Table of Content

10 March 2026, Volume 48 Issue 3

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Interpretation of Standards

Interpretation of research and innovation part of the WHO Global Tuberculosis Report 2025

Shu Wei, Liu Yuhong

Chinese Journal of Antituberculosis. 2026, 48(3):  307-312.  doi:10.19982/j.issn.1000-6621.20250507

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Technological innovation is pivotal to curbing the tuberculosis (TB) epidemic through sustained research and development. On Nov 12, 2025, World Health Organization released the Global Tuberculosis Report 2025. This paper reviews the key achievements in the areas of TB research and innovation for new diagnostics, drugs, and regimens as well as vaccines introduced in the report, and discusses some of China’s indigenous progresses in related areas. The authors aim to make China’s TB professionals better informed about the latest research development in TB prevention and control around the globe, fostering indigenous TB innovation efforts with greater originality.

Original Articles

Clinical cohort analysis of the efficacy and safety of extended-course bedaquiline in patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis

Wang Jing, Jing Wei, Li Weiwen, Zhu Qingdong, Pang Yu, Chu Naihui, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(3):  313-319.  doi:10.19982/j.issn.1000-6621.20250372

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Objective: To evaluate the efficacy and safety of extended-course (>6 months) bedaquiline-containing regimens in the treatment of multidrug-resistant/rifampin-resistant pulmonary tuberculosis (MDR/RR-PTB). Methods: Patients with MDR/RR-PTB treated at Beijing Chest Hospital, Capital Medical University, between January 1, 2020 and January 1, 2024 were included in this cohort study. Outcomes were compared between patients receiving a standard course (≤6 months) and those receiving an extended course (>6 months) of bedaquiline-containing combination regimens. The treatment completion rate and the incidence of adverse events were recorded. Multivariable logistic regression was used to analyze factors associated with a Fridericia-corrected QT interval (QTcF) >500 ms. Results: A total of 126 patients were included in the study. Among them, 75 patients (59.5%) were assigned to the standard group, while 51 patients (40.5%) were assigned to the extended group. No serious cardiac adverse events were observed in either the standard-course or extended-course group. There was no statistically significant difference between the two groups in the proportion of favorable treatment outcomes (standard vs. extended: 86.7% (65/75) vs. 88.2% (45/51)), the difference was statistically significant (χ²=0.043, P=0.835). Likewise, the incidences of QTcF 450-500 ms (standard vs. extended: 37.3% (28/75) vs. 43.1% (22/51)) and QTcF >500 ms (standard vs. extended: 10.7% (8/75) vs. 9.8% (5/51)) did not differ significantly between the two groups (χ²=1.851, P=0.173; χ²=0.414, P=0.521). Multivariable analysis showed that a history of cardiac disease (OR=6.50, 95%CI: 1.52-27.80) was risk factor for QTcF prolongation (>500 ms). Conclusion: For patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis, extended-course use of bedaquiline demonstrates good overall efficacy and safety, with no observed increase in the risk of serious adverse events.

Evaluation of diagnostic value of novel blood-derived biomarkers for active pulmonary tuberculosis

Zhang Yujie, Zhou Jie, Wang Yun, Fan Lin

Chinese Journal of Antituberculosis. 2026, 48(3):  320-328.  doi:10.19982/j.issn.1000-6621.20250380

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Objective: To evaluate the diagnostic value of tuberculosis-specific biomarkers in peripheral blood for active pulmonary tuberculosis (PTB). Methods: In a prospective study, peripheral blood samples were collected from 10 patients with active PTB (PTB sequencing group) and 10 healthy individuals (control sequencing group) admitted to the Tuberculosis Department of Shanghai Pulmonary Hospital between June and July 2024 for transcriptome sequencing to screen for potential diagnostic target genes. Subsequently, from February to October 2025, peripheral blood samples were collected from 69 PTB patients (TB validation group), 22 non-TB patients (non-TB validation group), and 58 healthy individuals (control validation group) was used to measure. The mRNA expression levels of candidate genes in peripheral blood were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The diagnostic value of the identified biomarkers for active PTB was assessed by calculating sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) against the final clinical diagnosis reference standard. Results: Sixteen candidate genes were identified by transcriptomic sequencing of peripheral blood. After qRT-PCR validation, three biomarkers with upregulated expression levels were identified: TRIM22, FKBP9, and ERRFI1. Compared to the control validation group, the expression levels of all three markers were significantly higher in the TB validation group (TRIM22: 42.32 vs. 14.53; FKBP9: 6.41 vs. 0.20; ERRFI1: 5.70 vs. 0.44), with statistically significant differences (Z=-5.030, -4.425, -6.044, respectively; all P<0.05). Compared to the control validation group, ROC curve analysis revealed that TRIM22 demonstrated a sensitivity, specificity, and AUC of 80.00%, 91.38%, and 0.956, respectively; FKBP9 had 98.44%, 91.67%, and 0.769, respectively; and ERRFI1 had 94.29%, 97.76%, and 0.819. The diagnostic performance did not improve significantly when the three genes were used in combination (AUC=0.796). When compared to non-TB patients, only ERRFI1 showed diagnostic value in distinguishing active PTB, with a sensitivity of 87.76%, specificity of 98.28%, and an AUC of 0.972. Conclusion: The peripheral blood levels of TRIM22, FKBP9, and ERRFI1 in patients with active PTB can effectively distinguish them from healthy individuals, showing promising diagnostic potential. These markers may serve as novel targets for the diagnosis of active PTB.

Clinical application value of combined molecular biology testing with bronchoalveolar lavage fluid (BALF) for diagnosing smear-negative pulmonary tuberculosis

Hou Tianyong, Ren Liping, Li Jingying, Wang Jianwei, Fan Shuhui, Wu Yuanming, Wang Quanhong, Ding Weimin

Chinese Journal of Antituberculosis. 2026, 48(3):  329-334.  doi:10.19982/j.issn.1000-6621.20250371

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Objective: To investigate the clinical application value of combined molecular biology testing (GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology) with bronchoalveolar lavage fluid (BALF) in the diagnosis of smear-negative pulmonary tuberculosis. Methods: A total of 150 patients with suspected pulmonary tuberculosis and negative smear results admitted to the Fourth People’s Hospital of Taiyuan from January 2024 to April 2025 were enrolled as study subjects. BALF specimens were collected and all underwent GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology. Based on final clinical diagnosis results, the diagnostic value of BALF with different molecular biological testing as well as the combined five methods for smear-negative pulmonary tuberculosis patients was evaluated. Results: Among 150 patients, 108 cases were clinically diagnosed as pulmonary tuberculosis, 7 cases as non-tuberculous mycobacterial infection (NTM), and 35 cases as non-tuberculosis. Using the final diagnosis as the criterion, the sensitivities of GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology were 66.7% (72/108), 62.9% (68/108), 54.6% (59/108), 59.3% (64/108) and 62.9% (68/108), respectively; the specificities were 100.0% (42/42), 97.6% (41/42), 97.6% (41/42), 97.6% (41/42) and 100.0% (42/42), respectively; and the areas under the receiver operating characteristic (ROC) curve (AUC) were 0.67, 0.6, 0.52, 0.56 and 0.62, respectively. The combined application of five molecular biological methods showed that the strategy combining GeneXpert MTB/RIF with fluorescent quantitative PCR demonstrated excellent diagnostic performance (sensitivity 92.5% (100/108), specificity 92.8% (39/42),AUC=0.85). Conclusion: The combined molecular biological testing using BALF specimens provides an effective laboratory protocol for the rapid early diagnosis of suspected pulmonary tuberculosis patients with negative sputum smear results, demonstrating comprehensive superiority in diagnostic efficacy over any single testing method, which is worthy of clinical promotion and application.

The application value of nanopore sequencing in the diagnosis of tuberculous serous effusion and screening for coinfections

Zhu Qingdong, Zhao Chunyan, Huang Xuewen, Huang Aichun, Zeng Chunmei, Xu Chaoyan, Lan Yanqun, Song Chang

Chinese Journal of Antituberculosis. 2026, 48(3):  335-341.  doi:10.19982/j.issn.1000-6621.20250386

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Objective: To explore the application value of nanopore sequencing in the diagnosis of tuberculous serous effusion and to evaluate its advantages in rapidly and accurately identifying Mycobacterium tuberculosis and screening for coinfecting pathogens. Methods: From October 2021 to May 2025, patients with suspected tuberculous serous effusion who visited Nanning Fourth People’s Hospital were enrolled. Their effusion samples were collected for nanopore sequencing. Their final clinical diagnoses were used as reference standard for comparing sequencing results with conventional tests (acid-fast staining, TB-DNA PCR, GeneXpert MTB/RIF, and solid mycobacterial culture). Results: Nanopore sequencing achieved significantly better diagnostic performance than any conventional test: sensitivity 73.1% (19/26), specificity 100.0% (27/27), positive predictive value (PPV) 100.0% (19/19), negative predictive value (NPV) 79.4% (27/34), and Kappa 0.734, surpassing those of acid-fast staining (sensitivity 11.5% (3/26), specificity 100.0% (27/27), PPV 3/3, NPV 54.0% (27/50), Kappa 0.117), culture (sensitivity 30.8% (8/26), specificity 100.0% (27/27), PPV 8/8, NPV 60.0% (27/45), Kappa 0.312), TB-DNA PCR (sensitivity 34.6% (9/26), specificity 100.0% (27/27), PPV 9/9, NPV 61.4% (27/44), Kappa 0.350), GeneXpert MTB/RIF (sensitivity 34.6% (9/26), specificity 100.0% (27/27), PPV 9/9, NPV 61.4% (27/44), Kappa 0.350), and TB antibody detection (sensitivity 46.2% (12/26), specificity 81.5% (22/27), PPV 70.6% (12/17), NPV 61.1% (22/36), Kappa 0.278). Moreover, nanopore sequencing revealed that 42.1% (8/19) of tuberculosis cases co-infected with nontuberculous mycobacteria (NTM), viruses, fungi, or bacteria. Conclusion: Nanopore sequencing demonstrated excellent performance in the diagnosis of tuberculous serous effusion, with diagnostic efficacy significantly better than that of traditional pathogen detection methods. It can effectively improve the early diagnosis rate of tuberculosis and offers a new solution for screening coinfections, showing important clinical application value.

Analysis of factors influencing disability and mortality in HIV-negative tuberculous meningitis patients from 2011 to 2023

Jiao Xiaoke, Tian Yuan, Xiang Jingling, Nie Wenjuan, Pang Yu, Wang Jing

Chinese Journal of Antituberculosis. 2026, 48(3):  342-348.  doi:10.19982/j.issn.1000-6621.20250408

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Objective: To explore the influencing factors of disability and mortality in HIV-negative patients with tuberculous meningitis (TBM), and to provide a basis for early identification and intervention in high-risk populations. Methods: We collected clinical data from patients diagnosed with and treated for TBM at Beijing Chest Hospital, Capital Medical University, from January 1, 2011, to December 31, 2023, and constructed a retrospective cohort. A total of 837 patients were included based on the inclusion and exclusion criteria. Data on patients’ age, sex, Glasgow Coma Scale (GCS) score, cerebrospinal fluid (CSF) etiological test result, diabetes comorbidity, multidrug-or rifampicin-resistance status, intrathecal drug administration via lumbar puncture, and steroid use were collected. Cox proportional-hazards regression was employed to identify factors influencing disability and mortality in HIV-negative TBM patients. Results: Among the 837 patients, 499 (59.62%) experienced disability, and 150 (17.92%) died. The Cox model revealed that age was an independent risk factor whereas high GCS was a protective factor for both disability and mortality (P<0.05). For disability, compared with patients aged ≤14 years, the adjusted hazard ratios (aHR) were 1.227 (95%CI: 1.030-1.460) for those aged 30-44 years, 1.284 (95%CI: 1.068-1.545) for those aged 45-59 years, and 1.350 (95%CI: 1.110-1.640) for those aged ≥60 years, indicating that the risk of disability increased with age. For GCS score, compared with patients with scores of 3-8, those with scores of 9-12 had an aHR of 0.741 (95%CI: 0.600-0.910), and those with scores of 13-15 had an aHR of 0.607 (95%CI: 0.480-0.760), indicating that the risk of disability decreased with increasing GCS score. Similarly, the Cox model showed that the risk of mortality also increased with age and decreased with increasing GCS score. Compared with patients aged ≤14 years, the aHRs for mortality were 1.246 (95%CI: 1.038-1.494) for those aged 30-44 years, 1.323 (95%CI: 1.100-1.594) for those aged 45-59 years, and 1.419 (95%CI: 1.150-1.748) for those aged ≥60 years. For GCS score, compared with patients with scores of 3-8, those with scores of 9-12 had an aHR of 0.670 (95%CI: 0.540-0.830), and those with scores of 13-15 had an aHR of 0.549 (95%CI: 0.430-0.690). Conclusion: HIV-negative TBM patients aged over 30 years and with low GCS scores have a significantly increased risk of disability, which are also core determinants of mortality. Clinicians should focus on patients with advanced age and significant consciousness impairment (low GCS scores), implement individualized management, enhance monitoring, and optimize treatment plans to improve outcomes.

Analysis of the application effect of compound balanced nutrition powder in anti-tuberculosis treatment on multidrug-resistant tuberculosis patients

Wei Liuying, Wu Xingxing, Huang Lianpiao, Zeng Chunmei, Zhao Chunyan, Song Chang, Nie Wenjuan, Pei Jie, Wei Xiaoying, Huang Aichun, Zhu Qingdong, Xie Zhouhua, Huang Xianzhen

Chinese Journal of Antituberculosis. 2026, 48(3):  349-355.  doi:10.19982/j.issn.1000-6621.20250350

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Objective: To explore the application effect of compound balanced nutrition powder in the anti-tuberculosis treatment on multidrug-resistant tuberculosis (MDR-TB) patients. Methods: From January 1, 2021 to June 30, 2023, MDR-TB patients admitted and treated to Nanning Fourth People’s Hospital were screened for nutritional risk with the NRS 2002 short form. Among 204 MDR-TB cases scoring ≥3, patient admission order was randomized in Excel (RAND function), 102 cases with odd numbers were assigned to the intervention group, and 102 cases with even numbers were assigned to the control group. After excluding lost-to-follow-up or treatment withdrawal cases, 98 patients in the intervention group and 92 patients in the control group were included in the analysis totally. After re-screening by a clinical nutritionist, controls received individualized nutritional assessment and diagnosis, daily caloric intake calculated and dietary counseling according to their degree of malnutrition. The intervention group received the same care plus a compound balanced nutrition powder. Nutritional intervention and anti-tuberculosis therapy proceeded concurrently in both groups. Relevant indicators and NRS 2002 scores were collected at four key time-points—1, 2, 3 and 6 months—to evaluate the effectiveness of the nutritional supplement in MDR-TB patients. Results: At 1 month, average serum albumin in the intervention group was (39.85±8.05) g/L vs. (37.22±7.42) g/L in controls, a difference that was statistically significant (t=-2.337, P=0.021). By 6 months, average total protein was 70.14±10.28 g/L in the intervention group and 72.87±7.43 g/L in controls; this difference was also significant (t=2.090, P=0.038). Sputum-smear and culture conversion rates consistently favored the intervention group: at 1 month 85.71% (84/98) vs. 75.00% (69/92) and 81.63% (80/98) vs. 70.65% (65/92), respectively (χ²=3.474,P=0.062;χ²=3.165, P=0.075); at 2 months 96.94% (95/98) vs. 92.39% (85/92) and 91.84% (90/98) vs. 88.04% (81/92)(χ²=1.968,P=0.161;χ²=0.759, P=0.384); and at 3 months both rates were 98.98% (97/98) for interventions group vs. 98.91% (91/92) for controls (χ²=0.002, P=0.964). At treatment completion, the care rate was 94.90% (93/98) in the intervention group, higher than the 89.13% (82/92) achieved by controls (χ²=2.171, P=0.141). Conclusion: The use of compound balanced nutrition powder as an adjuvant treatment can improve the nutritional status and clinical indicators of MDR-TB patients and to some extent increase the sputum conversion rate of MDR-TB patients, promoting their recovery.

Observation on the effect of traditional Chinese medicine syndrome differentiation and treatment combined with standard anti-tuberculosis regimen on postoperative rehabilitation in patients with spinal tuberculosis

Xu Liang, Dai Enuo, Yang Yongrui, Ruan Wenkai, Li Jianlong, Dang Rongpan, An Huigang, Zhao Wentao, Li Zhaofei, Zhao Yingxin, Li Ying, Sun Jianmin, Tan Hongdong

Chinese Journal of Antituberculosis. 2026, 48(3):  356-365.  doi:10.19982/j.issn.1000-6621.20250379

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Objective: To investigate the effect of traditional Chinese medicine (TCM) syndrome differentiation and treatment combined with standard anti-tuberculosis regimen on postoperative rehabilitation in patients with spinal tuberculosis. Methods: One hundred sixty patients with spinal tuberculosis admitted to Shandong Public Health Clinical Center from January 2022 to January 2024 were selected and divided into an observation group (80 patients) and a control group (80 patients) using random number table method. Both groups underwent surgical debridement, bone grafting, fusion, and internal fixation for spinal tuberculosis lesions, along with the H-R-E-Z anti-tuberculosis regimen for 2 weeks preoperatively and 18 months postoperatively. The observation group additionally received TCM syndrome differentiation and treatment. Follow-up was conducted to record changes in clinical symptoms and signs, laboratory indicators, and imaging findings before and after treatment, then clinical effectiveness and occurrences of adverse reactions were compared between the two groups. Results: All patients were followed up for 18 months. The observation group had an earlier time to getting out of bed ((5.2±2.4) days) and a shorter hospital stay ((12.5±4.3) days) compared to the control group ((8.3±3.7) days and (16.4±5.6) days), with statistically significant differences (t=-6.29, P<0.001; t=-4.94, P<0.001). However, there was no statistically significant differences in treatment costs between the observation group and control group ((33607.5±8920.7) yuan vs. (36832.2±8763.1) yuan, t=1.91, P=0.058). Except for the erythrocyte sedimentation rate index 2 weeks after surgery, postoperative visual analogue scale, Oswestry disability index, erythrocyte sedimentation rate, and C-reactive protein scores at 1 week and 2 weeks were (4.23±1.12) score, (55.43±5.12) %, (45.03±15.76) mm/1 h, (33.74±10.19) mg/L, and (3.44±0.39) score, (32.14±6.25) %, (29.51±12.08) mm/1 h, and (17.43±8.37) mg/L, all better than the control group ((5.94±1.33) score, (68.15±6.93) %, (58.64±16.31) mm/1 h, (47.53±11.30) mg/L, (4.69±1.04) score, (43.35±7.15) %, (31.94±14.24) mm/1 h, and (23.25±9.56) mg/L), with statistically significant differences (t value were -8.81, -13.21, -5.37, -8.11, -10.08, -10.55, -1.16, -4.10,P value were <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.247, <0.001). At 18 months post-operation, no statistically significant differences were found in clinical cure rates between the observation group and control group (90.0% (72/80) vs. 85.0% (68/80), χ²=0.91, P=0.340). During the follow-up period, the recurrence rates in the observation group and the control group were 1.2% (1/80) vs. 5.0% (4/80), and the overall adverse reaction rates were 47.5% (38/80) vs. 65.0% (52/80), with statistically significant differences (χ²=3.88, P=0.049; χ²=5.33, P=0.021). Conclusion: Traditional Chinese medicine syndrome differentiation and treatment can promote early postoperative recovery in patients undergoing spinal tuberculosis surgery, lay foundation for long-term bone graft fusion, and simultaneously reduce recurrence rate and the incidence of treatment-related adverse reactions.

Screening and identification of iron death-related gene MT1G in tuberculosis based on bioinformatics

Gao Yan, Peng Yingjie, Ge Xiao, Xu Jian, Liu Xiaohua, Liu Jinlong, Wang Yuanyuan

Chinese Journal of Antituberculosis. 2026, 48(3):  366-376.  doi:10.19982/j.issn.1000-6621.20250387

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Objective: To identify potential diagnostic biomarkers for tuberculosis by screening ferroptosis-related differentially expressed genes in tuberculosis through bioinformatics methods. Methods: Firstly, the expression of the ferroptosis-related marker FACL4 in tuberculosis was validated by immunohistochemistry using lung tissue sections from 6 pulmonary tuberculosis patients collected at Weifang Maternal and Child Health Hospital. Then, tuberculosis-associated differentially expressed genes were screened from the Gene Expression Omnibus (GEO) database, followed by bioinformatics analysis including kyoto encyclopedia of genes and genomes (KEGG) and gene ontology (GO) enrichment analysis and immune microenvironment validation. Next, the tuberculosis-related differentially expressed genes were intersected with the ferroptosis-related gene set to obtain a set of candidate genes associated with ferroptosis in tuberculosis, followed by enrichment analysis. To identify significantly and consistently high-expressed key genes, tuberculosis samples were further stratified into C1 and C2 molecular subtypes, and subtype-specific differentially expressed genes were re-screened using clustering and differential analysis. Finally, key gene expression was validated using online datasets, immunohistochemistry, immunofluorescence, and RT-PCR. Results: Immunohistochemical results showed that FACL4 was highly expressed in pulmonary tuberculosis tissues. A total of 1142 tuberculosis-associated differentially expressed genes were identified from the GEO database, all enriched in immune-related pathways and closely linked to immune microenvironment. A set of 438 ferroptosis-related genes was screened, and their intersection with the 624 upregulated tuberculosis-related differential genes resulted in 52 common ferroptosis-related differential genes. Further the 52 genes in tuberculosis samples were further screened into C1 and C2 subtypes for differential gene identification, ultimately identified 4 key candidate genes: MT1G, CDH1, IL1β, and PTGS2. RT-PCR, immunohistochemistry, and immunofluorescence confirmed that MT1G was significantly upregulated supporting its potential as a diagnostic biomarker. Conclusion: This study preliminarily validated the potential of the ferroptosis-related gene MT1G as a biomarker for tuberculosis, providing new strategies for exploring the immuno-pathological mechanisms of tuberculosis and the treatment of drug-resistant tuberculosis.

Analysis of the screening effectiveness and influencing factors of tuberculin skin test and interferon-gamma release assays for close contacts in schools: A retrospective real-world study

Gu Yuhong, Liu Zengwei, Wu Xiaoying, He Liqian, Zhang Yahui, Wu Guifeng

Chinese Journal of Antituberculosis. 2026, 48(3):  377-385.  doi:10.19982/j.issn.1000-6621.20250381

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Objective: To compare the application value of the tuberculin skin test (TST) and interferon-gamma release assays (IGRA) in screening for latent tuberculosis infection (LTBI) among close contacts of tuberculosis patients in school, explore influencing factors, and evaluate the performance of the corresponding prediction models. Methods: A retrospective analysis was conducted. Data of 6893 close contacts (including staff and students) from 58 schools and childcare institutions in Haizhu District, Guangzhou, who participated in tuberculosis screening between January 2022 and December 2024, were collected from the “Tuberculosis Information Management System,” a subsystem of the “China Information System for Disease Control and Prevention”. The data included general information (demographics, exposure characteristics, school type, student or teacher) and screening data (standardized symptom inquiry, infection examination method, chest X-ray result, index case identity, and etiological results). Among them, 2714 individuals underwent TST, and 4179 underwent IGRA. Univariate and multivariate logistic regression models were used to analyze factors associated with positive LTBI screening results. The discriminatory performance of prediction models based on the two test results was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The crude positive rate in the TST group was significantly higher than that in the IGRA group (22.62% (614/2714) vs. 8.33% (348/4179), χ²=280.041, P<0.001). After adjusting for confounders, the positive rates for IGRA and TST were 7.04% and 21.74%, respectively. The likelihood of a positive result with IGRA was only 29.20% of that with TST (aOR=0.292, 95%CI: 0.250-0.341, P<0.001). Multivariate logistic regression analysis revealed that for TST, female gender and increasing age were risk factors (aOR=1.549, 95%CI: 1.277-1.879; aOR=1.037, 95%CI: 1.015-1.061). For IGRA, increasing age was associated with increased LTBI positivity (aOR=1.094, 95%CI: 1.067-1.122), while having an index case being a teacher or other staff member, or the contact being a staff member, were protective factors (aOR=0.585, 95%CI: 0.415-0.826; aOR=0.305, 95%CI: 0.106-0.880; aOR=0.244, 95%CI: 0.115-0.520). The prediction model based on IGRA results showed moderate discriminatory power (AUC=0.716), while the model based on TST results showed lower discriminatory performance (AUC=0.641). Conclusion: In populations with widespread BCG vaccination, TST may overestimate the LTBI burden. IGRA demonstrates higher specificity, and its positive results show a more consistent association with known epidemiological risk factors. The model based on IGRA shows better discriminatory ability. It is recommended that in practical screening, IGRA or a “TST initial screening plus IGRA confirmation” strategy be prioritized to to improve screening efficiency and accurately identify targets for intervention.

Investigation and analysis of biosafety status in tuberculosis laboratories of 138 tuberculosis prevention and control institutions in Guangdong Province

Guo Huixin, Wu Zhuhua, Chen Yanmei, Yu Meiling, Peng Kehao, Xu Liuyue, Zhang Jianhui, Chen Xunxun

Chinese Journal of Antituberculosis. 2026, 48(3):  386-393.  doi:10.19982/j.issn.1000-6621.20250395

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Objective: To investigate the current status of biosafety in tuberculosis (TB) laboratories in TB prevention and control institutions in Guangdong Province, analyze and identify the existing problems, and propose improvement methods and measures, so as to provide scientific basis for further standardizing the biosafety management of TB laboratories. Methods: A questionnaire survey was conducted among management personnel of TB laboratories in 138 TB prevention and control institutions in Guangdong Province by means of official documents issued by Center for Tuberculosis Control of Guangdong Province. Quality control was implemented through consultation and Q&A as well as on-site verification. An analysis was carried out in terms of the basic situation, experimental activity management, equipment and facilities management. Results: Among the 138 investigated institutions, 131 (94.93%) had established organizational structure of biosafety management, 126 (91.30%) had formed biosafety committee, 127 (92.03%) had departments responsible for laboratory biosafety management, 127 (92.03%) had formulated rules and regulations related to laboratory biosafety management. A total of 120 (86.96%) TB laboratories were registered as biosafety level-2 laboratories, of which 31 (22.46%) were qualified as enhanced biosafety level-2 laboratories. A total of 104 (75.36%) TB laboratories had established a strain management system, all (100.00%) TB laboratories had formulated a waste management system, 133 (96.38%) had a biosafety emergency plan, and 130 (94.20%) had established laboratory personnel files. Conclusion: Most of the TB prevention and control institutions in Guangdong Province have basically established biosafety management systems, with relatively sound organizational structures and regulations. However, there are still issues such as low filing rates for biosafety laboratories, insufficient biosafety protection measures, and inadequate specialized biosafety training. It is urgent to strengthen the filing mechanism, ensure the implementation of funding support, and optimize the quality management system, so as to effectively guarantee the implementation of biosafety measures.

Analysis of characteristics of pulmonary tuberculosis patients aged 60 and above in Hefei City, 2015—2024

Cao Hong, Qian Bing, Zhao Kefu, Chen Lili, He Yuqin, Wu Jinju, Chen Shuangshuang, Xu Rui, Zhao Cunxi

Chinese Journal of Antituberculosis. 2026, 48(3):  394-404.  doi:10.19982/j.issn.1000-6621.20250394

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Objective: To analyze the characteristics of pulmonary tuberculosis (PTB) patients aged 60 years and above (elderly PTB patients) in Hefei City from 2015 to 2024, and to provide a scientific basis for the early detection of elderly PTB patients. Methods: A retrospective study was conducted, data of 14205 records of PTB patients aged ≥60 years registered in Hefei City from 2015 to 2024 were collected from the China Disease Prevention and Control Information System. Information such as gender, age, current residential address, patient source, registration date, and etiological results were included in the study. Time trend analysis of the registration rate of PTB patients was conducted using Joinpoint Regression Program 5.0.2 software, obtaining the average annual percentage change (AAPC). Results: From 2015 to 2024, there were 14205 elderly PTB patients in Hefei, accounting for 39.33% (14205/36122) of all PTB patients. The registration rate decreased from 148.16/100000 (1649/1.113 million) in 2015 to 85.06/100000 (1418/1.667 million) in 2024, with an average annual decline of 5.98% (AAPC=-5.98%, P=0.021). The male-to-female ratio of elderly PTB patients was 2.85∶1. The registration rate for males (155.34/100000 (10512/6.767 million)) was significantly higher than that for females (52.89/100000 (3693/6.982 million)), with a statistically significant difference (χ²=3494.594, P<0.001). Over the 10 years, the registration rate of elderly PTB patients showed a downward trend, with the largest average annual decline observed in the 60-64 age group (AAPC=-8.79%, P<0.001), followed by the 70-74 age group (AAPC=-8.76%, P<0.001). However, the registration rate increased with advancing age ( ${\chi }_{trend}^{2}$=1116.539, P<0.001), reaching the highest in the 75-79 age group (150.56/100000 (2674/1.776 million)). The peak registration period occurred mainly in May (9.62% (1366/14205)) and March (9.57% (1360/14205)). The registration rate of elderly PTB patients decreased in all regions of Hefei over the decade. Among urban areas, Shushan District had the largest annual decline (AAPC=-5.97%, P=0.003), followed by Baohe District (AAPC=-5.70%, P=0.009). Among suburban counties, Changfeng County had the largest annual decline (AAPC=-9.57%, P<0.001), followed by Chaohu City (AAPC=-8.59%, P=0.001), and Lujiang County had the smallest (AAPC=-4.15%, P=0.010). Passive detection accounted for 98.49% (13990/14205) of registered patients, while active detection accounted for only 1.38% (196/14205). Among passive detection cases, referral was the main source (66.34% (9424/14205)), followed by tracing (18.09% (2570/14205)). The number of patients detected by referral showed a annual downward trend ( ${\chi }_{trend}^{2}$=175.954, P<0.001), whereas that detected by tracing showed an upward trend ( ${\chi }_{trend}^{2}$=609.935, P<0.001). The etiological positive rate of elderly PTB patients was 53.76% (7637/14205), increasing from 40.93% (675/1649) in 2015 to 67.70% (960/1418) in 2024 ( ${\chi }_{trend}^{2}$=596.068, P<0.001). A total of 1238 patients had comorbid diabetes, with the comorbidity rate rising from 2.49% (41/1649) in 2015 to 17.42% (247/1418) in 2024 ( ${\chi }_{trend}^{2}$=468.359, P<0.001). Conclusion: From 2015 to 2024, the registration rate of PTB patients aged ≥60 years in Hefei showed a downward trend. However, high registration rates were observed in some regions, male patients, and the ≥75 age group, who should be prioritized in TB prevention and control. All regions need to strengthen multi-departmental collaboration, enhance public health awareness, and continuously optimize prevention and control strategies based on the characteristics of the elderly population to further reduce the incidence of PTB among the elderly.

Analysis of the dynamics and influencing factors of latent tuberculosis infection in a rural elderly population in Changxing County

Zhang Jian, Chen Bin, Zhang Mingwu, Qin Jiasheng, Song Yufang, Li Xuejing, Wang Wei

Chinese Journal of Antituberculosis. 2026, 48(3):  405-412.  doi:10.19982/j.issn.1000-6621.20250333

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Objective: To investigate the prevalence of latent tuberculosis infection (LTBI) among rural elderly individuals, the rate of LTBI conversion after one-year follow-up, and related factors, providing scientific data for precise tuberculosis prevention and control in primary healthcare settings. Methods: Utilizing the elderly health examination cohort in Changxing County, Zhejiang Province, a two-time-point interferon-gamma release assay (IGRA) was performed to detect LTBI status. Multivariable logistic regression analysis was employed to identify independent factors influencing baseline LTBI status and LTBI conversion at the one-year follow-up. Results: The baseline LTBI prevalence in the rural elderly population was 9.49% (97/1022). Among 925 baseline-negative individuals, 764 completed one-year follow-up, with 51 cases of LTBI conversion, yielding an annual conversion rate of 6.68% (51/764). A follow-up assessment was conducted one year later on the 51 individuals who had converted to positive, with 46 participants successfully evaluated. The IGRA reversion rate was 69.57% (32/46), and the persistent positivity rate was 28.26% (13/46). Multivariable analysis identified two baseline LTBI predictors: abnormal chest X-ray findings (OR=1.539, 95%CI: 1.008-2.350)and male gender (OR=1.700, 95%CI: 1.111-2.601). Higher hemoglobin levels increased conversion risk (OR=1.026, 95%CI: 1.006-1.047). Conclusion: The rural elderly population in Changxing County, Huzhou City, Zhejiang Province exhibits a relatively low baseline LTBI rate, and infection status among converters shows significant fluctuation. Therefore, a comprehensive assessment of exposure and disease progression risks is essential before implementing preventive interventions for elderly community-dwelling individuals with LTBI.

Review Articles

Progress in interventions to improve treatment adherence among patients with pulmonary tuberculosis

Meng Qiuyue, Rong Ningning, Liu Yadong, Yang Haixia, Ma Mingli

Chinese Journal of Antituberculosis. 2026, 48(3):  413-418.  doi:10.19982/j.issn.1000-6621.20250377

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Pulmonary tuberculosis (PTB) is a chronic respiratory infectious disease that continues to pose a substantial threat to global public health, characterized by a protracted disease course, high recurrence rate, and considerable treatment costs. Pharmacotherapy currently represents the primary therapeutic modality. However, due to a complex interplay of individual, socioeconomic, and contextual factors, patients generally demonstrate poor medication adherence, which consequently impairs the success rate of anti-tuberculosis treatment. This review synthesizes the major current intervention measures for improving medication adherence among PTB patients, aiming to provide a reference for the management of treatment adherence enhancement in this patient cohort.

Research progress on the mechanisms of lung injury caused by Mycobacterium abscessus

Ni Sheng, Sha Wei, Wang Li

Chinese Journal of Antituberculosis. 2026, 48(3):  419-425.  doi:10.19982/j.issn.1000-6621.20250397

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Mycobacterium abscessus complex (MABC) has high virulence and high drug resistance. The mechanisms of lung injury causing by MABC are complicated, mainly caused by the imbalance of host immune response and abnormal tissue repair. This review summarizes current researches on the mechanisms of MABC-induced lung injury, focusing especially on the roles of excessive inflammatory responses and abnormal repair processes, to identify crucial points of the disease development, to set the stage for more focused researches into particular pathogenic stages.