Table of Content

10 October 2025, Volume 47 Issue 10

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Special Topic

The construction and application of Chinese Tuberculosis Strains Resource Bank

Liu Dongxin, Wei Qiang, Liu Jianjun

Chinese Journal of Antituberculosis. 2025, 47(10):  1242-1248.  doi:10.19982/j.issn.1000-6621.20250214

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Pathogenic microorganism resources are crucial for infectious diseases diagnosis, treatment formulation, vaccines development, transmission characteristics research, drug resistance surveillance, evolutionary study, and pathogen-host interactions investigation. Tuberculosis remains the foremost cause of death by an infectious disease globally and represents one of the major communicable diseases in China, which has persistently posed a serious threat to the health of the Chinese population. The process of tuberculosis prevention and control generates a substantial volume of biological sample resources, including microbial strains, however, previous efforts in the management and utilization of tuberculosis-related biological samples have been plagued by issues such as disorganization, fragmentation, isolation, lack of standardized protocols, absence of quality control systems and information management frameworks, as well as incomplete clinical data, these inadequacies have resulted in significant losses of valuable Mycobacterium tuberculosis strains and associated biological samples, and also posing potential biosafety risks. Based on the current situations and demands of Chinese tuberculosis prevention and control, we discussed the necessity of establishing tuberculosis resource bank, the construction principles and classification, as well as the utilization of the mycobacterium sample bank. We hope to advance the standardized development and scientific application of tuberculosis biological sample banks in China, thereby continuously enhancing national research capabilities and service levels related to tuberculosis, and ultimately, contribute for the high-quality development of disease prevention and control initiatives.

Exploring diagnostic and therapeutic approaches for latent tuberculosis infection based on the theory of hidden pathogen (Fu Xie)

Feng Yinping, Zhang Zunjing, Cai Qiujie, Wang Xiaomeng, Ma Yan, Liu Zhongda, Gao Lei

Chinese Journal of Antituberculosis. 2025, 47(10):  1249-1253.  doi:10.19982/j.issn.1000-6621.20250327

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In Traditional Chinese Medicine (TCM) categorizes tuberculosis (TB) as “consumptive disease” (lao bing) or “consumptive disorder” (lao zhai). Latent tuberculosis infection (LTBI) is the primary source of TB onset and a continuous reservoir of new cases. LTBI presents with concealed clinical symptoms, aligning with the characteristics of “latent pathogen”(fu xie) in TCM. Authors review the origin and core principles of the latent pathogen theory, correspondence with the latent biological features of Mycobacterium tuberculosis. On this basis, a TCM diagnostic and therapeutic approach of “treatment based on stage differentiation”(fen qi bian zhi) and “syndrome-based treatment”(fen zheng lun zhi) is proposed, aiming to provide theoretical references for the early intervention of LTBI with TCM, regulation of immune homeostasis, and further reduction of TB incidence.

Original Articles

Preparation and performance evaluation of quality control paraffin blocks for the pathological diagnosis of tuberculosis

Huang Xiaojie, Du Weili, Zhao Hong, Su Dan, Liu Zichen, Zhao Yingli, Liu Yi, Che Nanying

Chinese Journal of Antituberculosis. 2025, 47(10):  1254-1260.  doi:10.19982/j.issn.1000-6621.20250181

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Objective: To develop a standardized method for preparing quality control (QC) paraffin blocks for pathological diagnosis of tuberculosis, and to evaluate their performance with respect to cellular morphology, spatial distribution of Mycobacterium tuberculosis (MTB), and MTB DNA. Methods: QC paraffin blocks containing different concentrations of MTB were prepared by combining inactivated MTB H37Rv suspension with sedimented cells from malignant pleural effusion, using 2% agar as the embedding matrix. Negative control blocks were generated by replacing the MTB suspension with phosphate-buffered saline (PBS). Each cylindrical agar block was sectioned longitudinally into four equal layers (approximately 3 mm thick), yielding stratified sample groups. Hematoxylin and eosin (HE) staining was used to assess the integrity of cellular morphology and the uniformity of spatial distribution. Acid-fast staining (AFB) and quantitative real-time PCR (qPCR) were employed to evaluate MTB load, IS6110 copy number, and the homogeneity of MTB distribution along the longitudinal axis of the blocks. Results: Standardized QC paraffin blocks compatible with both AFB staining and MTB DNA detection were successfully developed. HE staining confirmed the preservation of cellular morphology and a uniform spatial distribution of cells within the blocks. In AFB staining, stratified sample groups containing theoretical MTB loads of 33.6 and 336 bacilli per section consistently exhibited detectable bacilli across all slices, qualifying them as reliable positive QC materials for staining. The corresponding average MTB densities were (21.50±9.26) and (169.25±40.25) bacilli per 300 fields, respectively. Quantitative PCR analysis demonstrated consistent positivity in all blocks with theoretical MTB concentrations of 0.336, 3.36, 33.6, and 336 bacilli per section. The IS6110 gene copy numbers in these groups were (6.48±3.54), (26.53±6.65), (283.93±98.51), and (4446.75±833.84) copies per five sections, respectively. The coefficient of variation for Ct values remained below 5% in all groups, and the longitudinal distribution of MTB DNA within the blocks was uniform, supporting their qualification as standardized molecular QC materials. Negative controls were consistently negative in both AFB staining and qPCR, with no IS6110 amplification observed. Conclusion: We developed a standardized protocol for the preparation of QC materials tailored to the pathological diagnosis of tuberculosis. Based on assay sensitivity and clinical application scenarios, we recommend a minimum MTB load of 33.6 bacilli per section for AFB staining QC and 0.336 bacilli per section for molecular diagnostic QC. The selection of initial MTB concentration should be guided by the detection limits of the assay and the intended diagnostic context.

Feasibility of new vitrification cryopreservation technology for construction lung cancer organoid from surgical specimens

Huang Yuqing, Sun Zuyu, Liu Yi, Zhang Chen, Zhou Lijuan, Zhao Hong, Che Nanying

Chinese Journal of Antituberculosis. 2025, 47(10):  1261-1267.  doi:10.19982/j.issn.1000-6621.20250180

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Objective: To explore the feasibility of employing vitrification cryopreservation, an advanced cryopreservation technique, for preserving surgically resected lung cancer tissues to facilitate subsequent organoid generation. Methods: We prospectively collected tumor specimens from 12 patients with histologically confirmed lung cancer at Beijing Chest Hospital, Capital Medical University from July to August 2024. Following standardized pathological procedures, the tissues were immediately immersed in preservation medium, maintained at 4 ℃ during transportation, and processed within 2 hours. Each specimen was systematically divided into three aliquots of approximately 0.5 cm³. One was processed fresh for organoid culture (serving as the control), while the remaining two were subjected to vitrification cryopreservation and stored in a vapor-phase liquid nitrogen tank. The cryopreserved samples were subsequently thawed at two time points (1 week and 4 months) for comparative assessment of organoid culture. Results: All fresh specimens (100.0%, 12/12) successfully generated organoids. Vitrified samples showed success rates of 75.0% (9/12) and 50.0% (6/12) at 1-week and 4-month time points, respectively. Crucially, cryopreserved-derived organoids maintained morphological characteristics and tumor marker expression profiles comparable to those of the fresh controls. Notably, all specimens with post-thaw viability <55% after 4 months of storage failed to organoid generation. Conclusion: This small-scale study indicates that although long-term vitrification cryopreservation exerts certain detrimental effects on cell viability, the processed surgical specimens can still meet the requirements for organoid construction.

Analysis of the factors influencing adherence and treatment outcomes among pulmonary tuberculosis patients with comorbidities in China from 2010 to 2023

Yan Tianxin, Ma Wenbin, Wang Jia, Li Tao, Zhang Hui, Zhao Yanlin, Qu Yan, Luo Xiaofeng

Chinese Journal of Antituberculosis. 2025, 47(10):  1268-1278.  doi:10.19982/j.issn.1000-6621.20250237

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Objective: To analyse the treatment adherence, treatment outcomes, and associated influencing factors among pulmonary tuberculosis (PTB) patients with comorbidities in China from 2010 to 2023 and provide a scientific basis for improving treatment effectiveness in these patients. Methods: Using a retrospective research method, medical records of PTB patients with single comorbidity registered between 2010 and 2023 was extracted from “China Tuberculosis Information Management System” subsystem of the “China Center for Disease Control and Prevention Information System”. The study excluded patients with duplicate registrations, incomplete treatment records, mycobacterial species identification indicating non-tuberculosis mycobacterial infections, and drug-resistant PTB cases other than rifampin resistance. Finally, a cohort of 339411 PTB patients with comorbidities was obtained. The incidence rates of non-adherence and unfavorable treatment outcomes were calculated. Multivariable logistic regression models were conducted to identify factors associated with treatment adherence and treatment outcomes. Results: The incidence rate of irregular medication adherence among PTB patients with comorbidities was 4.26% (14463/339411), while the incidence rate of unfavorable treatment outcomes was 9.86% (33456/339411). Multivariable logistic regression models revealed that male gender, occupations in commercial and other services, and other unspecified categories, passive healthcare-seeking behavior, co-infection with HIV/AIDS or other comorbidities, re-treatment status, bacteriologically positive results, self-medication practices, and the diagnosis of drug-resistant PTB were all independent risk factors influencing treatment non-adherence (odds ratio (OR) with 95% confidence intervals (CI): 1.153 (1.107-1.201), 1.269 (1.102-1.455), 1.135 (1.086-1.186), 1.214 (1.166-1.265), 1.568 (1.419-1.730), 1.173 (1.130-1.217), 1.261 (1.198-1.327), 1.138 (1.096-1.181), 1.440 (1.390-1.492), and 4.100 (3.811-4.409), respectively). Additionally, male gender, passive healthcare-seeking behavior, re-treatment status, positive etiological detection, self-medication, non-use of fixed-dose combination (FDC) drugs, a diagnosis of drug-resistant PTB, and low treatment adherence were identified as independent risk factors for unfavorable treatment outcomes (OR (95%CI): 1.264 (1.224-1.306), 1.076 (1.043-1.111), 1.128 (1.083-1.173), 1.585 (1.531-1.642), 1.057 (1.027-1.088), 1.046 (1.017-1.075), 23.811 (22.341-25.385), and 28.468 (27.329-29.659), respectively). Conclusion: The treatment adherence and treatment outcomes of patients with PTB complicated by other diseases in China are influenced by the co-existing related diseases, targeted measures should be developed by integrating an analysis of population characteristics and the types of comorbidities that influence treatment adherence and outcomes among PTB patients with comorbid conditions. Efforts should be strengthened to actively detect cases of male and public service personnel, and enhance precise treatment management for re-treated, bacteriologically positive patients, and individuals with drug resistant comorbidities. To encourage patients to complete their full course of treatment, such that it reduces unfavorable treatment outcomes and improve overall treatment efficacy and rehabilitation levels, convenient and intelligent medication management tools should be promoted.

A study on the association between tuberculosis history and depressive status in Chinese population aged 45 years and older

Jiang Xiujing, Zhong Qin, Yi Jie, He Fei, Chen Xiaohong

Chinese Journal of Antituberculosis. 2025, 47(10):  1279-1288.  doi:10.19982/j.issn.1000-6621.20250125

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Objective: Based on the data from the China Health and Retirement Longitudinal Study (CHARLS), to explore the association between tuberculosis (TB) history and depressive status in middle-aged and elderly adults, as well as the potential influencing factors. Methods: A cross-sectional study design was used, a total of 15273 middle-aged and elderly individuals aged 45 years or order were included in this study and divided into two groups: depression group and non-depression group. Multiple imputation was used to process the missing data, and the association between TB history and depressive status was evaluated through multi-stage adjusted logistic regression model and subgroup analysis. The important factors affecting depressive status were visualized through nomogram. Results: Among 15273 middle-aged and elderly individuals, 5658 (37.05%) were in the depression group and 9615 (62.95%) were in the non-depression group. The proportion of patients with a history of TB in the depression group (0.90%, 51/5658) was higher than that in the non-depression group (0.52%, 50/9615) with a statistically significant difference (χ²=7.316, P=0.007). After adjustment of multiple model, TB history remained significantly related to depression (Model 3: OR=1.61, 95%CI: 1.05-2.46). Subgroup analysis showed that although the correlation strength between TB and depression had a higher trend in women (OR=2.06, 95%CI: 1.11-3.95) and younger groups (OR=2.18, 95%CI: 1.32-3.64), the interaction test did not show significant effect on gender (OR=0.51, 95%CI: 0.23-1.14, P_interaction=0.714) or age (OR=0.51, 95%CI: 0.23-1.14, P_interaction=0.102). The nomogram analysis indicated that the history of TB (risk score=5.150) had a greater impact on depression than the elderly (risk score=0.790), smoking (risk score for former smokers=0.910, risk score for current smokers=1.240) and high physical activity (risk score=0.180). Sensitivity analysis showed that the main results before and after interpolation were consistent, supporting the robustness of the conclusion. Conclusion: TB history is significantly associated with the depressive status of Chinese middle-aged and older people, and is not affected by gender or age. TB infection may have a long-term negative impact on mental health. It is suggested that depression screening and intervention measures should be included into the routine follow-up care for patients with TB.

Analysis of reported incidence trends of pulmonary tuberculosis in Shanghai, China, 2009—2023, using a Joinpoint regression model

Ding Yuanlu, Xiao Wenjing, Tao Fangfang, Feng Wei, Wang Ye, Rao Lixin, Shen Xin, Chen Jian, Chen Jing

Chinese Journal of Antituberculosis. 2025, 47(10):  1289-1299.  doi:10.19982/j.issn.1000-6621.20250123

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Objective: To analyze the epidemiological characteristics and reported incidence trends of pulmonary tuberculosis (PTB) in Shanghai from 2009 to 2023 using a Joinpoint regression model, and to provide a scientific basis for evaluating the effectiveness of TB control measures and optimizing strategies. Methods: Data on PTB cases in Shanghai from 2009 to 2023—including reported incidence counts, population classification, household registration status, etiological classification, and occupational classification—were obtained from the “Communicable Disease Reporting Information Management System”, a subsystem of the “China Information System for Disease Control and Prevention”. Descriptive epidemiological methods were used to analyze characteristics of reported PTB incidence, and the Joinpoint regression model, annual percent change (APC), and average annual percent change (AAPC) were applied to evaluate temporal changes in PTB incidence. Results: From 2009 to 2023, the average annual reported PTB incidence rate in Shanghai was 26.49 per 100000 (93342/352.363 million), decreasing from 35.72 per 100000 (6745/18.885 million) in 2009 to 18.35 per 100000 (4541/24.746 million) in 2023, with an average annual percentage decline of 4.65% and an overall downward trend (AAPC=-5.429%, t=-2.790, P=0.005). The average annual etiological positivity rate was 48.56% (43242/89050), declining from 45.30% (3007/6638) in 2009 to 37.07% (2360/6367) in 2016, then increasing to 71.46% (3024/6232) in 2023, showing an overall upward trend (AAPC=3.033%, t=2.941, P=0.003). The decline in incidence among the non-registered resident population (AAPC=-10.503%) was faster than that among registered residents (AAPC=-3.350%), and since 2022, the incidence rate among non-registered residents had been lower than that of registered residents. The incidence rate in males (34.91 per 100000 (63283/181288000)) was significantly higher than in females (17.57 per 100000 (30059/171075000)), but the rate of decline (AAPC=-6.041%) was faster than that in females (AAPC=-4.312%). Among the elderly population (≥60 years), the incidence rate showed an overall declining trend, with AAPCs of -3.198% in the 60-74 year group and -7.996% in the ≥75-year group, but remained higher than that of other age groups. The proportions of retirees and unemployed individuals increased from 14.89% (1004/6745) and 13.49% (910/6745) in 2009 to 39.40% (1789/4541) and 29.29% (1330/4541) in 2023, respectively, both showing significant upward trends ( {\chi }_{trend}^2=3064.851 and 4504.868, both P<0.001). Conclusion: Significant progress has been achieved in TB prevention and control in Shanghai, as evidenced by a sustained decline in the reported incidence rate and a gradual improvement in the bacteriological positivity rate. Although the overall incidence among non-registered residents, males, the elderly, and individuals without employment has shown a downward trend, the incidence in these groups remains relatively high. It is recommended to continue strengthening the management of infectious sources and proactive screening of high-risk populations, and to integrate information technologies with precise intervention strategies to advance progress toward the goal of “End-TB”.

A survey and analysis of quality of life among young and middle-aged pulmonary tuberculosis patients and their spouses

Xie Yuanqi, Song Lin, Yao Yanhua, Cai Lili

Chinese Journal of Antituberculosis. 2025, 47(10):  1300-1310.  doi:10.19982/j.issn.1000-6621.20250081

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Objective: To investigate the status and influencing factors of quality of life (QoL) among young and middle-aged patients with pulmonary tuberculosis (PTB) and their spouses, thereby providing evidence-based guidance for targeted interventions to improve their QoL. Methods: From September to November 2023, a stratified cluster sampling method was employed to conduct a questionnaire-based survey among hospitalized young and middle-aged PTB patients and their spouses at two tuberculosis (TB) designated hospitals in Guangdong Province, including 60 patient-spouse pairs at the First Navy Hospital of Southern Theater Command and 60 patient-spouse pairs at Central People's Hospital of Zhanjiang. A total of 240 pieces of questionnaire were distributed (120 for patients and 120 for spouses). Missing data were handled via listwise deletion, excluding responses with missing values in key variables (Generic Quality of Life Inventory-74 (GQOLI-74) scores and core demographic characteristics). Ultimately, 221 valid responses were collected (112 from patients and 109 from spouses), yielding a response rate of 92.08%. The survey included a self-developed general information questionnaire and the GQOLI-74. The general information questionnaire for patients covered the following aspects: (1) Sociodemographic Characteristics: Age, sex, educational level, local household registration status, employment status, household income, per capita living space; (2) QoL Parameters: Marital relationship, sexual life; (3) Clinical Data: Treatment category, diagnostic category, presence of complications, disease duration, adverse reactions to anti-TB medications, smoking status, body mass index (BMI), sleep quality, treatment adherence, current treatment phase, and disease severity; (4) Exposure to TB-related health education. The spouse questionnaire included five aspects: (1) Sociodemographic Characteristics: Age, sex, educational level, local household registration status, employment status, household income, per capita living space; (2) Patient Clinical Data: Patient's treatment category, diagnostic category, presence of complications, and disease duration; (3) QoL Parameters: Marital relationship, sexual life; (4) Health Status: Smoking status, BMI, sleep quality, presence of chronic illnesses; (5) Exposure to TB-related health education and level of knowledge regarding TB prevention and control. Univariable and multivariable linear regression models were employed to analyze the QoL status and its influencing factors among both patients and their spouses. Results: According to GQOLI-74, the average overall QoL score for spouses was 57.74±8.01, significantly higher than that of the patients (50.56±6.05, t=4.550, P<0.001). In the domains of social and physical functioning, spouses also scored significantly higher than patients (62.86±10.63 vs. 52.91±12.31, t=3.317, P<0.001; and 62.95±12.90 vs. 55.06±14.27,t=2.257, P=0.026). In contrast, differences in material life (37.39±13.63 for patients vs. 43.39±18.28 for spouses) and psychological functioning (56.88±11.45 for patients vs. 61.74±11.75 for spouses) were not statistically significant (t=1.683, P=0.095; t=1.704, P=0.091). Multiple linear regression analysis identified household income, sexual life, marital relationship, and TB-related health education as independent predictors of QoL in both patients (β=3.104,P<0.001;β=2.625,P=0.012;β=2.657,P=0.003;β=3.758,P=0.001) and their spouses (β=4.407,P<0.001;β=4.836,P<0.001;β=2.286,P=0.038;β=5.319,P=0.002). In addition, adverse drug reactions (β=-2.344, P=0.005) and treatment adherence (β=1.582, P=0.010) were independent factors influencing patients' QoL. For spouses, awareness of TB prevention and control knowledge was an independent predictor (β=3.807, P<0.001). Conclusion: This study confirms that PTB significantly compromises the QoL of both young and middle-aged patients and their spouses, influenced by a combination of clinical, psychosocial, and educational factors. The findings provide empirical support for family-centered, targeted interventions aimed at improving QoL among affected households.

Building and evaluating a predictive model for secondary pulmonary tuberculosis based on Random Forest model

Chu Guangyan, Li Ting, Yu Jianing, He Di, Zhang Kun, Hou Shaoying, Yan Shichun

Chinese Journal of Antituberculosis. 2025, 47(10):  1311-1317.  doi:10.19982/j.issn.1000-6621.20250166

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Objective: To investigate the screening value of Random Forest model algorithm for secondary pulmonary tuberculosis, aiming to provide a basis for early clinical identification of secondary pulmonary tuberculosis. Methods: A total of 1208 healthy individuals who underwent physical examination at the Health Management Center of Heilongjiang Provincial Hospital from March to September 2021, and 876 patients with secondary pulmonary tuberculosis who were initially diagnosed and received treatment at Heilongjiang Provincial Infectious Disease Hospital were identified. Based on inclusion and exclusion criteria, 367 secondary pulmonary tuberculosis patients were assigned to the observation group and 376 healthy individuals to the control group. Basic demographic data was collected. The dataset was divided into a training set (495 cases) and a testing set (248 cases) with a 2∶1 ratio. The model incorporated 38 predictive variables. A Random Forest model was constructed using the training set data, and its performance was validated and evaluated using the testing set data. A comparative analysis of the top ten important variables identified by the model was performed for the two groups. Results: In this study, the optimal parameters for the Random Forest model were determined to be 5 nodes and 300 trees. The model demonstrated high performance with an accuracy of 99.60%, precision of 99.92%, sensitivity of 99.20%, specificity of 99.87%, and an area under the receiver operating characteristic curve (AUC) of 0.986 (95%CI: 0.978-0.995). The top ten variables ranked by mean decrease in Gini index were identified as: platelet distribution width (30.02), albumin-to-globulin ratio (20.70), indirect bilirubin (19.32), albumin (17.97), mean corpuscular hemoglobin concentration (12.24), urine specific gravity (11.26), total bilirubin (10.09), total bile acids (7.43), lymphocyte percentage (6.92), and aspartate aminotransferase/alanine aminotransferase ratio (6.50).Compared with the control group, the observation group exhibited significantly higher platelet distribution width (15.90 (15.50, 16.20) fl), AST/ALT ratio (1.41 (1.02, 1.79)), and a higher proportion of abnormal urine specific gravity (340 cases (92.64%) vs. normal: 27 cases (7.36%)) versus the control group (12.00 (11.10, 13.30) fl; 0.95 (0.77, 1.15); abnormal: 290 cases (77.13%) vs. normal: 86 cases (22.87%)). These differences were statistically significant (Z=-16.907, P<0.001; Z=-11.951, P<0.001; χ²=34.670, P<0.001, respectively). Conversely, the observation group had significantly lower levels of albumin ((38.42±6.47) g/L), total bilirubin (12.80 (9.10, 19.00) μmol/L), indirect bilirubin (7.60 (5.05, 11.80) μmol/L), albumin-to-globulin ratio (1.17 (0.97, 1.40)), total bile acids (2.80 (1.79, 5.12) μmol/L), lymphocyte percentage (22.90 (15.50, 32.55) %), and mean corpuscular hemoglobin concentration (322.00 (317.00, 328.00) g/L) compared with the control group ((45.14±2.13) g/L; 22.25 (18.40, 26.90) μmol/L; 17.40 (14.30, 19.10) μmol/L; 1.60 (1.50, 1.70); 4.60 (3.70, 5.50) μmol/L; 34.60 (29.07, 39.90) %; 336.00 (331.00, 343.00) g/L). These differences were also statistically significant (t=-18.891, P<0.001; Z=-14.313, P<0.001; Z=-16.994, P<0.001; Z=-17.030, P<0.001; Z=-9.675, P<0.001; Z=-12.684, P<0.001; Z=-16.843, P<0.001, respectively). Conclusion: The Random Forest prediction model constructed in this study for secondary pulmonary tuberculosis patients exhibited excellent performance. It is recommended that early screening for tuberculosis patients should pay attention to changes in certain nutritional indicators (such as indirect bilirubin, total bilirubin, albumin, etc.) to optimize screening strategy. Furthermore, nutritional therapy should be emphasized during the treatment of secondary pulmonary tuberculosis patients.

Analysis on influencing factors of the use of intelligent health management tools among patients with pulmonary tuberculosis in Inner Mongolia Autonomous Region in 2023

Zhang Weile, Li Dongxu, Wang Liwei, Su Min, Gao Yulong

Chinese Journal of Antituberculosis. 2025, 47(10):  1318-1325.  doi:10.19982/j.issn.1000-6621.20250183

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Objective: To analyse the influencing factors of the use of intelligent health management tools such as electronic pillbox and mobile WeChat among patients with pulmonary tuberculosis (PTB) in Inner Mongolia Autonomous Region, and to provide experiences for the promotion of digital technology. Methods: With data from the China Information System for Disease Control and Prevention and Easy Supervision System, we analyzed the acceptance and influencing factors of the use of intelligent health management tools among 8043 PTB patients in Inner Mongolia Autonomous Region from 1 January to 31 December 2023. Results: The usage rate of intelligent health management tools among PTB patients was 87.91% (7071/8043) in Inner Mongolia Autonomous Region in 2023. Univariable analysis revealed statistically significant differences in gender (χ²=4.827, P=0.028), occupation (χ²=12.823, P=0.012), demographic classification (χ²=5.471, P=0.019), diagnostic classification (χ²=8.803, P=0.032), and areas (χ²=376.284, P<0.001). Multivariable logistic regression analysis showed that male (OR=0.84, 95%CI: 0.72-0.97), domestic and unemployed (OR=0.71, 95%CI: 0.60-0.85), local patients (OR=0.43, 95%CI: 0.20-0.93), bacteriologically negative (OR=0.86, 95%CI: 0.74-0.99), central area (OR=0.15, 95%CI: 0.12-0.18) and eastern area (OR=0.38, 95%CI: 0.31-0.46) had a lower use of the intelligent health management tools, while the patients with tuberculosis pleurisy showed a higher use of the tools (OR=1.56, 95%CI: 1.06-2.28). Conclusion: The acceptance of intelligent health management tools for PTB patients was relatively high in Inner Mongolia Autonomous Region in 2023, however, attention should be paid to the health management for male patients, domestic and unemployed patients, local patients, bacteriologically negative patients, and patients from the central and eastern regions.

Research on influencing factors of preventive treatment of latent tuberculosis infection based on thematic analysis:Taking Shijiazhuang City as an example

Shi Xiaojing, Wang Xin, Guo Jianhua, Zhao Qingran, Wang Yuhan

Chinese Journal of Antituberculosis. 2025, 47(10):  1326-1332.  doi:10.19982/j.issn.1000-6621.20250193

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Objective: To analyze influencing factors of preventive treatment of latent tuberculosis infection (LTBI) based on thematic analysis, to provide reference for rapid promotion of preventive treatment. Methods: A purposive sampling method was used to select 30 managers involved in all aspects of preventive treatment work in Shijiazhuang City from 2022 to 2023 and 75 latent tuberculosis infectors who met the preventive treatment standard and lived in the city during the same period as the research objects. Semi-structured in-depth individual interview was conducted to collect their understanding and attitude towards preventive treatment policy. Thematic analysis was conducted for summarization and analysis with software MAXQDA 22.0. Through double independent open coding and axial coding, a theme framework of influencing factors of LTBI preventive treatment was constructed, reliability of coding results was evaluated with coding consistency coefficient, then difference in response frequency on the overall theme between latent tuberculosis infectors and preventive treatment managers was analyzed. Results: In-depth interview with 105 subjects formed a final thematic framework of LTBI preventive treatment influencing factors which included four general themes: cognitive factors (95 times), decision support (54 times), risk management (48 times) and policy funds (33 times), covering 8 sub-themes and 230 categories. There was a statistically significant difference in the response frequencies of latent tuberculosis infectors and preventive treatment managers in the overall theme (χ²=13.097, P=0.004). Latent tuberculosis infectors and preventive treatment managers had insufficient knowledge of LTBI and preventive treatment (46 times), latent tuberculosis infectors cannot obtain effective decision support (54 times), difficulties in treatment management (21 times), and lack of policy and financial support (33 times) directly affected the smooth conduction of preventive treatment. Conclusion: Individual cognitive level and health beliefs, timeliness and effectiveness of decision support, risk management, policy and financial support affect the promotion of preventive treatment.

Distribution and drug resistance characteristics of pathogens in patients with pulmonary tuberculosis and non-pulmonary tuberculosis complicated with lower respiratory tract infections

Wang Liping, Zhang Pei, Qin Xiaohua, Zhou Xin, Jiang Caihua, Li Xuezheng

Chinese Journal of Antituberculosis. 2025, 47(10):  1333-1341.  doi:10.19982/j.issn.1000-6621.20250128

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Objective: To explore the distribution characteristics and drug resistance differences of pathogenic bacteria in patients with pulmonary tuberculosis and non-pulmonary tuberculosis combined with lower respiratory tract infections, and to provide a basis for clinical precise medication. Methods: A cross-sectional survey design was adopted. A total of 11854 patients with pulmonary infections who were admitted to the Public Health Clinical Center of Shandong Province from January 2021 to December 2024 were selected as the research subjects. Through medical record inquiries, those with incomplete medical records were excluded, and the patients were divided into the pulmonary tuberculosis complicated with lower respiratory tract infection (PTB-LRTI) group (2047 cases), the non-tuberculous mycobacterial lung disease complicated with lower respiratory tract infection (PNTM-LRTI) group (385 cases), and the bacterial pneumonia (BP) group (1869 cases) based on clinical diagnosis. Respiratory tract specimens such as sputum, bronchoalveolar lavage fluid, and brushes of the research subjects were collected for bacterial culture. The positive bacterial strains were subjected to drug sensitivity tests, and duplicate isolates from the same patient were excluded. The pathogen spectra and drug resistance characteristics of the respiratory tract specimens of the three groups of research subjects were compared and analyzed. Results: Gram-negative bacteria were the main pathogens in the three groups. Klebsiella pneumoniae (32.30%,773/2397), Pseudomonas aeruginosa (14.95%,358/2397), Enterobacter cloacae (9.02%,216/2397), Escherichia coli (8.40%,201/2397), and Acinetobacter baumannii (4.22%,101/2397) were the top five pathogens detected in the PTB-LRTI group, which were the same as those in the PNTM-LRTI group. Pseudomonas aeruginosa (27.38%,555/2027), Klebsiella pneumonia (21.41%,434/2027), Stenotrophomonas maltophilia (7.05%, 143/2027), Acinetobacter baumannii (6.66%,135/2027) and Staphylococcus aureus (5.28%,107/2027) were the top five pathogens detected in the BP group. The resistance rate of Klebsiella pneumoniae to piperacillin/tazobactam (4.40%, 24/773) and imipenem (0.78%, 6/773) was low in the PTB-LRTI group; the resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam (5.31%, 19/358), ceftazidime (5.59%, 20/358), and imipenem (13.41%, 48/358) were significantly different from those of the PTB-LRTI group and BP group (χ²=15.139, P=0.001; χ²=15.524, P<0.001; χ²=9.148, P=0.010); the resistance rate of Acinetobacter baumannii to the tested antibiotics is less than 30%; the resistance rate of Staphylococcus aureus to rifampicin (13.89%, 5/36) was significantly higher than that of the BP group (2.80%, 3/107), and the difference was statistically significant (χ²=8.308, P=0.016). There were differences in the distribution of carbapenem-resistant enterobacteriaceae (CRE) bacteria among the three groups. In the PTB-LRTI group, the detection rate of CRE was the highest for Enterobacter cloacae (35.42%, 17/48), followed by Klebsiella pneumoniae (14.58%, 7/48) and Escherichia coli (14.58%, 7/48). Conclusion: There are significant differences in the distribution of pathogenic bacteria and drug resistance characteristics between PTB-LRTI, PNTM-LRTI and BP. Clinically, it was necessary to use antibacterial drugs rationally based on the results of drug sensitivity tests, and at the same time, strengthen infection control measures to reduce the risk of infection with drug-resistant bacteria.

The auxiliary diagnostic value of Mycobacterium tuberculosis-specific cytokines combined with common laboratory indicators in early extrapulmonary tuberculosis

Zhang Xin, Zheng Huiqiang, Liu Yuan, Wu Xia, Wang Haidong, Tan Xiaowen

Chinese Journal of Antituberculosis. 2025, 47(10):  1342-1349.  doi:10.19982/j.issn.1000-6621.20250176

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Objective: To evaluate the auxiliary diagnostic value of detecting Mycobacterium tuberculosis (MTB)-specific cytokines (interferon-γ (IFN-γ) and interleukin-2 (IL-2)) combined with common laboratory indicators in extrapulmonary tuberculosis. Methods: A prospective study was conducted. A total of 158 inpatients with extrapulmonary tuberculosis who were treated at Xi'an Chest Hospital from August 2023 to September 2024 were consecutively included as the extrapulmonary tuberculosis group; 107 inpatients with non-tuberculous extrapulmonary diseases treated at Xi'an Chest Hospital during the same period were selected as the control group. All subjects underwent MTB-specific dual-factor detection, mycobacterium culture, real-time fluorescent quantitative PCR (qRT-PCR), real-time fluorescent RNA isothermal detection (SAT-TB), MTB nucleic acid detection (isothermal amplification DNA), GeneXpert MTB/RIF detection (referred to as “Xpert”), and acid-fast bacilli smear microscopy. Additionally, procalcitonin (PCT), C-reactive protein (CRP), systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were tested. The auxiliary diagnostic value of MTB-specific dual factors alone and in combination with common laboratory indicators (PCT, CRP, SII, NLR, and PLR) for extrapulmonary tuberculosis was evaluated. Results: With clinical diagnosis as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of MTB-specific dual-factor detection were 78.48% (124/158), 71.96% (77/107), 80.52% (124/154), and 69.37% (77/111), respectively. The sensitivity was higher than that of the other 6 methods. Both the Youden index (0.504) and the consistency test Kappa value (0.501) were higher than those of the other 6 detection methods. In the methodological comparison, the positive detection rate of the serological group (MTB-specific dual factors) was 78.48% (124/158), which was significantly higher than that of the molecular biology group (qRT-PCR, SAT-TB, Xpert, and isothermal amplification DNA) and the bacteriology group (mycobacterium culture and acid-fast bacilli smear microscopy), with positive rates of 39.87% (63/158) and 26.58% (42/158), respectively. The differences were statistically significant (χ²=48.743 and 85.333, both P<0.001). In the comparison of laboratory indicators, the levels of PCT, CRP, SII, and PLR in the extrapulmonary tuberculosis group were 0.00 (0.00, 0.09) pg/ml, 24.08 (3.56, 71.69) mg/L, 976.76 (571.92, 2159.82), and 190.66 (135.02, 267.31), respectively; in the control group, the levels were 0.06 (0.00, 0.18)pg/ml, 10.05 (0.39, 63.44) mg/L, 784.56 (401.14, 1409.55), and 151.54 (108.23, 218.47), respectively. The differences between the two groups were statistically significant (U=-2.592, -2.024, -2.484, and -3.285; P=0.010, 0.043, 0.013, and 0.001, respectively). The results of the receiver operating characteristic curve showed that the area under the curve for the detection of MTB-specific dual factors combined with common laboratory indicators (PCT, CRP, SII, NLR, and PLR) was 0.801 (95%CI: 0.720-0.881). Conclusion: MTB-specific dual-factor detection has good sensitivity in the diagnosis of extrapulmonary tuberculosis, and combining it with common laboratory indicators (PCT, CRP, SII, NLR, and PLR) can improve the diagnostic accuracy of extrapulmonary tuberculosis.

Analysis of clinical characteristics and anti-tuberculosis treatment effectiveness of elderly patients with pulmonary tuberculosis complicated with anemia

Chen Lulu, Luo Mengxing, Zou Xin, Yao Xin, Xu Yuyan, Liu Zhonghua

Chinese Journal of Antituberculosis. 2025, 47(10):  1350-1357.  doi:10.19982/j.issn.1000-6621.20250133

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Objective: To explore the clinical characteristics and anti-tuberculosis treatment outcomes of elderly patients with pulmonary tuberculosis complicated with anemia to provide a reference for the prevention, control and treatment of pulmonary tuberculosis complicated with anemia. Methods: Elderly pulmonary tuberculosis patients aged 60 and above who visited Shanghai Pulmonary Hospital from 2018 to 2020 were selected and divided into anemia group and non-anemia group to compare their clinical characteristics and treatment outcomes. Further stratified analysis was conducted based on patients' severity of anemia, and Kaplan-Meier method was used to evaluate their survival difference. Cox regression model and restricted cubic spline were used to analyze the association between anemia and treatment outcomes, and subgroup analysis was performed. Results: A total of 904 elderly patients with pulmonary tuberculosis were included, among whom 316 were anemic and 588 were non-anemic. With the increase of severity of anemia (non-anemia, mild anemia, moderate to severe anemia), the proportion of patients with ≥3 lung fields involved (72.28% (425/588) vs. 78.32% (224/286) vs. 96.67% (29/30); H=8.028, P=0.005), cavities (22.11% (130/588) vs. 38.81% (111/286) vs. 46.67% (14/30); H=31.651, P<0.001), and positive sputum culture (41.84% (246/588) vs. 61.19% (175/286) vs. 86.67% (26/30); H=42.564, P<0.001) increased. Compared with non-anemia patients, the treatment success rate of anemia patients decreased by 14.88% (84.18% (495/588) vs. 69.30% (219/316); χ²=28.154, P<0.001), and the cumulative survival rate of patients with moderate to severe anemia within 36 months was the lowest (99.66% (586/588) vs. 96.85% (277/286) vs. 86.67% (26/30); χ²=24.290, P<0.001). Cox regression analysis and trend test results showed that after adjusting for confounding factors, anemia was one of the risk factors for poor prognosis (HR=1.515, 95%CI: 1.091-2.104), and the risk of adverse outcomes increased with the severity of anemia (HR=1.449, 95%CI: 1.115-1.883). The restricted cubic spline results showed that there was a linear dose-response relationship between anemia and adverse outcomes (χ²=35.040, P_{overall trend}<0.001; χ²=1.700, P_nonlinearity=0.191). Further subgroup analysis results were still robust, and there was no significant interaction between anemia and prognosis in terms of gender (P_interaction=0.219), age (P_interaction=0.151), and drug resistance (P_interaction=0.810). Conclusion: Elderly pulmonary tuberculosis patients with anemia have more severe lung damage, lower treatment success rate and cumulative survival rate, especially those with moderate to severe anemia. In clinical treatment, attention should be paid to the screening and intervention of anemia in elderly pulmonary tuberculosis patients to further reduce the occurrence of adverse outcomes.

Characteristics and correlation of immune function and nutritional status in patients with pulmonary tuberculosis combined with extrapulmonary tuberculosis

Zhang Fan, Chen Muxing, Chen Xiaohong, Nie Wenjuan, Chu Naihui

Chinese Journal of Antituberculosis. 2025, 47(10):  1358-1364.  doi:10.19982/j.issn.1000-6621.20250194

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Objective: To analyze the characteristics of immune function and nutritional status and their relationship with pulmonary tuberculosis (PTB) patients combined with extrapulmonary tuberculosis (EPTB). Methods: In this retrospective study, 226 PTB-only patients and 226 patients combined with EPTB (PTB+EPTB group) from Fuzhou Tuberculosis Prevention and Control Hospital in Fujian Province and the Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University from March 2019 and October 2023 were enrolled according to inclusion criteria. The differences in immune function indicators (CD3⁺, CD4⁺, CD8⁺, and CD45⁺ T cells) and nutritional status indicators (body mass index (BMI), serum albumin, hemoglobin) were compared between the two groups, and their correlation was analyzed. The relationship between immunonutritional status and the extent of disease dissemination (number of extrapulmonary infection sites) was also evaluated. Results: The PTB+EPTB group demonstrated significantly lower BMI (19.35 (17.65, 21.59) kg/m² vs. 20.30 (19.02, 22.05) kg/m²), serum albumin (35.70 (31.70, 38.98) g/L vs. 41.05 (38.50, 44.10) g/L), and hemoglobin levels (117.00 (102.00, 128.00) g/L vs. 128.00 (119.00, 139.00) g/L) compared with the PTB-only group (W=30593.500, 40415.000, 34752.500, respectively; all P<0.001). The levels of immune function indicators (CD3⁺, CD4⁺, CD8⁺, CD45⁺ T cells) in the PTB+EPTB group were significantly lower than those in the PTB-only group. The CD4⁺ T cell counts with the smallest change showed statistical significance (303.50 (172.25, 459.75) cells/μl vs. 430.50 (306.25, 572.75) cells/μl; W=34000.000, P<0.001). The serum albumin levels in patients with a single extrapulmonary infection site was significantly higher than that in patients with multiple infection sites (36.20 (32.50, 39.20) g/L vs. 34.40 (29.75, 37.45) g/L; W=6430.500, P=0.014). Correlation analysis revealed moderate correlations between albumin and hemoglobin and CD3⁺ T cells (r=0.420 and r=0.322, respectively) and CD4⁺ T cells (r=0.412 and r=0.336, respectively) in the PTB+EPTB group, whereas these correlations were weak in the PTB-only group (r=0.192 and r=0.177; r=0.100 and r=0.102, respectively). Conclusion: Compared to PTB-only patients, PTB+EPTB patients demonstrate more severe cellular immuno-suppression and malnutrition, a stronger correlation between immune function and nutritional status, and worse nutritional status in those with multiple infection sites. It is recommended to routinely assess immunonutritional status, emphasized the role of nutritional support therapy, and dynamically monitor PTB-only patients to reduce the risk of EPTB development.

Global development trends and hotspots of researches on elderly tuberculosis, 2000—2025: a visualized bibliometric analysis

Wang Hangxing, Zhang Ning, Liu Xiaoqing, Kang Lin

Chinese Journal of Antituberculosis. 2025, 47(10):  1365-1377.  doi:10.19982/j.issn.1000-6621.20250202

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Objective: To analyze global development trends and hotspots of researches on elderly tuberculosis from 2000 to 2025 using bibliometric methods, aiming to provide references for future research and prevention strategies. Methods: Literature with topics of “tuberculosis” and “elderly” published between January 1, 2000, and March 10, 2025, was retrieved from the Web of Science Core Collection. A total of 4103 publications were identified, limited to “Article” and “Review” categories. VOSviewer 1.6.18, CiteSpace 6.1.R6, and Bibliometrix were applied to visualize publication output, distributions of country/region and institution, authors, journals, and keywords. Research hotspots and frontiers were further identified through burst keyword detection. Results: The annual number of publications on elderly tuberculosis increased from 50 in 2000 to 350 in 2024, showing a continuous upward trend, with an average annual growth rate of approximately 8.9%. The publications involved 167 countries/regions and 1442 journals. The top five productive countries were the United States (996), China (598), the United Kingdom (400), South Africa (332), and India (319), accounting for 64.3% of the total output. Highly productive institutions included the London School of Hygiene & Tropical Medicine (94), the University of Cape Town (91), and the University of the Witwatersrand (80). Keyword co-occurrence analysis revealed that research hotspots focused on the epidemiological characteristics of elderly tuberculosis, HIV co-infection and immunosenescence mechanisms, diagnostic technologies, and treatment optimization, with “immunosenescence” emerging as a recent research frontier. Conclusion: Research on elderly tuberculosis has remained active, but international collaboration and cross-disciplinary integration require further strengthening. Future studies should focus on immunosenescence mechanisms, rapid diagnostic techniques, and individualized prevention strategies to improve tuberculosis control among the elderly.

Review Articles

Research advances in the collection and preservation of human fecal samples

Tao Jing, Xie Mengjiao, Song Yang, Wei Qiang

Chinese Journal of Antituberculosis. 2025, 47(10):  1378-1385.  doi:10.19982/j.issn.1000-6621.20250215

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Human fecal samples have long been widely used as important biological samples in scientific research and clinical practice due to their advantages of easy collection and non-invasiveness. However, the quality and stability of fecal samples can be easily affected by various factors. Any deviation in the collection or preservation process may alter the physicochemical properties or microbial community structure of the samples, affecting the reliability of downstream testing. This paper focuses on quality control in fecal sample collection and preservation. It reviews existing collection and preservation methods and analyses their applications and differentiated needs in disease diagnosis and prevention, fecal microbiota transplantation (FMT), and fundamental medical research. The aim is to provide scientific researchers with a basis of reference to promote the multidisciplinary research and application of fecal samples.