Table of Content

01 August 2026, Volume 48 Issue 8

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Guideline·Standard·Consensus

Guidelines for the application of tuberculin skin test

Standardization Professional Branch of Chinese Antituberculosis Association, Tuberculosis Infect Control Branch of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis

Chinese Journal of Antituberculosis. 2026, 48(8):  1083-1095.  doi:10.19982/j.issn.1000-6621.20260202

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Diagnosis of tuberculosis infection is a critical method for defining latent tuberculosis infection and assisting in the diagnosis of active tuberculosis. With the promotion and application of new technologies such as interferon-gamma release assays and tuberculosis antigen-based skin tests, how to further standardize and efficiently apply the tuberculin skin test (TST) to serve China’s tuberculosis prevention and control efforts is an issue worthy of exploration. This guideline was initiated by the Center for Tuberculosis Research, Chinese Academy of Medical Sciences, and developed by experts organized jointly by the Standardization Professional Branch of the Chinese Antituberculosis Association, the Infection Control Professional Branch of the Chinese Antituberculosis Association, and the Editorial Board of Chinese Journal of Antituberculosis. Based on domestic and international research progress and clinical practice experience, the expert panel thoroughly discussed the application value of TST in the auxiliary diagnosis of tuberculosis, identification of recent infection, and guidance for preventive treatment, and proposed corresponding recommendations, which aims to provide scientific and standardized practical guidance for tuberculosis prevention and control workers.

Interpretation of Standards

Interpretation of the Guidelines for the prevention and management of mother-to-child transmission of tuberculosis

Wang Xiaomin, Xu Peng, Chen Zhenyan, Long Yujiao, Wang Jin, Liu Han, Gao Wenying, Fang Mutong

Chinese Journal of Antituberculosis. 2026, 48(8):  1113-1119.  doi:10.19982/j.issn.1000-6621.20260197

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Prevention and control of tuberculosis (TB) during pregnancy and mother-to-child transmission (MTCT) are key and challenging issues in the global TB prevention and control system. Especially in TB high burden areas, with the rapid development of assisted reproductive technology, its clinical diagnosis, treatment and public health management face greater challenges. Focusing on the newly released Guidelines for the prevention and management of mother-to-child transmission of tuberculosis (hereinafter referred to as “the Guidelines”), this paper systematically elaborates on key contents including pre-pregnancy TB screening, diagnosis and standardized treatment of active TB during pregnancy, management of latent tuberculosis infection, evaluation and management of neonatal TB, as well as prevention and control related to in vitro fertilization and embryo transfer (IVF-ET). The Guidelines recommend pre-pregnancy screening among high-risk populations. For suspected cases during pregnancy, sputum molecular biological testing is prioritized. Once TB is confirmed, anti-tuberculosis treatment balancing efficacy and fetal safety should be initiated immediately, with multidisciplinary management implemented. After delivery of pregnant women with gestational TB, neonates may receive preventive treatment and follow-up after excluding active TB. Individuals planning IVF-ET should complete TB assessment and prevention first. It is emphasized that early evaluation, molecular testing-assisted diagnosis, rational preventive treatment and appropriate timing of Bacillus Calmette-Guérin vaccination should be carried out for neonates after exposure, with postpartum isolation and breastfeeding management implemented. By promoting advanced diagnostic technologies, strengthening healthcare worker training, implementing multidisciplinary collaboration and patient education, early detection and intervention of gestational TB can be achieved, adverse maternal and neonatal outcomes can be reduced, and the effective implementation of TB MTCT prevention and control strategies at both clinical and public health levels can be promoted.

Expert Note

Rational return to non-sputum screening for tuberculosis: inherent limitations and reconsideration of the position of tongue swabs

Gao Qian

Chinese Journal of Antituberculosis. 2026, 48(8):  1120-1123.  doi:10.19982/j.issn.1000-6621.20260110

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As a non-sputum testing method, tongue swab detection is expected to break through bottlenecks in large-scale tuberculosis screening. Nevertheless, relevant current studies differ markedly in research scenarios: most focus on evaluating its auxiliary diagnostic performance among clinically suspected patients, while validation data for community population screening remain scarce, with findings from several existing studies failing to meet WHO-recommended screening benchmarks. Restricted by the biological properties of tongue swabs, this technique struggles to satisfy the high-sensitivity requirements for mass population screening. Accordingly, future research shall adjust developmental priorities and explore novel high-sensitivity screening assays based on host non-specific biomarkers alongside pathogen-specific biomarker detection.

Original Articles

Association between magnitude of tuberculin skin test reactions and risk of pulmonary tuberculosis among senior high school students

Liao Wenping, Zhang Liyi, Lyu Juan, Xin Yu, Su Qian, Zhang Wen

Chinese Journal of Antituberculosis. 2026, 48(8):  1124-1129.  doi:10.19982/j.issn.1000-6621.20260209

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Objective: To explore the association between the magnitude of tuberculin skin test (TST) reactions and the risk of active pulmonary tuberculosis (PTB) among senior high school students, so as to provide scientific evidence for optimizing school-based PTB screening strategies. Methods: A prospective cohort study was conducted. From September to December 2022, stratified random cluster sampling was adopted to recruit 27339 Grade 1 and Grade 2 senior high school students from 15 administrative districts of Chongqing to establish the study cohort. All participants were followed up for 2 years to monitor incident active PTB. Cox proportional hazards regression models were used to analyze the association and dose-response relationship between TST reaction intensity and PTB risk. Results: Among the 27339 participants, 15641 (57.21%) had negative TST results, 3352 (12.26%) mild positive reactions, 4455 (16.30%) moderate positive reactions, and 3891 (14.23%) strong positive reactions. The total person-years of observation were 54663. A total of 35 new active PTB cases were identified, with an overall incidence density of 64.03/100000 person-years and a 2-year cumulative incidence of 128.02/100000. Both incidence density and 2-year cumulative incidence rose markedly as TST reaction intensity increased. Significant differences were observed in the distribution of TST reaction grades across subgroups stratified by gender, school type and regional epidemic level (χ²=32.928, 146.846, 318.985, all P<0.001). Among the 3891 students with strong TST positivity, males accounted for 49.78% (1937 students) and females 50.22% (1954 students); 55.69% (2167 students) attended public schools and 44.31% (1724 students) private schools; 48.34% (1881 students) resided in high-burden areas and 51.66% (2010 students) in medium-burden areas. In terms of disease onset timing, the peak incidence in the strong-positive and moderate-positive groups occurred within the first year of follow-up (179.90/100000 (7/3891) and 112.23/100000 (5/4455), respectively), while the peak for the negative and mild-positive groups appeared in the second year (70.33/100000 (11/15641) and 149.16/100000 (5/3352), respectively). Multivariate Cox regression revealed that students with strong TST positivity had a 2.470 (95%CI: 1.065-5.736)-fold higher risk of developing PTB compared with TST-negative students. Each 1 mm increase in the mean induration diameter corresponded to a 5.1% elevation in disease risk (HR=1.051, 95%CI: 1.018-1.086). Stratified analysis demonstrated that the strongest association between strong TST positivity and PTB risk was found in the medium epidemic burden subgroup (HR=4.983, 95%CI: 1.115-22.266). Conclusion: Strong TST positivity is an independent risk factor for active PTB among senior high school students, with a clear dose-response relationship and distinct temporal distribution of disease onset. Tiered and categorized management strategies are recommended for students with varying TST reaction intensities.

Investigation results and analysis of associated factors of tuberculosis infection and disease among school students in Xichang City, Sichuan Province, 2023

Xia Hongli, Hua Jiao, Lu Jiankang

Chinese Journal of Antituberculosis. 2026, 48(8):  1130-1138.  doi:10.19982/j.issn.1000-6621.20260104

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Objective: The current study investigate the prevalence of Mycobacterium tuberculosis (MTB) infection and pulmonary tuberculosis (PTB), as well as their associated factors among school students in Xichang City, Sichuan Province in 2023, aiming to provide evidence for developing targeted prevention and control strategies for PTB. Methods: A total of 67922 school students in Xichang City in 2023 were enrolled as research subjects, with demographic data extracted from the student status management platform of Xichang Municipal Bureau of Education and Sports. Interferon-gamma release assay (IGRA) was performed to screen MTB infection, and chest imaging examinations were conducted for 35284 students. The chi-square test was adopted to compare intergroup differences across variables. Multivariate logistic regression was used to identify risk factors for MTB infection, while Firth logistic regression (penalized likelihood logistic regression) was applied to analyze factors associated with PTB disease. Results: The overall prevalence of MTB infection among 67922 students was 6.71% (4550/67856), and the detection rate of PTB cases was 114.84 per 100000 population (78/67922). Multivariate logistic regression analyses demonstrated that Yi ethnic students had significantly higher risks of tuberculosis infection and disease than Han students (infection: OR=2.564, 95%CI: 2.351-2.796; disease: OR=1.830, 95%CI: 1.768-1.890). Students originating from counties within the autonomous prefecture exhibited elevated risks of both infection and disease compared with local Xichang students (infection: OR=1.299, 95%CI: 1.208-1.396; disease: OR=1.318, 95%CI: 1.263-1.374). Students aged ≥15 years had higher risk of infection and disease than those younger than 15 years (infection: OR=1.384, 95%CI: 1.260-1.521; disease: OR=1.248, 95%CI: 1.163-1.332). Males showed 1.217-fold higher risk of tuberculosis infection (OR=1.217, 95%CI: 1.156-1.278) and 1.220-risk higher odds of developing PTB (OR=1.220, 95%CI: 1.148-1.298) relative to females. The risk of PTB increased progressively with grade elevation (OR=1.097, 95%CI: 1.071-1.124), and third-grade secondary vocational students bore the highest risk of MTB infection (OR=2.219, 95%CI: 1.512-3.257). Conclusion: The prevalence of MTB infection and detection rate of PTB remain relatively high among school students in Xichang City. Key populations prioritized for tuberculosis prevention and control include Yi ethnic students, students from other counties of the autonomous prefecture, students aged ≥15 years, male students, and students in higher grades. We recommend stratified active screening differentiated by high-risk subgroups to facilitate early detection and timely treatment and effectively interrupt tuberculosis transmission in campus settings.

Analysis of re-screening for latent tuberculosis infection in 2025 and related factors affecting infection status among rural doctors in Zhongmu County, Henan Province, based on 2017 screening

Liu Zisen, Zhao Yaqi, Zhang Bin, Xin Henan, Du Jiang, Feng Boxuan, He Yijun, Li Zihan, Yu Yilin, Wang Dakuan, Yan Jiaoxia, Gao Lei, Jin Qi, Duan Weitao, Cao Xuefang

Chinese Journal of Antituberculosis. 2026, 48(8):  1139-1147.  doi:10.19982/j.issn.1000-6621.20260062

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Objective: To systematically reassess the latent tuberculosis infection (LTBI) status among rural doctors in Zhongmu County, Henan Province via re-screening conducted in 2025 based on the baseline LTBI screening implemented in 2017, and to explore influencing factors associated with changes in infection status. Methods: Using an open-cohort study design, from September 12 to 21, 2025, 599 village doctors registered in Zhongmu County, Henan Province, who had participated in the 2017 baseline screening for Mycobacterium tuberculosis (MTB), were re-screened for LTBI (using the QuantiFERON-TB Gold (abbreviated as “QFT”) test) in accordance with the inclusion criteria, to assess the LTBI screening status of this population across different years. Univariate and multivariate logistic regression models were applied to identify factors correlated with QFT test results. Results: In 2025, a total of 516 participants were included in the study, of whom 20.74% (107/516) tested for LTBI, markedly lower than the LTBI prevalence of 27.71% (166/599) recorded in 2017. After age and gender standardization, the standardized LTBI prevalence declined from 23.14% in 2017 to 15.47% in 2025, with a statistically significant difference (χ²=9.163, P=0.002). Among the 333 participants who completed both rounds of MTB infection screening, the QFT reversion rate in 2025 was 21.84% (19/87) for those who were LTBI in 2017, while the QFT conversion rate in 2025 was 4.88% (12/246) for those who were not infected with MTB in 2017. Multivariate regression analysis indicated that participants who had never smoked were more likely to achieve QFT reversion compared with current smokers (adjusted OR(95%CI)=3.464 (0.803-24.101)), with a marginally significant trend (P=0.068). Participants with a practice duration of ≥26 years exhibited a greater risk of QFT conversion relative to those with a practice duration of <26 years (adjusted OR (95%CI)=7.520 (0.978-27.820)), with a marginally significant trend (P=0.052). Participants with a monthly income of <2500 RMB had significantly higher risks of QFT conversion than those with a monthly income of ≥2500 RMB (adjusted OR (95%CI)=3.706 (1.058-12.987), P=0.042). Conclusion: Consistent with the overall declining tuberculosis epidemic in Henan Province, the LTBI prevalence among rural doctors in Zhongmu County decreased significantly in 2025 relative to 2017, yet remained higher than that of the general population. While sustaining population-wide tuberculosis prevention and control strategies, targeted infection control measures should be further guaranteed and implemented for frontline medical staff such as rural doctors. Special attention should be paid to MTB infection surveillance for rural doctors who smoke, earn less than 2500 RMB monthly, or have worked in the profession for an extended period.

Latent profile analysis of self-management and nursing strategies for newly treated pulmonary tuberculosis patients during continuous treatment stage

Liu Tiantian, Qiang Dujiayi, Yang Afang, Shen Qiongyang, Zhu Xinghua, Yao Xiuyu, Li Hongzhi

Chinese Journal of Antituberculosis. 2026, 48(8):  1148-1157.  doi:10.19982/j.issn.1000-6621.20260080

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Objective: To explore the latent class characteristics of self-management behaviors in pulmonary tuberculosis patients during their continuous treatment stage, analyze the influencing factors of different latent classes, and provide a reference for formulating individualized out-of-hospital intervention strategies. Methods: Using convenient sampling method, 403 pulmonary tuberculosis patients who completed initial treatment at Zhengzhou Sixth People’s Hospital from June to December 2025, were selected as research subjects. These patients were then transferred to home for continuous treatment and received follow-up visits. A general information questionnaire, the Self-management Scale for Tuberculosis Patients, and the Nursing Needs Questionnaire for Pulmonary Tuberculosis Patients Receiving Home Treatment were used to conduct a questionnaire survey, and Mplus 8.3 software was adopted for latent profile analysis. Results: The self-management behaviors of newly treated pulmonary tuberculosis patients during the continuous treatment stage could be divided into three latent classes: the low cognition-low willingness-moderately strong behavior group (24 cases, 6.0%), the low cognition-moderate willingness-weak behavior group (85 cases, 21.0%), and the high self-management group (294 cases, 73.0%). Multivariate logistic regression analysis revealed that, with the high self-management group as the reference group, the independent and relevant factors for the low cognition-low willingness-moderate behavior group were: no stable occupation (OR=14.737, 95%CI:2.995-72.501), treatment duration <3 months (OR=8.914, 95%CI:2.081-38.179), 3-6 months (OR=7.352, 95%CI:1.948-27.748), and no tuberculosis family contact history (OR=5.232, 95%CI:1.405-19.476); the risk factors for the low cognition-moderate willingness-weak behavior group were: no stable occupation (OR=8.089, 95%CI:3.033-21.574), treatment duration <3 months (OR=7.251, 95%CI:3.023-17.391), no family contact history (OR=5.738, 95%CI:2.565-12.835), treatment duration 3-6 months (OR=3.465, 95%CI:1.557-7.713), and no chronic diseases (OR=2.867, 95%CI:1.293-6.361). Conclusion: Self-management behaviors exhibit prominent heterogeneity among pulmonary tuberculosis patients receiving continuous treatment. Occupational stability, treatment duration, chronic disease history, family tuberculosis contact history, and age serve as key determinants of self-management subgroups.

Evaluation of safety and efficacy of anti-tuberculosis fixed-dose combination in patients with drug-susceptible pulmonary tuberculosis

Li Xinda, Hou Zhili, Ouyang Bing, Du Yadong, Guan Liying, Yu Hongmei, Zhang Haiqin, Xie Yongjie, Tang Peijun, Xiao Yu, Zhang Ying, Lu Yu

Chinese Journal of Antituberculosis. 2026, 48(8):  1158-1162.  doi:10.19982/j.issn.1000-6621.20260253

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Objective: To evaluate the safety and efficacy of anti-tuberculosis fixed-dose combination (FDC) in the treatment of drug-susceptible pulmonary tuberculosis via a real-world study. Methods: A single-arm prospective cohort design was adopted. A total of 305 patients with drug-susceptible pulmonary tuberculosis were enrolled from September 2024 to September 2025 at 10 provincial and municipal designated tuberculosis hospitals nationwide including Beijing Chest Hospital, Capital Medical University. All patients received anti-tuberculosis FDC therapy: ethambutol hydrochloride, pyrazinamide, rifampicin and isoniazid tablets for a 2-month intensive phase, followed by rifampinand isoniazid tablets/capsules for a 4-month continuation phase. A 6-month follow-up was conducted to assess efficacy and safety. Efficacy indicators included sputum culture conversion rate, drug susceptibility, lung lesion absorption and cavity changes. Safety indicators covered liver and renal function, blood routine, urine routine and the incidence of adverse events. Results: The sputum conversion rate reached 98.7% (150/152) after 6 months of FDC treatment. Pulmonary imaging results revealed marked lesion absorption in 180 patients (59.0%) and partial lesion absorption in 79 patients (25.9%); cavities were closed in 156 patients (51.1%) and shrunk in 88 patients (28.9%). The overall treatment success rate was 91.1% (278/305). A total of 219 adverse events were recorded, among which 203 were Grade Ⅰ, 10 Grade Ⅱ and 5 Grade Ⅲ. One death occurred due to brain tumor, which was unrelated to anti-tuberculosis drugs. The predominant adverse events included 27 (8.9%, 27/305) gastrointestinal adverse reactions, 33 (10.8%, 33/305) cases of elevated transaminases and total bilirubin, and 111 (36.4%, 111/305) cases of hyperuricemia. Conclusion: Anti-tuberculosis FDC demonstrates favorable efficacy, safety and treatment completion rate for drug-susceptible pulmonary tuberculosis.

The application value of tongue swab nucleic acid testing in the diagnosis of suspected tuberculosis

Qi Yunfeng, Wang Xueyu, Kang Wanli, Nie Wenjuan, Wang Yiwen

Chinese Journal of Antituberculosis. 2026, 48(8):  1163-1169.  doi:10.19982/j.issn.1000-6621.20260109

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Objective: To evaluate the diagnostic value of tongue swab nucleic acid detection (tongue swab) in suspected pulmonary tuberculosis patients. Methods: A prospective study was conducted from October to December 2025. A total of 176 patients with suspected pulmonary tuberculosis who were admitted to Zhoukou Infectious Disease Hospital, Henan Province, were consecutively enrolled. According to the exclusion criteria, 106 suspected cases were included and subjected to tongue swab, MGIT 960 liquid culture (MGIT 960), GeneXpert MTB/RIF (Xpert), and sputum smear acid-fast staining (sputum smear) to evaluate the diagnostic efficacy of these four methods. Results: Among the 106 suspected cases, 85 (80.19%) were confirmed as pulmonary tuberculosis, and 21 (19.81%) were non pulmonary tuberculosis. The positive detection rates for tongue swab, MGIT 960, Xpert, and sputum smear among these 106 suspected cases were 50.00% (53/106), 50.00% (53/106), 59.43% (63/106), and 40.57% (43/106), respectively. Using confirmed pulmonary tuberculosis as reference standard, the sensitivity of tongue swab (61.18% (52/85)) was comparable to that of MGIT 960 (62.35% (53/85)), higher than that of sputum smear (50.59% (43/85)), but lower than that of Xpert (74.12% (63/85)). The specificity (95.24% (20/21)) and accuracy (67.92% (72/106)) of tongue swab were comparable to those of MGIT 960 (100.00% (21/21) and 69.81% (74/106), respectively), Xpert (100.00% (21/21) and 79.25% (84/106), respectively), and sputum smear (100.00% (21/21) and 60.38% (64/106), respectively). The area under the receiver operating characteristic curve (AUC) of tongue swab was 0.782, which was lower than that of Xpert (0.871; Z=-2.686, P=0.007), but comparable to those of MGIT 960 (0.812; Z=-0.870, P=0.384) and sputum smear (0.753; Z=0.853, P=0.394). Tongue swab showed excellent agreement with sputum smear (Kappa=0.774, 95%CI: 0.655-0.892), and good agreement with both MGIT 960 (Kappa=0.736, 95%CI: 0.607-0.865) and Xpert (Kappa=0.736, 95%CI: 0.609-0.862). Conclusion: Tongue swab demonstrates favorable clinical application value in the diagnosis of pulmonary tuberculosis. It can serve as an effective tool for tuberculosis screening and auxiliary diagnosis, particularly for patients with difficulty in sputum expectoration or inability to provide sputum specimens.

Serum expression levels and clinical value of IFN-γ, IL-2 and IL-6 in elderly pulmonary tuberculosis patients aged 60 years and older

Wei Daijue, Deng Mingkun, Chen Yan, Yang Zengwei, Tong Chongxiang

Chinese Journal of Antituberculosis. 2026, 48(8):  1170-1175.  doi:10.19982/j.issn.1000-6621.20260038

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Objective: To evaluate the expression levels of interferon-γ (IFN-γ), interleukin-2 (IL-2) and interleukin-6 (IL-6) in elderly patients with pulmonary tuberculosis, and analyze the diagnostic value of individual and combined detection of these three indicators. Methods: A retrospective study was conducted. Clinical data were collected from 475 suspected elderly pulmonary tuberculosis patients aged ≥60 years admitted to Lanzhou Pulmonary Hospital from 2023 to 2025. The data included baseline data, imaging findings, etiological results, biochemical tests as well as serum IFN-γ, IL-2 and IL-6 results. Subjects were divided into pulmonary tuberculosis group and non-tuberculosis group based on final clinical diagnosis. Difference in expression levels of the three cytokines between two groups were compared, and the clinical auxiliary value of detecting serum IFN-γ, IL-2, and IL-6 individually or in combination for diagnosing elderly pulmonary tuberculosis was evaluated. Results: Among 475 elderly subjects, 234 were clinically diagnosed with pulmonary tuberculosis and 241 were non-tuberculosis patients. Serum expression levels of IFN-γ (23.14 (2.73, 95.52) pg/ml), IL-2 (17.64 (1.57, 115.05) pg/ml) and IL-6 (19.14 (6.85, 60.86) pg/ml) in tuberculosis group were significantly higher than those in non-tuberculosis group (1.29 (0.00, 5.31), 1.97 (0.00, 7.46), 7.00 (2.18, 16.49) pg/ml), with statistically significant differences (Z=120.866, 80.050, 31.786, Ps<0.001). The sensitivities of single testing for IFN-γ, IL-2 and IL-6 were 59.83% (140/234), 55.56% (130/234) and 56.84% (133/234), specificities were 83.40% (201/241), 84.65% (204/241) and 74.69% (180/241), accuracies were 71.79% (341/475), 70.32% (334/475) and 65.89% (313/475), and corresponding AUC values were 0.74, 0.71 and 0.69 respectively. For combined testing, the sensitivities of IFN-γ+IL-2, IFN-γ+IL-6, IL-2+IL-6 and three-marker panel were 58.97% (138/234), 73.93% (173/234), 67.52% (158/234) and 77.78% (182/234). Their specificities were 90.87% (219/241), 73.86% (178/241), 80.91% (195/241) and 83.40% (201/241), and their accuracies were 75.16% (357/475), 73.89% (351/475), 74.32% (353/475) and 80.63% (383/475). AUC values were 0.76, 0.80, 0.81 and 0.83, respectively. Conclusion: The serum expression levels of IFN-γ, IL-2, and IL-6 in elderly patients with pulmonary tuberculosis were significantly higher than those in non-tuberculosis patients. The combined testing of three markers demonstrated markedly superior diagnostic performance compared to single testing, offering significant clinical value for the auxiliary diagnosis of elderly pulmonary tuberculosis cases.

Factors associated with treatment outcomes of Mycobacterium abscessus pulmonary disease: a retrospective case-control study

Cheng Wen, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(8):  1176-1183.  doi:10.19982/j.issn.1000-6621.20260091

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Objective: To investigate the independent risk factors associated with treatment outcomes in patients with Mycobacterium abscessus pulmonary disease (MAB-PD) and provide evidence for clinical prognostic assessment and individualized therapy. Methods: This retrospective study included 197 patients diagnosed with MAB-PD at Beijing Chest Hospital, Capital Medical University between January 2015 and January 2025. Data on demographic characteristics, underlying diseases, laboratory parameters, and treatment regimens were collected. Patients were divided into a favorable outcome group (cured/treatment completed) and an unfavorable outcome group (treatment failure/death). Univariate and multivariate logistic regression models were employed to identify independent risk factors associated with treatment outcomes. Results: Among the 197 patients, 86 (43.6%) achieved favorable outcomes, 62 (31.5%) experienced unfavorable outcomes, and 49 (24.9%) were lost to follow-up. In univariable analysis, age (OR=1.049, 95%CI: 1.022-1.077; P<0.001) and educational level (university degree or above vs. junior college or below, OR=0.307, 95%CI: 0.133-0.732; P=0.008) were associated with treatment outcome. Multivariate logistic regression analysis revealed that age was the only independent risk factor for unfavorable outcomes in MAB-PD patients (OR=1.040, 95%CI: 1.011-1.070, P=0.007), with each additional year increase in age was associated with a 4.0% higher risk of unfavorable outcomes. The incidence of adverse events was 10.2% (20/197). Conclusion: Increased age is an independent risk factor for unfavorable treatment outcomes in MAB-PD patients, suggesting that comprehensive treatment management and nutritional support for older patients should be strengthened in clinical practice to improve prognosis.

Multi-center study on CE-T₁WI radiomics-based machine learning model in differentiating tuberculous spondylitis from brucella spondylitis

Guo Xiaowen, Jiao Tianyu, Sun Li, Ni Conghui, Wang Zilin, Wang Hao

Chinese Journal of Antituberculosis. 2026, 48(8):  1184-1191.  doi:10.19982/j.issn.1000-6621.20250524

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Objective: To evaluate the value of a contrast-enhanced T₁-weighted imaging (CE-T₁WI) based radiomics model in differentiating tuberculous spondylitis (TS) from brucella spondylitis (BS). Methods: Clinical data and CE-T₁WI images from 274 confirmed patients (131 TS, 143 BS) in 4 medical centers were collected. Radiomics features were extracted from manually delineated regions of interest (ROIs) using 3D-Slicer. Feature selection was performed using the Mann-Whitney U test (P<0.05), Spearman correlation analysis (coefficient>0.9), and the LASSO algorithm. The dataset was randomly split into a training cohort (n=219) and a validation cohort (n=55) in an 8∶2 ratio. Four machine learning models (Random Forest, Extra Trees, XGBoost, LightGBM) were established, and their diagnostic performances were evaluated using ROC curves. Results: A total of 107 radiomics features were initially extracted from CE-T₁WI images. After feature selection, 11 optimal features were retained for model construction, including 7 texture features, 3 shape features, and 1 first-order feature. In the validation cohort, the AUC values of Random Forest, Extra Trees, XGBoost, and LightGBM models established based on these features were 0.773, 0.822, 0.838, and 0.702, respectively. Among them, the XGBoost model demonstrated the best overall diagnostic performance with relatively high accurate rate, sensitivity and specificity. Conclusion: The CE-T₁WI-based radiomics machine learning models are effective for differentiating TS from BS. The XGBoost model showed best diagnostic performance, making it a promising tool for clinical decision-making.

Imaging feature analysis of pseudo-pulmonary embolism on dual-phase computed tomography angiography in pulmonary tuberculosis patients with bronchial-pulmonary shunts

Guo Jinlong, Min Xuhong, Song Biao, Li Yuan, Wang Shanghu, Chen Wu

Chinese Journal of Antituberculosis. 2026, 48(8):  1192-1198.  doi:10.19982/j.issn.1000-6621.20260089

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Objective: To investigate the imaging characteristics of pulmonary artery-bronchial artery dual-phase computed tomography angiography (CTA) in patients with pulmonary tuberculosis pseudo pulmonary embolism (PE) under the influence of bronchial-pulmonary shunt (BPS), in order to improve the diagnosis of pseudo-PE. Methods: A retrospective study was conducted on clinical data of 51 patients with pulmonary tuberculosis and pseudo-PE diagnosed and treated at Anhui Chest Hospital from August 2017 to January 2025. Fifty-one patients with pulmonary tuberculosis and true PE during the same period were selected as controls. The imaging features of dual-phase CTA in these two groups were compared and analyzed. Post-processing techniques including volume rendering (VR) and maximum intensity projection (MIP) were used to evaluate the status, quantity, and distribution of abnormal pulmonary artery filling on dualphase CTA in pseudoPE patients, and to observe the associated dilation and twisting of bronchial arteries. Results: The detection rate of hemoptysis in the pseudo-PE group was 47.1% (24/51), significantly higher than that in the true PE group (15.7%, 8/51; χ²=11.657, P=0.001). In the pseudo-PE group, the detection rates of destroyed lung and lobar/segmental atrophy in intrapulmonary lesions on CT were 47.1% (24/51) and 33.3% (17/51), respectively, significantly higher than those in the true PE group (15.7% (8/51) and 11.8% (6/51), respectively; χ²=11.657, P=0.001; χ²=6.793, P=0.009). In the pseudo-PE group, 55 pulmonary arteries at the lobar/segmental level or above exhibited abnormal filling on pulmonary arterial-phase CTA, and all showed delayed contrast agent filling on bronchial arterial-phase CTA. In the true PE group, 95 pulmonary arteries at the lobar/segmental level or above showed filling defects on pulmonary arterial-phase CTA, with no contrast opacification observed on bronchial arterial-phase CTA. The median CT values of abnormal pulmonary arteries on dualphase CTA in the pseudo-PE group were 178.00 (94.00, 250.00) HU and 412.00 (337.00, 462.00) HU, respectively, which were significantly higher than those in the true PE group (57.00 (48.00, 69.00) HU and 59.00 (50.00, 70.00) HU, respectively; Z=―9.330, P<0.001; Z=―10.192, P<0.001). Among the 55 pseudo-PE pulmonary arteries on pulmonary arterial phase CTA, 46 (83.6%, 46/55) showed filling defects and 9 (16.4%, 9/55) showed poor filling. Meanwhile, 69 associated tortuous and dilated bronchial arteries were detected on bronchial arterial-phase CTA, indicating pseudo-PE secondary to bronchial-pulmonary shunts (BPS). The pseudo-PE lesions involved 42 (76.4%, 42/55) upper lobe pulmonary arteries, 4 (7.3%, 4/55) right pulmonary arteries, 6 (10.9%, 6/55) left pulmonary arteries, and 3 (5.4%, 3/55) left lower lobe pulmonary arteries. Conclusion: In patients with pulmonary tuberculosis and BPS, pseudo-PE exhibits certain characteristics on pulmonary artery-bronchial artery dual-phase CTA. Effectively identifying its imaging features can provide assistance for early clinical diagnosis and treatment.

Analysis of the therapeutic effect of 26 cases of thoracic tuberculosis and paravertebral abscess with tube drainage assistance

Fan Jun, Dong Weijie, Tang Kai, Li Yuan, Yan Guangxuan, Wang Heng, Zhu Qiankun, Li Yongchao, Lan Tinglong

Chinese Journal of Antituberculosis. 2026, 48(8):  1199-1204.  doi:10.19982/j.issn.1000-6621.20250529

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Objective: To evaluate the clinical efficacy and safety of CT-guided catheter drainage as an adjunctive treatment for thoracic spinal tuberculosis with paravertebral abscess. Methods: A retrospective analysis was conducted on 26 patients with thoracic spinal tuberculosis complicated by paravertebral abscess who were treated in the Department of Orthopedics, Beijing Chest Hospital, Capital Medical University, between January 2020 and July 2024. All patients underwent CT-guided catheter drainage under local anesthesia. Operative time, blood loss, drainage volume, and duration of drainage were recorded. Preoperative and postoperative body temperature, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were compared. All patients were followed up for 12-24 months. Results: All 26 patients successfully underwent catheter drainage. The mean drainage duration was (4.8±2.3) days, and the total drainage volume ranged from 50 to 200 ml. The ESR decreased from a preoperative level of (49.8±20.4) mm/1 h to a postoperative level of (19.4±10.2) mm/1 h; CRP levels decreased from (20.9±9.6) mg/L preoperatively to (8.6±3.6) mg/L postoperatively; and the VAS score decreased from (7.5±1.8) preoperatively to (2.4±1.6) postoperatively, with all differences being statistically significant (t=3.464, 3.492, and 3.650, respectively; all P<0.001). No serious complications, such as major vascular injury, nerve injury, or sinus tract formation, were observed. During follow-up, all abscesses resolved, the extent of vertebral inflammation decreased, and no recurrence was observed. Conclusion: CT-guided catheter drainage is a safe, minimally invasive, and effective treatment for thoracic spinal tuberculosis with paravertebral abscess. It can reduce abscess burden, improve inflammatory markers and clinical symptoms, and may help decrease the invasiveness of subsequent surgical procedures. This technique is particularly suitable for patients in poor general condition or those who cannot tolerate thoracotomy, and has promising clinical application value.

Study on hospitalization cost and its influencing factors of pulmonary tuberculosis under the diagnosis-related group payment model

Lyu Yongyun, Li Xiaoqin, Wu Mengtai, Zhou Min, Tian Nan, Shen Ling

Chinese Journal of Antituberculosis. 2026, 48(8):  1205-1213.  doi:10.19982/j.issn.1000-6621.20250528

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Objective: To explore the composition characteristics and key influencing factors of hospitalization cost for pulmonary tuberculosis patients in Kunming under the Diagnosis-Related Group (DRG) payment model, so as to provide empirical evidence for improving local health economic policies related to tuberculosis prevention and control and optimizing the allocation of health resources. Methods: Medical records and DRG settlement data of 6878 inpatient admissions (2019) and 6851 inpatient admissions (2023) with a primary diagnosis of pulmonary tuberculosis in a Grade A tertiary hospital in Kunming were collected. After natural logarithmic transformation of total hospitalization cost, t-test and analysis of variance (ANOVA) were used for univariable analysis, and a multiple linear regression model was applied to screen the key influencing factors of total cost. Results: A comparison between 2019 and 2023 showed that total hospitalization cost for patients decreased from 86699500 yuan to 82742000 yuan, and per-episode costs fell from 12599.67 yuan to 12077.36 yuan. The proportion of diagnostic, therapeutic, and consumable costs rose from 41.37% (3586.40/8669.95), 13.12% (1137.85/8669.95), and 1.29% (111.94/8669.95) to 46.93% (3883.01/8274.20), 18.35% (1518.36/8274.20), and 1.85% (153.33/8274.20), respectively. Conversely, the proportion of general service and pharmaceutical costs decreased from 12.34% (1070.10/8669.95) and 31.86% (2762.44/8669.95) to 10.93% (904.63/8274.20) and 21.93% (1814.86/8274.20), respectively. Statistical analysis showed that in 2019, age (F=46.887, P<0.001), medical payment method (F=10.277, P<0.001), admission severity (F=113.119, P<0.001), and number of comorbidities (F=422.203, P<0.001) were all significant influencing factors of total hospitalization cost. In 2023, these factors remained significant, with the following values: age (F=38.116, P<0.001), medical payment method (F=2.637, P<0.05), admission severity (F=284.103, P<0.001), and number of comorbidities (F=114.027, P<0.001). Multiple linear regression revealed that length of hospital stay was the primary factor affecting total hospitalization cost (2019: β'=0.688, t=85.160, P<0.001; 2023: β'=0.592, t=61.760, P<0.001). Conclusion: The DRG payment model can effectively control hospitalization cost and optimize the cost structure for pulmonary tuberculosis patients in Kunming. Length of hospital stay is the primary factor influencing total hospitalization cost, while patient age, payment method, admission condition, and comorbidities also exert significant effects. In the future, DRG payment policies should be optimized in combination with these relevant influencing factors to improve the efficiency of health resource utilization.

Review Articles

Advances in Mycobacterium tuberculosis regulation of host lipid metabolism reprogramming

Zeng Lina, Li Wensi, Lu Hailin, Wang Wenfei, Chen Xinchun, Deng Guofang, Xie Shuixiang

Chinese Journal of Antituberculosis. 2026, 48(8):  1214-1219.  doi:10.19982/j.issn.1000-6621.20260098

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Tuberculosis is a major global infectious disease caused by Mycobacterium tuberculosis (MTB). The pathogen’s ability to establish long-term persistence and evade host immunity is central to the development of chronic infection. Lipid metabolism plays a pivotal role in host-pathogen interactions: MTB not only actively hijacks host lipids as a nutrient source but also systematically reprograms the host lipid metabolic network to evade immune clearance and establish persistent infection. A deeper understanding of the molecular mechanisms by which MTB hijacks and reprograms host lipid metabolism provides important theoretical foundations and potential targets for the development of host-directed therapies focusing on host lipid metabolism. This review systematically summarizes the molecular mechanisms by which MTB hijacks host lipids as a nutrient source and reprograms host lipid metabolism to achieve immune evasion, and discusses future research directions and clinical translation prospects in this field.

Cell-free RNA liquid biopsy for stratified diagnosis and dynamic monitoring of tuberculosis: research progress and translational challenges

Ding Guangzhao, Liu Rongmei

Chinese Journal of Antituberculosis. 2026, 48(8):  1220-1225.  doi:10.19982/j.issn.1000-6621.20260161

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The diagnosis and therapeutic monitoring of tuberculosis still face several critical challenges, including difficulties in etiological sampling for paucibacillary and pediatric cases, inadequate differentiation between active tuberculosis and latent tuberculosis infection, and the absence of reproducible molecular biomarkers for dynamic therapeutic response assessment. In recent years, cell-free RNA (cfRNA), a liquid biopsy signature reflecting host immune responses and transcriptional regulatory profiles, has demonstrated promising application potential in stratified diagnosis and longitudinal monitoring of tuberculosis. Nevertheless, direct clinical evidence supporting cfRNA for tuberculosis infection remains limited, mainly manifested as insufficient sample sizes, overestimated diagnostic performance arising from case-control study designs, lack of independent external validation, and the absence of evaluations on real-world clinical benefits. Centered on core clinical tasks in tuberculosis management, this review summarizes research advances of cfRNA in the identification of active tuberculosis, risk stratification of latent tuberculosis infection, therapeutic response evaluation, and auxiliary diagnosis among special populations. It also generalizes the impacts of key technical procedures—including pre-analytical processing, depletion of highly abundant RNA, library construction and sequencing, targeted quantification, as well as model development and validation—on result stability and clinical translatability. Furthermore, this paper discusses its complementary role alongside existing etiological tests, immunological assays and radiological assessments.

Research progress on influencing factors and management strategies of medical delay in patients with spinal tuberculosis

Yang Yueqi, Fu Linlin, He Lanfang, Cao Yuanlin, Yu Sihan, Zhang Yingfang, Xia Tongxia

Chinese Journal of Antituberculosis. 2026, 48(8):  1226-1230.  doi:10.19982/j.issn.1000-6621.20260124

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Spinal tuberculosis (STB), a major form of osteoarticular tuberculosis, has become a significant concern in both clinical and public health domains due to its insidious onset, diagnostic challenges, and high risk of disability. In recent years, delayed medical consultation among STB patients has become increasingly prominent, with an average total delay of 4 to 11 months. This paper summarizes and analyzes the current status, influencing factors, and management strategies related to consultation delay in STB, aiming to inform evidence-based interventions for reducing disability, improving patient outcomes, and formulating scientific countermeasures. Future efforts should focus on strengthening public health education, improving the health insurance system, raising diagnostic alertness among primary care physicians, optimizing diagnostic technologies, and establishing comprehensive, individualized treatment plans.

Pharmacotherapy of rifampicin-resistant/multidrug-resistant tuberculosis: advances and prospects in health economic research

Sun Danyuchen, Liu Yuhong

Chinese Journal of Antituberculosis. 2026, 48(8):  1231-1230.  doi:10.19982/j.issn.1000-6621.20260191

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This paper systematically reviews advances in health economic research on pharmacotherapy for rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB). By sorting out economic evaluation evidence concerning conventional second-line anti-TB regimens, short-course all-oral regimens containing new anti-TB drugs (including bedaquiline-containing regimens, delamanid-containing regimens, BPaL regimen (B: bedaquiline; Pa: pretomanid; L: linezolid) and BPaLM regimen (M: moxifloxacin)), as well as patient management models (such as digital directly observed treatment and community-based management), this article summarizes the costs, effectiveness and cost-effectiveness of different interventions. Overall, short-course regimens incorporating new drugs can improve treatment success rates and deliver favorable cost-effectiveness or direct cost savings in multiple national settings. Patient-centered innovative management models can also substantially reduce disease burden. Nevertheless, existing studies have limitations in coverage of special populations, comprehensiveness of cost perspectives, and integration of real-world data. Future research should strive to establish a more comprehensive, precise and translatable economic evaluation system, so as to facilitate the optimization of RR/MDR-TB prevention and treatment strategies and rational allocation of public health resources.