Table of Content

10 June 2026, Volume 48 Issue 6

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Guideline·Standard·Consensus

Expert consensus on the diagnosis and treatment of breast tuberculosis

Jiangxi Chest Hospital/Jiangxi Provincial Key Laboratory of Tuberculosis, Chinese Antituberculosis Association, Guangzhou National Laboratory

Chinese Journal of Antituberculosis. 2026, 48(6):  737-750.  doi:10.19982/j.issn.1000-6621.20260010

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Breast tuberculosis is a form of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis infection. Although its overall incidence is low, it is characterized by nonspecific clinical manifestations and imaging features, making it prone to confusion with diseases such as breast cancer and granulomatous mastitis. This often leads to a high rate of misdiagnosis and significant local tissue destruction. In recent years, the incidence of breast tuberculosis has shown an upward trend due to the increasing population of immunocompromised individuals. Currently, there is a lack of specific guidelines for the diagnosis and treatment of breast tuberculosis both domestically and internationally; clinical practice largely relies on general principles for extrapulmonary tuberculosis, which presents certain limitations. To standardize the clinical management of breast tuberculosis, the Jiangxi Chest Hospital/Jiangxi Provincial Health and Health Commission Key Laboratory of Tuberculosis, the Chinese Antituberculosis Association, and Guangzhou National Laboratory, in collaboration with multidisciplinary clinical experts, have formulated this consensus based on the GRADE system and the Delphi method. This consensus systematically elucidates the epidemiological characteristics, clinical manifestations, and imaging and pathological features of breast tuberculosis. It clarifies stratified diagnostic criteria, underscores the pivotal role of etiological and molecular biological examinations in definitive diagnosis, and proposes a comprehensive treatment strategy anchored in standardized anti-tuberculosis therapy and supplemented by individualized surgical intervention. This consensus aims to provide clinicians with evidence-based guidance to enhance the early recognition, precise diagnosis, and treatment of breast tuberculosis, thereby improving patient prognosis.

Original Articles

Analysis of influencing factors of malnutrition and treatment outcomes among elderly patients with pulmonary tuberculosis aged 60 years and above

Reyhangul·Aken , Muratjan·Amat , Gao Xusheng, Ding Caihong, Zeng Yi, Chen Yu, Bai Yan, Fan Lin

Chinese Journal of Antituberculosis. 2026, 48(6):  751-759.  doi:10.19982/j.issn.1000-6621.20260029

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Objective: Explore the clinical characteristics of elderly patients (aged 60 years and above) with pulmonary tuberculosis and malnutrition, as well as to analyze the factors associated with malnutrition and treatment outcomes. Methods: We conducted a multicenter, retrospective cohort study involving a large sample size. A total of 1401 newly diagnosed, drug-sensitive PTB patients aged 60 years or older were consecutively enrolled from November 1, 2020, to April 30, 2024, across four hospitals: Shanghai Pulmonary Hospital, Shandong Public Health Clinical Center, Nanjing Second Hospital (Jiangsu), and Shenyang Tenth People’s Hospital. Patients were categorized into a malnutrition group (study group) and a non-malnutrition group (control group) based on the presence of malnutrition assessed by the GLIM criteria within 24 hours of admission. Comprehensive clinical information was collected for all patients throughout their treatment course. A binary logistic regression model was employed to analyze the factors influencing treatment outcomes in these malnourished patients. Results: The prevalence of malnutrition among elderly drug-sensitive PTB patients was 47.61% (667/1401). In comparison to the non-malnutrition group, which exhibited a cure rate of 50.27% (369/734) and a treatment completion rate of 26.43% (194/734), the malnutrition group demonstrated significantly lower rates of cure (41.68% (278/667)) and treatment completion (21.89% (146/667)). Additionally, the malnutrition group had a markedly higher rate of unfavorable treatment outcomes (36.43% (243/667) vs. 23.30% (171/734)), with all differences being statistically significant (χ²=10.383, P=0.001; χ²=3.922, P=0.048; χ²=28.959, P<0.001). Multivariable logistic regression analysis identified several independent risk factors for treatment outcomes, including aged 70-79 years (OR=1.551, 95%CI: 1.373-1.814), concurrent bacterial pneumonia (OR=1.432, 95%CI: 1.223-1.837), involvement of three or more lung fields (OR=1.565, 95%CI: 1.058-2.316), and adverse drug reactions (OR=1.744, 95%CI: 1.210-2.515). Conclusion: Elderly PTB patients suffering from malnutrition are characterized by a high comorbidity rate, elevated rates of unfavorable outcomes, and low rates of treatment completion and cure. Clinical management should focus on individuals aged 70-79 years, those with concurrent bacterial pneumonia, patients with three or more lung fields affected, and those experiencing adverse drug reactions, in order to improve treatment outcomes of this vulnerable population.

Construction and validation of a risk prediction model for restenosis after interventional treatment of tuberculous airway stenosis

Xu Yong, Zhou Teng, Liu Junjia

Chinese Journal of Antituberculosis. 2026, 48(6):  760-768.  doi:10.19982/j.issn.1000-6621.20250441

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Objective: To analyze the risk factors for restenosis after interventional treatment of tuberculous airway stenosis, construct a risk prediction model, and verify its predictive performance. Methods: A total of 350 patients with tuberculous airway stenosis who received interventional therapy in the Suzhou Fifth People’s Hospital from April 2021 to October 2024 were retrospectively collected as the research subjects. The patients were randomly divided into a modeling group and a validation group at a ratio of 4∶1 using the set-away method. Clinical data of patients was collected and LASSO regression was performed to identify key variables and do multivariable analysis, and a nomogram prediction model was constructed based on independent risk factors. Receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were used to verify performance of the model. Results: The incidence of restenosis after interventional treatment in patients included in this study was 41.71% (146/350). Ten key variables were screened by LASSO regression for multivariable analysis. The results showed that diabetes (OR=3.126, 95%CI:1.017-9.604), microscopic active period (OR=2.646, 95%CI:1.197-5.851), stenosis length >3 cm (OR=5.437, 95%CI:2.682-11.022), and increased systemic immune inflammation index (OR=1.008, 95%CI:1.006-1.011) were all risk factors for restenosis after treatment of tuberculous airway stenosis, while receiving systemic antituberculosis treatment before treatment (OR=0.326, 95%CI:0.150-0.707) was protective factor. The ROC curve analysis showed that the AUCs of the modeling group and the validation group were 0.878 (95%CI:0.832-0.924) and 0.867 (95%CI:0.771-0.962), respectively; The Hosmer Lemeshow test results for the modeling group and validation group were 5.419 (P=0.712) and 6.331 (P=0.610), respectively; The DCA results showed that within the high-risk threshold range of 0.1-0.8, using a nomogram model for preventive intervention in patients could achieve higher standardized net benefit compared to average intervention and no intervention. Conclusion: The restenosis of patients with tuberculous airway stenosis after interventional treatment is related to diabetes, microscopic active period, stenosis length >3 cm, and increased systemic immune inflammation index factors. Based on the relevant factors, a nomogram prediction model can be constructed to conduct risk assessment and early prediction of restenosis, which can provide reference for disease management plans for patients after interventional treatment.

Association between nutritional risk, inflammatory indicators, and glycemic control in patients with tuberculosis complicated by diabetes mellitus

Fan Jiahua, Yan Liang, Chen Hua, Lu Chunli, Wang Min, Huang Yaling, Li Yan

Chinese Journal of Antituberculosis. 2026, 48(6):  769-778.  doi:10.19982/j.issn.1000-6621.20250503

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Objective: To investigate the relationship between nutritional risk, inflammatory markers, and glycemic control in patients with tuberculosis and diabetes comorbidity (TB-DM), providing evidence for optimizing the integrated management of TB-DM patients. Methods: A cross-sectional study was conducted, enrolling 264 TB-DM patients admitted to the Guangzhou Chest Hospital from January to December 2023. Patients were grouped and compared based on their Nutritional Risk Screening 2002 (NRS-2002) scores and glycated hemoglobin (HbA1c) levels. Data collected included nutritional indicators such as body mass index (BMI), albumin (ALB), prognostic nutritional index (PNI), immuno-inflammatory indicators such as CD cell subsets, white blood cell count (WBC), neutrophil count (Neu), lymphocyte count (LYM), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and glycemic indicators (random blood glucose and HbA1c). Multivariable logistic regression was used to analyze the association between nutritional risk and poor glycemic control. Mediation analysis was further employed to examine the mediating role of inflammatory markers in the relationship between nutritional risk and glycemic control. Results: Patients with nutritional risk (NRS-2002 ≥3) accounted for 50.4% (133/264). Compared to the no-nutritional-risk group, the nutritional-risk group had significantly lower nutritional and immune indicators: BMI (20.20 (18.73, 22.95) kg/m² vs. 22.14 (20.55, 24.22) kg/m², Z=-4.759, P<0.001), ALB ((30.93±7.02) g/L vs. (36.48±7.08) g/L, t=6.393, P<0.001), CD4⁺ T-cell count (392 (260, 560) cells/μl vs. 564 (394, 756) cells/μl, Z=-5.108, P<0.001), and a higher sputum smear-positive rate (60.90% (81/133) vs. 39.69% (52/131), χ²=11.874, P<0.001). Notably, this group had significantly higher inflammatory levels: NLR (5.20 (3.54, 10.14) vs. 3.64 (2.61, 5.48), Z=-4.510, P<0.001), C-reactive protein (22.54 (6.36, 58.32) mg/L vs. 5.23 (1.36, 22.12) mg/L, Z=-4.852, P<0.001), but lower HbA1c levels (7.50% (6.60%, 10.00%) vs. 8.60% (7.35%, 10.20%), Z=-2.711, P=0.007). Multivariable logistic regression analysis indicated that, after adjusting for confounders, nutritional risk was independently inversely association with poor glycemic control (OR=0.357, 95%CI: 0.194-0.656). Mediation analysis revealed that inflammatory markers (WBC, Neu, NLR) were significant mediators in the effect of nutritional risk on HbA1c levels, accounting for 31.29%, 50.44%, and 53.16% of the total effect, respectively. Conclusion: In TB-DM patients, those with nutritional risk often present with more severe inflammatory status and immunosuppression, but their blood glucose levels may be relatively lower, potentially due to severe bodily catabolism. Inflammation is a key pathway linking nutritional risk to glycemic control. In the clinical management of TB-DM patients, while actively controlling blood glucose, we should attach high importance to nutritional assessment, and regulating inflammation should be considered a crucial component of comprehensive treatment.

Analysis of the characteristics of peripheral blood clinical detection indicators in patients with pulmonary tuberculosis complicated with osteoarticular tuberculosis

Wang Xinyan, Pan Hongfang, Mei Xue, Zhang Yi, Liu Jie

Chinese Journal of Antituberculosis. 2026, 48(6):  779-786.  doi:10.19982/j.issn.1000-6621.20250505

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Objective: To investigate the distribution characteristics of peripheral blood lymphocyte subsets in patients with pulmonary tuberculosis complicated with osteoarticular tuberculosis (PTB-OTB) and to analyze the correlations of B lymphocytes with inflammatory markers and nutritional status. Methods: A retrospective study was conducted on 96 patients with pulmonary tuberculosis (PTB group), 75 patients with osteoarticular tuberculosis (OTB group), and 90 patients with PTB-OTB who were admitted to the Eighth Medical Center of Chinese PLA General Hospital from January 2022 to July 2025. Flow cytometry was used to detect the absolute counts of peripheral blood T lymphocyte subsets. Meanwhile, laboratory indicators were collected, including body mass index (BMI), hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), prealbumin (PA), and albumin (Alb). Differences in various indicators among the three groups were compared, and Spearman correlation analysis was performed to explore the associations between B lymphocytes and clinical indicators in the PTB-OTB group. Results: The proportion of sputum smear-positive patients in the PTB-OTB group (41.1%, 37/90) was significantly lower than that in the PTB group (67.7%, 65/96)(χ²=13.268, P<0.001). The BMI (18.92 (17.43, 21.05) kg/m²) and Hb (103 (92, 129) g/L) in the PTB-OTB group were significantly lower than those in the OTB group (20.74 (18.21, 21.60)) kg/m², (125 (105,141) g/L) and the PTB group (20.48 (18.04, 21.85) kg/m², 126 (113, 135) g/L)(Z=4.220, P<0.001; Z=2.512, P=0.036; Z=2.677, P=0.022; Z=3.708, P=0.010). The ESR ((30 (20, 52) mm/1 h and 34 (27, 74) mm/1 h) and CRP (22.61 (10.54, 50.07) mg/L and 18.66 (6.76, 40.29) mg/L) levels in the PTB-OTB and OTB groups were significantly higher than those in the PTB group (17 (7, 38) mm/1 h and 4.61 (1.55, 26.74) mg/L)(Z=3.322, P=0.003; Z=3.815, P<0.001; Z=3.885, P<0.001; Z=3.028, P=0.007). In contrast, Alb levels of the two above groups (37.7 (33.0, 41.5) g/L and 36.2 (33.8, 40.0) g/L) were significantly lower than those in the PTB group (40.3 (37.5, 44.0) g/L)(Z=2.982, P=0.009; Z=3.254, P=0.003). The PA level in the PTB-OTB group (19.34 (18.27, 21.54) mg/dl) was lower than that in the PTB group (21.51 (19.27, 24.60) mg/dl)(Z=3.242, P=0.004). After adjusting for potential factors via analysis of covariance, no significant differences were observed in the absolute counts of CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells, NK cells, and NKT cells among the three groups. However, the B lymphocyte count in the PTB-OTB group ((99 (52, 198) cells/μl) was significantly lower than that in the OTB group (156 (85, 294) cells/μl) and the PTB group (177 (90, 254) cells/μl)(Z=2.667, P=0.023; Z=4.255, P<0.001). Spearman correlation analysis showed that in the PTB-OTB group, B lymphocyte count was significantly positively correlated with BMI (r=0.251, P=0.020), Hb (r=0.342, P=0.001), Alb (r=0.310, P=0.004), and PA (r=0.254, P=0.018), but showed no significant correlation with ESR (r=―0.138, P=0.211) or CRP (r=―0.191, P=0.078). Conclusion: Patients with PTB-OTB present with specific decreased absolute count of peripheral blood B lymphocytes, which is closely associated with poor nutritional status. These findings suggest that B lymphocytes may serve as a potential biomarker for assessing the dissemination risk of Mycobacterium tuberculosis. This study may provide a theoretical basis for the early identification of high-risk TB patients with disseminated disease, guiding clinical nutritional interventions, and evaluating immune reconstitution in the future.

Screening of anti-tuberculosis activity and analysis of chemical constituents of the Ethnomedicine Botrychium ternatum

Li Jing, Chen Shuangshuang, Chen Chunhua, Yang Guoxiang, Yang Chengnao, Zheng Luyun, Tan Chengjian, Li Chuanyou, Li Jie, Zhou Peifu, Dai Xiaowei

Chinese Journal of Antituberculosis. 2026, 48(6):  787-794.  doi:10.19982/j.issn.1000-6621.20260021

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Objective: To screen ethnomedicines with anti-tuberculosis activity, evaluate their efficacy and chemical composition, and provide new insights for tuberculosis treatment. Methods: Fifteen ethnomedicines were selected through literature review, and their total extracts were prepared. Initial screening for activity against Mycobacterium smegmatis (M.sm) was performed using the solid agar disk diffusion method. The medicine with the best activity was further extracted to obtain organic solvent fractions (petroleum ether, dichloromethane, n-butanol). The minimum inhibitory concentrations (MIC) of these fractions against M.sm and Bacillus Calmette-Guérin (BCG) were determined by the resazurin microtiter broth dilution assay. The activity against the standard strain H37Rv and clinical isolates (including drug-resistant and drug-sensitive strains) of Mycobacterium tuberculosis was evaluated via the microbroth dilution method. The chemical constituents of the total extract and petroleum ether fraction from Botrychium ternatum were analyzed by high-performance liquid chromatography-mass spectrometry (HPLC-MS) to preliminarily explore the potential anti-tuberculosis components. Results: Among the 15 ethnomedicines screened, 10 exhibited inhibitory activity against M.sm, with Botrychium ternatum showing the strongest activity (inhibition zone diameter: 18.33±4.04 mm). Resazurin assay results indicated significant inhibitory effects for the total extract and the petroleum ether fraction of Botrychium ternatum against M.sm and BCG, with MICs of 1875 μg/ml against M.sm for both, and MIC of 2 μg/ml, and 1 μg/ml against BCG for total extract and the petroleum ether fraction, respectively. Microbroth dilution testing against 11 clinical isolates of Mycobacterium tuberculosis showed that the MICs for the total extract and the petroleum ether fraction mainly ranged from 14 to 58 μg/ml, with the lowest MIC for the petroleum ether fraction reaching 14 μg/ml. HPLC-MS analysis identified 44 compounds in the total extract and 33 compounds in the petroleum ether fraction of Botrychium ternatum. Conclusion: Botrychium ternatum demonstrated the best activity against M.sm among the 15 ethnomedicines. Further evaluation confirmed its significant anti-tuberculosis activity, particularly for its petroleum ether fraction. This study not only verified the feasibility of screening anti-tuberculosis agents from ethnomedicines, but also provided important candidate substances and scientific basis for developing new anti-tuberculosis drugs through compositional analysis.

Analysis of Traditional Chinese Medicine syndrome characteristics in 619 severe pulmonary tuberculosis patients based on syndrome element differentiation

Xia Lu, Mu Tingting, Cai Qiujie, Ma Yan, Gong Mengmeng, Ye Dan, Zhang Wei

Chinese Journal of Antituberculosis. 2026, 48(6):  795-802.  doi:10.19982/j.issn.1000-6621.20260016

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Objective: To investigate the clinical symptoms, signs, and distribution patterns of syndrome elements in patients with severe pulmonary tuberculosis (PTB), providing references for developing precise Traditional Chinese Medicine (TCM) syndrome differentiation, as well as diagnostic and treatment strategies. Methods: Clinical data were collected from patients with severe PTB admitted to the Department of Tuberculosis at Shanghai Public Health Clinical Center between January 2020 and January 2025. Symptoms, signs, tongue coating, pulse manifestations, and current symptoms were recorded. Association rule analysis and cluster analysis were used to summarize syndrome elements, characterize syndrome patterns, identify major TCM syndrome types, and preliminarily explore corresponding diagnostic and treatment protocols. Results: A total of 619 patients with severe PTB were enrolled, including 488 males and 131 females, with a male-to-female ratio of 3.73∶1. The age ranged from 18 to 95 years, with a median (quartile) age of 76 (71,81) years; 88.69% (549/619) were over 60 years old. Among them, 520 cases (84.01%) had comorbidities, mainly type 2 diabetes mellitus (412 cases, 66.56%), hypertension (368 cases, 59.45%), and coronary heart disease (230 cases, 37.16%). The main clinical symptoms were sputum production (583 cases, 94.18%), poor appetite (567 cases, 91.60%), weight loss (480 cases, 77.54%), fatigue (423 cases, 68.34%), cough (376 cases, 60.74%), shortness of breath (354 cases, 57.19%), altered consciousness (355 cases, 57.35%), and fever (322 cases, 52.02%). Association analysis of syndrome elements revealed that the lung-qi deficiency association was the strongest (51.53%, with a confidence level of 100.00%). Cluster analysis showed that syndrome elements mainly clustered into two categories as lung-spleen qi deficiency, and phlegm-fire (heat) yin deficiency. While seven independent syndrome elements were identified, including cold, blood stasis, dampness, qi blockage, blood stirring, yang deficiency and heart. The dominant TCM syndrome types were lung-spleen qi deficiency syndrome (56.70%, 351/619) and phlegm-heat yin deficiency syndrome (39.74%, 246/619). Conclusion: Patients with severe PTB present with complex clinical manifestations and multiple comorbidities. Clinical diagnosis and treatment should break through TCM classification frameworks, adhere to the principle of “simultaneous regulation of multiple organs and addressing both root and branch”, with emphasis on the interactions among phlegm, stasis, and deficiency, which can provide evidence for developing precise TCM intervention protocols.

Interferon-gamma release assays for diagnosing extrapulmonary tuberculosis in adults: a systematic review and Meta-analysis

Guo Chenhao, Liu Xinyu, Zhan Sirui, Wang Lili, Ma Mengting, Li Xiumei, Qi Linping, Li Weiping

Chinese Journal of Antituberculosis. 2026, 48(6):  803-812.  doi:10.19982/j.issn.1000-6621.20260145

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Objective: To systematically evaluate the diagnostic accuracy of interferon-γ release assays (IGRA) for extrapulmonary tuberculosis (EPTB) in adults across different specimen types and assay methods, and to provide evidence-based guidance for optimizing clinical diagnostic pathways. Methods: A systematic search was conducted across PubMed, Web of Science, and the Cochrane Library databases from January 2014 to May 2025, to identify studies comparing the diagnostic accuracy of commercial IGRA (T-SPOT.TB or QuantiFERON-TB Gold series) with composite reference standards (culture and/or clinical diagnosis). Bivariate random effect models were used to combine sensitivity and specificity, and subgroup analyses (specimen type, detection method, disease type, etc.) and meta-regression were conducted. Results: A total of 28 studies (32573 participants) were included. The overall pooled sensitivity, specificity, and area under curve (AUC) values were 0.83 (95%CI: 0.79-0.87), 0.86 (95%CI: 0.82-0.90), and 0.9089, respectively. The sensitivity of IGRA for detecting body fluid samples was comparable to that of blood samples (0.86 vs. 0.84), but the specificity was higher (0.92 vs. 0.81). The enzyme-linked immunospot assay (ELISPOT) demonstrated superior specificity compared to the enzyme-linked immunosorbent assay (ELISA)(0.86 vs. 0.81). For tuberculous pleurisy, the AUC value of pleural effusion ELISPOT detection was 0.972, which was superior to that of blood detection (AUC=0.909). Blood ELISPOT detection showed good diagnostic performance in the lymph node tuberculosis subgroup (AUC=0.936). IGRA had limited diagnostic value for osteoarticular tuberculosis (AUC=0.734). Conclusion: IGRA is an effective auxiliary tool for diagnosing EPTB, but its detection performance depends on the type of specimen and the detection method. Evidence suggests that for patients suspected of having tuberculous pleurisy, pleural effusion ELISPOT testing should be prioritized, while for lymph node tuberculosis, blood ELISPOT testing should be preferred. In the diagnosis of osteoarticular tuberculosis, IGRA results should be interpreted with caution.

Status and influencing factors of medication adherence among elderly tuberculosis patients based on digital technologies

Zhang Yue, Huang Jinpeng, Gao Dan, Ling Lin

Chinese Journal of Antituberculosis. 2026, 48(6):  813-820.  doi:10.19982/j.issn.1000-6621.20250405

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Objective: To explore the status and influencing factors of medication adherence in elderly patients with tuberculosis based on digital technology management. Methods: With the convenience sampling method, 220 elderly tuberculosis patients who were hospitalized at the Tuberculosis Diagnosis and Treatment Center of Hangzhou Red Cross Hospital from August 2024 to August 2025 and who received digital technology for medication adherence management after discharge were selected as the study participants. Data on demographic characteristics and disease-related variables were collected through medical record review. Medication adherence, activities of daily living, and family support were assessed via structured questionnaires. Univariate analysis and binary logistic regression were performed to explore the associations between these variables and medication adherence. Results: A total of 205 elderly tuberculosis patients were included, with 139 (67.8%) in the medication compliance group and 66 (32.2%) in the medication non-compliance group. Multivariate logistic analysis showed that skin allergic reactions caused by anti-tuberculosis drugs (OR=16.357, 95%CI:1.683-158.968), gastrointestinal adverse reactions induced by anti-tuberculosis drugs (OR=3.804, 95%CI:1.318-10.978), history of allergy to other medications (OR=10.782, 95%CI:1.714-67.828), good follow-up response to digital technology (OR=0.317, 95%CI:0.128-0.790), high family support (OR=0.085, 95%CI:0.017-0.414), mild dependence on activities of daily living (OR=0.083, 95%CI:0.008-0.901), and non-dependence on activities of daily living (OR=0.029, 95%CI:0.001-0.675) were independent factors associated with medication adherence among elderly tuberculosis patients managed via digital technology (P<0.05). Conclusion: The medication adherence of elderly patients with tuberculosis based on digital technology management is affected by the skin allergic reactions and gastrointestinal adverse reactions caused by anti-tuberculosis drugs, history of allergy to other medications, follow-up response to digital technology, daily living ability and family support level. The nursing staff should implement tailored interventions based on the influencing factors to improve the medication adherence under the digital health management model.

Analysis of influencing factors and pathways on psychological burden associated with pulmonary tuberculosis treatment in Southern Xinjiang Region of the Xinjiang Uygur Autonomous Region

Zhang Yaying, Wang Senlu, Guliziba Kuerbanjiang, Abulikemu Aili, Liang Chen, Yuan Shuanglong, Li Caihong, Cao Mingqin

Chinese Journal of Antituberculosis. 2026, 48(6):  821-829.  doi:10.19982/j.issn.1000-6621.20250454

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Objective: To investigate the factors influencing treatment-related psychological burden among tuberculosis patients in Southern Xinjiang Uygur Autonomous Region and their underlying pathways. Methods: From January 2024 to July 2025, a stratified clustered random sampling method was used to select 1483 patients with pulmonary tuberculosis who were registered in the Tuberculosis Information Management System and completed treatment in 8 counties/districts of 4 prefectures in southern Xinjiang for questionnaire survey. Multilevel model and structural equation model were constructed to explore the influencing factors of treatment-related psychological burden and their pathways, and to test the mediating effect of patients’ medication compliance. Results: A total of 1483 patients were included, with 470 (31.7%) exhibiting high psychological burden. Multilevel modeling revealed that lower educational attainment (OR=1.675, 95%CI:1.293-2.169), poor disease cognition (OR=2.340, 95%CI:1.733-3.159), poor medication adherence (OR=2.370, 95%CI:1.639-3.426), family dysfunction (OR=1.695, 95%CI:1.157-3.003), insufficient family support (OR=2.329, 95%CI:1.771-3.062), and dissatisfaction with treatment (OR=3.109, 95%CI:2.229-4.336) were independent risk factors for psychological burden. Structural equation modeling results indicated that family functioning (β=0.120) and satisfaction (β=0.367) exerted direct positive effects on psychological burden, while family support demonstrated a direct negative effect (β=-0.097). Medication adherence fully mediated the effects of family functioning and family support on psychological burden. Their direct effects were -0.096 and 0.117, respectively, while indirect effects were -0.001 and 0.003. Conclusion: The treatment-related psychological burden of patients with pulmonary tuberculosis in Southern Xinjiang is affected by many factors, such as education level, disease cognition, family function, family support, treatment satisfaction and medication compliance. Family function and family support indirectly affect psychological burden through medication compliance.

Construction of an optimal prediction model for treatment outcomes in retreatment pulmonary tuberculosis

Du Xilong, Maiwulajiang·Yimamu , Na Yan, Paziliya·Yasheng , Guo Gang, Maiweilanjiang·Abulimiti , Zhang Liping, Zheng Yanling

Chinese Journal of Antituberculosis. 2026, 48(6):  830-839.  doi:10.19982/j.issn.1000-6621.20260040

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Objective: Based on the clinical data of patients with retreatment pulmonary tuberculosis, this study systematically compared the performance of nine machine learning models in treatment outcome classification to construct the optimal prediction model and provide a predictive tool for optimizing the management of retreatment pulmonary tuberculosis patients. Methods: A total of 1396 patients with retreatment pulmonary tuberculosis registered and managed by the Kashgar in Xinjiang Uyghur Autonomous Region from January 1 to December 31, 2022 were enrolled. They were randomly divided into a training set (978 cases) and a test set (418 cases) at a 7∶3 ratio. Feature selection was performed using Random Forest and Cramér’s V coefficient. Nine machine learning models were constructed, including Logistic Regression, Support Vector Machine, Decision Tree, Random Forest, XGBoost, LightGBM, Gradient Boosting Tree, Multilayer Perceptron, and CatBoost. Model performance was evaluated using accuracy, precision, recall, F1-score, area under the curve (AUC), and average precision (AP). The optimal model was selected and interpreted using SHapley Additive exPlanations (SHAP) analysis. Results: The CatBoost model exhibited the best overall performance on the test set, with an accuracy of 89.2%, precision of 88.5%, recall of 89.2%, F1-score of 0.885, AUC of 0.829, and AP of 0.941. SHAP analysis revealed that 2-month sputum smear examination (absolute MeanSHAP value=0.595), treatment regimen (absolute MeanSHAP value=0.367), and treatment mode (absolute MeanSHAP value=0.290) were the three features with the highest contribution to predicting treatment outcomes in retreatment pulmonary tuberculosis. Conclusion: The CatBoost model performed robustly and excellently in predicting adverse treatment outcomes in patients with retreatment pulmonary tuberculosis. Combined with SHAP interpretation, it can effectively identify key predictors and provide an effective tool for risk assessment of adverse treatment outcomes in retreatment pulmonary tuberculosis patients.

Global burden of tuberculosis in children aged 0-14 years, 1990—2023, and trend projections for 2024—2050

Liu Lin, Yin Xiaocheng, Zhang Xiaofo, Liang Linlong, Yang Ju

Chinese Journal of Antituberculosis. 2026, 48(6):  840-848.  doi:10.19982/j.issn.1000-6621.20250432

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Objective: To analyze the trend of global tuberculosis burden of children aged 0-14 years from 1990 to 2023, explore the correlation between social demographic index (SDI) and age, predict the burden change to 2050, and provide the basis for the World Health Organization (WHO) strategy of “ending tuberculosis epidemic” in 2035. Methods: Based on the global burden of disease (GBD) research data from 1990 to 2023, the estimated annual percentage change (EAPC) was used to analyze the time trend of incidence rate, mortality and disability adjusted life years (DALYs) of children’s tuberculosis; Using the autoregressive integrated moving average (ARIMA) model, predict the disease burden until 2050. Results: From 1990 to 2023, the incidence, death and DALYs of tuberculosis in children aged 0 to 14 years in the world decreased by 45.06%, 67.05% and 65.13% respectively, the age standardized incidence rate (ASIR) decreased from 133.01/100000 to 63.18/100000, the age standardized mortality rate (ASMR) decreased from 11.61/100000 to 3.50/100000, the age standardized DALYs rate (ASDR) decreased from 1074.08/100000 to 341.96/100000, EAPC The range is -3.92%--2.38% (P<0.001). In 2023, low SDI areas will account for 76.85% (51328.34/66789.10) of child tuberculosis deaths, and their ASMR (7.71/100000) will be 85.67 times that of high SDI areas (0.09/100000); Children under the age of 5 have the highest number of deaths, with 48452.88 cases, and their ASMR (7.54/100000) is much higher than that of children aged 5-9 (1.33/100000). ARIMA model predicts that the global ASIR of children’s tuberculosis in 2050 will be 36.83/100000, ASMR will be 1.39/100000, and ASDR will be 142.34/100000. Conclusion: Despite substantial global declines in the childhood TB burden from 1990 to 2023, significant inequalities remain, concentrated in low-SDI regions and among children under 5 years. Achieving the 2035 “End TB” target necessitates targeted scaling up of child-friendly diagnostics, expanded preventive therapy, and precise interventions for MDR-TB.

Analysis of related factors influencing interferon-gamma release assay results in patients having coexistent tuberculosis and acquired immune deficiency syndrome

Huang Aichun, Lan Yanqun, Xu Chaoyan, Zhang Jie, Li Weiwen, Zhu Qingdong, Xie Zhouhua

Chinese Journal of Antituberculosis. 2026, 48(6):  849-855.  doi:10.19982/j.issn.1000-6621.20250437

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Objective: To investigate the related factors influencing interferon-gamma release assay (IGRA) results in patients having coexistent tuberculosis and acquired immune deficiency syndrome (AIDS). Methods: We enrolled 268 patients with coexistent tuberculosis and AIDS admitted to The Fourth People’s Hospital of Nanning from January 1, 2020 to June 30, 2023, including 141 cases with positive IGRA results showing a positivity rate of 52.6%, and the other 127 IGRA-negative patients. Clinical data and factors affecting the IGRA test results in patients were analyzed by establishing a multivariable logistic regression model. Results: The rate of concurrent other opportunistic infections was 42.6% (60/141) among the positive group, lower than that of the negative group at 65.4% (83/127), with a statistically significant difference (χ²=13.958, P<0.001). The incidence of extra-pulmonary tuberculosis in the positive group was 24.8% (35/141), lower than that of the negative group at 37.8%, with a statistically significant difference (χ²=5.260, P=0.022). The incidence of shortness of breath was 24.8% (35/141), lower than that of the negative group at 36.2% (46/127), with a statistically significant difference (χ²=4.116, P=0.042). The incidence of superficial lymph node enlargement was 31.9% (45/141), higher than that of the negative group at 21.3% (27/127), with a statistically significant difference (χ²=3.861, P=0.049). The rate of lactate dehydrogenase (LDH) >250U/L was 47.7% (63/141), lower than that of the negative group at 63.5% (75/127), with a statistically significant difference (χ²=6.162, P=0.013). The rate of lymphocyte count <1.1×10⁹/L was 52.5% (74/141), lower than that of the negative group at 71.7% (91/127), with a statistically significant difference (χ²=10.379, P=0.001). The rate of CD4⁺ T cell count ≤50 cells/μl was 25.5% (36/141), lower than that of the negative group at 59.1% (75/127), with a statistically significant difference (χ²=30.948, P<0.001). The rate of CD8⁺ T cell count <350 cells/μl was 34.8%(49/141), lower than that of the negative group at 49.6% (63/127), with a statistically significant difference (χ²=6.061, P=0.014). Multivariable logistic regression analysis showed that the presence of superficial lymph node enlargement (OR (95%CI)=0.359 (0.181-0.712)) was an independent protective factor for negative IGRA results in patients with co-morbid tuberculosis and AIDS, while concurrent other opportunistic infections (OR (95%CI)=0.359 (0.181-0.712)), the presence of extrapulmonary tuberculosis (OR (95%CI)=2.080 (1.105-3.916)), and CD4⁺ T cell count ≤50 cells/μl (OR (95%CI)=2.957 (1.466-5.966)) were independent risk factors for negative IGRA results in patients having coexistent tuberculosis and AIDS. Conclusion: Among patients having coexistent tuberculosis and AIDS, the positive rate of IGRA is low. For those with low CD4⁺ T-cell counts, concurrent other opportunistic infections, or having extra-pulmonary tuberculosis, when IGRA test results are negative, the possibility of false negative should be considered. In clinical application, when using IGRA to assist in the diagnosis of AIDS combined with tuberculosis, it is necessary to conduct a comprehensive analysis based on the patient’s condition.

Analysis of drug resistance gene mutation characteristics in Mycobacterium tuberculosis strains from five northwestern provinces of China

Jiang Xuefeng, Zhou Linjun, Sun Yan, Jiang Mingxia, Ma Ling, Mei Li, Liu Dongxin

Chinese Journal of Antituberculosis. 2026, 48(6):  856-864.  doi:10.19982/j.issn.1000-6621.20250458

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Objective: To analyze the characteristics of drug resistance-related gene mutations in Mycobacterium tuberculosis (MTB) isolated from five provinces in Northwest China, evaluate the efficacy of whole genome sequencing (WGS) technology in predicting phenotypic drug resistance, explore the applicability of existing rapid molecular diagnostic methods in this region, and provide scientific basis for the prevention and control of regional drug-resistant tuberculosis. Methods: From 2013 to 2022, 2125 clinical isolates of MTB were collected from Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, Qinghai Province, and Xinjiang Uygur Autonomous Region. Phenotypic drug susceptibility testing was performed using the microplate method for 13 anti-tuberculosis drugs. Simultaneously, WGS and drug resistance gene mutation analysis were conducted. Taking the phenotypic drug susceptibility results as the gold standard, the sensitivity and specificity of WGS in predicting phenotypic drug resistance were analyzed. Additionally, the regional drug resistance mutation spectrum and sites not covered by rapid molecular diagnostic methods were analyzed. Results: Among the 1716 strains with phenotypic drug susceptibility results, the resistance rates of rifampin and isoniazid were 5.30% (91/1716) and 10.72% (184/1716), respectively. WGS predicted the sensitivity of rifampin, isoniazid, ethambutol, amikacin, kanamycin, levofloxacin, moxifloxacin, ethionamide, bedaquiline, clofazimine, and streptomycin to be 96.74% (89/92), 72.83% (134/184), 67.92% (36/53), 5/6, 7/8, 54.84% (17/31), 59.09% (13/22), 80.00% (24/30), 1/8, 23.08% (3/13), and 97.22% (35/36), respectively, with specificities all exceeding 98.34%. The most prevalent resistance mutations to rifampin and isoniazid in the northwest region were rpoB_Ser450Leu (58.16%, 57/98) and katG_Ser315Thr (68.71%, 101/147), respectively, but there were also some rare mutations such as rpoB_Ser450Trp, katG_Ser315Ile, katG_Pro429fs, rpoB_His445_Lys446delinsGln. The coverage rates of rapid molecular detection methods for resistance loci of rifampin, isoniazid, and fluoroquinolones were 97.94% (95/97), 93.01% (133/143), and 78.95% (15/19), respectively. Conclusion: WGS has a high predictive value for the resistance of MTB to traditional anti-tuberculosis drugs in Northwest China. The presence of numerous rare mutation sites in this region suggests the need to further expand the target coverage of molecular diagnostic methods to improve the accuracy of drug-resistant molecular diagnosis, thereby blocking the transmission of drug-resistant tuberculosis.

The application value of the QuantiFERON-TB Gold Plus for active pulmonary tuberculosis diagnosis and treatment response monitoring

Yuan Shaoying, Cui Zhongfeng, Du Jiang, Cao Xuefang, Feng Boxuan, He Yijun, Li Zihan, Zhao Yaqi, Yu Yilin, Gao Lei, Xin He’nan, Li Hongzhi

Chinese Journal of Antituberculosis. 2026, 48(6):  865-873.  doi:10.19982/j.issn.1000-6621.20250456

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Objective: To evaluate the application value of QuantiFERON-TB Gold Plus (QFT-Plus) as a diagnostic adjunct for active pulmonary tuberculosis (PTB) and for monitoring anti-tuberculosis treatment response. Methods: A prospective study was conducted, patients with suspected PTB visiting the Outpatient Department of Integrated Traditional Chinese and Western Medicine Tuberculosis Division at Sixth People’s Hospital of Zhengzhou in Henan Province from June 2023 to April 2025 were screened based on the recruitment criteria. Recruited patients underwent basic demographic characteristic surveys, medical history assessments, and questionnaires on PTB-related suspected symptoms. Sputum and blood samples were collected for pathogen detection and QFT-Plus testing, respectively. According to the inclusion criteria, pathogen-positive drug sensitive PTB patients with excluded drug-resistant and non-tuberculous mycobacterial infections were classified as the “PTB group”, while pathogen-negative patients with excluded clinical diagnosis of PTB were categorized as the “other pulmonary diseases group”. The diagnostic performance of QFT-Plus for PTB was determined using the final clinical diagnosis as the reference standard. The QFT-Plus test results were monitored at baseline (T0), 4 weeks (T1), 8 weeks (T2), and 6 months (T3) of treatment, along with sputum culture outcomes. The correlation between the changes in the antigen tube of TB1, TB2 response and TB2-TB1, and the culture outcome were analyzed. Results: A total of 355 patients were recruited, of whom 134 patients were ultimately included in accordance with the inclusion criteria. Among them, 109 patients with PTB group, and 25 patients with other pulmonary diseases group. Referring to the final clinical diagnosis,the sensitivity, specificity, agreement rate, and Kappa value of QFT-Plus in detecting PTB were 88.07% (96/109), 76.00% (19/25), 85.82% (115/134), and 0.578, respectively. Among 35 PTB patients who completed monitoring at T1, T2, and T3, the QFT-Plus positive rates at the four time points were 97.14% (34/35), 88.57% (31/35), 82.86% (29/35), 77.14% (27/35), respectively, with no significant difference (Q_trend=7.415, P=0.060). The TB1 values at the four time points were 1.62 (0.96, 4.78), 1.48 (0.41, 3.57), 1.01 (0.31, 3.38), and 1.50 (0.45, 2.22) IU/ml, respectively. The corresponding values for TB2 were 2.97 (1.03, 5.79), 2.01 (0.65, 7.50), 1.27 (0.42, 4.02), and 1.92 (0.54, 2.96) IU/ml. Both indicators demonstrated a decreasing trend (Q_trend=9.221, P=0.027; Q_trend=10.730, P=0.013). However, the TB2-TB1 levels (0.12 (-0.03, 0.61), 0.05 (-0.07, 0.74), 0.01 (-0.08, 0.50), 0.07 (-0.02, 0.68) IU/ml) showed no significant differance (Q_trend=3.757, P=0.289). Conclusion: QFT-Plus testing can be used as an adjunctive tool for the diagnosis of PTB, but it is not yet supported as a reliable tool for monitoring treatment response.

Study on the diagnostic value of GeneXpert MTB/RIF and BACTEC MGIT 960 in bronchoalveolar lavage fluid combined with peripheral blood IGRA testing for etiologically negative pulmonary tuberculosis diagnosis

Qiao Xiaobo, Li Jing, Wang Baoqian, Zhou Weidong, Wang Fei, Zhang Qibo, Li Tongxia

Chinese Journal of Antituberculosis. 2026, 48(6):  874-881.  doi:10.19982/j.issn.1000-6621.20260095

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Objective: To evaluate the individual and combined diagnostic/application value of Mycobacterium tuberculosis/rifampicin resistance real-time fluorescent quantitative nucleic acid amplification detection technology (GeneXpert MTB/RIF, referred to as “Xpert”) and BACTEC MGIT 960 liquid culture method(referred to as “culture”)in bronchoalveolar lavage fluid (BALF), as well as tuberculosis-specific interferon-gamma release assay (referred to as “TB-IGRA”) in peripheral blood, for the etiologically negative pulmonary tuberculosis (PTB). Methods: A retrospective analysis was conducted. According to the setting inclusion criteria, we enrolled outpatients and inpatients with suspected PTB and negative sputum-smear and sputum-Xpert results who admitted to Qingdao Chest Hospital between October 2021 and November 2023. All included patients simultaneously received BALF Xpert and culture, and peripheral blood TB-IGRA tests. The examination results were recorded and analyzed. A clinically confirmed diagnosis was as the benchmark standard, 134 clinically confirmed etiologically negative PTB patients were enrolled in the tuberculosis group (TB group) and 92 non-PTB patients were included in the no-TB group. Multivariate logistic regression analysis and the receiver operating characteristic (ROC) curve were used to compare the positive detection rates of the above-mentioned three testing methods, and to evaluate their diagnostic/application efficacy for etiologically negative PTB, by using them individually and in combination. Results: Among 226 patients with suspected PTB, the positive detection rates of Xpert, mycobacterial culture and IGRA were 41.15% (93/226), 34.07% (77/226) and 57.96% (131/226), respectively. The positive detection rate of IGRA was significantly higher than that of Xpert (χ²=24.446, P<0.001) and mycobacterial culture (χ²=45.306, P<0.001). The positive detection rates of combined tests of Xpert+culture, Xpert+IGRA, culture+IGRA, and the three methods were 42.48% (96/226), 61.95% (140/226), 59.73% (135/226) and 61.95% (140/226) respectively. The positive detection rates of the three methods combined and Xpert+IGRA combined were markedly higher than those of single Xpert (χ²=45.021, P<0.001) and single mycobacterial culture (χ²=61.016, P<0.001). Xpert showed superior specificity (100.00% (92/92)) versus IGRA (78.26% (72/92)) and higher accuracy (81.86% (185/226)) versus culture (72.12% (163/226)). IGRA had higher sensitivity (82.84% (111/134)) than both Xpert (69.40% (93/134)) and culture (55.22% (74/134)). The combination of culture+IGRA had the highest sensitivity (84.33% (113/134)). The combined detection of Xpert+IGRA and the triple combination achieved the highest specificity (100.00% (92/92)), accuracy (89.82% (203/226)) and positive detection rate (61.95% (140/226)). The areas under the ROC curves (AUC) were as follows: the triple combination (0.933), Xpert+IGRA (0.928), culture+IGRA (0.890), Xpert+culture (0.867), IGRA (0.866), Xpert (0.863) and culture (0.769). Conclusion: This study validated the applicable scenarios of different diagnostic methods. For instance, IGRA can be used for screening and auxiliary diagnosis of etiologically negative PTB due to its high sensitivity. Xpert can be used for early and rapid diagnosis of etiologically negative PTB due to its high specificity and accuracy. The combination of culture and IGRA yielded the highest sensitivity, thereby can effectively reduce the risk of missed diagnosis in etiologically negative PTB. The combination of Xpert and IGRA achieved higher sensitivity, specificity, accuracy, positive detection rate and AUC values, demonstrating optimal diagnostic efficacy, which contributes to improving clinical diagnostic consistency and is clinically feasible.

Review Articles

Application, methods, and practice of therapeutic drug monitoring in individualized anti-tuberculosis therapy

Cheng Wen, Guo Lifang, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(6):  882-891.  doi:10.19982/j.issn.1000-6621.20260144

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Tuberculosis remains one of the leading causes of death from infectious diseases globally. In anti-tuberculosis treatment, the pharmacokinetic and pharmacodynamic properties of drugs are crucial for optimizing therapeutic efficacy, avoiding treatment delays, acquired drug resistance, and adverse drug reactions. Therapeutic drug monitoring (TDM) provides a basis for formulating precise dosing regimens by measuring drug concentrations in patients, combining quantitative pharmacokinetic models with therapeutic windows, thereby enhancing treatment success rates and controlling toxicity risks. In recent years, with the deepening of population pharmacokinetic and pharmacodynamic research, therapeutic monitoring strategies for first-line and second-line anti-tuberculosis drugs have been increasingly refined. This article systematically reviews the detection methods, main clinical application scenarios, and monitoring schemes and target concentrations of anti-tuberculosis drugs in TDM. On this basis, it focuses on updating the latest research progress and monitoring recommendations for pregnant women and children. Combining clinical practice and research progress in China, it discusses their role and value in optimizing tuberculosis treatment, especially in individualized dosing.

Research progress of serological markers for the prognostic evaluation of pulmonary tuberculosis

Zhang Wenya, Zhang Yanqiu, Wang Weidong, Xu Xiaowan, He Mengya, Sun Dingyong

Chinese Journal of Antituberculosis. 2026, 48(6):  892-902.  doi:10.19982/j.issn.1000-6621.20250513

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Accurate prognostic evaluation is crucial for improving clinical outcomes in pulmonary tuberculosis (TB). Serological markers can dynamically and quantitatively reflect the host’s inflammatory, metabolic, and immune status, complementing the limitations of traditional methods. This article systematically reviews the research progress on five categories of serological markers related to prognosis: (1) Non-specific inflammatory and acute-phase response indicators (e.g., CRP, PCT), whose dynamic changes correlate with disease activity and treatment response; (2) Nutritional and metabolic status indicators (e.g., Alb, AG), which assess systemic condition and mortality risk; (3) Innate immune and microenvironment regulatory markers (e.g., sTREM-1, IP-10), revealing immunopathological status; (4) Immune effector cytokines (e.g., IFN-γ, IL-6, IL-10), whose balance influences disease progression; (5) Novel markers related to programmed cell death and metabolic reprogramming (e.g., GSDMD, GPX4), providing new insights from the perspective of cell fate. Multi-marker combinations and predictive models are key directions for enhancing prognostic efficacy. Although some markers show good predictive value, challenges remain, such as lack of specificity and standardization. Future efforts should focus on multi-dimensional integration, model construction, and prospective validation to advance their translation into precise clinical management.

Research progress on financial toxicity and its influencing factors in elderly patients with pulmonary tuberculosis

Yuan Nan, Liu Yu, Du Guichun

Chinese Journal of Antituberculosis. 2026, 48(6):  903-908.  doi:10.19982/j.issn.1000-6621.20250512

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Pulmonary tuberculosis (PTB) remains one of the major global public health challenges. Elderly patients with PTB often become a high-risk population for financial toxicity due to prolonged treatment duration, multiple comorbidities, and a single source of income. Financial toxicity not only severely impairs the quality of life of patients and their families but also frequently leads to treatment interruption or even abandonment, thereby exacerbating the widespread transmission of PTB. Therefore, reducing financial toxicity among elderly PTB patients is an essential prerequisite for achieving the World Health Organization’s End TB Strategy. This review aims to summarize the current status, influencing factors, and existing interventions regarding financial toxicity in this population. It provides a reference for standardized clinical assessment and offers a theoretical basis for optimizing medical insurance policies targeting the elderly population, helping to narrow the gap between this group and the WHO End TB Strategy targets.