Table of Content

10 May 2026, Volume 48 Issue 5

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Special Topic

Current status and optimization paths of latent tuberculosis infection screening in patients with rheumatic immune diseases in China

Gao Li, Zhang Guoqin

Chinese Journal of Antituberculosis. 2026, 48(5):  561-566.  doi:10.19982/j.issn.1000-6621.20250401

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Tuberculosis is an infectious disease that poses a serious threat to human health. Patients with rheumatic diseases have much higher risk of tuberculosis infection than the general population due to impaired autoimmune systems and the influence of drugs. Screening for latent tuberculosis infection and providing preventive treatment are of great significance for controlling the condition and reducing the spread of tuberculosis. However, clinical screening still faces multiple predicaments such as complex disease characteristics, insufficient adaptability of screening technologies and uneven resource allocation, non-standard clinical decision-making, and the lack of community management. This article elaborates on the prevalence of latent tuberculosis infection in rheumatic diseases patients, screening techniques and resource allocation, clinical decision-making, preventive treatment and management, etc., to explore effective ways to increase the screening rate. It conducts in-depth analysis from multiple aspects, explores the paths to improve the screening rate, provides references for relevant policy making, helps improve patient prognosis, and reduces the burden on social medical care.

Original Articles

Trend of pulmonary tuberculosis reported incidence in Hunan Province from 2009 to 2023: a population-based study using Joinpoint regression model

Huang Guojun, Wang Qiqi, Zheng Wenjing, Liu Jianjun, Bai Liqiong, Liang Jun, Yu Shicheng, Xu Zuhui, Wan Yanping, Liu Xie, Yao Hongyan, Ming Hui

Chinese Journal of Antituberculosis. 2026, 48(5):  567-575.  doi:10.19982/j.issn.1000-6621.20260018

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Objective: This study aims to evaluate the effectiveness of pulmonary tuberculosis (PTB) prevention and control by analyzing the long-term trend of PTB reported incidence in Hunan Province and to reveal its epidemiological characteristics across different populations and regions, providing a scientific basis for optimizing prevention and control strategies. Methods: Data on PTB reported incidence in Hunan Province from 2009 to 2023 was extracted from the “China Disease Prevention and Control Information System”. The PTB age-standardized reported incidences across years were calculated, and stratified analyses were conducted by sex, age, region, and etiological test result category. The Joinpoint regression model was used to analyze the change trend, identify turning points, and calculate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC) as evaluation metrics. Results: From 2009 to 2023, the age-standardized reported incidence of PTB in Hunan Province showed an overall declining trend (AAPC=-3.91%; 95%CI:-5.21% to -2.59%). The year 2020 marked a turning point, after which the decline accelerated (AAPC=-8.61%; 95%CI:-14.36% to -2.48%). The age-standardized reported incidence of PTB was higher in males than in females, with a faster decline rate in males (AAPC:-4.19% vs. -3.03%). The average reported incidence of PTB was highest among individuals aged 60 and above (194.51/100000 (322929/166026000)), but the decline was slower (AAPC=-2.42%; 95%CI:-3.01% to -1.82%). For those aged 15-59-year, the average reported incidence was (75.37/100000 (490884/651287000)), showing a faster decline (AAPC=-3.73%; 95%CI:-4.11% to -3.30%). The average reported incidence in the 0-14-year age group was low (2.98/100000 (5491/184359000)) and exhibited multiple fluctuations, with an upward trend observed from 2016 to 2019 (APC=19.50%; 95%CI: 9.90% to 25.45%). Regionally, the average reported incidences ranked as follows: Western Hunan (94.04/100000), Southern Hunan (86.10/100000), Northern Hunan (78.47/100000) and Central Hunan (76.57/100000), with Central Hunan showing the fastest decline (AAPC=-2.76%; 95%CI:-3.36% to -2.15%), while Southern Hunan showed a slower decline (AAPC=-1.93%; 95%CI:-2.85% to -0.63%). The standardized reported incidence of bacteriologically confirmed PTB decreased rapidly during 2009—2017 (APC=-6.83%; 95%CI:-9.20% to -5.20%), while the reported incidence of bacteriologically negative PTB declined sharply after 2018 (APC=-14.97%; 95%CI:-18.06% to -11.45%). Conclusion: The reported incidence of PTB in Hunan Province has significantly declined, demonstrating effective prevention and control measures. There are notable differences in incidences among various populations and regions, with the elderly, males, and areas in Western Hunan identified as high-risk groups and key areas.

Molecular characterization and risk factors of cross-resistance between isoniazid and prothionamide in multidrug-resistant Mycobacterium tuberculosis in Ningbo, China

Che Yang, Zhang Dongliang, Li Xiangchen, Lu Yewei, Liu Zhengwei

Chinese Journal of Antituberculosis. 2026, 48(5):  576-585.  doi:10.19982/j.issn.1000-6621.20250414

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Objective: This study aimed to investigate the characterization, the drug resistance-associated gene mutations in multidrug-resistant Mycobacterium tuberculosis (MDR-MTB) strains based on whole-genome sequencing (WGS) and to analyze the risk factors of cross-resistance between isoniazid (INH) and prothionamide (Pto). Methods: A total of 134 MDR-MTB isolates selected in the drug resistance survey in Ningbo between 2021 and 2024 were enrolled in the study. WGS was conducted to detect the genomic DNA extracted from clinical isolates. The sequencing data were analyzed using an in-house pipeline and the gene mutations determined based on MTB drug resistance gene database. The conventional drug susceptibility test was also used to detect the drug-resistant profiles against 9 antibiotics (levofloxacin, bedaquiline, linezolid, delamanid, clofazimine, amikacin, capreomycin, para-aminosalicylic acid and Pto). Combined with phenotypic drug susceptibility testing results and clinical data, the cross-resistance profile and risk factors between INH and Pto among MDR-MTB isolates were comprehensively analyzed. Results: Among 134 MDR-MTB isolates, 129 (96.3%, 129/134) carried INH resistance-associated mutations. Mutations were present in all three INH resistance-associated genes, katG, inhA and ahpC. The main mutation types were katG Ser315Thr (89.1%, 98/110), inhA c-15t (50.0%, 17/34) and ahpC c-81t (4/9). Among 134 MDR-MTB isolates, the overall Pto resistance rate (INH-Pto cross-resistance rate) was 20.2% (27/134), with 92.6% (25/27) harboring mutations. The gene mutations associated with Pto resistance were ethA and inhA, with mutation rates of 63.0% (17/27) and 77.8% (21/27), respectively. The major mutation types were ethA 11_12insA (70.6%, 12/17) and inhA t-8C (66.7%, 14/21). Among MDR-MTB and Pre-XDR-MTB, the INH-Pto cross-resistance rates were 20.2% (27/134) and 43.6% (24/55). Multivariate logistic regression showed that moxifloxacin given (OR (95%CI): 4.123 (1.207-14.080)) and the resistance of levofloxacin (OR (95%CI): 0.075 (0.019-0.293)) were risk factors for INH-Pto cross-resistance. Conclusion: The prevalence of INH-Pto cross-resistance among MDR-MTB was serious in Ningbo and the mutation type inhA t-8C was closely with INH-Pto cross-resistance. The regimen for INH-Pto cross-resistant patients should be according to the drug susceptibility results of fluoroquinolones and choose optimal treatment.

Study on the application of AI-assisted CT reading system in early detection of pulmonary tuberculosis in general hospitals

Sun Zheng, Liu Jiongya, Chen Chi, Yu Quanji, Li Yanan, Chen Cheng, Zhu Limei

Chinese Journal of Antituberculosis. 2026, 48(5):  586-593.  doi:10.19982/j.issn.1000-6621.20250419

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Objective: This study aimed to analyze the value of artificial intelligence (AI)-assisted imaging diagnostic technology in improving the detection rate of pulmonary tuberculosis in general hospitals. Methods: This prospective and retrospective study, conducted from June to December 2024, selected 75786 patients who underwent chest CT scans at the outpatient clinics of two general hospitals, Jiangsu Provincial People’s Hospital and the Second Affiliated Hospital of Nanjing Medical University, for AI-assisted screening for pulmonary tuberculosis. Subsequently, radiologists reviewed the AI-suspected images, excluding those without suspected pulmonary tuberculosis, before a panel of experts confirmed the diagnosis. A total of 259 patients were ultimately diagnosed with pulmonary tuberculosis. Simultaneously, we used binary logistic regression to analyze the impact of clinical characteristics and CT findings on the effectiveness of AI analysis, aiming to demonstrate the effectiveness of AI in detecting pulmonary tuberculosis in actual clinical practice. Results: Among 75786 CT scans from two general hospitals, AI (AI-guided diagnostic tool) used a threshold of 0.56 to identify suspected pulmonary tuberculosis, AI indicated 8574 scans as potentially indicating pulmonary tuberculosis, ultimately confirming 259 cases. Among these, 196 were clinically diagnosed, accounting for 75.68% (196/259), representing a 102.34% ((259-128)/128) increase in detection rate compared to the number of reported cases during the same period (χ²=41.800, P<0.001). The median (interquartile range) AI threshold for confirmed pulmonary tuberculosis was 0.65 (0.59, 0.69), while the median threshold for excluded patients was 0.62 (0.59, 0.70), with no statistically significant difference (U=1783.500, P=0.738). Calcification and fibrosis were more prevalent in non-pulmonary tuberculosis cases, with adjusted odds of 0.52 (95%CI: 0.32-0.84, P=0.008) and 0.52 (95%CI: 0.31-0.86, P=0.011), respectively. Conclusion: AI-assisted CT image reading systems can significantly improve the detection efficiency of pulmonary tuberculosis patients and reduce the missed diagnosis rate; however, the diagnosis of pulmonary tuberculosis still relies on comprehensive clinical diagnosis. Calcification and fibrosis imaging features are not helpful in the diagnosis of pulmonary tuberculosis. Therefore, AI-assisted CT image reading has good application potential in general hospitals.

Analysis of out-of-pocket medical expenses and influencing factors of multidrug-resistant/rifampicin-resistant pulmonary tuberculosis patients in Changsha City

Xie Cifu, Yin Pengliang, Song Lixin, Xiong Zi

Chinese Journal of Antituberculosis. 2026, 48(5):  594-602.  doi:10.19982/j.issn.1000-6621.20250436

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Objective: With investigation on the out-of-pocket medical expenses and concerned influencing factors of multidrug-resistant/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) patients in Changsha City, to provide evidences for optimizing the medical insurance policies and local subsidy policies for MDR/RR-PTB patients. Methods: An investigation was conducted among 141 patients with MDR/RR-PTB who completed the full course of treatment in two designated drug-resistant tuberculosis hospitals in Changsha (Hunan Provincial Chest Hospital and Changsha Central Hospital) from January 1, 2020 to December 31, 2024. Data on the participants’ gender, age, occupation, and treatment classification were obtained through the Tuberculosis Information Management System. Meanwhile, data on marital status, educational level, type of medical insurance, and annual household income were collected via questionnaire surveys. In addition, data on patients’ classification, drug resistance type, treatment regimen, comorbidities, medical costs, and cost details were retrieved from the Hospital Information Management System. The medical expenses of patients were analyzed and stepwise multiple linear regression was used to analyze the influencing factors of out-of-pocket medical expenses for patients with MDR/RR-PTB. Results: The average medical costs of the full course treatment for the 141 MDR/RR-PTB patients were 185535 yuan, with 102594 yuan covered by medical insurance reimbursement, 57504 yuan out-of-pocket expenses incurred within the hospital, and 25437 yuan out-of-pocket expenses incurred outside the hospital. The out-of-pocket ratio was 44.7% (82941/185535). The medical costs with a relatively high proportion were 125386 yuan (67.6%) for medications, 27058 yuan (14.6%) for laboratory tests, and 4920 yuan (2.7%) for examinations. The results of stepwise multiple linear regression analysis showed that the out-of-pocket medical expenses for patients with rifampicin-monoresistant PTB were 1.21 (95%CI: 1.03-1.42) times as much as multidrug-resistant patients. The out-of-pocket expenses of the short-course chemotherapy regimen and the new long-course regimen (including Bdq) were 2.10 (95%CI: 1.21-3.67) times and 1.45 (95%CI: 1.23-1.70) times as much as those of the traditional long-course regimen (excluding Bdq), respectively. Conclusion: The out-of-pocket medical expenses of MDR/RR-PTB patients in Changsha city are relatively high, with drug resistance type and treatment regimen being the main influencing factors. It is urgent to optimize the medical insurance reimbursement policies for MDR/RR-PTB patients and introduce local subsidy policies as well.

Analysis of genetic mutation characteristics associated with linezolid resistance in Mycobacterium tuberculosis

Wu Yaning, Huang Misun, Guo Yi, Bo Xianglong, Wang Ruihuan, Xing Jianliang, Fan Xueting, Xu Da, Zhao Lili, Zhao Xiuqin, Li Guilian, Liu Haican, Li Machao

Chinese Journal of Antituberculosis. 2026, 48(5):  603-615.  doi:10.19982/j.issn.1000-6621.20250467

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Objective: To analyze the phenotypic characteristics of linezolid resistance and the mutation profiles of resistance-associated genes in clinical Mycobacterium tuberculosis (MTB) isolates, and to investigate the correlation between phenotypic and genotypic resistance. Methods: A total of 757 MTB clinical isolates collected from Southern Xinjiang Uygur Autonomous Region between June 2017 and December 2020 were included. The minimum inhibitory concentration (MIC) of linezolid was determined using the microplate broth microdilution method. Whole-genome sequencing was performed to analyze mutations in three known resistance-related genes (rrl, rplC, and tsnR) as well as in genes interacting with rplC and/or tsnR (interaction score ≥0.70). Statistical analyses were applied to evaluate the MIC distribution, phenotypic and genotypic resistance profiles, and their correlations. Results: Among the 757 isolates, the Beijing genotype (lineage 2) was predominant (62.22%). The overall resistance rate to linezolid (MIC≥1 μg/ml) was 6.34% (48/757), with both MIC₅₀ and MIC₉₀ values of 0.5 μg/ml and MIC₉₉ of 2 μg/ml. Among multidrug-resistant (MDR) and pre-extensively drug-resistant (pre-XDR) strains, the linezolid resistance rates were 6.09% (12/197) and 17.57% (13/74) respectively. Their MIC₅₀ values were 0.25 μg/ml and 0.5 μg/ml, MIC₉₀ values were 0.5 μg/ml and 1 μg/ml, and MIC₉₉ values were 2 μg/ml and 4 μg/ml, respectively. Pre-XDR phenotype was significantly associated with linezolid resistance (χ²=17.407, P<0.001). Mutation frequencies in rrl, rplC, and tsnR genes were 8.85% (67/757), 0.53% (4/757), and 1.32% (10/757), respectively. Among the 48 linezolid-resistant isolates, 43.75% (21/48) harbored mutations in these genes. Specifically, mutations in rrl and tsnR were detected in 18 (37.50%) and 3 (6.25%) isolates, respectively, while no mutations were found in rplC. Among the susceptible isolates, 24 types of rrl mutations, 4 types of rplC mutations, and 5 types of tsnR mutations were identified. Using the broth microdilution method as the gold standard, the sensitivity and specificity of rrl mutations alone for predicting linezolid resistance were 37.50% (18/48) and 93.09% (660/709), respectively. Combining rrl and tsnR mutations increased the sensitivity to 43.75% (21/48). Among the 152 interacting genes, ten genes (Rv1540, dnaJ1, fbiC, fmu, fusA2, infC, nusG, purA, rpoC, and rpsF) were significantly associated with linezolid resistance (for nusG, Fisher’s exact test was used, P<0.05; for the other genes, the chi-square test was used, with χ² values were 5.941, 4.985, 5.027, 4.732, 3.944, 4.673, 19.814, 5.789, and 29.234 respectively, with all P<0.05). Conclusion: Pre-XDR strains have a significantly increased risk of linezolid resistance. Molecular detection methods based on rrl, rplC, or tsnR genes showed limited sensitivity for predicting phenotypic resistance, indicating the existence of unelucidated resistance mechanisms. It is recommended that in clinical practice, a combined diagnostic strategy incorporating phenotypic drug susceptibility testing and genomic analysis be adopted for high-risk patients such as those with pre-XDR, and research on novel linezolid resistance mechanisms should be accelerated to improve the accuracy of linezolid resistance identification and provide reliable evidence for rational clinical drug use.

Comparison of clinical application effect between a novel fluorescent probe-based PCR method and three laboratory methods for detecting the Mycobacterium tuberculosis

Wu Gang, Zhang Zhengbin, Lu Zhouqin, Wang Xiaojun, Zhou Meilan, Li Yuehua

Chinese Journal of Antituberculosis. 2026, 48(5):  616-620.  doi:10.19982/j.issn.1000-6621.20250423

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Objective: To compare the diagnostic efficacy of the novel PCR-fluorescent probe method (DiagMed qPCR) with smear microscopy, liquid culture, and real-time fluorescent PCR in the detection of pulmonary tuberculosis. Methods: A total of 238 sputum samples from suspected pulmonary tuberculosis patients at Wuhan Pulmonary Hospital from March 20, 2021, to June 1, 2021, were consecutively enrolled. Taking clinical comprehensive diagnosis results as the reference standard, the diagnostic performance of smear microscopy, liquid culture, real-time fluorescent PCR, and DiagMed qPCR was evaluated and compared. Meanwhile, with the results of liquid culture and species identification as references, the correlation coefficient between the threshold cycle number (Ct) and bacterial load in samples from the two nucleic acid testing methods were assessed and compared. Results: Among the 238 patients, 167 cases were diagnosed with pulmonary TB, 1 case with nontuberculous mycobacterial disease, and 70 cases with pulmonary infections caused by fungi, viruses, and other non-tuberculous conditions based on clinical comprehensive diagnosis. Taking the clinical comprehensive diagnosis as the reference, the sensitivities of smear microscopy, liquid culture, real-time fluorescent PCR, and DiagMed qPCR for diagnosing pulmonary tuberculosis were 45.51% (76/167), 47.31% (79/167), 58.68% (98/167), and 58.68% (98/167), respectively; the specificities were 100.00% (71/71), 100.00% (71/71), 98.59% (70/71), and 98.59% (70/71), respectively; the AUC (%) values were 72.75%, 78.74%, 81.14%, and 82.24%, respectively. DiagMed qPCR and real-time fluorescence PCR showed the same positive detection rate for pulmonary TB (58.68%). The correlation coefficient R² between the Ct value of DiagMed qPCR and sputum bacterial content was higher than that of real-time fluorescent PCR assay (smear bacterial quantity grade: 0.213 vs. 0.187; culture-positive growth time: 0.293 vs. 0.290). Conclusion: In the detection of tuberculosis, both the DiagMed qPCR method and the real-time fluorescent PCR assay exhibit high sensitivity and specificity. However, the former demonstrates a stronger negative correlation between Ct values and bacterial load, which can improve detection efficiency.

Expression and clinical significance of co-signaling molecules on surface of T lymphocytes in different states of Mycobacterium tuberculosis infection

Tong Jing, Liu Kewei, Guo Can, Shi Jin, Pang Yu, Gao Mengqiu, Li Shanshan

Chinese Journal of Antituberculosis. 2026, 48(5):  621-630.  doi:10.19982/j.issn.1000-6621.20250433

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Objective: To detect the expression of T lymphocyte subsets and T cell surface co-signaling molecules in peripheral blood of populations with different Mycobacterium tuberculosis infection statuses and analyze their clinical significance. Methods: A prospective study design was employed. A total of 22 patients with pulmonary tuberculosis (TB group), 20 individuals with latent Mycobacterium tuberculosis infection (LTBI group), who met the inclusion and exclusion criteria, were enrolled at Beijing Chest Hospital Affiliated to Capital Medical University between August 3, 2023 and October 30, 2024. In addition, 22 healthy volunteers (HC group) who underwent physical examination during the same period were recruited as controls. Peripheral blood mononuclear cells from the three groups were analyzed using full-spectrum multiparametric flow cytometry to investigate the proportions of T lymphocytes and the distributions of 13 co-signaling molecules on T cells surface among different populations. Results: The levels of CD3⁺ T cells in the TB group ((53.23±16.15) %) and CD4⁺ T cells ((33.06±9.58) %) were significantly lower than those in the HC group ((65.59±13.94) % and (40.39±11.01) % respectively), and the level of CD8⁺ T cells ((16.88±7.59) %) was lower than that in the HC group ((24.07±8.86) %) and the LTBI group ((24.56±7.09) %), the differences were statistically significant (q=4.156, P=0.013; q=3.594, P=0.036; q=4.267, P=0.010; q=4.450, P=0.007). In CD4⁺ T cells, the expression level of CTLA-4 in the TB group (0.42% (0.21%, 1.92%)) was significantly higher than that in the HC group (0.20% (0.14%, 0.34%)) and the LTBI group (0.14% (0.07%, 0.20%)), the expression level of CD160 in the TB group (0.00% (0.01%, 0.05%)) was significantly lower than that in the HC group (0.08% (0.01%, 0.17%), the proportion of TIGIT in the LTBI group ((20.87±6.11) %) was significantly higher than that in the HC group ((13.93±5.28) %) and the TB group ((12.92±5.13) %), and the differences were all statistically significant (Z=2.503, P=0.037; Z=4.548, P<0.001; Z=2.447, P=0.043; q=5.877, P<0.001; q=4.903, P=0.003). In CD8⁺ T cells, the expression level of CTLA-4 in the TB group (1.03% (0.22%, 1.63%)) was significantly higher than that in the HC group (0.10% (0.04%, 0.46%)) and the LTBI group (0.08% (0.05%, 0.12%)), and the differences were statistically significant (Z=3.477, P=0.002; Z=4.279, P<0.001). Among the co-stimulatory signaling molecules, the expression levels of GITR of CD4⁺ T cells in the TB group and the LTBI group (2.34% (1.36%, 5.20%) and 2.01% (1.64%, 3.80%) respectively) were significantly higher than that in the HC group (1.48% (0.88%, 1.64%)), and the proportions of CD40L of CD4⁺ T cells, OX40 and ICOS of CD8⁺ T cells in the TB group (0.07% (0.03%, 0.10%), 0.16% (0.05%, 0.46%) and 7.28% (4.46%, 16.56%) respectively) were significantly higher than those in the HC group (0.02% (0.01%, 0.05%), 0.03% (0.01%, 0.09%), and 2.97% (1.48%, 5.54%) respectively), and the differences were all statistically significant (Z=2.834, P=0.014; Z=3.027, P=0.007; Z=2.825, P=0.014; Z=3.655, P<0.001; Z=3.364, P=0.002). Conclusion: The proportion of T lymphocytes in the peripheral blood of patients infected with Mycobacterium tuberculosis, especially those with active pulmonary tuberculosis, is imbalanced. At the same time, the expression of co-signaling molecules on the surface of T cells also changes, suggesting that such patients have immunosuppression or may have T cell exhaustion. This may provide new directions for development of tuberculosis diagnosis, host-directed immunotherapy, and new tuberculosis vaccine.

Influence factors of metabolic dysfunction-associated fatty liver disease on short-term effectiveness of anti-tuberculosis therapy in primary pulmonary tuberculosis patients

Huang Jun, Du Zhixiang, Hu Chunmei

Chinese Journal of Antituberculosis. 2026, 48(5):  631-640.  doi:10.19982/j.issn.1000-6621.20250422

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Objective: To explore the impact and influencing factors of metabolic dysfunction-associated fatty liver disease (MAFLD) on short-term effectiveness of anti-tuberculosis treatment in patients with newly diagnosed pulmonary tuberculosis (PTB), to provide a theoretical basis for individualized treatment of PTB patients. Methods: A case-control study was conducted, enrolling 320 newly diagnosed PTB patients admitted to Nanjing Second Hospital, Jiangsu Province from January to December 2023. According to the effectiveness at the end of the 2nd month of anti-tuberculosis treatment, the patients were divided into a favorable effectiveness group (146 cases) and a poor effectiveness group (174 cases). Demographic characteristics, metabolic indicators (including blood lipids, blood glucose, hepatic steatosis, etc.) and clinical data of the patients were collected. Univariable analysis was used to screen metabolic indicators related to treatment effectiveness, and multivariable logistic regression analysis was performed to identify factors influencing treatment effectiveness. Results: Univariable analysis revealed that in the poor-response group, 42.0% (73/174) of patients had a body mass index (BMI) >24 kg/m², 54.0% (94/174) had concomitant diabetes, hypertension (52/174, 29.9%), and hepatic steatosis (103/174, 59.2%). These proportions all were significantly higher than those in the good response group (24.7% (36/146), 17.1% (25/146), 15.1% (22/146), and 12.3% (18/146), respectively; χ² values: 17.739, 46.276, 9.803, 74.155; P<0.05 for all). Multivariable analysis indicated that abnormal triglycerides (OR=6.179, 95%CI: 3.159-12.312), abnormal high-density lipoprotein cholesterol (OR=2.134, 95%CI: 1.233-3.586), and complicated diabetes mellitus (OR=4.412, 95%CI: 2.464-7.666) were independent risk factors for poor anti-tuberculosis treatment effectiveness. Patients who met the diagnostic criteria for MAFLD had a significantly increased risk of poor treatment effectiveness (OR=11.15, 95%CI: 6.04-20.57). Conclusion: Abnormal triglycerides, abnormal high-density lipoprotein cholesterol, and concomitant diabetes mellitus are independent risk factors for poor anti-tuberculosis treatment effectiveness. MAFLD is an important factor affecting the prognosis of PTB. Clinically, enhanced monitoring and management should be implemented for PTB patients complicated with MAFLD.

Clinical characteristics and survival analysis of patients with lung cancer concurrent with drug-resistant pulmonary tuberculosis

Zhang Shanshan, Han Yaxuan, Zhang Xiaoyan, Li Jianying, Ren Fei, Zhang Yaohui, Yang Haixia

Chinese Journal of Antituberculosis. 2026, 48(5):  641-650.  doi:10.19982/j.issn.1000-6621.20250462

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Objective: To analyze the clinical characteristics and survival prognosis of patients with lung cancer concurrent with drug-resistant pulmonary tuberculosis (LC+DR-PTB), and to explore the factors influencing their prognosis. Methods: A retrospective cohort study was conducted, including 223 patients admitted to Xi’an Chest Hospital from January 2020 to March 2025. They were divided into three groups: the lung cancer group (LC group, n=126), the lung cancer concurrent with drug-sensitive pulmonary tuberculosis group (LC+DS-PTB group, n=82), and the lung cancer concurrent with drug-resistant pulmonary tuberculosis group (LC+DR-PTB group, n=15). Clinical characteristics of those patients were collected, and conduct matching using the propensity score matching (PSM) method, after matching, there were 54 cases in the LC group, 51 cases in the LC+DS-PTB group, and 15 cases in the LC+DR-PTB group. The survival curves were plotted using the Kaplan-Meier method, and the survival differences between groups were compared using the log-rank test. The Cox proportional hazards regression model was used to analyze the prognostic factors. Results: Comparison of baseline clinical characteristics before PSM: compared with the LC group, the LC+DR-PTB group had poorer Eastern Cooperative Oncology Group performance status (ECOG)(1 (1, 1) vs. 1 (1, 2); U=521.500, P=0.001), lower body mass index (BMI)((22.40±3.54) kg/m² vs. (19.84±4.23) kg/m²; t=2.610, P=0.010), and a higher proportion of underlying lung diseases (7.9% (10/126) vs. 33.3% (5/15); Fisher’s exact test, P=0.011). After PSM, the median overall survival (mOS) was 60.0 months in the LC group, 36.0 months in the LC+DS-PTB group, and 30.3 months in the LC+DR-PTB group, with a statistically significant difference (χ²=6.019, P=0.049). The multivariate Cox proportional hazards regression analysis showed that coexisting sensitive pulmonary tuberculosis (HR (95%CI): 3.288 (1.448-7.466)) and coexisting drug-resistant pulmonary tuberculosis (HR (95%CI): 4.446 (1.500-13.176)), age ≥65 (HR (95%CI): 2.957 (1.100-7.946)) and underlying diseases (HR (95%CI): 2.428 (1.107-5.326)) were independent risk factors for overall survival (OS) of lung cancer; surgical treatment (HR (95%CI): 0.162 (0.034-0.762)) was an independent protective factor for OS of lung cancer. In the LC+DR-PTB group, rifampicin resistance pulmonary tuberculosis was the most common (40.0%, 6/15), with a treatment success rate of only 33.3% (5/15). The retreatment rate was 46.7% (7/15), which was significantly higher than 13.7% (7/51) in the LC+DS-PTB group (Fisher’s exact test, P=0.011). The diagnostic delay was 23 (6, 33) days, significantly longer than 6 (4, 17) days in the LC+DS-PTB group (U=212.500, P=0.046). The treatment delay was 6 (3, 12) days, significantly longer than 1 (0, 5) days in the LC+DS-PTB group (U=152.500, P=0.006). Conclusion: LC+DR-PTB patients have complex clinical features, often presenting with poorer baseline ECOG scores and BMI, and often accompanied by underlying pulmonary diseases. The diagnosis and treatment of active pulmonary tuberculosis often have obvious delay, and the success rate of tuberculosis treatment is low, and the retreatment rate is high. Comorbidity status is an independent risk factor affecting the overall survival of lung cancer patients and has a poor prognosis.

Analysis of current status of mental vulnerability of tuberculosis patients and its influencing factors

Meng Ting, Chen Jingfang, Deng Guofang, Lin Yi, Yuan Jinsong, Ma Mengting

Chinese Journal of Antituberculosis. 2026, 48(5):  651-660.  doi:10.19982/j.issn.1000-6621.20260001

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Objective: To assess the level and influencing factors of mental vulnerability among tuberculosis(TB) patients. Methods: A total of 807 tuberculosis patients who visited the Shenzhen Third People’s Hospital from January 31 to June 30, 2025 were selected as subjects with convenience sampling. Data were collected using the general information questionnaire, the Mental Vulnerability Questionnaire, the Hospital Anxiety and Depression Scale, the Brief Illness Perception Questionnaire and the Perceived Social Support Scale. Multiple linear regression analysis was employed to identify overall influencing factors, with stratified analysis based on treatment classification (newly diagnosed/retreatment) to screen independent influencing factors of mental vulnerability for both groups. Results: The average score of mental vulnerability among tuberculosis patients was 56.08±11.03. Correlation analysis demonstrated that mental vulnerability was positively correlated with anxiety and depression (r=0.136, P<0.001) and illness perception (r=0.105, P<0.05), and negatively correlated with perceived social support (r=-0.741, P<0.001). Multivariate regression analysis revealed that age >65 years (β=2.081, 95%CI: 0.036-4.126), single drug resistance (β=3.016, 95%CI: 0.947-5.084), multidrug resistance (β=4.137, 95%CI: 2.171-6.104), and the presence of comorbidities (β=4.843, 95%CI: 3.688-5.998) were significant risk factors for mental vulnerability in tuberculosis patients, while perceived social support (β=-12.365, 95%CI:-13.202--11.527) was identified as a protective factor. Stratified analysis indicated that perceived social support was a protective factor in both the newly diagnosed group (β=-0.661, 95%CI:-0.701--0.622) and the retreatment group (β=-0.687, 95%CI:-0.792--0.582), while comorbidities were risk factors in both groups (newly diagnosed: β=4.605, 95%CI: 3.576-5.634; retreatment: β=4.261, 95%CI: 1.397-7.126). Multidrug resistance showed significant effects only in the retreatment group (β=6.248, 95%CI: 2.699-9.796), whereas urban residency provided protective effects solely in the retreatment group (β=-4.431, 95%CI:-7.902--0.960). Conclusion: The mental vulnerability of patients with tuberculosis was relatively high, with somato-psychological symptoms being the prominent manifestation. Healthcare professionals should pay particular attention to elderly, drug-resistant, and comorbid patients, and focus on early physical disease symptom complaints. Regardless of treatment stage, enhancing social support and strengthening the management of comorbidities should be fundamental intervention strategies. For retreatment patients, more attention should be paid to the cumulative psychological trauma associated with multidrug resistance and the accessibility of medical resources, while for newly diagnosed patients, their psychological stress responses need to be identified early.

Evidence summary on hospital-family digital health management with integrated traditional Chinese and Western medicine for tuberculosis patients

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

Chinese Journal of Antituberculosis. 2026, 48(5):  661-669.  doi:10.19982/j.issn.1000-6621.20250482

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Objective: By searching, screening, evaluating and summarizing the best evidence on hospital-family digital health management with integrated traditional Chinese and Western medicine for tuberculosis patients, to provide a basis for clinical health management implementation. Methods: Evidence-based questions were identified with PIPOST model (Population-Intervention-Professional-Outcome-Setting-Type of evidence) based on structured evidence. Guided by the “5S” evidence hierarchy model, a systematic search was conducted in UpToDate, PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, BMJ Best Practice, JBI, CNKI, WanFang Data, VIP, and CBM, as well as the professional society websites such as WHO, SIGN, NTCA, ERS, MedLive, and CATA, for clinical decision support tools, guidelines, expert consensus statements, evidence summaries, systematic reviews, meta-analyses, and RCTs on health management for tuberculosis patients. The search covered all available records from database establishment to July 30, 2025. Two researchers trained in evidence-based nursing independently extracted evidence from the literatures. Results: A total of 25 literatures were included, including 2 clinical decision-making articles, 10 guidelines, 3 evidence summaries, 3 expert consensus, 5 systematic reviews, and 2 randomized controlled trials. Therefore 28 best pieces of evidence were summarized, which covered 6 themes: multidisciplinary team building, disease cognition and prevention management, symptom identification and medication management, rehabilitation management, discharge preparation and home management, and digital management and effect evaluation. Conclusion: This study summarizes the best evidence of digital hospital-family health management with integrated traditional Chinese and Western medicine for tuberculosis patients, and provides scientific, reliable and highly timely evidence-based clinical management plans. Medical staff can construct nursing programs based on relevant evidence according to the clinical situations, improving the health management compliance of tuberculosis patients.

Predictive value of baseline chest CT features for anti-tuberculosis treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis

Zhao Xiaoting, Han Jing, Hou Zhili, Ding Wenlong, Zhang Yuyang, Zhang Shuo, Xing Zhiheng

Chinese Journal of Antituberculosis. 2026, 48(5):  670-676.  doi:10.19982/j.issn.1000-6621.20250420

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Objective: To investigate the predictive value of baseline chest CT imaging features for predicting treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis during the treatment phase. Methods: A retrospective case-control study design was employed. Patients with non-drug-resistant pulmonary tuberculosis admitted at Tianjin University Haihe Hospital between July 2017 and April 2024 were enrolled. Patients were categorized into a poor prognosis group (n=118) based on treatment outcomes and matched with a good prognosis group (n=183). Differences in baseline chest CT features and clinical indicators between the two groups were systematically compared using univariate analysis and logistic regression analysis. An efficacy prediction model was subsequently constructed. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis identified the following as independent risk factors for poor treatment prognosis: retreated tuberculosis (OR=6.257, 95%CI: 2.977-13.153, P<0.001), baseline CT showing cavity (OR=1.994, 95%CI: 1.116-3.564, P=0.020), bronchiectasis (OR=3.610, 95%CI: 1.395-9.341, P=0.008), fibrous stripe (OR=1.889, 95%CI: 1.073-3.328, P=0.028), involvement of more than three lung lobes (OR=2.293, 95%CI: 1.241-4.237, P=0.008), and decreased serum creatinine (OR=3.074, 95%CI: 1.539-6.137, P=0.001). The final prediction model formula was established as: logit(p)=-2.327+1.834×(Retreated tuberculosis)+0.690×(Cavity)+1.284×(Bronchiectasis)+0.636×(Fibrous stripe)+0.830×(Involved lung lobes>3)+1.123×(Decreased serum creatinine). The model achieved an area under the curve (AUC) of 0.808 (95%CI: 0.759-0.857). Conclusion: The prediction model constructed based on baseline chest CT imaging features combined with clinical indicators showed good predictive value for the treatment outcomes of patients with non-drug-resistant pulmonary tuberculosis.

Mechanism of Tounong San in abscess-type lymph node tuberculosis treatment using network pharmacology

Yang Bin, Cao Yuqing, Zong Xingyu, Wang Chaohong, Zhao Liping, Su Dahong, Gong Mengmeng, Ma Yan, Shi Yiheng, Lin Weibing, Zhao Jinfeng, Cheng Simin, Miao Tiantian, Wang Guirong

Chinese Journal of Antituberculosis. 2026, 48(5):  677-686.  doi:10.19982/j.issn.1000-6621.20260041

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Objective: To explore the underlying molecular mechanism of Tounong San in abscess-type lymph node tuberculosis treatment using network pharmacology. Methods: The active components and potential target of Tounong San were searched and screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). These genes were mapped with the abscess-type lymph node tuberculosis related genes obtained by Genecards and OMIM database, thereby obtaining inter section targets. The String 11.5 database and Cytoscape 3.9.1 software were used to construct the protein-protein interaction (PPI) network and the active ingredient-core target network. Then, gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis of core target genes were carried out by using DAVlD 6.8 platform. Using the DAVID database, we performed intersection target gene ontology functional enrichment analysis and signaling pathway enrichment analysis of the Kyoto gene and genome database. Results: A total of 72 effective drug targets were screened out. Enrichment analysis indicated that the signaling pathways involved in Tounong San in abscess-type lymph node tuberculosis treatment were cell apoptosis and oxidative stress response signaling pathways. AKT1, TP53, ALB and CASP3 might be the key genes in Tounong San-mediated abscess-type lymph node tuberculosis treatment. Conclusion: Tounong San may influence AKT1, TP53, ALB and CASP3 gene expression, to achieve the purpose of treating abscess-type lymph node tuberculosis.

Clinical Case Discussion

A case of AIDS with rifampicin-resistant tuberculous breast abscess and literature review

Li Qin, Li Linhong, Liu Jiao, Feng Mei, Xie Qi, Zhang Guixian, Yang Qiong, Yang Dandan

Chinese Journal of Antituberculosis. 2026, 48(5):  687-693.  doi:10.19982/j.issn.1000-6621.20250522

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Objective: To report the clinical diagnosis and management of one case of AIDS complicated with rifampicin-resistant tuberculous breast abscess, enhance understanding of the diagnosis and treatment of drug-resistant extrapulmonary tuberculosis in immunocompromised hosts, and analyze the clinical features, imaging characteristics and prognosis of tuberculous breast abscesses in confuction with a literature review, thereby providing evidence-based guidance for clinical differential diagnosis and the selection of treatment regimens. Methods: A retrospective analysis was conducted on the clinical diagnosis and management of a patient with AIDS complicated with rifampicin-resistant tuberculous breast abscess. Case reports of patients with tuberculous breast abscesses were retrieved from databases including CNKI, Wanfang Data, Chinese Journal Full-text Database, and PubMed using the keywords “tuberculous breast abscess” “AIDS/HIV” “rifampicin resistance” “imaging”, and “molecular detection techniques” for the period from October 2019 to June 2025. The clinical features, imaging characteristics, and prognostic outcomes of tuberculous breast abscesses were combined with the present case. Results: This patient was a 36-year-old woman with a 6-year history of HIV infection who was admitted to Yunnan Provincial Infectious Disease Hospital presenting with a 9-year history of a nodule in the left breast and more than 3 months of distension and pain in the right breast. Right breast ultrasound, CT scan and pus GeneXpert MTB/RIF testing revealed, Mycobacterium tuberculosis (MTB) positive with a mutation at the His526Tyr site of the rpoB gene confirming the diagnosis of rifampicin-resistant tuberculous breast abscess. After 11 months of treatment with a bedaquiline-containing short-course, all-oral regimen (6Bdq-Lfx-Lzd-Cs-Cfz/5Lfx-Lzd-Cs-Cfz) in combination with standard antiretroviral therapy, the lesions gradually resolved. A literature review identified nine cases of tuberculous breast abscess, none of whom were complicated with HIV infection. An analysis of these 10 patients, including the present case, revealed that 7 cases were reported in the international literature; 9 were female, of whom 7 were women of childbearing age (31-40 years), and 1 was a 77-year-old male. Clinical manifestations were predominantly breast masses, swelling and pain, or cold abscesses; some cases presented with ulceration or sinus tract formation; unilateral involvement was more common (7 cases). Ultrasound, CT or MRI scans typically revealed hypoechoic or mixed-echo lesions, thickened walls, internal debris or annular enhancement,but all lacked specific findings. Delayed diagnosis was reported in 8 cases, of which 2 were initially misdiagnosed as suppurative mastitis or breast cancer, and 6 had an unclear diagnosis. Pathological confirmation was obtained in 5 cases, and MTB was confirmed by microbiological testing in 5 cases. All 9 retrieved cases were treated with the drug-sensitive regimen “H-R-Z-E”. Three cases were cured, and 7 cases showed improvement in clinical symptoms and imaging findings after completion of treatment. Conclusion: Tuberculous breast abscesses are most commonly seen in women of childbearing age and lack specific clinical and imaging features, resulting in high rates of misdiagnosis and delayed diagnosis. Molecular testing and histopathological examination hold significant value for early diagnosis and drug resistance screening in such patients. Standardised anti-tuberculosis treatment can markedly improve patient prognosis. When breast nodules or abscesses present with disseminated or atypical manifestations in the context of HIV infection, and show poor response to general anti-infective therapy, tuberculosis should be actively considered. A good prognosis can still be achieved through standard anti-tuberculosis and antiviral treatment, provided that drug interactions are managed appropriately.

Review Articles

Research progress on latent tuberculosis infection in patients with hematological malignancies

Hu Xinyang, Liu Yang, Gao Jingtao

Chinese Journal of Antituberculosis. 2026, 48(5):  694-699.  doi:10.19982/j.issn.1000-6621.20250466

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Tuberculosis remains a global public health threat, with latent tuberculosis infection (LTBI) affecting nearly one in four individuals worldwide. While current control efforts appropriately target high-risk populations, LTBI has been extensively characterized in most immunocompromised groups-yet it remains markedly under-investigated in patients with haematological malignancies (HM). The profound immunosuppression intrinsic to the underlying disease, intensified by high-dose cytotoxic chemotherapy and hematopoietic stem-cell transplant conditioning, drives LTBI prevalence in this cohort well above that of the general population. Moreover, LTBI itself is increasingly recognized as an independent contributor to both the incidence and mortality of HM, underscoring the imperative for heightened clinical vigilance. This review synthesizes the contemporary evidence on LTBI in HM patients, providing an evidence-based framework to guide screening, diagnosis, and preventive therapy, and delineates the critical knowledge gaps that continue to impede optimal patient care.

Research progress of digital twin technology in tuberculosis prevention and control

Shan Liyan, Li Longfen, Li Wenming, Luo Yun, Zhang Huajie, Wang Ge, Huang Yuanqing, Li Shan, Wu Huachao, Shi Chunjing, Shen Lingjun

Chinese Journal of Antituberculosis. 2026, 48(5):  700-706.  doi:10.19982/j.issn.1000-6621.20260002

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As a new digital technology connecting the physical world and the digital world, digital twin technology provides new ideas and methods for tuberculosis prevention and control by creating a virtual model with real-time mapping and dynamic interaction. This paper systematically reviews the research progress of digital twin technology in the prediction, diagnosis, treatment and management of tuberculosis, focusing on its application value in epidemic simulation and transmission prediction, personalized diagnosis and treatment plan optimization, patient adherence management, etc., and discusses the current technical challenges such as data integration, model construction, and privacy protection. Finally, the future development direction is prospected, and it is pointed out that multimodal data fusion, artificial intelligence algorithm optimization, and multi-omics technology integration will be important development trends of digital twin technology in the field of tuberculosis prevention and control. The in-depth application of digital twin technology will help improve the accuracy and efficiency of tuberculosis prevention and control, and provide technical support for achieving the strategic goal of “ending the tuberculosis epidemic”.

Advances in CRISPR-Cas system-based detection of Mycobacterium tuberculosis

Huang Zhenyang, Li Wenjun, Sun Yansong, Li Hao

Chinese Journal of Antituberculosis. 2026, 48(5):  707-715.  doi:10.19982/j.issn.1000-6621.20250449

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Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), poses a severe threat to global public health security. However, traditional MTB detection methods, such as smear microscopy and bacterial culture, suffer from insufficient sensitivity, prolonged turnaround times, and delayed drug resistance detection, which have constrained the achievement of the World Health Organization (WHO)’s “End TB” strategy. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technology, characterized by high specificity and rapidity, offers transformative potential for MTB testing. This review systematically outlines the latest research progress of CRISPR in MTB point-of-care testing, drug resistance gene detection, and multi-target combined testing. It highlights key challenges in current research, including complex sample pretreatment, poor reagent stability, and inadequate adaptability to primary healthcare settings. Future efforts should focus on simplifying and integrating sample pretreatment and optimizing reagent lyophilization techniques, aiming to provide references for the clinical translation of CRISPR-based MTB detection and the precise prevention and control of TB.

Advances in the research on the pathogenesis of tuberculous uveitis

Lai Xiaoyu, Liao Qinghua, Wen Wenpei, Guo Huixin, Lin Weibin, Chen Xunxun

Chinese Journal of Antituberculosis. 2026, 48(5):  716-622.  doi:10.19982/j.issn.1000-6621.20250474

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Tuberculous uveitis (TBU) is the most common manifestation of intraocular tuberculosis, with an increasing global incidence, and represents a major infectious cause of visual impairment and blindness in clinical settings. The diagnosis and treatment of TBU pose substantial challenges, chiefly owing to the incomplete understanding of its complex pathogenesis. Debate has long persisted as to whether TBU results from direct infection of intraocular tissues by Mycobacterium tuberculosis (MTB), an immune hypersensitivity reaction triggered by distant infectious foci, or a molecular mimicry mechanism involving autoimmunity. In recent years, advances in immunology and molecular biology have greatly deepened our understanding of TBU pathogenesis. It is now widely accepted that the pathogenesis of TBU cannot be explained by a single mechanism, but rather involves a dynamic interplay among the pathogen, host immune response, and ocular microenvironment. This review aims to systematically elaborate the historical discovery and conceptual evolution of TBU, thoroughly investigate diverse pathogenesis hypotheses and supporting evidence, and summarize the currently accepted integrated view of its pathogenesis. Emphasis is placed on the latest research advances in host genetic susceptibility, key immune cell subsets (e.g., Th1/Th17 cells), cytokine networks, and MTB virulence factors, so as to provide novel perspectives and directions for future basic research and clinical practice.

Post-tuberculosis lung disease (PTLD): research progress on a neglected global health burden, pathogenesis, and clinical management

Yang Huan, Peng Aohui, Jiang Xinyu, Chen Yuanyuan

Chinese Journal of Antituberculosis. 2026, 48(5):  723-630.  doi:10.19982/j.issn.1000-6621.20250486

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Post-tuberculosis lung disease (PTLD) is a complex, chronic, and multifactorial condition that has increasingly become a significant global public health burden, affecting more than half of all tuberculosis (TB) survivors. Currently, although the standardized definition of PTLD is being continuously refined, its underlying pathogenesis remains poorly understood, thereby constraining the development of therapeutic interventions aimed at improving long-term post-TB outcomes. This review systematically synthesizes recent advancements in international research on PTLD by analyzing systematic reviews, expert consensuses, and clinical studies. It aims to provide an integrated framework of PTLD by elucidating its clinical characteristics, diagnostic criteria, and pathogenic mechanisms. Furthermore, this review discusses current clinical management strategies and future research directions to offer evidence-based insights for precision clinical decision-making and long-term chronic disease management for TB survivors.