.19%-―0.85%, P=0.017). For different age groups, the mortality rates of pulmonary tuberculosis in 0-49 years old group and ≥65 years old group showed significant downward trends, their AAPC were ―7.05% (95%CI: ―11.52%-―2.34%, P=0.009) and ―3.94% (95%CI: ―6.22%-―1.62%, P=0.005) respectively. The age-period-cohort model showed that risk of tuberculosis death increased with age, particularly in people over 65 years old, from 2.93/100000 in the 66-67 age group to 6.10/100000 in the 84-85 age group. The period effect showed that the overall risk of tuberculosis death showed a downward trend with the change of period, risk ratio (RR) decreased from 1.35 in the 2011—2012 period group to 0.81 in the 2019—2020 period group. The cohort effect showed a lower risk of tuberculosis death for those born later, with RR decreasing from 5.91 in the 1926—1927 born cohort to 0.16 in the 1998—1999 born cohort. Conclusion: The mortality rate of pulmonary tuberculosis in Guangzhou showed a decreasing trend, but there was a large gap between male and female. It is necessary to focus on men and elderly people over 65 years old and implement targeted prevention and treatment measures.

Evaluation the efficacy of tongue swab-based PCR fluorescence probe method for pulmonary tuberculosis

Chen Jifei, Huang Lihua, Luo Lanbo, Sui Wenxian, Pang Yu, Liu Aimei

Chinese Journal of Antituberculosis. 2025, 47(1):  51-60.  doi:10.19982/j.issn.1000-6621.20240324

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Objective: To evaluate the diagnostic accuracy of tongue swab-based PCR fluorescence probe method for pulmonary tuberculosis (PTB), analyze the consistency across various PTB diagnostic methods, and explore its application value in the diagnosis of PTB. Methods: A prospective study was conducted to recruit 76 suspected PTB patients who sought health care in Guangxi Chest Hospital from January to March 2024. Clinical symptoms and laboratory results, including sputum smear microscopy, GeneXpert MTB/RIFXpert, and tuberculous infection T-lymphocyte spot tests, were collected. The tongue swab method utilized a nucleic acid detection kit for Mycobacterium tuberculosis complex. Using sputum culture or microbiological reference standard (MRS) as reference standard, parameters with high diagnostic efficacy were selected through baseline comparison, univariate ROC analysis, variable correlation analysis, Lasso regression, and forest plots to fit a model for PTB diagnosis consistency analysis was conducted to compare the tongue swab method with the existing PTB diagnostic methods including Xpert, sputum culture, and smear. Results: Using sputum culture as the reference, there were statistically significant differences among Xpert (χ²=49.045, P<0.001), tongue swab method (χ²=42.626, P<0.001), and sputum smear (χ²=17.443, P<0.001) between positive and negative groups. AUCs were ranked as follows: Xpert (AUC=0.902), tongue swab method (AUC=0.875), and sputum smear (AUC=0.709). Model fitting indicated that Xpert combined with the tongue swab method was the optimal diagnostic model. Univariate ROC and comparative analysis showed that Xpert outperformed the tongue swab method (AUCs of 0.902 and 0.875, sensitivities of 87.10% and 83.87%, specificities of 93.33% and 91.11%, respectively; P<0.001 for both), although the difference was not statistically significant (Z=0.795, P=0.427). Using MRS as a reference, significant differences were found for the tongue swab method (χ²=46.723, P<0.001) and sputum smear (χ²=23.262, P<0.001) between MRS positive and negative groups, with AUCs of 0.888 for the tongue swab method and 0.738 for sputum smear. Model fitting selected the tongue swab method as the optimal diagnostic model. Univariate ROC analysis indicated that the tongue swab method significantly outperformed sputum smear (AUCs of 0.888 and 0.738, sensitivities of 82.35% and 50.00%, specificities of 95.24% and 97.62%, P<0.001 for both), with a significant difference (Z=2.889, P=0.004). The tongue swab method demonstrated high consistency with MRS (Kappa=0.7847) and Xpert (Kappa=0.8348), with an overall consistency rate of 92.11%. Conclusion: Regardless of whether sputum culture or MRS is used as a reference, the tongue swab method shows a diagnostic accuracy comparable to that of Xpert and significantly superior to sputum smear, suggesting its potential as a valuable diagnostic method for PTB.

The evaluation of the smear-positive and Xpert-negative outcome as an early indicator of nontuberculous mycobacteria existence in clinical specimen

Zhao Yue, Wang Haoran, Cheng Meijin, Wang Wei, Liang Ruixia, Huang Hairong

Chinese Journal of Antituberculosis. 2025, 47(1):  61-65.  doi:10.19982/j.issn.1000-6621.20240300

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Objective: To evaluate the diagnostic reliability of smear-positive/Xpert-negative results as an early predictor for the presence of non-tuberculous mycobacteria (NTM) in clinical specimens. Methods: A retrospective analysis was conducted on laboratory examination data from patients newly diagnosed with pulmonary diseases at Henan Chest Hospital between January 2019 and April 2024. The dataset included cases with positive smear microscopy results and those with NTM confirmed by isolation and culture. The accuracy of smear-positive/Xpert-negative results as a predictive indicator for NTM isolation and identification was assessed. The proportion of patients diagnosed with NTM during the study period who presented smear-positive/Xpert-negative results was analyzed to evaluate the sensitivity of this predictive indicator. Additionally, the proportion of smear-positive tuberculosis patients with negative Xpert test results was examined to determine the specificity of this indicator. Results: Among the smear-positive patients included in the study, 8.22% (202/2458) exhibited negative Xpert test results during the same period. Of the 148 patients with smear-positive/Xpert-negative results and concurrent culture-based identification, 138 cases (93.24%) were confirmed as NTM through culture, demonstrating the high accuracy of smear-positive/Xpert-negative results as an early predictor for NTM in clinical specimens. When the additional criterion of a negative interferon-gamma release assay (IGRA) result was applied, the predictive accuracy increased to 100.00% (73/73). However, this refinement significantly reduced the sensitivity of the prediction to 37.61% (44/117). The sensitivity of smear-positive/Xpert-negative results in predicting the presence of NTM was 39.78% (109/274) among patients with NTM disease. Conversely, the specificity of this indicator was remarkably high at 99.56% (2256/2266) among patients with smear-positive tuberculosis. Conclusion: In patients suspected of tuberculosis, smear-positive/Xpert-negative results serve as an early and reliable predictor for the identification of NTM.

Study on serum TNFSF14 and sIL-2R levels in elderly patients with pulmonary tuberculosis and their correlation with short-term prognosis

Pan Meimin, Li Wenjuan, Zhang Xuehong, Yang Lihui, He Juan, Tan Yongwei

Chinese Journal of Antituberculosis. 2025, 47(1):  66-71.  doi:10.19982/j.issn.1000-6621.20240226

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Objective: To analyze the changes of serum tumor necrosis factor superfamily member 14 (TNFSF14) and Soluble interleukin 2 receptor (sIL 2R) levels in elderly patients with pulmonary tuberculosis and their correlation with short-term prognosis. Methods: A total of 80 elderly patients with pulmonary tuberculosis who admitted to the First Hospital of Changsha City from June 2019 to July 2022 were selected as the observation group, and other 80 elderly healthy persons who received physical examinations during the same period were selected as the control group. The patients in observation group were followed up for 3 months after treatment and were divided into good prognosis group (65 cases) and poor prognosis group (15 cases) according to their short-term prognosis. Logistic regression was used to analyze the relevance between serum TNFSF14, sIL-2R and short-term prognosis. Results: The serum TNFSF14 level and sIL-2R level in the observation group were (12.55±1.20) ng/L and (255.80±25.15) pmol/L respectively, which were higher than those in the control group ((3.80±0.53) ng/L and (100.96±10.10) pmol/L). The differences were statistically significant (t=9.434, P<0.001; t=8.166, P<0.001). After the patients in the observation group received treatment, a 3-month follow-up found that 10 cases (12.50%) were cured, 55 cases (68.75%) were effective and 15 cases (18.75%) were ineffective. So a total of 65 cases (81.25%) had good prognosis, while 15 cases (18.75%) had poor prognosis. The serum TNFSF14 level and the serum sIL-2R level of the patients in the poor prognosis group were (14.35±1.51) ng/L and (275.64±27.10) pmol/L respectively, which were higher than those in the good prognosis group ((12.09±1.18) ng/L and (253.33±25.13) pmol/L). The differences were statistically significant (t=6.334, P<0.001; t=3.055, P=0.003). The positive rate of sputum bacteria in poor prognosis group (93.33% 14/15) was higher than that in good prognosis group (58.46%, 38/65), and the difference was statistically significant (χ²=6.515, P=0.011). Logistic regression analysis results showed that the increased levels of serum TNFSF14 (OR=8.913, 95%CI: 1.993-48.002), sIL-2R (OR=7.132, 95%CI: 1.054-35.172) and positive sputum bacteria (OR=9.947, 95%CI: 1.233-80.253) were risk factors for poor prognosis in elderly patients with pulmonary tuberculosis. The results of ROC curve showed that the AUC of serum TNFSF14 alone, sIL-2R alone and their combination in predicting the short-term prognosis of elderly patients with pulmonary tuberculosis were 0.703 (95%CI: 0.549-0.857), 0.726 (95%CI: 0.579-0.873) and 0.901 (95%CI: 0.818-0.999), respectively. Conclusion: Serum TNFSF14 and sIL-2R are at high levels in elderly patients with pulmonary tuberculosis, and the high level of TNFSF14 and sIL-2R will increase the risk of short-term poor prognosis in patients. In clinical practice, the levels of both serum TNFSF14 and sIL-2R should be closely monitored to predict the occurrence of poor prognosis in patients.

Oleic acid upregulates the expression of perilipin 2 enhancing macrophage clearance of Mycobacterium tuberculosis

Lu Hailin, Wang Wenfei, Tao Wenhui, Lin Peicong, Chen Xinchun, Deng Guofang, Xie Shuixiang

Chinese Journal of Antituberculosis. 2025, 47(1):  72-76.  doi:10.19982/j.issn.1000-6621.20240489

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Objective: To investigate the role of oleic acid (OA) in the clearance of Mycobacterium tuberculosis (MTB) by macrophages and explore the underlying mechanisms. Methods: Macrophages induced from the human monocyte leukemia cell line (THP-1) were infected with the standard MTB strain H37Ra with or without oleic acid. The effect of oleic acid on the clearance of MTB by macrophages was assessed using colony-forming unit (CFU). Key target genes were identified through RNA-seq, and relevant pathways were determined using gene enrichment analysis. Real-time quantitative PCR was used for validating gene expression. Results: After 72 hours of infection with H37Ra, the CFU for macrophages (H37Ra group) was 49×10⁴ (48×10⁴, 59×10⁴), significantly higher than that of macrophages induced with oleic acid (OA+H37Ra group) at 34×10⁴ (30×10⁴, 42×10⁴) (U=3.500, P=0.017). RNA-seq data showed that the expression of recombinant perilipin 2 (PLIN2) in the OA+H37Ra group was significantly higher than in the H37Ra group. In oleic acid-induced macrophages, the CFU in the PLIN2 knock down group was 86×10⁴ (78×10⁴, 96×10⁴), significantly higher than that in the control group (56×10⁴ (54×10⁴, 62×10⁴); U=3.000, P=0.015). In the OA+H37Ra group, the relative expression of PLIN2 was 3.219±0.298, significantly higher than the 0.555±0.028 in the H37Ra group (t=15.410, P<0.01). The relative expression of PPARγ in the OA+H37Ra group was 0.666±0.075, significantly lower than the 2.217±0.153 in the H37Ra group (t=14.700, P<0.01). In the OA+H37Ra group, the relative expression of ACOX1 and HADHA was 1.410±0.124 and 1.107±0.111, both significantly lower than the H37Ra group of 2.476±0.207 and 3.140±0.240 (t=13.520, P<0.01; t=12.760, P<0.01) respectively. Conclusion: Oleic acid regulates fatty acid oxidation in macrophages through the lipid droplet surface protein PLIN2, promoting the clearance of MTB by macrophages.

Meta-analysis of the efficacy, adverse reactions, and fatality rate of glucocorticoid combined with anti-tuberculosis drugs in the treatment of tuberculous serositis

Shi Yilin, Gu Yan

Chinese Journal of Antituberculosis. 2025, 47(1):  77-86.  doi:10.19982/j.issn.1000-6621.20240497

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Objective: To systematically evaluate the efficacy, adverse reactions and mortality of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis. Methods: Randomized controlled trials (RCTs) of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis were retrieved from CNKI, Wanfang, VIP, China Biomedical Literature Database, PubMed and Web of Scienceby using a combination of subject words and free words, and references in research articles were included. The search period was from the establishment of the database to August 1, 2024. Chinese search terms include extra pulmonary tuberculosis, tuberculous meningitis, tuberculous pleurisy, tuberculous pericarditis, glucocorticoids, steroid hormones, dexamethasone, methylprednisolone, etc.; English search terms include tuberculosis, tuberculous meningitis, tuberculous pleurisy, tuberculous pericarditis, glucocorticoids, steroid hormones, dexamethasone, methylprednisolone, etc. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature, and then used Stata 15.1 software to analyze the heterogeneity of the included data and analyze the publication bias to comprehensively evaluate the efficacy, adverse reactions and mortality of tuberculous serositis after glucocorticoids on the basis of anti-tuberculosis therapy. Results: A total of 4619 related literatures were retrieved.After excluding the literatures that did not meet the inclusion criteria, 31 literatures and 2410 patients were included for meta-analysis. Among them,1228 patients in the anti-tuberculosis therapy combined with glucocorticoids therapy group (experimental group) and 1182 patients in the anti-tuberculosis treatment group (control group). According to the type of disease, the patients were further divided into tuberculous meningitis group (including 23 studies, 876 cases in the experimental group and 876 cases in the control group), tuberculous pleurisy group (including 6 studies, 280 cases in the experimental group and 276 cases in the control group) and tuberculous pericarditis group (including 2 studies, 72 cases in the experimental group and 30 cases in the control group). The results of meta-analysis showed that the combination of glucocorticoids was more effective in the treatment of tuberculous meningitis, tuberculous pleurisy, and tuberculous pericarditis compared with the control group (OR(95%CI)=4.63 (3.48-6.17), 6.62 (3.55-12.34), 7.92 (2.44-25.66)), and the mortality rate against tuberculous meningitis was lower (OR (95%CI)=0.45 (0.23-0.87)), and there were fewer adverse reactions to tuberculous pleurisy (OR(95%CI)=0.31 (0.18-0.52)). Conclusion: Glucocorticoids combined with anti-tuberculosis drugs therapy can improve the efficacy of tuberculous meningitis, tuberculous pleurisy and tuberculous pericarditis, and reduce the mortality rate of tuberculous meningitis and the adverse drug reactions of tuberculous pleurisy.

Clinical characteristics and surgical outcomes of 12 cases of non-tuberculous mycobacterial spondylitis

Fan Jun, Wang Heng, Lan Tinglong, Dong Weijie, Tang Kai, Li Yuan, Yan Guangxuan, Xu Shangsheng, Kang Zhigang, Qin Shibing

Chinese Journal of Antituberculosis. 2025, 47(1):  87-95.  doi:10.19982/j.issn.1000-6621.20240258

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Objective: To investigate the clinical characteristics of patients with non-tuberculous mycobacterial (NTM) spondylitis, aiming to enhance the quality of clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on the clinical data of 12 patients with NTM spondylitis who underwent surgical treatment at the Department of Orthopedics, Beijing Chest Hospital Affiliated with Capital Medical University, the Fourth People’s Hospital of Qinghai Province, and Harbin Chest Hospital Affiliated with Harbin Medical University, from January 2023 to September 2024. The analysis included patient demographics, clinical symptoms and signs, lesion location, pre-admission diagnosis and treatment, laboratory and imaging findings, drug treatment regimens, surgical interventions, prognosis, and follow-up outcomes. Results: All 12 patients with NTM spondylitis had one or more underlying conditions or diseases associated with immunosuppression. The time from disease onset to diagnosis ranged from 12 to 24 months. Among these patients, 8 had received anti-tuberculosis treatment for 1 year or more, while 4 had undergone such treatment for 6 to 9 months. Three patients underwent MGIT 960 liquid culture, with only 1 patient subsequently tested for TB-DNA. Next-generation sequencing (NGS) was performed on 5 patients, pathological DNA diagnosis on 2 patients, and combined NGS and pathological DNA characterization on 2 patients. Ultimately, 8 different NTM species were identified, predominantly including the M.avium complex, M.intracellulare, and M.abscessus complex. Preoperative anti-NTM treatment consisted of a 6-week regimen for 7 patients, an 8-week regimen for 4 patients, and a 4-week regimen for 1 patient with concurrent pulmonary infection. Among these patients, 3 underwent posterior-only surgical intervention, while 1 patient received anterior-only surgery due to severe bone destruction. Of the 8 patients who required reoperation, 5 underwent combined anterior and posterior procedures, 1 had anterior-only surgery, and 2 underwent sinusectomy. Three patients required a third-stage operation or an additional sinusectomy. Postoperative anti-NTM therapy and rehabilitation training were maintained for 8 to 12 months. At the 2-year follow-up, 8 patients achieved complete recovery, while 4 patients continued to have sinus tracts or residual cavities, including 1 patient who ceased treatment after undergoing 7 surgical procedures. Conclusion: NTM spondylitis often presents with a clear history of occupational exposure and diverse infection strains, frequently resulting in long-term misdiagnosis and inappropriate treatment due to insufficient strain identification, thereby prolonging the disease course. Pathological and molecular biological testing can facilitate definitive diagnosis. Surgical intervention is the primary treatment for patients with chronic disease progression and severe spinal damage, achieving a cure rate of approximately two-thirds but carrying a significant risk of reoperation. Therefore, accurate identification of the causative pathogens and timely preoperative diagnosis are essential. Adequate and targeted anti-NTM therapy should be administered promptly to minimize the risk of postoperative sinus formation and abscess exacerbation, ensuring favorable surgical outcomes.

Review Articles

Research progress on active case finding of tuberculosis in the elderly population: a literature review

Sun Danyuchen, Liu Yuhong

Chinese Journal of Antituberculosis. 2025, 47(1):  96-101.  doi:10.19982/j.issn.1000-6621.20240419

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Tuberculosis (TB) remains a major infectious disease that poses a significant threat to global public health, with an increasing burden among the elderly population. China is one of the countries with high TB burden, and the aging trend has been severe in recent years. Therefore TB prevention and control among the elderly population is crucial to the target of ending TB, especially the TB case finding among aged patients. The author reviewed and summarized domestic and international research literature on active screening for TB in the elderly population, providing an overview of current epidemiological status of tuberculosis in the elderly population, the approaches for conducting active screening, the factors affecting screening effectiveness, and existing challenges. The aim is to elucidate the importance and necessity of implementing active case-finding strategies in the elderly population.

Interaction between lung cancer and tuberculosis in disease development and progression

Liu Ruihua, Sarina , Wang Furong

Chinese Journal of Antituberculosis. 2025, 47(1):  102-111.  doi:10.19982/j.issn.1000-6621.20240353

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Lung cancer is the primary cause of cancer-related mortality in China, a nation with a notably high prevalence of Mycobacterium tuberculosis (MTB) infection. Consequently, a significant population suffers from concurrent tuberculosis and lung cancer. MTB infection reshapes the host immune system, fostering a microenvironment conducive to the initiation and progression of lung cancer.Current monotherapies targeting either pulmonary tuberculosis or lung cancer exhibit limited effectiveness in managing patients with both conditions and may even lead to mutual interference. This review synthesizes evidence from PubMed and Chinese databases, offering an in-depth analysis of the mechanisms by which MTB infection facilitates lung cancer development and progression. Furthermore, it examines the overlapping clinical manifestations of these diseases, which complicate accurate diagnosis, and discusses potential strategies for integrated treatment.

Short Articles

Gingival tuberculosis:a case report and literature review

Dong Xuehua, Wang Baoqian, Wang Feifei, Hao Yu, Wang Yanbin

Chinese Journal of Antituberculosis. 2025, 47(1):  112-115.  doi:10.19982/j.issn.1000-6621.20240333

Abstract ( 94 )   HTML ( 14 )   PDF (2306KB) ( 162 )   Save

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Very few reports about gingival tuberculosis were reported, leading to high misdiagnosis rate and neglections of clinicians. We took “Gingival tuberculosis” as keyword,searched literature in CNKI,Wanfang,WHIP and PubMed database. A total of 35 related articles were identified,after removing duplicate reports, we finally included 14 papers with 14 gingival tuberculosis patients. Clinical characteristics, diagnosis and treatment of those patients were analyzed to provide consolidated experience for clinicians.