Table of Content

10 November 2025, Volume 47 Issue 11

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Guideline·Standard·Consensus

Expert consensus on the rational use of rifamycins in the treatment of tuberculosis with comorbidities

National Clinical Research Center for Infectious Disease/Shenzhen Third People's Hospital , Tuberculosis and Diabetes Branch of Chinese Antituberculosis Association , Multidisciplinary Diagnosis and Treatment Branch of Chinese Antituberculosis Association

Chinese Journal of Antituberculosis. 2025, 47(11):  1391-1415.  doi:10.19982/j.issn.1000-6621.20250254

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Tuberculosis frequently coexists with multiple chronic diseases, necessitating combination pharmacotherapy. Rifamycin-class anti-tuberculosis agents exhibit clinically significant interactions with many drugs used to treat comorbidities, potentially reducing their efficacy, causing treatment failure, or increasing toxicity. However, evidence-based clinical guidance on these interactions is currently lacking. To improve clinicians’ understanding of the interactions between rifamycins and medications for comorbid conditions and to support their rational use, this consensus statement was developed. It was based on a systematic review of domestic and international literature, drug-label information, and appraisal of the best available evidence, and was finalized after three rounds of focused discussion and revision. The document covers an overview of rifamycins agents, their mechanisms of drug-drug interaction, guiding principles for clinical application, and a comprehensive summary of evidence on interactions with commonly prescribed comorbidity medications, together with practical dose-adjustment recommendations. The aim is to provide safe and effective rifamycin-based therapeutic regimens for tuberculosis patients with comorbidities and to offer an actionable reference for clinical practice.

Special Topic

Analysis of syndrome differentiation and treatment for “Scrofula” (Luoli) in Huangdi Neijing

Li Bo, Dong Yumeng, Cao Yuqing, Ji Xinyu, Mu Tingting, Gong Mengmeng, Zhang Xuyang, Cai Qiujie, Ma Yan

Chinese Journal of Antituberculosis. 2025, 47(11):  1416-1420.  doi:10.19982/j.issn.1000-6621.20250326

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This paper systematically reviews the discussion of on luoli (tuberculous lymphadenitis) in the Huangdi Neijing (Neijing), revealing its core pathogenesis as “Obstruction of Shaoyang Meridians and Intermingling of Phlegm and Blood Stasis”, the disease onset perspective of “Disharmony of Zang-Fu Organs as the Root Cause and Retention of Toxic Qi in Meridians as the Symptomatic Manifestation”, and its treatment system of “Dredging Qi and Blood, and Combining Regulation and Tonification”.By analyzing key classics such as the Lingshu (Miraculous Pivot)·Cold and Heat, Lingshu (Miraculous Pivot)·Meridians, synthesized with the commentaries of later medical practitioners, the study clarifies the guiding value of Neijing theory for modern diseases such as tuberculous lymphadenitis and autoimmune lymphadenopathy, providing classical support for clinical practice.

Application of electronic nose in rapid diagnosis of pulmonary tuberculosis

Wang Ke, Sun Hu, Baihetinisha Tuerdi

Chinese Journal of Antituberculosis. 2025, 47(11):  1421-1425.  doi:10.19982/j.issn.1000-6621.20250218

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Pulmonary tuberculosis (PTB) remains a major global public health challenge, and timely diagnosis is critical for effective epidemic control and transmission reduction. Conventional diagnostic methods, such as sputum culture, are time-consuming and require specialized laboratory facilities, limiting their accessibility in primary care and resource-limited settings. In recent years, electronic nose (eNose) technology has gained increasing attention as a promising tool for the rapid diagnosis of pulmonary tuberculosis, due to its non-invasiveness, speed, and high sensitivity. Emerging evidence suggests that eNose technology can rapidly identify active pulmonary tuberculosis by analyzing volatile organic compounds (VOCs) in exhaled breath. However, its clinical translation remains limited by several challenges, including the lack of standardized instrumentation, variability in data interpretation, and insufficient integration into routine diagnostic workflows. The author provides a comprehensive overview of the current state of eNose applications in tuberculosis diagnosis, elucidating its underlying mechanisms, diagnostic advantages, and existing barriers, and discusses future directions to improve early case detection and advance innovative diagnostic strategies for tuberculosis control.

Original Articles

Feasibility study on the use of electronic pillboxes to assist students with latent tuberculosis infection in preventive medication

Qin Nan, Liu Lei, Wu Zheyuan, Deng Qian, Chen Jing, Chen Bin, Chen Cheng, Zhang Tianyuan, Chen Hao, Shen Xin

Chinese Journal of Antituberculosis. 2025, 47(11):  1426-1432.  doi:10.19982/j.issn.1000-6621.20250200

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Objective: To explore the feasibility of electronic pillboxes assisting students with latent tuberculosis infection (LTBI) to carry out tuberculosis preventive therapy (TPT), so as to provide scientific basis for the promotion and application of related technologies. Methods: (1) Twenty-five students who were found to have LTBI during the physical examination for admission to Yining Health School in Ili Kazakh Autonomous Prefecture, Xinjiang Uygur Autonomous Region in September 2023 and met the TPT criteria, and used electronic pillboxes to assist TPT, were included as the research subjects to analyze the completion rate and compliance of TPT. (2) Using purposive sampling method, a total of 7 individuals were selected from the staff of the Tuberculosis Prevention Department of Yining City Center for Disease Control and Prevention, school doctors, and LTBI students who use electronic pillboxes for medication check-in. Face to face semi-structured interviews were conducted, mainly focusing on the influencing factors and feasibility of using electronic pillboxes to assist TPT. Results: Among the 25 students who used electronic pillboxes to assist with TPT for LTBI, 15 (60%) completed TPT; the total number of times medication should be taken was 2077, and the actual number of times medication should be taken was 1697, with a medication rate of 81.70%. Among them, there were 917 active check-ins, with an active check-in rate of 44.15%. The medication rate in the first month of TPT was 99.42% (691/695), with an active check-in rate of 73.09% (508/695). In the third month, the medication rate was 57.71% (434/752), with an active check-in rate of 23.01% (173/752). With the increase of treatment time, the medication rate and active check-in rate both significantly decreased, and the differences were statistically significant (χ²=-19.078, P<0.05; χ²=-20.652, P<0.05). After excluding the situation where the electronic pillbox cannot be used normally due to equipment technical issues, the total number of times medication should be taken was 1209, and the actual number of times medication was taken was 1083, with a medication rate of 89.58%. Among them, the number of active check-in times was 874, and the active check-in rate was 72.29%; the medication rate and active check-in rate were significantly higher than those without excluding equipment technical problems, and the differences were statistically significant (χ²=35.765, P<0.05; χ²=242.910, P<0.05). The interview results showed that user experience, infrastructure, training, and communication, all had an impact on the implementation of TPT by electronic pillboxes assisted student LTBI. Conclusion: The application of electronic pillboxes to assist LTBI students in conducting TPT is feasible. The promotion and application of electronic pillboxes in TPT requires local efforts to strengthen infrastructure resource construction, enhance health education, and promptly solve technical problems that may arise during use.

Application effect of mobile medical technology in health management of tuberculosis patients: A Meta-analysis

Gao Dan, Yao Liwei, Huang Jinpeng, Liu Xiaoxia, Zhang Yue, Ling Lin

Chinese Journal of Antituberculosis. 2025, 47(11):  1433-1441.  doi:10.19982/j.issn.1000-6621.20250227

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Objective: To systematically evaluate the application effect of mobile medical technology in tuberculosis patient health management, to provide reference for clinical practice. Methods: A systematic search of Web of Science, Embase, Cochrane Library, PubMed, CINAHL, CBM, CNKI, WanFang Data and VIP database was conducted for randomised controlled trials about mobile medical technology’s usage on tuberculosis patient health management. The retrieval time limit was from database establishment to May 30, 2025. Two researchers independently screened literature,extracted data and evaluated quality. Meta-analysis was performed using RevMan 5.4 and Stata 16.0 software. Results: A total of 10 articles and 5615 patients were included. Meta-analysis showed that after applying mobile medical technology for the health management of tuberculosis patients, treatment compliance rate (RR=1.20,95%CI:1.12-1.29,P<0.001), treatment success rate (RR=1.09,95%CI:1.03-1.16,P=0.006), and sputum examination rate (RR=1.14,95%CI:1.06-1.22,P<0.001) of the observation group were all statistically significantly higher than those of the conventional group. Adverse outcomes occurrence in the observation group was significantly lower than that of the conventional group (RR=0.75,95%CI:0.59-0.96,P=0.020). Subgroup analysis showed that compared with information reminders and electronic pill boxes, patients who received intervention through WeChat program (RR=1.28,95%CI:1.17-1.40, P<0.001) and mobile face-to-face video (RR=1.29,95%CI:1.13-1.46,P<0.001) had significantly higher treatment compliance rates; compared with hospital-community and hospital-family intervention models, patients took hospital-community-family intervention model had significantly higher treatment compliance rate (RR=1.24,95%CI:1.16-1.33,P<0.001); compared with an ≤3 months intervention, patients getting intervention >3 months had significantly higher treatment compliance rate (RR=1.23,95%CI:1.19-1.27,P<0.001). Conclusion: The implementation of mobile medical technology can improve treatment compliance rate, treatment success rate and sputum examination rate of tuberculosis patients, and reduce incidence of adverse outcomes. Mobile medical technology with strong real-time interaction such as WeChat and mobile video can be used, together with adopting hospital-community-family linkage mode, extending intervention time, constructing intervention plan according to factors influencing usage of mobile medical technology, to further improve the intervention effect.

Meta-analysis of patient delay among tuberculosis patients in China

Li Xinlin, Wan Bin, Zhao Xia, He Ting, Zhang Miao, Yao Rong, Yu Qiaolin, Dai Li

Chinese Journal of Antituberculosis. 2025, 47(11):  1442-1453.  doi:10.19982/j.issn.1000-6621.20250393

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Objective: This systematic review aims to evaluate the patient delay among pulmonary tuberculosis (PTB) patients in China, providing a robust basis for optimizing PTB prevention and control strategies and improving the efficiency of healthcare services. Methods: PubMed, Web of Science, The Cochrane Library, Embase, CNKI, Wanfang Database, VIP database, and other databases were searched to extract relevant literature on patient delay rate among Chinese PTB patients, with the search period as from database inception to January 2025. Two reviewers independently screened literature, extracted data, and assessed the quality of the included literature. Meta-analysis was performed using Stata 15.0 software. Results: A total of 39 studies were included, comprising 31 Chinese-language articles and 8 English-language articles. These studies included 918828 PTB patients, among whom 544839 experienced patient delay. The results showed that the patient delay rate among Chinese PTB patients was 52.2% (95%CI: 48.9%-55.5%). Analysis revealed that age≥60 years (OR=1.32, 95%CI: 1.30-1.34, P=0.001), occupation being workers and farmers (OR=1.28, 95%CI: 1.24-1.32, P=0.001), homemakers and unemployed individuals (OR=1.44, 95%CI: 1.35-1.53, P=0.001), students/children (OR=1.65, 95%CI: 1.46-1.82, P=0.001), being passively detected with PTB (OR=3.24, 95%CI: 3.22-3.26, P=0.001), retreatment (OR=1.04, 95%CI: 1.01-1.07, P=0.001), with positive etiological results (OR=1.26, 95%CI: 1.24-1.27, P=0.001) were risk factors for patient delay in PTB patients. Conclusion: The patient delay rate among Chinese PTB patients remains at a high level. Relevant public health strategies should be developed to address the issue of patient delay.

Investigation and analysis of a tuberculosis cluster outbreak in a primary elderly care facility

Ma Yingzi, Dai Xiaoqi, Zhang Yang, He Tao, Geng Haiyang, Li Renzhong

Chinese Journal of Antituberculosis. 2025, 47(11):  1454-1458.  doi:10.19982/j.issn.1000-6621.20250131

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Objective: To analyze the epidemiological characteristics and response measures of a tuberculosis (TB) cluster outbreak in a grassroots nursing home, and summarize the experience in managing TB outbreaks among special populations in key settings, and provide references for TB prevention and control in similar institutions. Methods: On April 15, 2021, the disease control agency identified two pulmonary tuberculosis cases in a grassroots nursing home through the China Disease Control and Prevention Information System, prompting immediate on-site epidemiological investigation and outbreak response. The outbreak was monitored for 40 months, during which 11 rounds of screening were performed. The screening included assessments for suspected pulmonary tuberculosis symptoms, Mycobacterium tuberculosis infection testing, chest X-ray examinations, and laboratory tests. Descriptive epidemiological methods were used to analyze case characteristics and intervention processes. Results: Among 324 elderly residents and staff in the nursing home, 36 active pulmonary tuberculosis cases were identified, along with 116 latent tuberculosis infection (LTBI) cases. The first screening round after the initial two index cases detected 23 additional pulmonary tuberculosis cases (69.44%, 25/36), while 11 more cases were identified during 18 months of follow-up. No further cases were detected after 18 months. Comorbidities were common among residents, and the uptake of preventive chemotherapy was low (51 cases, 43.97%). Conclusion: Grassroots nursing homes were places with high incidence of tuberculosis. Active monitoring should be carried out every day in grassroots nursing homes. Epidemiological investigation and epidemic situation disposal should be carried out immediately when pulmonary tuberculosis patients were found. Preventive treatment should be actively carried out for those with LTBI, and follow-up observation time should be extended.

Analysis of drug resistance and transmission of Mycobacterium tuberculosis in high-altitude areas of Sichuan Province, China

Gao Yuan, Lei Hui, He Lu, Yu Zihan, Chen Chuang, He Jin’ge, Xia Lan

Chinese Journal of Antituberculosis. 2025, 47(11):  1459-1464.  doi:10.19982/j.issn.1000-6621.20250217

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Objective: To analyze the drug resistance profile and genetic diversity of Mycobacterium tuberculosis (MTB) in high-altitude regions of Sichuan Province (Sêrxü County, 4520 meters) and provide scientific data for formulating targeted tuberculosis (TB) prevention and control strategy, establishing MTB strain bank, and exploring influence of high altitude on MTB evolution in high altitude and alpine areas of China. Methods: A prospective study design was adopted, sputum samples from 189 pulmonary tuberculosis (PTB) patients, collected by designated medical institutions in Sêrxü County, Sichuan Province between June 2023 and April 2024, were obtained following standard procedures and subjected to modified Lowenstein-Jensen (LJ) solid culture, followed by genetic chip analysis and sequencing by a higher-level institution. Ultimately, a total of 75 valid strains were finally included in the study. An MTB sequence analysis platform was used to analyze the strain type, drug resistance, gene mutation, lineage, and clustering status of all strains. Results: Among the 75 strains, 33 strains were found to be resistant to 9 anti-tuberculosis drugs, with 33 resistant mutation sites and 35 types of resistant mutations. The total drug resistance rate was 44.00%. Among them, 10 strains (13.33%) were multidrug-resistant strains, 2 strains (2.67%) were pre-extensively drug-resistant strains, and 21 strains (28.00%) were other resistant strains. Among the 33 drug-resistant strains, 14 strains (42.42%) were single-mutation resistant, 12 strains (36.36%) had two resistance-related mutations, and 7 strains (21.21%) had three or more resistance-related mutations. For the 9 anti-TB drugs, the resistance rate to isoniazid was the highest (42.42%, 14/33), followed by rifampicin (39.39%, 13/33). In the lineage typing, the East Asian type (L2 type) accounted for 89.33% (67/75), mainly the Beijing East Asian type (94.03%, 63/67), while the other 8 strains were European-American type (L4 type, 10.67%). Fifty-one strains were clustered strains, with a clustering rate of 68.00%, and a total of 12 clusters were identified. The number of clustered strains ranged from 2 to 12, with 2 strains being the most common type (50.00%, 6/12). Conclusion: The proportion of drug-resistant tuberculosis in Sêrxü County, a high-altitude and cold area in Sichuan Province, is significantly higher than that in other regions. The main prevalent lineage is L2 type, and the clustering rate is relatively high, indicating a serious risk of recent tuberculosis transmission. The region should further strengthen tuberculosis prevention and control efforts to reduce the spread of MTB and the emergence of drug resistance.

Analysis of anxiety and depression among tuberculosis prevention and control staff in primary healthcare institutions in Hunan Province

Zhou Meng, Xu Zuhui, Fan Jiangjing

Chinese Journal of Antituberculosis. 2025, 47(11):  1465-1473.  doi:10.19982/j.issn.1000-6621.20250185

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Objective: To explore the prevalence and influencing factors of anxiety and depression among tuberculosis (TB) control staff in primary healthcare institutions in Hunan Province. Methods: A stratified cluster sampling approach was employed. In March to April 2023, six counties and districts across three cities and prefectures (Changde City, Yongzhou City, and Xiangxi Autonomous Prefecture) were selected from Hunan Province, which include a total of 1256 primary healthcare institutions. Overall, 1289 TB control staff served as the research subjects. Social-demographic data and work-related details were collected through self-administered online questionnaire. Self-Rating Anxiety Scale and Self-Rating Depression Scale were utilized to assess the anxiety and depression level of the research subjects. Results: One thousand one hundred and sixty-one valid pieces of questionnaire were collected with a response rate of 90.07% (1161/1289). A total of 138 staff (11.89%, 138/1161) were identified as having varying degrees of anxiety. The overall average anxiety score was 41.12±8.07. Multivariable analysis indicated that TB control staff with poor self-rated health (β=2.003, t=5.618, P<0.001), younger age (β=-0.091, t=-4.270, P<0.001), professional qualification as village doctor or nurse (β=0.729, t=2.685,P=0.007), monthly income≤2000 yuan (β=-1.052, t=-3.099, P=0.002), and working in community health service center or township health center (β=-1.135, t=-2.311, P=0.021) had higher anxiety scores. Regarding depression, 358 staff (30.84%, 358/1161) were evaluated to have varying degrees of depression. The overall average depression score was 44.51±12.84. Multivariable analysis revealed that TB control staff with younger age (β=-0.138, t=-3.590, P<0.001), poor self-rated health (β=2.634, t=4.687, P<0.001), monthly income ≤2000 yuan (β=-1.415, t=-2.699, P=0.007), professional qualification as village doctor or nurse (β=1.182, t=2.728, P=0.006), engagement of TB work ≤5 years (β=-1.553, t=-3.156, P=0.002), and working in Xiangxi Autonomous Prefecture and Yongzhou City (β=1.411, t=2.710, P=0.007) had higher depression scores. Conclusion: The proportion of anxiety and depression among TB control staff in primary healthcare institutions in Hunan Province is higher than that of the general Chinese population. Self-rated health, professional qualification, age and income are common factors influencing occurrence of anxiety and depression.

The application value of performing nanopore sequencing on bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis

Zhu Qingdong, Song Chang, Huang Aichun, Zeng Chunmei, Li Weiwen, Tan Qiuqing, Zhao Chunyan, Xie Zhouhua

Chinese Journal of Antituberculosis. 2025, 47(11):  1474-1480.  doi:10.19982/j.issn.1000-6621.20250199

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Objective: To evaluate the diagnostic value of nanopore sequencing on bronchoalveolar lavage fluid (BALF) for pulmonary tuberculosis(PTB). Methods: A prospective study was conducted. BALF samples were collected from 577 suspected PTB patients who were admitted to the Fourth People’s Hospital of Nanning, Guangxi Zhuang Autonomous Region, from October 2021 to August 2023 and met the inclusion criteria. The samples were subjected to acid-fast bacilli staining smear microscopy (AFB), mycobacterial solid culture, MTB-DNA, GeneXpert MTB/RIF (hereinafter referred to as “Xpert”), and nanopore sequencing. Positive detection rates of the five detection methods were calculated. With the final clinical diagnosis as the reference standard, the diagnostic efficacies of single-method and combined detection method were comparatively analyzed. Results: Among the 577 suspected PTB patients, 473 were diagnosed with PTB, and 104 were diagnosed with non-tuberculous diseases. The positive rates of AFB, mycobacterial solid culture, MTB-DNA, Xpert, and nanopore sequencing were 19.06% (110 cases), 28.60% (165 cases), 25.13% (145 cases), 26.86% (155 cases), and 57.19% (330 cases) respectively. Among them, nanopore sequencing could independently detect 144 positive patients. The sensitivities of nanopore sequencing, mycobacterial solid culture, Xpert, MTB-DNA, AFB, and traditional etiological methods(combined the four methods except nanopore sequencing) were 68.71% (325/473), 30.44% (144/473), 32.35% (153/473), 30.02% (142/473), 20.08% (95/473), and 46.30% (219/473) respectively; the specificities were 95.19% (99/104), 79.81% (83/104), 98.08% (102/104), 97.12% (101/104), 85.58% (89/104), and 75.96% (79/104) respectively; the Kappa values were 0.416, 0.048, 0.139, 0.122, 0.024, and 0.120 respectively; and the AUC values were 0.820, 0.551, 0.652, 0.636, 0.528, and 0.611 respectively. The combined diagnosis strategies showed that sensitivities of nanopore sequencing combined with each one of mycobacterial solid culture, Xpert, MTB-DNA, and AFB were 72.94% (345/473), 69.98% (331/473), 71.04% (336/473), and 70.61% (334/473) respectively; and the specificities were 76.92% (80/104), 93.27% (97/104), 92.31% (96/104), and 82.69% (86/104) respectively; the Kappa values were 0.359, 0.420, 0.427, and 0.367 respectively; and the AUC values were 0.751, 0.817, 0.818, and 0.768 respectively. Conclusion: Compared with the other four methods, nanopore sequencing technology has the best detection efficacy for PTB, and it combined with MTB-DNA test has the best diagnostic efficacy, which shows its significant advantages in diagnosing PTB and is expected to become an important tool for PTB diagnosis.

Effect of chronic non-immune system diseases on the sensitivity of interferon-γ release assay for the detection of tuberculosis infection

Liu Zengbin, Liu Jiajia, Wu Yaning, Wang Yafei, Xu Da, Huang Misun, Zhang Jingrui, Li Machao, Li Xiaoyi, Li Guilian, Wei Huiqiang

Chinese Journal of Antituberculosis. 2025, 47(11):  1481-1488.  doi:10.19982/j.issn.1000-6621.20250286

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Objective: To investigate the effect of chronic non-immune system diseases on the sensitivity of interferon-gamma release assay (IGRA) for detection of tuberculosis (TB) infection. Methods: A retrospective study was conducted. Electronic medical records of inpatients at the Second Hospital of Hebei Medical University from January to October 2024 were collected. A total of 3057 inpatients with complete clinical data were selected, following an approximate 1∶1 ratio of IGRA-positive to IGRA-negative cases. The data included clinical diagnosis of TB or chronic non-immunological diseases, IGRA results, and spot-forming cell counts, as well as age and gender data closely related to the above diseases. After excluding 125 patients with active TB and 98 with a history of TB, 2834 patients were included to analyze the effect of chronic non-immune diseases on the sensitivity of IGRA for detection of TB infection. Results: Among the 2834 patients without definitive evidence of TB infection, 1534 (54.13%) were male and 1300 (45.87%) were female, with an age range of 4 months to 98 years (median (IQR): 57.0 (37.0, 68.0) years). There were 1300 (45.87%) IGRA-positive and 1534 (54.13%) IGRA-negative cases. Patients with comorbidities included anemia (531, 18.74%), hypoalbuminemia (591, 20.85%), diabetes (541, 19.09%), hypertension (965, 34.05%), hepatitis B (96, 3.39%), and tumors (709, 25.02%). Among tumor cases, 393 (55.43%) were malignant tumors, 78 (11.00%) were suspected malignancies, and 238 were (33.57%) benign tumors. Multivariate logistic regression analysis showed that, compared to females, non-diabetics, and the 0-9 years age group, the risk of a positive IGRA was significantly increased in males, patients with diabetes, and those in the 10-19, 20-49, and 50-98 years age groups (OR (95%CI): 1.773 (1.507-2.085), 1.453 (1.183-1.785), 3.405 (1.143-10.142), 22.070 (8.027-60.678), and 45.822 (16.732-125.486), respectively). Conversely, patients with anemia had a decreased likelihood of a positive IGRA compared to non-anemic patients (OR (95%CI)=0.591 (0.477-0.732)). Conclusion: Anemia may lead to the false-negative results of the IGRA test, whereas diabetes mellitus may lead to the false positivity or increased TB infection. These findings suggest that IGRA results should be interpreted cautiously in patients with these comorbidities to avoid misdiagnosis.

Application of magnetic resonance 3D BRAVO enhanced scanning in the imaging diagnosis of intracranial tuberculosis

Ning Fenggang, Fang Kun, Wang Jue, Lyu Yan, He Wei, Hou Dailun

Chinese Journal of Antituberculosis. 2025, 47(11):  1489-1494.  doi:10.19982/j.issn.1000-6621.20250207

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Objective: To investigate the value of three-dimensional brain volume imaging (3D BRAVO) contrast-enhanced magnetic resonance imaging (MRI) in the imaging diagnosis of intracranial tuberculosis. Methods: A total of 122 patients with intracranial tuberculosis who were clinically diagnosed and had complete data at Beijing Chest Hospital affiliated to Capital Medical University from April 2021 to August 2024 were collected as the research subjects. All patients underwent tuberculosis related laboratory tests (including cerebrospinal fluid testing), cranial MRI plain and enhanced scans, and 3D BRAVO enhanced MRI scans. The imaging characteristics of the study subjects’ skull magnetic resonance conventional enhanced scan and 3D BRAVO enhanced scan were analyzed, and the value of magnetic resonance 3D BRAVO enhanced scan in the imaging diagnosis of intracranial tuberculosis was evaluated. Results: Thirty-two cases (26.2%, 32/122) had clinical manifestations of tuberculosis poisoning and respiratory symptoms (such as cough, sputum, chest pain, etc.); 81 cases (66.4%, 81/122) experienced fever and headache; 73 cases (59.8%, 73/122) had neurological symptoms and signs, among which 113 cases (92.6%, 113/122) had routine and biochemical abnormalities in cerebrospinal fluid laboratory tests. All patients underwent lumbar puncture examination, and 57 cases (46.7%, 57/122) had intracranial pressure higher than 180 mmH₂O (1 mmH₂O=0.0098 kPa). All patients underwent routine magnetic resonance enhanced scans of their heads: 30 cases (24.6%, 30/122) showed meningeal type; 40 cases (32.8%, 40/122) showed parenchymal type, 29 cases (23.8%, 29/122) showed mixed type (meningeal and parenchymal lesions coexisted), 23 cases (18.9%, 23/122) showed no intracranial tuberculosis; Magnetic resonance 3D BRAVO enhanced scan: 43 cases (35.2%, 43/122) showed meningeal type; 22 cases (18.0%, 22/122) showed cerebral parenchyma type, 45 cases (36.9%, 45/122) showed mixed type, and 12 cases (9.8%, 12/122) showed no intracranial tuberculosis. The detection rate of lesions in intracranial tuberculosis patients by 3D BRAVO enhanced magnetic resonance imaging was significantly higher than that by conventional enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=9.091, P=0.001); The detection rate of meningeal tuberculosis was significantly higher than that of routine enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=27.034, P<0.001). Among 122 patients who underwent 3D BRAVO enhanced magnetic resonance imaging, 9 had concurrent hydrocephalus and 29 had concurrent cerebral infarction; 10 cases of concurrent cerebral neuropathy. Conclusion: Magnetic resonance 3D BRAVO enhanced scanning has important auxiliary diagnostic value for the classification and early detection of intracranial tuberculosis.

Construction and performance evaluation of a cascade integrated system combining deep learning-based lesion segmentation and classification for tuberculous and Brucella spondylitis

Parhat Yasin, Yasen Yimit, Abuduresuli Tuersun

Chinese Journal of Antituberculosis. 2025, 47(11):  1495-1507.  doi:10.19982/j.issn.1000-6621.20250192

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Objective: To develop and evaluate a deep learning-based cascaded ensemble system that integrates lesion segmentation and classification models for the intelligent differentiation of tuberculous spondylitis (TS) and brucellar spondylitis (BS), aiming to improve diagnostic accuracy and efficiency in clinical practice. Methods: In this retrospective study, spinal magnetic resonance imaging (MRI) data were collected from 202 patients with pathologically or microbiologically confirmed spondylitis treated at the First People’s Hospital of Kashi Prefecture between January 2021 and January 2025, including 113 TS and 89 BS cases. All patients underwent MRI scans incorporating fat-suppressed T2-weighted imaging (T₂WI-FS) sequences. The proposed end-to-end diagnostic framework combined a U-Net-based lesion segmentation model with ImageNet-pretrained ResNet50 or EfficientNet classification models in a cascade, using both soft and hard voting strategies. Segmentation performance was assessed with Dice coefficient, intersection over union (IoU), sensitivity, specificity, precision, and accuracy on validation and independent test sets. Classification performance was evaluated using accuracy, F1-score, precision, recall, and the area under the receiver operating characteristic curve (AUC). Results: For the lesion segmentation model based on U-Net, on the validation set, the Dice coefficient was 0.851±0.057, IoU was 0.744±0.081, sensitivity was (87.4±8.1) %, specificity was (99.5±0.3) %, precision was (83.8±8.2) %, and accuracy was (99.1±0.4) %. On the test set, the Dice coefficient was 0.835±0.085, IoU was 0.725±0.115, sensitivity was (83.9±10.4) %, specificity was (99.6±0.2) %, precision was (83.8±9.0) %, and accuracy was (99.1±0.4) %. For lesion classification, the ResNet50 model achieved an accuracy of 79.6%, F1-score of 83.8%, precision of 85.3%, recall of 82.5%, and AUC of 0.855 on the validation set; on the test set, it achieved an accuracy of 75.2%, F1-score of 78.6%, precision of 75.7%, recall of 81.7%, and AUC of 0.822. The EfficientNet model showed an accuracy of 79.0%, F1-score of 84.4%, precision of 80.7%, recall of 88.5%, and AUC of 0.852 on the validation set; on the test set, it had an accuracy of 73.2%, F1-score of 78.2%, precision of 71.7%, recall of 86.0%, and AUC of 0.800. In the cascade ensemble system, the ResNet50-based model with soft voting achieved the optimal diagnostic performance on the test set, with an accuracy of 80.4%, F1-score of 83.1%, precision of 78.3%, recall of 88.5%, and AUC of 0.853. Conclusion: The proposed cascaded deep learning system provides an effective solution for differentiating TS from BS. By integrating multimodal MRI radiomic features, it captures subtle microstructural and pathological differences between the two diseases, significantly enhancing diagnostic performance and offering a promising auxiliary tool for clinical decision-making.

Application value of machine-learning-based diagnostic model on tuberculous pleurisy

Li Tingting, Liu Huanqing, Lei Qian, You Zhuhong, Zhao Guolian

Chinese Journal of Antituberculosis. 2025, 47(11):  1508-1514.  doi:10.19982/j.issn.1000-6621.20250224

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Objective: To develop a machine-learning-based predictive model for diagnosing tuberculous pleurisy (TBP) to improve clinical diagnostic accuracy. Methods: We retrospectively collected clinical data of 523 pleural effusion patients (375 with TBP and 148 with non-TBP) admitted in Xi’an Chest Hospital between January 2020 and December 2021. Fifteen indicators, including adenosine deaminase (ADA), tuberculosis infection T-cell spot test (T-SPOT.TB), and C-reactive protein (CRP), were incorporated. Seven machine learning algorithms, including random forest, support vector machine, and neural network, were employed to construct predictive models. Model performances were evaluated using 5-fold cross-validation. Feature importance was analyzed using SHapley Additive exPlanations (SHAP). Results: The model developed with Neural Network demonstrated optimal performance, achieving an area under the curve (AUC) of 0.932 on the test set, with an accuracy of 88.6%, precision of 94.4%, and recall rates of 89.3%. SHAP analysis identified ADA (SHAP value=0.12~0.18) and T-SPOT.TB (SHAP value=0.10~0.15) as two most significant predictors, with a notable synergistic effect (P<0.001). Conclusion: The Neural Network machine learning model developed in this study exhibited excellent diagnostic performance. Through interpretable analysis, key predictive factors and their interactions were elucidated, providing a novel tool for precise diagnosis of TBP. This model can assist clinical decision-making, particularly for cases in the “gray zone” under conventional diagnostic criteria.

Research on the impact of DRG payment reform based on difference-in-differences method on hospitalization expenses of pulmonary tuberculosis patients

Zhang Jinping, Zhou Xiaoping, Ding Zhiwei, Zhang Haiyan, Dong Panpan

Chinese Journal of Antituberculosis. 2025, 47(11):  1515-1521.  doi:10.19982/j.issn.1000-6621.20250198

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Objective: To comprehensively analyze the impact of the Diagnosis Related Groups (DRG) payment method on the treatment costs of inpatients with pulmonary tuberculosis, and provide scientific evidence to support policy formulation. Methods: A retrospective study was conducted including 20369 patients primarily diagnosed with pulmonary tuberculosis and admitted to Beijing Chest Hospital, Capital Medical University from June 15, 2017, to June 14, 2024. Taking the implementation of DRG in 2022 as the time cut-off, patients were divided into a pre-implementation group (n=11653) and a post-implementation group (n=8716). A difference-in-differences (DID) model was applied to control for variables such as age, gender, and length of hospital stay, so as to analyze the net effect of the DRG policy. Additionally, the parallel trend test was conducted to verify the model assumptions. Results: Following the implementation of DRG, the hospital days of the patient was decreased from 12 d to 6 d. The median total hospitalization cost of patients was 16588.04 yuan, representing an 18.88% reduction compared with the pre-implementation period (20411.17 yuan). Specifically, drug costs decreased by 60.07% ((2801.14-7015.36)/7015.36), treatment costs decreased by 14.77% ((804.75-944.20)/944.20), while examination costs increased slightly by 1.83% ((1066.20-1047.00)/1047.00). These differences before and after the implementation were statistically significant (U=-51.354, P<0.001; U=-25.708, P<0.001; U=-42.403, P<0.001; U=-17.628, P<0.001; U=-3.106, P=0.002). The parallel trend test confirmed the presence of a policy effect. The DID model further indicated that the net effect of the policy significantly reduced total costs, examination costs, treatment costs, and drug costs by 32.20%, 52.80%, 48.00%, and 36.80% respectively. Conclusion: The DRG payment reform substantially reduced the length of hospital day and hospitalization costs of patients with pulmonary tuberculosis, with particularly prominent effects on drug and treatment costs. These finding highlight the positive role of prospective payment system in controlling medical costs, alleviating patient financial burden, and improving the efficiency of medical insurance funds, thereby providing empirical evidence to support payment reforms in tuberculosis prevention and control. Nevertheless, attention should be paid to structural changes in examination costs, and further efforts are needed to refine grouping criteria and optimize diagnostic processes.

Treatment of pulmonary tuberculosis based on the theory of “three books and two systems” in the book Li Xu Yuan Jian

Mu Tingting, Zhang Xuyang, Ma Yan, Cai Qiujie

Chinese Journal of Antituberculosis. 2025, 47(11):  1522-1527.  doi:10.19982/j.issn.1000-6621.20250329

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Pulmonary tuberculosis is an important branch of Traditional Chinese Medicine(TCM) deficiency and fatigue disease, caused by invasion of pulmonary tuberculosis insects and deficiency of vital energy, involving dysfunction of lungs, spleen, and kidneys. The “three books and two systems” theory proposed by Ming Dynasty physician Wang Qishi in his book Li Xu Yuan Jian provides guidance for the diagnosis and treatment of pulmonary tuberculosis based on syndrome differentiation. This article combines ancient literature and modern clinical practice to explore the guiding significance of the “three books and two systems” theory for pulmonary tuberculosis treatment, and clarifies that Yin deficiency and fire excess are the core pathogenesis of pulmonary tuberculosis; The imbalance of lungs is the starting point, the imbalance of spleen is the basis and outcome, and the imbalance of kidneys is the root cause. The three organs interact with each other and together constitute the pathogenesis and transmission process of pulmonary tuberculosis; Treatment should be based on nourishing lungs, spleen, and kidneys, mainly by nourishing Yin and lowering fire to promote the generation of gold and water, nourishing Qi and cultivating Yin to nourish soil and produce gold, nourishing Yin and supplementing Yang to strengthen the foundation and nourish the essence. At the same time, treatment should clear fire, kill insects, and eliminate evil, while also stop bleeding and resolving phlegm, and regulate the balance of supporting the body and eliminating evil, and combine with applying test cases of taking the “three books and two systems” theory on treating pulmonary tuberculosis, in order to provide theoretical basis and clinical reference for treating pulmonary tuberculosis with TCM.

Review Articles

Research progress on tuberculosis preventive treatment for close contacts of multidrug-resistant tuberculosis patients

Zu Zhipeng, Chen Haiting, Chen Yuanyuan, Nie Wenjuan, Xu Kaijin, Ruan Qiaoling, Liu Zhengwei, Zhou Lin, Wang Xiaomeng, Gao Lei

Chinese Journal of Antituberculosis. 2025, 47(11):  1528-1534.  doi:10.19982/j.issn.1000-6621.20250299

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Tuberculosis preventive treatment (TPT) among close contacts of multidrug-resistant tuberculosis (MDR-TB) patients is a critical intervention to reduce their risk of developing active tuberculosis. Early implementation of effective prevention is crucial for protecting individual health and curbing the spread of drug-resistant tuberculosis. Currently, the TPT regimen for close contacts of MDR-TB patients is limited, and there is a lack of evidence in China. Therefore, this review focuses on core issues in the field of TPT for MDR-TB close contacts, including domestic and international guideline recommendations, available drug regimens, and their efficacy and safety based on current research. The aim is to provide scientific references and decision-making support for developing more optimized management strategies for MDR-TB close contacts and safer, more effective short-course preventive regimens in China.