Table of Content

10 March 2025, Volume 47 Issue 3

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Guideline·Standard·Consensus

Expert consensus on multidisciplinary diagnosis and treatment of tuberculous peritonitis

Senior Department of Tuberculosis, the 8th Medical Center of Chinese PLA General Hospital , Editorial Board of Chinese Journal of Antituberculosis , Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange , Promotive Association for Medical and Health Care

Chinese Journal of Antituberculosis. 2025, 47(3):  243-257.  doi:10.19982/j.issn.1000-6621.20250025

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Tuberculous peritonitis lacks specific clinical manifestations, making differential diagnosis difficult, and often leading to delayed confirmation of diagnosis, which increases the difficulty of treatment. In the process of diagnosis and treatment, multiple specialties and departments are usually involved, requiring the involvement of multidisciplinary teams (MDTs). Timely diagnosis and treatment are crucial for the prognosis of patients with tuberculous peritonitis. However, there is still a lack of relevant guiding consensus or guidelines for the multidisciplinary diagnosis and treatment of tuberculous peritonitis in China. Therefore, in order to provide reasonable and standardized systematic diagnosis and treatment for patients with tuberculous peritonitis, improve patient prognosis, and reduce mortality, Senior Department of Tuberculosis, the Eighth Medical Center of the Chinese People’s Liberation Army General Hospital, the Editorial Board of Chinese Journal of Antituberculosis, and Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care jointly organized multidisciplinary experts to formulate the Expert consensus on multidisciplinary diagnosis and treatment of tuberculous peritonitis, based on China’s current diagnostic and therapeutic experience and research achievements in tuberculous peritonitis. This consensus summarizes the epidemiological characteristics, pathophysiological mechanisms, and main clinical manifestations of tuberculous peritonitis, introduces common examination methods for tuberculous peritonitis, proposes the diagnostic criteria and treatments suggestions of tuberculous peritonitis, and especially gives recommendations on the indications, contraindications, preoperative preparation, surgical method and timing selection, and postoperative patient management, etc. It aims to provide clinical physicians with scientific and practical reference.

Interpretation of Standards

Interpretation of social organization standard of Diagnosis Specification of Intraocular Tuberculosis

Duan Hongfei, Tao Yong

Chinese Journal of Antituberculosis. 2025, 47(3):  258-261.  doi:10.19982/j.issn.1000-6621.20240572

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On October 17, 2024, the social organization standard Diagnosis Specification of Intraocular Tuberculosis (T/CHATA 045—2024) was officially released and implemented on the same day. This article interprets the core points of the standard, aiming to help medical personnel at all levels of healthcare institutions across the country grasp the key points of intraocular tuberculosis diagnosis, improve the standardization of diagnosis, reduce misdiagnosis and missed diagnosis, and regulate diagnosis.

Special Topic

[¹⁸F]FDT-PET-CT technology that may bring revolutionary changes to tuberculosis clinical research

Zhang Peize, Gao Qian, Deng Guofang

Chinese Journal of Antituberculosis. 2025, 47(3):  262-265.  doi:10.19982/j.issn.1000-6621.20250006

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Current tuberculosis treatment monitoring relies on traditional bacteriological and imaging methods, which are insufficient to meet clinical needs. Recently, Khan et al. reported a novel approach to image live Mycobacterium tuberculosis (MTB) in vivo via PET-CT using [¹⁸F]Fluoro-2-deoxy-trehalose (2-[¹⁸F]FDT), a reporter of mycobacteria-selective enzyme activity. This technique images live MTB in non-human primates and monitor the effects of treatment through the change of [¹⁸F]FDT uptake. Moreover, [¹⁸F]FDT is a safe tracer that is primarily excreted via the kidneys. We believe that this technology holds great potential for applications in determining tuberculosis treatment endpoints, differentiating active tuberculosis, assessing drug efficacy, and accelerating the development of anti-tuberculosis drugs and vaccines. We provide a brief overview of the imaging principles and preliminary findings of this technology, as well as a discussion of its potential applications of tuberculosis clinical researches for peer references.

Original Articles

Clinical characteristics analysis of HIV-infected cases diagnosed with tuberculosis after surgery due to pulmonary nodules

Li Leilei, Shi Lei, Wang Lin, Li Hongwei, Xu Liran, Pang Yu, Song Yanzheng

Chinese Journal of Antituberculosis. 2025, 47(3):  266-273.  doi:10.19982/j.issn.1000-6621.20240436

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Objective: To summarize the clinical characteristics of HIV-positive patients diagnosed with tuberculous pulmonary nodules after they received surgery due to pulmonary nodules and enhance the diagnosis and treatment capabilities for this group of population. Methods: A retrospective analysis was conducted in 129 HIV-positive patients who underwent lung resection for pulmonary nodules admitted to the Department of Thoracic Surgery of Shanghai Public Health Clinical Center from January 1, 2015 to July 1, 2024, of which 14 patients were confirmed to be pulmonary tuberculosis after surgery. The clinical data of those 14 patients, including demographic characteristics, medical history, laboratory examination results and imaging data, were collected and their clinical characteristics were analyzed. Results: Among 14 HIV-positive patients who were diagnosed as tuberculous pulmonary nodules after surgery, most of them (85.7%, 12/14) were asymptomatic and were found through physical examination. The CD4⁺ T lymphocyte count was less than 400 cells/μl in 10 patients, and the negative rate of IGRA test was higher (70.0%, 7/10). The main imaging findings were pulmonary nodules with a diameter of 11-20 mm (50.0%, 7/14), solid nodules (92.9%, 13/14), irregular shapes (71.4%, 10/14), and fuzzy boundaries (64.3%, 9/14). There were certain degrees of malignant morphological features, including spiculation (50.0%, 7/14), pleural traction or thickening (50.0%, 7/14), and positive functional imaging (64.3%, 9/14). Conclusion: Most of the patients with tuberculous pulmonary nodules and living with HIV have no obvious clinical symptoms before surgery. Their immunological testing for tuberculosis may have false-negative results influenced by the immune status. It’s a challenge to differentiate tuberculosis from malignant tumors by imaging features. Using comprehensive diagnostic methods for definite diagnosis is recommended.

The value of pneumonectomy in the treatment of pulmonary mucormycosis

Zhu Jiankun, Meng Qian, Kong Kangbao, Jin Feng

Chinese Journal of Antituberculosis. 2025, 47(3):  274-281.  doi:10.19982/j.issn.1000-6621.20240441

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Objective: To explore the value of pneumonectomy in the treatment of pulmonary mucormycosis by reviewing relevant literature. Methods: A total of 10 patients were found having pulmonary mucormycosis treated with pneumonectomy through searching CNKI and PubMed database from 2004 to 2024. This study summarized characteristics of these 10 patients and analyzed indications and effectiveness of pneumonectomy in the treatment of pulmonary mucormycosis. Results: All 10 patients were deeply infected, 1 case showed signs of disseminated infection in the remaining lungs, 8 out of the 10 patients had pulmonary artery invasion proved by postoperative pathological test, and 2 of them formed pulmonary artery pseudoaneurysm. Nine patients were found having main bronchial invasion, one of them involved carina, and one case had an astrobnopleural fistula. Among the 10 patients, 6 had diabetes mellitus, among whom 4 got long-term cure after surgery and 2 died during perioperative period. There were 3 patients with hematologic diseases and 1 patient with both hematologic diseases and diabetes mellitus, all of them died of hematologic diseases and related complications during the follow-up. Conclusion: Pulmonary mucormycosis has the characteristics of rapid progression and invasion of large vessels and central airways. In the presence of deep infection, involving pulmonary artery trunk and branches, invading main bronchus, etc., it can be used as indication for pneumonectomy. The underlying disease should be actively controlled, combined with antifungal drug therapy and intensive postoperative monitoring, which can reduce the occurrence of postoperative complications.

The application value of individualized precision treatment for closure of bronchopleural fistula after lung cancer resection surgery

He Zhongliang, Xu Weihua, Xin Shunxin, Chen Guoxing, He Xueming, Wang Lei

Chinese Journal of Antituberculosis. 2025, 47(3):  282-286.  doi:10.19982/j.issn.1000-6621.20240443

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Objective: To summarize and evaluate the treatment methods and clinical value of individualized precision therapy for closure of bronchopleural fistula (BPF) after lung cancer resection. Methods: A total of fifty-seven postoperative BPF patients with non-small cell lung cancer admitted to Tongde Hospital of Zhejiang Province from July 2018 to May 2023 were selected as the research subjects. The research subjects underwent thorough preparation and multidisciplinary discussions, and personalized precision treatment was applied for closure based on the location and size of the BPF. For small fistulas, precise surgical injection of biological glue was used to close the fistula tract. For middle fistulas, surgical suture combined with endoscopic one-way valves was used for closure. For large fistulas, improved surgical repair combined with endoscopic cardiac occluders was used for closure. The clinical efficacy of individualized precision therapy was analyzed. Results: All 57 study subjects completed individualized precision treatment without any in-hospital deaths. After surgery, 4 cases (7.0%) were ineffective, and 3 cases (5.3%) showed partial remission; 50 cases (87.7%) showed clinical symptom relief; two cases (3.5%) were complicated with aspiration pneumonia, two cases (3.5%) were complicated with subcutaneous hemorrhage, and three cases (5.3%) were complicated with incision infection, all of which improved after treatment. Among the 17 patients with small fistulas, 16 were successfully closed after treatment, and 1 was ineffective. Among the 25 patients with middle fistulas, 23 were successfully closed after treatment, 1 was ineffective, and 1 partially relieved. Among the 15 patients with large fistulas, 11 were successfully closed after treatment, 2 were ineffective, and 2 partially relieved. Conclusion: The application of personalized precision treatment for closure of BPF after lung cancer resection has a high success rate and significant therapeutic effect.

Application of Da Vinci robotic surgery combined with preoperative nourishing vascular pre-embolization in the surgical treatment of chronic pulmonary aspergillosis

Fu Qiang, Shi Qinlang, Li Shaopeng, Zhou Zizi, Huang Pilai, Qiao Kun

Chinese Journal of Antituberculosis. 2025, 47(3):  287-291.  doi:10.19982/j.issn.1000-6621.20240507

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Objective: By combining preoperative vascular embolization with the Da Vinci robotic surgical system, study its application value in the surgical treatment of chronic pulmonary aspergillosis. Methods: A retrospective analysis was conducted on clinical data of 7 patients with chronic pulmonary aspergillosis and hemoptysis who underwent Da Vinci robot surgery at Department of Thoracic Surgery, Shenzhen Third People’s Hospital from January 1, 2022 to December 31, 2023. These clinical data included gender, age, intraoperative blood loss, operation time, postoperative chest tube indwelling time, postoperative hospital stay. The therapeutic effect and safety were analyzed. Results: Among the 7 patients, 5 were male and 2 were female, with an average age of (34.2±15.1) years. No major intraoperative bleeding or conversion to open chest surgery occurred. The average surgical duration was (363.3±196.0) minutes, with an average intraoperative blood loss of (127.1±62.4) ml; the mean postoperative chest tube placement duration was (9.4±5.8) days, and the average hospital stay was (10.7±6.2) days. Conclusion: Combining Da Vinci robotic surgery with preoperative nourishing artery embolization is a safe and effective method for treating chronic pulmonary aspergillosis, future clinical studies with larger sample sizes are still needed to validate conclusions.

Comparative study of fluorescence staining method and inflation-deflation method for thoracoscopic pulmonary tuberculosis segmentectomy

Gong Sheng, Wang Ning, Li Dan, Li Gang, Liu Yu, Jiang Liangshuang, Yao Xiaojun

Chinese Journal of Antituberculosis. 2025, 47(3):  292-297.  doi:10.19982/j.issn.1000-6621.20240433

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Objective: To compare and analyze the clinical efficacy of fluorescence staining method and inflation-deflation method in thoracoscopic pulmonary tuberculosis (PTB) segmentectomy. Methods: Clinical data of 96 PTB patients who underwent thoracoscopic pulmonary segmentectomy at Department of Thoracic Surgery, Public Health Clinical Center of Chengdu from January 2021 to May 2024 were retrospectively collected. The patients were divided into a fluorescence staining group (63 cases) and an inflation-deflation group (33 cases) according to the method in determining the intersegment. We compared and analyzed the differences in the time to determine the intersegmental plane, surgical duration, intraoperative blood loss, postoperative drainage time, postoperative hospital stay duration, and incidence of postoperative complications between the two groups. Results: The time to determine the intersegmental plane in the fluorescence staining group ((28.98±9.32) s) was significantly shorter than that in the inflation-deflation group ((1077.56±194.00) s), with statistically significance (t=-42.656,P<0.001). However, there was no statistically significant difference in surgical duration ((141.32±67.50) min), intraoperative blood loss (100 (50, 200) ml), postoperative drainage time ((7.08±4.24) d), postoperative hospital stay ((10.73±4.32) d), postoperative complication rate (23.81% (15/63)) in the fluorescence staining group compared to the inflation-deflation group ((129.24±61.70) min, 100 (50, 100) ml, (7.21±3.06) d, (9.55±4.15) d, 12.12% (4/33), respectively)(t=-0.857, P=0.394; Z=-0.973, P=0.334; t=0.159, P=0.874; t=1.293, P=0.199; χ²=1.864, P=0.172). Conclusion: The fluorescence staining thoracoscopy technology is safe and effective in determine the intersegment plane during thoracoscopic segmentectomy for PTB without increasing intraoperative blood loss, surgical time, postoperative drainage time, hospital stay time, or complications. This technology is worthy of clinical reference and promotion.

The diagnostic value of GeneXpert MTB/RIF Ultra in detecting sputum samples for newly diagnosed pulmonary tuberculosis

Jia Hui, Jing Hui, Ling Xiaojie, Wang Yan, Li Xuezheng

Chinese Journal of Antituberculosis. 2025, 47(3):  298-304.  doi:10.19982/j.issn.1000-6621.20240372

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Objective: To evaluate the diagnostic performance of GeneXpert MTB/RIF Ultra (referred to as “Xpert Ultra”) in detecting sputum samples for newly diagnosed pulmonary tuberculosis. Methods: A total of 443 suspected new cases of pulmonary tuberculosis patients who visited the Shandong Public Health Clinical Center from July 2019 to May 2022 were collected as research subjects. After comprehensive clinical diagnosis, there were 243 cases in the pulmonary tuberculosis group and 200 cases in the non-pulmonary tuberculosis group. After collecting sputum samples from the research subjects, they were subjected to fluorescence staining smear microscopy, BACTEC MGIT 960 liquid culture (referred to as “MGIT 960 culture”), Xpert Ultra, and GeneXpert MTB/RIF (referred to as “Xpert”) detection; MGIT 960 cultured positive samples were further subjected to strain identification. Sputum samples from 231 patients (125 in the tuberculosis group and 106 in the non-pulmonary tuberculosis group) were simultaneously subjected to Xpert Ultra direct detection and centrifugal precipitation treatment. Using the clinical comprehensive diagnosis results and MGIT 960 culture results as reference standards, evaluate the diagnostic value of the above methods for newly diagnosed pulmonary tuberculosis. Results: Using clinical comprehensive diagnosis as the reference standard, the sensitivity and specificity of Xpert Ultra were 68.72% (167/243) and 100.00% (200/200), respectively. The sensitivity of Xpert Ultra was higher than smear fluorescence staining microscopy (36.63% (89/243)) and MGIT 960 culture (62.14% (151/243)), and the differences were statistically significant (χ²=54.830, P<0.001; χ²=3.198, P<0.05). The AUC of Xpert Ultra was the largest, which was 0.809, and highly consistent with clinical comprehensive diagnosis (Kappa value of 0.66). Using MGIT 960 culture as the reference standard, the sensitivity and specificity of Xpert Ultra were 94.70% (143/151) and 94.52% (276/292), respectively. The sensitivity of Xpert Ultra was higher than smear fluorescence staining microscopy (60.26% (91/151)) and Xpert (90.07% (136/151)), and the differences were statistically significant (χ²=13.411, P<0.001; χ²=3.847, P<0.05); and the AUC of Xpert Ultra was 0.946, indicating the highest diagnostic efficiency and almost identical to that of MGIT 960 culture (Kappa value of 0.88). Xpert Ultra can accurately distinguish between Mycobacterium tuberculosis and nontuberculous mycobacteria, and its “trace” results could serve as a diagnostic basis for newly diagnosed pulmonary tuberculosis. For the 231 patients’ sputum samples, direct testing and testing after centrifugal sedimentation were performed, and using clinical comprehensive diagnosis as the reference standard, it was found that the sensitivity of Xpert Ultra testing on sedimented sputum samples (80.00%, 100/125) was 12.00% higher than that of direct testing on sputum samples (68.00%, 85/125); in the tuberculosis group, 31.20% (39/125) of the samples showed at least a one-log increase in semi-quantitative results. Conclusion: Xpert Ultra testing of sputum samples has good diagnostic performance for newly diagnosed pulmonary tuberculosis and is of significant value for its rapid diagnosis and treatment.

Diagnostic value of probe capture-based targeted next-generation sequencing and metagenomic next-generation sequencing for detecting Mycobacterium tuberculosis in bronchoalveolar lavage fluid

Shi Yuru, Gu Dejian, Wu Jing, Liu Ting, Qin Linghan, Yue Li, Qi Yingjie

Chinese Journal of Antituberculosis. 2025, 47(3):  305-311.  doi:10.19982/j.issn.1000-6621.20240448

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Objective: To explore the diagnostic value of probe capture-based targeted next-generation sequencing (tNGS) and metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid for detection of pulmonary tuberculosis. Methods: A retrospective study was conducted from the bronchoalveolar lavage fluid of 117 presumed pulmonary tuberculosis patients admitted to the Tuberculosis Department of Anhui Provincial Hospital during June 2023 to March 2024 was retrospectively analyzed. The patients received tNGS, mNGS, acid fast bacilli smear microscopy, culture and Xpert MTB/RIF. The performance of tNGS and mNGS for detection of Mycobacterium tuberculosis was evaluated. Results: Among 117 suspected tuberculosis patients, 71 patients (60.68%) were diagnosed with pulmonary tuberculosis, while 46 cases (39.32%) were non tuberculosis patients. The sensitivity of mNGS, tNGS,smear combined with culture, smear combined with culture and Xpert MTB/RIF were 77.46% (55/71), 76.06% (54/71), 34.29% (24/70) and 54.93% (39/71) respectively. The specificity were 100.00% (46/46), 95.65% (44/46), 95.65% (44/46) and 95.65% (44/46). The positive predictive values were 100.00% (55/55), 96.43% (54/56), 92.31% (24/26) and 95.12% (39/41), while the negative predictive values were 74.19% (46/62), 72.13% (44/61), 48.89% (44/90) and 57.89% (44/76). The accordance rate were 86.32% (101/117), 83.76% (98/117), 58.62% (68/116) and 70.94% (83/117), and the Youden index were 0.77,0.72, 0.30 and 0.51. The performance of the first two groups was higher than that of the last two groups. The RPM values of Mycobacterium tuberculosis detected by mNGS and tNGS were 0.22 (0.02,1.95) and 28.54 (1.65,138.16), respectively, with statistically significant difference (Z=6.338,P<0.05). The accordance rate of detection of resistance to rifampicin, fluoroquinolone, and isoniazid between tNGS and phenotypic method was 100.00%. Conclusion: mNGS and tNGS have better diagnostic efficacy in the diagnosis of pulmonary tuberculosis compared to traditional detection methods. At the same time, tNGS can also be used for drug resistance detection, providing reference for clinical treatment.

Effective and safety of concurrent intensity-modulated radiotherapy and anti-tuberculosis chemotherapy in patients with active pulmonary tuberculosis comorbid with thoracic tumor

Yang Haixia, Zhang Xiaoyan, Huang Yi, Li Qiu

Chinese Journal of Antituberculosis. 2025, 47(3):  312-321.  doi:10.19982/j.issn.1000-6621.20240450

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Objective: To explore the effectiveness and safety of concurrent anti-tuberculosis chemotherapy and intensity-modulated radiotherapy (IMRT) in patients with active pulmonary tuberculosis and different types of thoracic malignancies. Methods: Clinical data, laboratory examination and imaging results of 28 patients with comorbidities in Xi’an Chest Hospital from May 20, 2022 to February 20, 2023 were collected, and the diagnosis method, medication basis and effectiveness evaluation of pulmonary tuberculosis were retrospectively analyzed. At the same time, the target area and dose of radiotherapy, the limit of organs at risk, the remission of tumor related symptoms and the control of tumor were analyzed. The effectiveness and adverse reactions of anti-tuberculosis and anti-tumor treatment were analyzed descriptively. Results: Eastern Cooperative Oncology Group (ECOG)≥2, body mass index (BMI)<18.5, stage Ⅳ, tuberculous lesion and tumor irradiation area overlap happened in 20, 11, 26 and 15 cases, respectively. Chest tumors included 18 cases of lung cancer, 5 cases of esophageal cancer, and 5 other cases (2 cases of thymoma and 3 cases of pleural mesothelioma). Among the 28 patients, 23 had taken drug susceptibility test based on etiological test result of pulmonary tuberculosis, and the other 5 were clinically diagnosed as active pulmonary tuberculosis, all of them received standard anti-tuberculosis therapy. By the end of follow-up, 8 cases were cured for tuberculosis, 10 cases completed treatment, 1 case failed, 7 cases died of tumor progression, 2 cases continued anti-tuberculosis treatment; 18 cases (64.3%) were successfully treated (cured+treatment completed). Image-guided IMRT was used in thoracic tumor radiotherapy, and the improvement of tumor-related symptoms after radiotherapy was all >80% (83.3%-100.0%). Radiotherapy best response evaluation result (2-3 months) was as follows: complete response in 0 case, partial response in 16 cases, stable in 8 cases, progress in 4 cases, disease control (complete response+partial response+stable) in 24 cases (85.7%). Adverse reactions: hematological toxicity: ≥grade 3 leukopenia, lymphocytopenia and anemia were observed in 2, 6 and 1 cases respectively. Non-hematologic toxicity: ≥grade 3 radiation esophagitis, radiation pneumonia, ALT and AST elevation happened in 1 patient for each. There were 2 patients with central lung cancer with airway obstruction and caseous pneumonia, of which 1 patient also had tuberculous lymph node bronchial fistula, and 1 patient was pathologically confirmed to have tuberculosis and cancer coexisted in the same bronchus. Symptoms of these 2 cases worsened after receiving 20 Gy and 14 Gy radiation respectively, after that their radiotherapy were terminated. Conclusion: Image-guided IMRT is safe and effective with acceptable side effects in active pulmonary tuberculosis and thoracic malignancy patients treated with standard anti-tuberculosis drugs. Patients with tuberculous caseous pneumonia, central lung cancer with open tuberculous lymph node bronchial fistula, co-existed cancer and endobronchial tuberculosis induced significant atmospheric tract obstruction which is not effectively relieved should be cautious for receiving IMRT.

The prevalence and influencing factors of post-tuberculosis lung disease: A Meta-analysis

Song Feier, Mao Yanjun, Xia Qiuyue, Zhou Yang, Lin Huan

Chinese Journal of Antituberculosis. 2025, 47(3):  322-330.  doi:10.19982/j.issn.1000-6621.20240454

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Objective: To identify the prevalence and influencing factors of post-tuberculosis lung disease. Methods: Computerized search was performed for studies on prevalence and influencing factors of post-tuberculosis lung disease in CNKI, WANFANG DATA, VIP, CBM, Cochrane Library, Medline, Embase, Web of Science and CINAHL database from the time of database establishment to September 2024. Both Chinese and English search words were ‘Tuberculosis, Pulmonary/Pulmonary Consumption/Pulmonary Phthis*/post-tb/post tuberculosis’ ‘Lung Diseases/Disease, Pulmonary’ ‘Factor, Risk/Population at Risk/Risk Scores/Health Correlates/Factor, Social Risk/Risk Factor Scores’ ‘Case-Control Studies/Cohort Studies/Cross-Sectional Studies’. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators, and Meta-analysis was performed using Stata 17.0 software. Results: Twenty papers with a total of 795890 patients were included. Meta-analysis showed that the prevalence of post-tuberculosis lung disease was 33.2% (95%CI: 12.0%-58.8%). Low education level (OR=2.32, 95%CI: 1.51-3.56, P<0.001), low BMI (SMD=-0.39, 95%CI: -0.43--0.34, P<0.001), low income (OR=1.19, 95%CI: 1.08-1.32, P=0.001), urban residence (OR=1.13, 95%CI: 1.09-1.16, P<0.001), combined diabetes (OR=2.37, 95%CI: 2.19-2.55, P<0.001), combined cancer (OR=2.01, 95%CI: 1.85-2.18, P<0.001), times of hospitalization (SMD=0.44, 95%CI: 0.25-0.63, P<0.001) and other factors were influential factors for post-tuberculosis lung disease. Conclusion: There are many factors influencing post-tuberculosis lung disease, nursing staff should address the influencing factors and develop individualized interventions to reduce the occurrence of post-tuberculosis lung disease.

Construction of an evaluation indicator system for Zero Tuberculosis Community in Zhejiang Province

Wu Qian, Wang Wei, Zhang Yu, Chen Songhua, Chen Bin

Chinese Journal of Antituberculosis. 2025, 47(3):  331-337.  doi:10.19982/j.issn.1000-6621.20240412

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Objective: To develop a practical evaluation indicator system for “Zero Tuberculosis Community” in Zhejiang Province, which could provide a scientific basis for the standardized construction of “Zero Tuberculosis Community” throughout the province and to optimize tuberculosis prevention and control strategies. Methods: First, a set of indicator pool was constructed through the literature review. Second, two rounds of correspondence were conducted by jointly applying the Delphi method and Analytic Hierarchy Process (AHP) method. Finally, the indicator system was determined based on expert ratings and opinions, and the indicator weights were calculated. Results: A total of 26 experts were invited. The indicator system includes 3 first-level indicators, 13 secondary indicators, and 50 tertiary indicators. The experts had a relatively high level of enthusiasm, authority and coordination. The first-level indicators, in descending order of indicator weight, were implementation actions (0.412), construction effectiveness (0.324), and organizational support (0.264). Conclusion: The indicator system constructed in this study has a certain degree of scientificity and reliability, which can provide a reference for a comprehensive and objective evaluation of the effectiveness of the construction of “Zero Tuberculosis Community”.

Study on pulmonary tuberculosis disease burden in the elderly aged 60 and above in China, 2005—2020

Zhang Mengdi, Wang Qiqi, Wang Xin, Zheng Wenjing, Sun Wenshan, Xiao Yiran, Guo Xiaomin, Liu Jianjun, Huang Fei, Yao Hongyan

Chinese Journal of Antituberculosis. 2025, 47(3):  338-347.  doi:10.19982/j.issn.1000-6621.20240508

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Objective: To analyze the disease burden caused by pulmonary tuberculosis (PTB) in the elderly aged 60 and above in China from 2005 to 2020 to provide reference for developing reasonable and effective measures of TB control and prevention. Methods: Data related to PTB incidence, mortality, and demographic among the elderly aged 60 and above in China from 2005 to 2020 were collected from the Tuberculosis Management Information System, the National Disease Surveillance Points System and the China Disease Control and Prevention Information System respectively. DisMod Ⅱ model was used to estimate the prevalence and calculate disability-adjusted life years (DALYs) attributed to PTB. The temporal trends of PTB disease burden including standardized incidence, prevalence, mortality, DALYs rate and DALYs were analyzed, as well as the distribution characteristics of DALYs rate/standardized DALYs rate in different gender, region, and age. Results: From 2005 to 2020, the age-standardized incidence, prevalence, mortality and DALYs rates of PTB among the elderly aged 60 and above in China showed downward trend. The age-standardized incidence decreased from 174.60/100000 in 2005 to 84.73/100000 in 2020 (AAPC=-4.59%, P<0.001); the age-standardized prevalence declined from 1117.00/100000 in 2005 to 605.60/100000 in 2020 (AAPC=-3.90%, P<0.001); the age-standardized mortality fell from 35.44/100000 in 2005 to 6.67/100000 in 2020 (AAPC=-10.11%, P<0.001); and the age-standardized DALYs rates reduced from 972.90/100000 in 2005 to 276.76/100000 in 2020 (AAPC=-7.11%, P<0.001). The total DALYs attributed to PTB in the elderly was 14785000 person-years during 16 years, with 10701800 for males and 4083200 for females. The age-standardized DALYs rates attributed to PTB in elderly males decreased from 1433.14/100000 in 2005 to 426.85/100000 in 2020 (AAPC=-7.08%, P<0.001), and in elderly females decreased from 549.10/100000 in 2005 to 140.20/100000 in 2020 (AAPC=-7.36%, P<0.001). An obvious declining trend was observed in the age group of 60-64, 65-69, 70-74, 75-79, and 80-84 (which decreased from 766.51/100000, 962.88/100000, 1198.22/100000, 1213.31/100000, and 1024.62/100000 in 2005 to 196.99/100000, 250.27/100000, 316.11/100000, 379.65/100000, and 389.89/100000 in 2020, respectively) except for the group of 85 and above (with AAPC values of -7.73%, -8.33%, -7.50%, -6.12%, -5.60%, and Ps<0.001). The standardized DALYs rates attributed to PTB among the elderly in China decreased slightly less in urban areas (AAPC=-6.54%, P<0.001) than in rural areas (AAPC=-6.89%, P<0.001). Additionally, the western region showed a smaller decline (AAPC=-6.04%, P<0.001) compared with the eastern (AAPC=-7.07%, P<0.001) and central regions (AAPC=-7.63%, P<0.001). Conclusion: From 2005 to 2020, the declining trend occurred among the age-standardized incidence, prevalence, mortality, and DALYs rates of PTB in the elderly aged 60 and above in China, but the overall disease burden remained heavily. Disease burden levels and decline trends varied across populations. DALYs and age-standardized DALYs rates in males were higher than that in females, rural areas higher than urban areas, and western region higher than central and eastern regions. The decline of DALYs and standardized DALYs rates in males were lower than that in females, urban areas higher than rural areas, western region higher than eastern and central regions. More attention should be paid on the elderly, males and the western region, and more precise and scientific strategic measures should be explored based on the epidemic characteristics of different regions and populations in the future.

Analysis and trend prediction of Mycobacterium tuberculosis drug resistance in Jilin City

Liu Juxiu, Zhang Jianhua, Wen Junjun, Jiang Xiaoshuang

Chinese Journal of Antituberculosis. 2025, 47(3):  348-354.  doi:10.19982/j.issn.1000-6621.20240470

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Objective: To analyze the drug resistance status and change trend among pulmonary tuberculosis (PTB) patients in Jilin City in recent years. Methods: A retrospective study was conducted, basic information and drug susceptibility test (DST) result of Mycobacterium tuberculosis from samples of 796 sputum-positive PTB patients admitted to Jilin City Tuberculosis Hospital between January 2023 and June 2024 were collected according to inclusion criteria. Their drug resistance status was analyzed, and time-series trend prediction was performed for different types of drug resistance. Results: From January 2023 to June 2024, the overall drug resistance rate to 16 anti-tuberculosis drugs among 796 patients was 43.59% (347/796). The rates of multidrug resistance (MDR), mono-drug resistance, poly-drug resistance, and pre-extensive drug resistance (pre-XDR) were 14.82% (118/796), 9.30% (74/796), 2.01% (16/796), and 5.90% (47/796), respectively. No extensively drug-resistant (XDR) cases were detected. The drugs with a resistance rate exceeding 10% were ranked as follows: streptomycin (26.26%, 209/796)>isoniazid (23.87%, 190/796)>rifampicin (18.84%, 150/796)>rifabutin (14.70%, 117/796)>levofloxacin (13.57%, 108/796)>moxifloxacin (12.31%, 98/796)>pasiniazide (11.43%, 91/796). The mono-drug resistance rate in the elderly group (13.20%, 45/341) was higher than that in the middle-aged group (5.86%, 17/290) and the young group (7.27%, 12/165). The MDR rates in the young group (20.00%, 33/165) and middle-aged group (18.97%, 55/290) were higher than that in the elderly group (8.80%, 30/341). Pre-XDR rates in the young group (7.88%, 13/165) and middle-aged group (10.00%, 29/290) were also higher than that in the elderly group (2.05%, 7/341). All differences were statistically significant (χ²=11.009, P=0.004; χ²=17.248, P<0.001; χ²=18.204, P<0.001). MDR (28.02%, 72/257) and pre-XDR rates (14.79%, 38/257) were higher in retreatment patients than in new patients (8.53% (46/539) and 2.03% (11/539), respectively), with statistically significant differences (χ²=52.307, P<0.001; χ²=48.934, P<0.001). Time-series analysis predicted that drug resistance rates from July to December 2024 should be 6.67% for mono-drug resistance, 0.78% for poly-drug resistance, an increase in MDR to 11.92%, and a pre-XDR rate of 4.02%. Conclusion: Between January 2023 and June 2024, different kinds of drug resistance among PTB patients in Jilin City remained high. Predictions for July to December 2024 indicate MDR and pre-XDR levels remained high, however, all four types of resistance have a downward trend. Strengthened management and real-time monitoring of drug use and resistance to streptomycin, isoniazid, rifampicin, rifabutin, levofloxacin, and other drugs are necessary, especially for mono-drug resistance in elderly patients and MDR in young and middle-aged patients, to reduce the occurrence of MDR and pre-XDR cases.

Active screening and influencing factor analysis of pulmonary tuberculosis among elderly people

Qin Xueling, Chen Li, Sun Xiaoying, Hu Shanpeng, Lu Zhen, He Nailing, Zhang Jifen

Chinese Journal of Antituberculosis. 2025, 47(3):  355-361.  doi:10.19982/j.issn.1000-6621.20240457

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Objective: By conducting continuous active tuberculosis screening among elderly people aged 65 and above, the study aims to evaluate the implementation effect and influencing factors of active screening in the elderly, providing data support for precise formulation of tuberculosis prevention and control measures among the elderly. Methods: From 2020 to 2023, we conducted face-to-face questionnaire survey and digital radiography (DR) examination for the elderly people in four counties/districts and four townships/streets in Rizhao City for four consecutive years. We performed univariable analysis on characteristics, previous tuberculosis history, and close contact history with tuberculosis patients, as well as multivariable logistic regression analysis, to analyze the effectiveness and influencing factors of active screening for tuberculosis among the elderly population. Results: From 2020 to 2023, 21876, 18575, 1789, and 19883 people were screened respectively, totaling 77723 person-times, and 123 cases of pulmonary tuberculosis were detected, with a detection rate of 158.25/100000. The detection rate for male (240.97/100000, 82/34029) was significantly higher than that for female (93.83/100000, 41/43694,χ²=26.212,P<0.001); The detection rate of active pulmonary tuberculosis increased from 118.24/100000 (51/4133) in those aged 65-74 years old to 448.43/100000 (5/1115) in people aged 85-108 years old; Detection rates among people with pulmonary tuberculosis history and close contact history with pulmonary tuberculosis patients were 479.70/100000 (39/8130) and 519.02/100000 (103/19845), respectively. Screening was conducted at the same research site for four consecutive years from 2020 to 2023, and as the times of screening increased, the detection rates of active pulmonary tuberculosis in the elderly people showed a downward trend ($\chi_{\text {trend }}^{2}$=14.682,P<0.001) and the etiological positive rate showed a downward trend ($\chi_{\text {trend }}^{2}$=12.749,P<0.001)too. Logistic multivariable analysis showed that higher age (75-84 years and 85-108 years) was risk factor for pulmonary tuberculosis (OR (95%CI)=8.25 (1.95-35.83), 12.53 (3.03-55.12)). Conclusion: Conducting active screening among elderly people can quickly identify patients with pulmonary tuberculosis, thereby reducing the epidemic of tuberculosis. After multiple screenings, the detection rates of active pulmonary tuberculosis among the elderly showed a significant downward trend. It is necessary to optimize screening strategy based on frequency of screening, screening methods, and risk factors of the population.

Review Articles

Application of single-cell transcriptome sequencing technology in tuberculosis research

Shi Hongyu, Zhang Guoliang, Xiao Guohui

Chinese Journal of Antituberculosis. 2025, 47(3):  362-368.  doi:10.19982/j.issn.1000-6621.20240512

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Tuberculosis, caused by Mycobacterium tuberculosis (MTB) infection, is one of the infectious diseases with the highest mortality rates globally, posing a severe threat to public health. The cellular immune response mechanisms triggered by MTB infection in the host are not yet fully understood. Single-cell transcriptome sequencing technology can reveal cellular heterogeneity at the resolution of individual cells, which can help researchers better understand the pathogenesis of tuberculosis and provide strong support for the development of targeted drugs, new diagnostic markers, and vaccines. This article reviewed the application of this technology in the exploration of tuberculosis pathogenesis, the analysis of cell subgroup heterogeneity in different clinical samples, and the disclosure of immune microenvironment, and discussed the limitations and future challenges of this technology, and looked forward to its potential application in tuberculosis research.

Research advances of Mycobacterium tuberculosis enrichment technology

Huang Misun, Wu Yaning, Li Guilian, Liu Haican

Chinese Journal of Antituberculosis. 2025, 47(3):  369-373.  doi:10.19982/j.issn.1000-6621.20240420

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Diagnostic methods for tuberculosis, particularly those based on pathogen detection, are extensively employed in clinical laboratories. However, these methods often fail to meet the clinical demands for rapid and accurate diagnosis, primarily due to the challenge posed by the low bacterial load in biological samples. The integration of enrichment technologies for Mycobacterium tuberculosis detection holds significant promise in enhancing both the sensitivity and accuracy of tuberculosis diagnostic assays, thereby improving clinical outcomes. In this review, we examine the current research on Mycobacterium tuberculosis enrichment technologies, aiming to provide valuable insights for the development and application of novel enrichment methods. We anticipate the emergence of more efficient techniques that will significantly enhance the sensitivity of tuberculosis diagnostic assays. This advancement is crucial for achieving early detection, diagnosis, and treatment, ultimately reducing tuberculosis transmission and mitigating adverse prognoses.

Research progress on bedaquiline resistance and drug resistance diagnosis

Yang Ziyi, Chen Suting

Chinese Journal of Antituberculosis. 2025, 47(3):  374-379.  doi:10.19982/j.issn.1000-6621.20240391

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Bedaquiline, a diarylquinoline compound, is a novel anti-tuberculosis drug used for treatment of rifampicin-resistant and multi-drug resistant tuberculosis. Since its approval, bedaquiline has significantly improved anti-tuberculosis treatment outcomes. However, with its widespread usage, the emergence of bedaquiline resistance and its monitoring have become critical clinical concerns. This paper reviews molecular mechanisms of bedaquiline resistance, methods for identifying different resistance phenotypes and genotypes, aiming to provide insights for the clinical usage of bedaquiline and the monitoring and management of resistance.