Table of Content

10 August 2025, Volume 47 Issue 8

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Guideline·Standard·Consensus

Expert consensus on molecular biology diagnosis of nontuberculous mycobacteria diseases

Nontuberculous Mycobacterial Diseases Branch of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2025, 47(8):  961-975.  doi:10.19982/j.issn.1000-6621.20250225

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The incidence of nontuberculous mycobacteria (NTM) disease has been on the rise. Traditional methods such as acid-fast bacilli staining and mycobacterial culture suffer from limitations including low sensitivity, being time-consuming, and inability to identify specific species. In contrast, molecular biology detection technologies have demonstrated unique advantages and great application prospects in the diagnosis of NTM diseases and precise species identification. However, there is lack of systematic and comprehensive guideline for the molecular diagnosis of NTM disease in China. In order to standardize the clinical application of molecular diagnostic techniques for NTM diseases and enhance the diagnosis and treatment capabilities of medical professionals, the Nontuberculous Mycobacterial Diseases Branch of Chinese Antituberculosis Association organized a writing group composed of domestic experts in the fields of NTM diseases, infectious diseases, microbiology, and methodology. Through systematic literature reviews, multiple rounds of online and offline discussions, and questionnaire surveys, the group evaluated the respective merits, limitations, and implementation status of current molecular detection technologies, discussed key issues in molecular diagnosis of NTM diseases, and ultimately formulated this consensus after iterative revisions through multiple consensus conferences. Focusing on core issues such as molecular targets for NTM disease diagnosis, molecular biological diagnostic techniques, and standardized interpretation protocols, the consensus formulated 11 evidence-based recommendations. It systematically establishes a technical framework and clinical application pathway for molecular biological diagnosis of NTM diseases, addressing core challenges like technical fragmentation and inconsistent interpretation standards. It provides actionable guidance for clinicians, clinical laboratories, and public health departments.

Special Topic

The potentials and challenges of using tongue swab for Mycobacterium tuberculosis complex detection through nucleic acid amplification tests in the diagnosis and screening of pulmonary tuberculosis

Xia Hui, Zhao Yanlin

Chinese Journal of Antituberculosis. 2025, 47(8):  976-980.  doi:10.19982/j.issn.1000-6621.20250124

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Tuberculosis (TB) remains a major global public health challenge. Etiological examination serves as a critical approach for TB diagnosis. However, some suspected pulmonary TB patients initially present with no sputum or face difficulties in providing qualified sputum specimens, limiting the effectiveness of sputum-based laboratory detection methods. Concurrently, non-sputum based diagnostic methods, such as oral swab, blood, urine, and other body fluids, has become a focus in TB diagnostic research and development. This article systematically analyzes the current research progress on tongue swab-based TB diagnosis and screening, existing challenges, and key considerations in the application of tongue swabs for TB diagnosis and screening. The aim is to provide references for technological optimization and pilot implementations across diverse scenarios.

Analysis of psychological support of tuberculosis patients at home and abroad

Meng Qinglin, Wang Yunxia, Tang Yan, Liu Eryong

Chinese Journal of Antituberculosis. 2025, 47(8):  981-985.  doi:10.19982/j.issn.1000-6621.20250049

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The current situation of psychological support for tuberculosis patients at home and abroad was thoroughly analyzed to reveal the psychological problems and influencing factors affected tuberculosis patients, and the effectiveness and shortcomings of the existing psychological support model. Both domestic and foreign patients generally suffer from psychological distress such as anxiety and depression, which are closely related to the characteristics of the disease, social environment, and individual differences. Domestic efforts rely on relevant policies to promote the implementation of psychological support, but there is still a gap compared to foreign countries in terms of professional resource allocation and community participation. The multidisciplinary collaboration and community led support model in foreign countries emphasizes the key role of comprehensive support service quality in improving patient treatment experience and rehabilitation outcomes, providing useful reference for China.

Original Articles

Analysis of the progress of Tuberculosis Care Pilot Project

Wang Yunxia, Meng Qinglin, Zhou Lin, Liu Eryong

Chinese Journal of Antituberculosis. 2025, 47(8):  986-991.  doi:10.19982/j.issn.1000-6621.20250082

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Objective: To analyze and evaluate the progress of tuberculosis (TB) prevention and treatment in the first 40 pilot counties (districts) of Tuberculosis Care Action Pilot Project. Methods: From April to June 2024, the National Center for Tuberculosis Control and Prevention of China CDC issused unified semi-structured electronic questionnaires to 40 pilot counties (districts) from 15 provinces, to learn the progress for capacity of patient detection, key population TB screening, and implementation of humanistic care measures for TB patients comparing to baseline. Results: In 2023, a total of 11037 pulmonary TB patients were confirmed and registered across the pilot counties (districts), of which 7330 were bacteriologically confirmed, with an overall positivity rate of 66.41% (7330/11037), meeting the 65% target specified for the final evaluation. Among the 562 bacteriologically negative TB cases, 427 met the criteria for a diagnosis of bacteriologically negative TB, with a compliance rate of 75.98% (427/562), falling short of the 90% target specified for the final evaluation. For key population TB screenings, the chest X-ray screening rate among individuals aged ≥65 years and diabetic patients were 22.38% (561911/2510827) and 14.99% (110675/738182), respectively, which were higher than those of baseline period (13.48%, 377436/2800877; 12.27%, 93808/764416). However, these rates were still relative low. In terms of patient management and humanistic care measures, 38 out of the 40 pilot counties (districts) were able to use information technology to manage patients, and all pilot counties (districts) provided full course health education to registered patients. Additonally, nutritional and psychological support were provided in 30 counties (districts), which was three times the number during baseline period (10). Conclusion: Notable progress has been achieved in pilot areas; however, improvement is still needed in the diagnostics of bacteriologically negative pulmonary TB and the screening of key populations.

Knowledge, attitude and practice survey on tuberculosis prevention and control among specific populations in Meigu County, Liangshan Yi Autonomous Prefecture, Sichuan Province

Sun Shanhua, Lezhe Laji, Gao Zhidong, Zhao Yao, He Xin, Xu Qiang, Yang Maosheng, Xu Yan

Chinese Journal of Antituberculosis. 2025, 47(8):  992-998.  doi:10.19982/j.issn.1000-6621.20250243

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Objective: To understand the current status of knowledge, attitude and practice (KAP) regarding tuberculosis (TB) prevention and control among key populations in Meigu County, Liangshan Yi Autonomous Prefecture, Sichuan Province, and provide a basis for carrying out TB health education in ethnic minority areas. Methods: A uniformly designed questionnaire was used to survey five categories of key populations in Meigu County. A census was conducted for all health system staff, middle school faculty in-service and middle school students attending school, and police staff in Meigu County; rural residents were surveyed by milti-stage sampling method. Except for students who used paper questionnaires, other populations were surveyed through Wenjuanxing (an online survey platform in China). A total of 12335 questionnaires were collected, of which 12038 were valid, representing a ralidity rate of 96.04%. Results: The overall awareness rates of the five key population groups in Meigu County were 90.97% (4712/5180) for health system personnel, 89.58% (3552/3965) for middle school faculty, 88.38% (844/955) for police workers, 71.80% (32212/44865) for middle school students, and 69.61% (3637/5225) for rural residents. The differences in rates were statistically significant (χ²=1555.74, P<0.001). Among the five core messages, the item “Which of the following statements is correct about preventing the transmission of tuberculosis?” had the poorest mastery. For each core message, the awareness rates were generally lower among rural residents and middle school students. The willingness of different populations to participate in TB prevention and control was generally high, with the proportion of willingness for each attitude among different populations all being ≥88.90%. In terms of TB prevention and control-related behaviors, the current smoking rates were 42.93% (82/191) among police workers, 37.42% (391/1045) among rural residents, 23.84% (247/1036) among health system personnel, 23.33% (185/793) among middle school faculty, and 7.47% (670/8973) among middle school students, with statistically significant differences in smoking rates (χ²=1121.30, P<0.001). Spitting in public was relatively common: 95.95% (994/1036) of health system personnel and 94.76% (181/191) of police workers reported seeing others spit in public, while the proportions for middle school faculty, rural residents, and middle school students were 79.32% (629/793), 78.09% (816/1045), and 52.41% (4703/8973), respectively. The proportion of people practicing correct coughing etiquette was generally low: only 16.17% (169/1045) of rural residents, followed by 32.95% (2957/8973) of middle school students, 40.84% (78/191) of police workers, 50.19% (398/793) of middle school faculty, and 83.88% (869/1036) of health system personnel, with statistically significant differences in rates (χ²=1292.52, P<0.001). Conclusion: In specific populations of Meigu County, the awareness rate of TB prevention and control knowledge among rural residents and middle school students is relatively low. All survey respondents showed a high willingness to participate in TB prevention and control. Unhealthy habits such as spitting anywhere and smoking are relatively common, and the proportion of people mastering correct coughing etiquette is low. It is necessary to carry out inter-departmental cooperation, integrate activities such as the patriotic health campaign and smoking ban activities in public places, and further strengthen health education on TB prevention and control.

Analysis of family functioning of patients with drug-resistant pulmonary tuberculosis and its influencing factors

Tang Lingling, Chen Danping, Li Yuru, Jiang Hua, Huang Le, Su Limin

Chinese Journal of Antituberculosis. 2025, 47(8):  999-1006.  doi:10.19982/j.issn.1000-6621.20250142

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Objective: To investigate the status quo and influencing factors of family functioning of patients with drug-resistant tuberculosis (DR-TB). Methods: A total of 300 DR-TB patients hospitalized in the Department of Tuberculosis at Shanghai Pulmonary Hospital, Affiliated to Tongji University, from October 2023 to October 2024 were selected. Family functioning was assessed using the Family Assessment Device (FAD). General demographic and clinical data of patients were collected. Multivariable logistic regression analysis was conducted to analyze the influencing factors of family functioning. Results: The average total FAD score of the 300 patients was (136.56±10.24), with subscale average scores as follows: communication (20.35±2.42), problem-solving (12.25±2.13), roles (25.47±2.50), behavioral control (21.31±2.04), affective responsiveness (14.91±2.24), affective involvement (17.43±2.33), and general functioning (27.62±3.11). Multivariable logistic regression analysis revealed that age ≥60 years (OR=3.739, 95%CI: 1.331-10.510), being unmarried (OR=2.362, 95%CI: 1.189-4.691), and PHQ-9 score ≥5 (OR=2.644, 95%CI: 1.358-5.149) were risk factors for impaired family functioning in DR-TB patients. In contrast, educational level being high school/technical secondary school (OR=0.113, 95%CI: 0.052-0.243), college or higher (OR=0.060, 95%CI: 0.023-0.153), medical insurance coverage (OR=0.139, 95%CI: 0.042-0.463), monthly household income >5000 yuan (OR=0.633, 95%CI: 0.471-0.850), and SF-36 score ≥80 (OR=0.611, 95%CI: 0.474-0.789) were protective factors. Interaction analysis demonstrated additive interactions between age and education level (RERI (95%CI): 1.809-3.143; AP (95%CI):0.313-0.462; S (95%CI):1.533-2.152), age and monthly household income (RERI (95%CI): 0.931-1.353; AP (95%CI): 0.355-0.543; S (95%CI):1.821-10.922), age and PHQ-9 score (RERI (95%CI):0.053-0.268; AP (95%CI):1.058-1.762; S (95%CI): 0.148-0.670), age and SF-36 score (RERI (95%CI):1.063-1.804; AP (95%CI): 0.152-0.721; S (95%CI):1.063-1.804), education level and monthly household income (RERI (95%CI):0.057-0.346; AP (95%CI):1.054-1.782; S (95%CI):0.160-0.765), and PHQ-9 score and SF-36 score (RERI (95%CI): 0.076-0.421; AP (95%CI): 1.022-1.821; S (95%CI): 0.165-0.873). Conclusion: The family functioning of DR-TB patients was at a general level, and was affected by many factors, and there were interactions among all factors. It is necessary to formulate and implement corresponding intervention measures according to these influencing factors, to effectively improve their family functioning, and further improve disease treatment effectiveness.

Investigation on the psychological and social support status of 445 pulmonary tuberculosis patients in Chongqing metropolitan area

Fan Jun, Wang Qingya, Wu Chengguo, Lei Rongrong, Zhang Ya, Zhang Ting

Chinese Journal of Antituberculosis. 2025, 47(8):  1007-1013.  doi:10.19982/j.issn.1000-6621.20250113

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Objective: To understand the psychological and social support needs of tuberculosis patients in Chongqing metropolitan area, and to provide a reference basis for providing targeted psychological and social support for tuberculosis patients. Methods: By means of convenient sampling and saturation principle, a survey was conducted on the general demographic characteristics, psychological and social support of pulmonary tuberculosis patients registered for treatment in the Chongqing metropolitan area from November 2023 to February 2024. A total of 453 pieces of questionnaire were distributed and retrieved, among which 445 were valid, with a validation rate of 98.23%. Results: The proportions of worry and fear emotion occurrence among patients after getting TB were 52.36% (233/445) and 20.90% (93/445), respectively, and the proportion of indifferent attitude was 13.48% (60/445). Patients in Chongqing were more likely to feel worried than those in Guang’an (58.92% (142/241) and 44.61% (91/204);χ²=9.074, P=0.003)). Patients in Guang’an were more convinced that active formal treatment could cure the disease than those in Chongqing (75.49% (154/204) and 66.80% (161/241);χ²=4.030, P=0.045). The proportion of patients who were willing to let their family members know about their illness was the highest (98.88% (440/445)), while the proportions of patients who were willing to let colleagues/classmates, employers/leaders know about their illness were relatively small, accounting for 15.96% (71/445) and 8.31% (37/445) respectively. The patients in Chongqing were more unwilling to let their employers/leaders know about their illness than those in Guang’an (4.41% (9/204) and 11.62% (28/241);χ²=7.527, P=0.006). The proportion of patients who were willing to relieve their burden by talking with family members/colleagues/friends was the highest (55.51% (247/445)), and patients in Chongqing were more willing to relieve their psychological burden by overcoming it by themselves (37.76% (91/241) and 28.43% (58/204);χ²=4.316, P=0.038). After learning about the patient’s illness, family members had the best attitude towards the patient and 82.30% (358/435) showed a greater concern for them, while there was a minority discrimination against the patient in other groups. Conclusion: The psychological state and social support of tuberculosis patients in Chongqing metropolitan area are different in different regions, and some patients face social discrimination. It is recommended to strengthen mental health support, enhance public awareness of TB, and formulate differentiated intervention measures according to the characteristics of different regions to improve the psychological state and social support level of patients.

Clinical characteristics and treatment outcomes of extracorporeal membrane oxygenation in 13 patients with severe pulmonary tuberculosis-associated acute respiratory distress syndrome

Huang Weiqiang, Liu Xudong, Wang Lili, Chen Xingxing, Shang Huihui, Xu Ya, Hu Ming

Chinese Journal of Antituberculosis. 2025, 47(8):  1014-1022.  doi:10.19982/j.issn.1000-6621.20250083

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Objective: To investigate the clinical characteristics and treatment outcomes of patients with severe pulmonary tuberculosis (PTB)-associated acute respiratory distress syndrome (ARDS) who underwent extracorporeal membrane oxygenation (ECMO), and to provide evidence to inform clinical decision-making in this high-risk population. Methods: A retrospective observational study was conducted, enrolling 13 patients with severe PTB-associated ARDS who received ECMO support in the Intensive Care Unit (ICU) of Wuhan Pulmonary Hospital between October 2020 and October 2024. Clinical data were systematically collected, including demographic information, comorbidities, disease severity scores, radiological and microbiological findings, as well as treatment-related variables such as anti-TB regimens, respiratory support strategies, ECMO configurations, use of prone positioning, and corticosteroid administration. Outcomes assessed included survival rates, durations of ECMO support, mechanical ventilation, and ICU stay, along with ECMO-related complications. Results: Of the 13 patients included in the study, 11 (84.6%) were male, with a median age of 51 years and a median disease duration of 40 days. The mean Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score was 25.23±7.11, and the median Sequential Organ Failure Assessment (SOFA) score was 7 (interquartile range (IQR): 4, 10). During ECMO support, 12 patients (92.3%) developed secondary infections with other pathogens. Six patients were newly diagnosed with PTB and had not received anti-TB treatment prior to admission. Positive diagnostic results were observed in 10 patients (76.9%) via metagenomic next-generation sequencing (mNGS) or GeneXpert MTB/RIF, in 12 (92.3%) via TB-DNA testing, and in 8 (61.5%) via acid-fast bacilli (AFB) smear. Infiltrative PTB was identified in 8 patients (61.5%). Prone position ventilation was applied in 7 patients (53.8%) before ECMO initiation and in 6 patients (46.2%) during ECMO therapy. Venovenous ECMO (VV-ECMO) was employed in 10 patients (76.9%), venoarterial ECMO (VA-ECMO) in 2 patients (15.4%), and 1 patient (7.7%) underwent conversion from VV-ECMO to VA-ECMO. ECMO-related complications occurred in 6 patients (46.2%), with gastrointestinal bleeding reported in 5 cases. The duration of ECMO support ranged from 1 to 88 days. The median durations (IQR) were: 13 (9, 31) days for ECMO, 27 (16, 47) days for mechanical ventilation, and 32 (23, 57) days for ICU stay. Six patients (46.2%) showed clinical improvement and were discharged. The post-discharge survival rates at 28 and 60 days were 46.2% (6/13) and 30.8% (4/13), respectively. Conclusion: ECMO may improve survival in patients with severe PTB-associated ARDS and appears to offer a reasonable balance of efficacy and safety. However, careful patient selection and comprehensive assessment of disease severity are essential before ECMO initiation, with a thorough evaluation of potential benefits and risks.

Synergistic effect of zuclopenthixol on the anti-tuberculosis activity of clofazimine and its mechanism of action on MmpL5-MmpS5

Zhang Ye, Liang Wenwen, Huo Chenchao, Shi Jinghua, Qi Xianglong, Cheng Kai, Lu Yu, Xu Jian

Chinese Journal of Antituberculosis. 2025, 47(8):  1023-1030.  doi:10.19982/j.issn.1000-6621.20250052

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Objective: To screen synergist of clofazimine (CFZ), a core drug for multidrug-resistant tuberculosis treatment, and investigate the mechanism underlying its enhanced antitubercular activity in relation to the inhibition of Mycobacterium tuberculosis mycobacterial membrane protein large5-mycobacterial membrane protein small5 (MmpL5-MmpS5) efflux system. Methods: The Rv0678 mutant strain Rv0678-M1 (C305T) was selected as the screening strain. The microplate colorimetric method was employed to screen CFZ synergist. The checkerboard method was used to evaluate the combined effects of zuclopenthixol and CFZ against different Mycobacterium tuberculosis strains. Molecular docking was performed to predict interactions between zuclopenthixol and MmpL5 or MmpL5-MmpS5 system. Surface plasmon resonance was utilized to analyze the binding affinity between zuclopenthixol and MmpL5 protein. Ethidium bromide (EtBr) accumulation assays were performed to assess the impact of zuclopenthixol on efflux activity in Rv0678-M1 strains. Results: Zuclopenthixol at 1/8×MIC reduced the MIC of CFZ against Rv0678 mutant strain to 1/16 of its original value, reversing CFZ resistance. Synergistic activity between zuclopenthixol and CFZ was observed in different M.tuberculosis strains (FICI=0.25-0.375), with stronger synergistic activity in Rv0678 mutants (FICI=0.25) and MmpL5-MmpS5 overexpression strains (FICI=0.25) compared to H37Rv (FICI=0.3125) and mmpS5 knockout strains (FICI=0.375). Surface plasmon resonance revealed moderate affinity between zuclopenthixol and MmpL5 (Kd=3.075×10^-4 mol), which was weaker than the affinity of CFZ for MmpL5 (Kd=1.218×10^-5 mol). Conclusion: Zuclopenthixol significantly enhances CFZ’s antitubercular activity by inhibiting the MmpL5-MmpS5 efflux system.

A study on the identification of Mycobacterium species using fluorescent PCR probe melting curve technique and DNA microarray chip technique

Fan Ruifang, Dai Xiaowei, Yang Xinyu, Chen Shuangshuang, Chen Hao, Yu Lan, Zhao Yanfeng, Li Chuanyou, Wang Nenhan

Chinese Journal of Antituberculosis. 2025, 47(8):  1031-1037.  doi:10.19982/j.issn.1000-6621.20250054

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Objective: To compare the clinical application value of fluorescent PCR probe melting curve assay (MeltPro) and DNA microarray chip technique for the Mycobacterium species identification. Methods: We collected the reference strains within the detection scope of both methods and the clinical isolates suspected to be nontuberculosis mycobacteria (NTM) stored in the Tuberculosis Laboratory the Beijing Center for Disease Control and Prevention from January 2016 to August 2023, and used the two methods for species identification. Strains yielding discrepant results underwent whole-genome sequencing analysis. Results: A total of 19 reference strains (one per species) were selected, with both the Melting Curve Method and the Gene Chip Method achieving a 100.00% concordance rate for their identification. A total of 180 clinical strains were collected, of which 8 strains were identified as Mycobacterium tuberculosis complex (MTBC), 1 strain showed the MTBC co-occuring with Mycobacterium fortuitum, and 171 strains were identified as NTM. The overall concordance rate between the two methods for clinical strains was 87.78% (158/180). The top four species by prevalence were Mycobacterium avium intracelluar complex (MAC)(38.26% (57/149)), Mycobacterium chelonae or Mycobacterium abscess (24.83% (37/149)), Mycobacterium kansas (17.45% (26/149)), and Mycobacterium fortuitum (12.75% (19/149)) in 149 NTM strains. Discrepant results occurred in 22 strains: 9 showed MAC discordance between two methods, 1 strain was identified as an Mycobacterium intracellulare using the DNA microarray chip technique, but as Mycobacterium lentiflavum by MeltPro,1 strain was identified as an Mycobacterium terrae using the DNA microarray chip, and as Mycobacterium nonchromogenicum by MeltPro, 10 strains had the identification results by DNA microarray chip, but yielded uninterpretable results by MeltPro, and 1 strain was uninterpretable by DNA microarray chip, but identified as Mycobacterium lentiflavum by MeltPro. Gordonia aichiensis (ANI=99.102),Mycobacterium wolinskyi (ANI=97.822),Mycobacterium monacense (ANI=97.365),Mycobacterium peregrinum (ANI=97.730/97.981/96.930) and Mycobacterium stomatepiae (ANI=96.277) were identified by WGS and calculation of Average Nucleotide Identity(ANI). Conclusion: Both the MeltPro assay and DNA microarray chip method demonstrate good clinical application value for the identification of Mycobacterium species; however, the MeltPro assay exhibits higher accuracy.

Construction and analysis of early warning and prediction model for risk factors of initially treated severe pulmonary tuberculosis

Xue Yu, Guo Shubin, Lei Xuan, Zhang Jing, Li Wensheng, Liu Yan, Li Huan, Liu Zhifeng, Wang Wei, Wen Li

Chinese Journal of Antituberculosis. 2025, 47(8):  1038-1043.  doi:10.19982/j.issn.1000-6621.20250064

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Objective: To investigate the epidemiological characteristics of initially treated severe pulmonary tuberculosis, analyze its risk factors and establish a prediction model, which provides evidence for early clinical identification of initially treated severe pulmonary tuberculosis and improvement of clinical outcomes. Methods: A total of 217 patients with initially treated pulmonary tuberculosis admitted to Beijing Chest Hospital, Capital Medical University, between January 2024 to June 2024 were divided into two groups according to the diagnostic criteria for severe pulmonary tuberculosis: the initially treated severe group (107 patients) and the initially treated non-severe group (110 patients). The information including baseline data, basic diseases, laboratory tests and bacteriological evidence was retrospectively collected. The differences in clinical data between two groups were compared. Multivariate logistic regression analysis was performed to analyze the risk factors for severe pulmonary tuberculosis before treatment initiation, establish the risk prediction model and plot a receiver operator characteristic (ROC) curve to evaluate the predictive value of this model for initially treated severe tuberculosis patients. Results: Multivariate logistic regression analysis showed that heart rate, albumin, neutrophile-lymphocyte ratio (NLR), sodium, respiratory distress were independent risk factors for the initial treated severe pulmonary tuberculosis. An increased heart rate was associated with an increased risk of severe pulmonary tuberculosis (OR=1.205, 95%CI: 1.010-1.436). An increase in the ratio of NLR significantly increased the risk of disease (OR=2.247, 95%CI: 1.133-4.455). Respiratory distress was the strongest risk factor, with an OR as high as 26.899 (95%CI: 1.713-289.780). Higher albumin levels were associated with a reduced risk of severe disease (OR=0.487, 95%CI: 0.270-0.876), as were higher blood sodium levels (OR=0.489, 95%CI: 0.257-0.928). ROC curve analysis showed that the area under the curve was 0.995 when the five risk factors were combined, and the sensitivity and specificity of predicting the initial severe pulmonary tuberculosis were 96.2% and 98.2%, respectively. Conclusion: Heart rate, respiratory distress, albumin, NLR, sodium were independent risk factors for the initial treatment severe pulmonary tuberculosis. Moreover, the combination of these five factors can effectively predict the occur of severe pulmonary tuberculosis.

Predicting pulmonary tuberculosis treatment outcomes using longitudinal chest CT radiomics and deep learning

Abuduresuli Tu’ersun, Abudukeyoumujiang Abulizi, Patiman Maimaiti, Huang Chencui, Shen Lingyan, Mayidili Nijiati

Chinese Journal of Antituberculosis. 2025, 47(8):  1044-1052.  doi:10.19982/j.issn.1000-6621.20250047

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Objective: To develop an effective imaging-based prediction tool for reducing overmedication in pulmonary tuberculosis patients. Methods: We collected longitudinal chest CT imaging data from 279 pulmonary tuberculosis patients who received treatment at the First People’s Hospital of Kashgar between January 2020 and January 2024. The dataset included both pre-treatment and post-treatment CT scans. A total of 3386 radiomic features were extracted to construct five distinct predictive models: (1) a pre-treatment CT-based model, (2) a post-treatment CT-based model, (3) a combined pre- and post-treatment CT radiomics model, (4) a delta radiomics model based on temporal changes in imaging features between pre- and post-treatment scans, (5) a deep learning model utilizing ResNet18 architecture incorporating both pre- and post-treatment CT images. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve (AUC). Additionally, SHapley Additive exPlanations (SHAP) and Gradient-weighted Class Activation Mapping (Grad-CAM) techniques were employed for model interpretation and visualization. Results: The combined model utilizing both pre- and post-treatment CT data achieved AUCs of 0.845 and 0.770 in the training and test sets, respectively. The deep learning model demonstrated superior performance with AUCs of 0.883 and 0.858 in the training and validation sets, respectively. Conclusion: The deep learning model based on longitudinal chest CT imaging demonstrated robust performance in predicting tuberculosis treatment outcomes, offering valuable support for personalized treatment strategies and resource optimization.

The value of machine learning algorithm-based diagnostic models in tuberculous pleural effusion

Jiao Jiahuan, Sun Changfeng, Wu Gang, Huang Fuli, Sheng Yunjian

Chinese Journal of Antituberculosis. 2025, 47(8):  1053-1061.  doi:10.19982/j.issn.1000-6621.20250033

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Objective: To explore the value of artificial intelligence Machine Learning Algorithm (MLA) based diagnostic models for tuberculous pleural effusion (TPE) diagnosis. Methods: A retrospective study was conducted. All of 233 patients with pleural effusion admitted to The People’s Hospital of Leshan from January 2020 to September 2022 were enrolled as an internal experimental group according to inclusion criteria. Patients were categorized into tuberculosis group (n=106) and non-tuberculosis group (n=127) based on TPE diagnosis. Clinical data were processed and analyzed using R software (version 4.1.1). Least absolute shrinkage and selection operator (LASSO) regression were employed for variable selection, followed by the development of four MLA-based diagnostic models: random forest (RF), support vector machine with linear kernel (SVM-linear), support vector machine with polynomial kernel (SVM-polynomial), and multivariate logistic regression. The diagnostic performance of each model was evaluated using the area under the receiver operating characteristics curve (AUC), and compared with the pleural adenosine deaminase (ADA). External validation was conducted using an independent cohort of 141 pleural effusion patients (101 with TPE and 40 without TPE) from The Affiliated Hospital of Southwest Medical University during the same period. Results: LASSO regression analysis identified total pleural protein, pleural ADA, mononuclear cell ratio in pleural fluid, serum neutrophil ratio, platelet count, fever, and night sweats as risk factors for TPE (penalty coefficients: 0.216, 0.058, 0.003, 0.049, 0.000, 0.045, 1.605, respectively), whereas pleural carcinoembryonic antigen (CEA), polymorphonuclear cell ratio in pleural fluid, and peripheral white blood cell count were associated with a lower risk of TPE (penalty coefficients: -0.072, -0.029, -0.567, respectively). The four MLA-based diagnostic models demonstrated TPE diagnostic sensitivities of 91.8% (RF), 84.5% (SVM-linear), 86.9% (SVM-polynomial), and 85.4% (multivariate logistic regression); specificities of 99.0%, 81.6%, 93.8%, and 81.6%; and AUC values of 0.988, 0.875, 0.959, and 0.886, respectively, all exceeding pleural effusion ADA performance (sensitivity 83.1%, specificity 77.9%, AUC 0.820). In the external validation cohort, the AUCs of the RF, SVM-linear, SVM-polynomial, and logistic regression models were 0.834, 0.827, 0.817, and 0.815, respectively. Conclusion: The novel random forest based diagnostic model demonstrated the best diagnostic performance for TPE identification, providing a simpler, more rapid, and clinical effective diagnostic approach.

Development and reliability and validity testing of the Pulmonary Tuberculosis Symptom Cluster Scale

Kong Hanhan, Chen Zijiao, Zeng Jianfeng, Wu Dan, Tang Lin, Wen Min

Chinese Journal of Antituberculosis. 2025, 47(8):  1062-1067.  doi:10.19982/j.issn.1000-6621.20250080

Abstract ( 48 )   HTML ( 4 )   PDF (912KB) ( 51 )   Save

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Objective: To develop the Pulmonary Tuberculosis Symptom Cluster Scale and to evaluate its psychometric properties, including reliability and validity. Methods: Guided by the Symptom Experience Model, the preliminary version of the scale was constructed through a comprehensive process involving literature review, semi-structured interviews with patients diagnosed with pulmonary tuberculosis (PTB), expert consultation via the Delphi method, and a pilot study. Subsequently, a cross-sectional survey was conducted among 162 hospitalized PTB patients at the Third People’s Hospital of Shenzhen. Item analysis, exploratory factor analysis (EFA), and internal consistency testing were employed to assess the reliability and construct validity of the scale. Results: The developed Pulmonary Tuberculosis Symptom Cluster Scale contains 17 items, covering four symptom clusters: systemic, gastrointestinal, respiratory, and psychological. The cumulative variance contribution rate was 65.058%. The scale’s Cronbach’s α coefficient was 0.837, the split-half reliability was 0.705. The content validity index of the scale was 0.840, with individual item content validity indices ranging from 0.801 to 1.000. Conclusion: The Pulmonary Tuberculosis Symptom Cluster Scale developed in this study has good reliability and validity, and can be used for the assessment of symptom clusters in tuberculosis patients.

Review Articles

Research progress on the application of artificial intelligence-based CT radiomics in the diagnosis and treatment response monitoring of tuberculosis

Zhu Qingdong, Zhao Chunyan, Xie Zhouhua, Song Shulin, Song Chang

Chinese Journal of Antituberculosis. 2025, 47(8):  1068-1076.  doi:10.19982/j.issn.1000-6621.20250149

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In recent years, radiomics models, have effectively distinguished pulmonary tuberculosis from lung cancer, nontuberculous mycobacterial lung disease, community-acquired pneumonia, etc, through integrating clinical features with deep learning technologies. They have shown excellent performance in the differential diagnosis of pulmonary tuberculosis, significantly outperforming traditional imaging evaluations. In particular, they can provide a powerful non-invasive diagnostic tool for extrapulmonary tuberculosis (such as intestinal tuberculosis and lymph node tuberculosis) cases with difficult diagnosis and limited sample acquisition. The constructed multimodal fusion models not only demonstrate high accuracy in differentiating intestinal tuberculosis from Crohn’s disease and lymph node tuberculosis from lymphoma but also show significant potential in predicting drug-resistant tuberculosis and dynamically monitoring treatment responses, presenting broad prospects in the diagnosis and treatment response monitoring of tuberculosis. However, constrained by issues such as uneven dataset quality, limited model generalization ability, and insufficient clinical validation, radiomics models still face severe challenges in the diagnosis and treatment of tuberculosis. Through in-depth literature analysis, this paper systematically reviews the latest research progress and application value of artificial intelligence (AI)-driven computed tomography (CT) radiomics technology in the diagnosis and treatment of tuberculosis (including pulmonary and extrapulmonary tuberculosis). It focuses on the innovative analysis of multimodal fusion technologies and clinical implementation scenarios, aiming to provide references for guiding future research directions, further promoting its application and development in the diagnosis and treatment response monitoring of tuberculosis, and contributing to the precision medicine, prevention, and control of tuberculosis.

Advances in the application of extracellular vesicles and the diagnosis of tuberculosis

Zhu Qingyu, Liu Jiayun, Long Yin

Chinese Journal of Antituberculosis. 2025, 47(8):  1077-1084.  doi:10.19982/j.issn.1000-6621.20250091

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The early and accurate diagnosis of tuberculosis (TB) remains a pressing challenge in global public health. In recent years, extracellular vesicle (EV) have emerged as a promising avenue for TB diagnostics. EV are nanoscale, membrane-bound structures that play critical roles in both intracellular and intercellular communication during host-pathogen interactions. Notably, they encapsulate microbial antigenic components with high specificity, offering considerable potential as novel biomarkers for disease detection. Current research efforts focus on identifying novel EV-derived biomarkers, applying highly sensitive nucleic acid detection technologies, and employing nanomaterial-based enrichment strategies to enhance the diagnostic yield of EV in the body fluids of patients with TB. This review summarizes the diagnostic value and recent advances in EV and their associated biomarkers in both pulmonary TB and extrapulmonary TB. Key technical limitations and potential breakthroughs are discussed, aiming to establish a conceptual framework that may guide future interdisciplinary investigations in this rapidly evolving field.