Table of Content

10 October 2026, Volume 48 Issue 10

Previous Issue   

Guideline. Standard. Consensus

Guidelines for the diagnosis and treatment of adult tuberculous meningitis (2026 edition)

Clinical Tuberculosis Branch of the Chinese Antituberculosis Association, Beijing Chest Hospital, Capital Medical University, Jiangxi Chest Hospital, Changchun Infectious Disease Hospital

Chinese Journal of Antituberculosis. 2026, 48(10):  1457-1470.  doi:10.19982/j.issn.1000-6621.20260279

Abstract ( 82 )   HTML ( 7 )   PDF (3188KB) ( 58 )   Save

Figures and Tables | References | Related Articles | Metrics

Tuberculous meningitis is the most severe form of tuberculosis, in addition to being the most difficult to diagnose. It is prone to delayed diagnosis and treatment, which negatively influence the prognosis of patients. The Clinical Tuberculosis Branch of the Chinese Antituberculosis Association, Beijing Chest Hospital, Capital Medical University, Jiangxi Chest Hospital and Changchun Infectious Disease Hospital, drawing on relevant domestic and international guidelines and supplementing them with new research evidence, combined with the clinical practice of tuberculous meningitis diagnosis and treatment in China, have developed the guidelines for the diagnosis and treatment of adult tuberculous meningitis (2026 edition). The guideline systematically summarizes the recommendations for diagnostic methods for tuberculous meningitis, updates the recommendations for treatment regimens, and provides recommendations for the management of tuberculous meningitis under special circumstances, offering evidence-based clinical practice guidance for further improving and optimizing the management of tuberculous meningitis in national and regional medical institutions.

Special Topic

Chest imaging combined with artificial intelligence for standardized tuberculosis screening: implementation bottlenecks and optimization strategies

Liu Zhenguo, Xing Wu, Ling Jie, Yao Shanhu, Bai Liqiong, Rong Pengfei

Chinese Journal of Antituberculosis. 2026, 48(10):  1471-1479.  doi:10.19982/j.issn.1000-6621.20260421

Abstract ( 37 )   HTML ( 3 )   PDF (1857KB) ( 24 )   Save

Figures and Tables | References | Related Articles | Metrics

Active case finding remains a cornerstone of global tuberculosis (TB) control, and chest radiography (CXR) is the primary imaging tool recommended for screening asymptomatic populations. In China, a dual-track case-finding system combining passive case finding among symptomatic individuals and communitybased active screening has been established. Building on this framework, expert consensus recommends the deployment of chest imaging combined with artificial intelligence-based computer-aided detection (AI-CAD) at primary care facilities, targeting highrisk groups to improve case-finding efficiency. However, existing studies have largely focused on validating the diagnostic performance of AI models, while critical gaps remain in the development of stratified screening standards tailored to China’s lowtomoderate TB burden setting, standardized endtoend workflows, systematic cost-effectiveness evaluations, and comprehensive quality assurance systems. Based on current World Health Organization (WHO) recommendations and national TB control guidelines, this commentary first clarifies the policy role of CXR in TB screening and proposes a stratified framework defining appropriate populations for AIassisted screening and tiered requirements for imaging equipment deployment. We then focus on the “mobile digital radiography (DR)-based screening combined with AI” model in primary care settings and analyze five major implementation challenges: population applicability, workflow optimization, costeffectiveness, model generalizability, and quality assurance. To address these challenges, we propose actionable strategies across five dimensions: (1)establishing standardized multisource imaging databases; (2)developing stratified and stepwise screening strategies and algorithms; (3)constructing integrated, end-to-end quality assurance mechanisms; (4)exploring multidisease integrated screening approaches; (5)conducting localized, realworld cohort evaluations. These efforts aim to provide systematic evidencebased support for establishing a closedloop TB prevention and control system integrating communitybased initial screening, AIdriven risk stratification, etiological confirmation, and longitudinal followup management.

Original Articles

A 6-month short-course regimen for rifampicin-resistant pulmonary tuberculosis in China: a nationwide multicenter single-arm clinical trial

Nie Wenjuan, Zhang Mingyue, Zhang Yungui, Rukeyamu·Abudushalamu , Xu Bing, Jin Long, Liang Ruixia, Wang Furong, Xiong Yu, Cui Junwei, Yi Hengzhong, Zhang Fan, Li Hongzhi, Cao Xuegang, Qiu Lei, Bao Zhijian, Wang Guangming, Zhang Fan, Song Yanan, Zhang Haiqin, Chu Naihui, Cheng Shiming

Chinese Journal of Antituberculosis. 2026, 48(10):  1480-1486.  doi:10.19982/j.issn.1000-6621.20260378

Abstract ( 39 )   HTML ( 5 )   PDF (1309KB) ( 17 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the efficacy and safety of a 6-month short-course B-Pa-L/M (bedaquiline-pretomanid-linezolid-moxifloxacin) regimen in Chinese patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB). Methods: This nationwide, multicenter, prospective, single-arm clinical trial was conducted at 18 designated tuberculosis hospitals across China from March to November 2025. Inclusion criteria: age 14-65 years, rifampicin-resistant confirmed by phenotypic drug susceptibility testing or molecular biological assay, sputum smear ≥1 time 2+ or ≥2 times 1+, and chest imaging consistent with pulmonary tuberculosis. Exclusion criteria: severe extrapulmonary tuberculosis, severe hepatic or renal dysfunction, QTc prolongation, HIV infection, malignancy, and severe psychiatric/neurological disorders. A total of 35 patients were screened; 1 was excluded due to negative baseline culture, and 35 were enrolled (B-Pa-L 10 cases, B-Pa-L-M 25 cases). Patients received the B-Pa-L/M regimen for 6 months. Treatment outcomes, sputum culture conversion, radiological improvement, and adverse events were assessed. Results: In the B-Pa-L subgroup (10 cases), 8 were cured, 1 lost to follow-up and 1 withdrew; in the B-Pa-L/M subgroup (25 cases), 22 were cured, 2 lost to follow-up and 1 was excluded due to negative baseline culture. The overall cure rate was 85.7% (30/35), and 5 (14.3%) had unfavorable outcomes. Of 32 patients with evaluable imaging, 28 (87.5%) showed marked radiological improvement, and 4 (12.5%) showed partial improvement, yielding a total radiological improvement rate of 100.0%. Adverse events were reported in 14 patients (40.0%), with 3 (8.6%) requiring discontinuation or dose reduction. The most common adverse events were peripheral neuropathy in 7 patients (20.0%), gastrointestinal reactions in 3 (8.6%), and hepatic dysfunction in 2 (5.7%). Severe adverse events included acute pancreatitis (1 case), severe nausea/vomiting (1 case), visual impairment (1 case), and bilateral lower extremity numbness/pain (1 case); all resolved after drug interruption or symptomatic treatment. No treatment-related deaths occurred. Conclusion: The B-Pa-L/M regimen demonstrated a high cure rate and favorable radiological improvement in Chinese patients with RR-PTB, with a manageable safety profile. These findings provide important clinical evidence for short-course treatment of drug-resistant tuberculosis in China.

Safety analysis of the B-Pa-L/M regimen for rifampicin-resistant pulmonary tuberculosis

Jiang Wenxin, Zhang Xiangrong, Tang Peijun, Qin Zhihua, Gao Chunjing, Zhang She, Zhao Xinguo, Zhu Limei, Liu Qiao

Chinese Journal of Antituberculosis. 2026, 48(10):  1487-1496.  doi:10.19982/j.issn.1000-6621.20260364

Abstract ( 35 )   HTML ( 7 )   PDF (1318KB) ( 16 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the safety of the B-Pa-L/M regimen in patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) and to assess its effectiveness in real-world clinical practice in China based on preliminary treatment outcomes. Methods: A multicenter real-world observational study was conducted among patients with RR-PTB who received the B-Pa-L/M regimen at six designated tuberculosis hospitals in Jiangsu Province, between April and August 2025. Baseline characteristics and follow-up data, including clinical manifestations, laboratory findings, electrocardiographic examinations, and radiological assessments, were collected. Adverse events (AEs) were graded according to version 5.0 of the Common Terminology Criteria for Adverse Events (CTCAE) issued by the U.S. National Cancer Institute. The incidence, severity, and management of AEs were analyzed, and bacteriological conversion and treatment outcomes were evaluated. Results: A total of 51 patients were enrolled, of whom one withdrew from treatment during the early treatment phase because of severe gastrointestinal adverse reactions, whereas the remaining patients continued treatment according to the planned regimen. Grade ≥3 AEs occurred in six patients (12.0%). Hematologic toxicity, Fridericia-corrected QT interval (QTcF) prolongation, and liver function abnormalities were the most common AEs, occurring in 46.0% (23/50), 34.0% (17/50), and 32.0% (16/50) of patients, respectively. During treatment, 14 patients (28.0%, 14/50) required treatment modification because of AEs, including dose reduction in four patients, temporary drug interruption in eight, and drug substitution in one; only one patient withdrew from treatment because of severe gastrointestinal toxicity. Among the 98 AE episodes recorded during treatment, 90.8% (89/98) resolved following dose adjustment, temporary drug interruption, or supportive treatment, whereas 9.2% (9/98) resulted in permanent discontinuation of the implicated drug or withdrawal from treatment. The overall treatment success rate was 92.0% (46/50). At the end of month 2, the sputum smear and culture conversion rates were 90.6% (29/32) and 100.0% (36/36), respectively. Conclusion: The B-Pa-L/M regimen demonstrated favorable clinical effectiveness and a manageable safety profile in patients with RR-PTB. Although AEs were common, most were mild to moderate and could be effectively managed through active safety monitoring and individualized interventions, enabling most patients to complete treatment and achieve a high treatment success rate.

Evaluate the efficacy and safety of the B-Pa-L/M and B-D-L-Lfx/C regimens for the treatment of rifampicin-resistant pulmonary tuberculosis

Han Yi, Xiao Yu, Kong Weijin, Lin Rong, Lou Jincheng, Xiong Yanjun, Wang Hua, Zhang Yungui

Chinese Journal of Antituberculosis. 2026, 48(10):  1497-1505.  doi:10.19982/j.issn.1000-6621.20260363

Abstract ( 35 )   HTML ( 3 )   PDF (1108KB) ( 15 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To compare the efficacy and safety of two short-course regimens, B-Pa-L/M and B-D-L-Lfx/C, in patients with rifampicin-resistant pulmonary tuberculosis, and to provide evidence for optimizing clinical treatment strategies. Methods: A randomized, multicenter study was conducted. A total of 90 patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) treated at two sites in Anhui Chest Hospital and Yunnan Provincial Infectious Disease Hospital between August 2024 and August 2025 were enrolled. Using a random number table, patients were allocated in a 1∶2 ratio into a B-Pa-L/M group (30 cases) and a B-D-L-Lfx/C group (60 cases). The sputum Mycobacterium tuberculosis culture conversion rate was used as the primary efficacy endpoint. The sputum culture conversion rates at each follow-up time point during treatment and the median time to conversion were compared between the two groups. In parallel, all adverse events (AEs) occurring during treatment were observed and recorded, and the incidence of AEs was compared between the two groups to evaluate the safety of the regimens. Results: No statistically significant differences were observed between the two groups in sputum culture conversion rates at weeks 4, 8, 16, or 24 (all Ps>0.05). At week 12, the sputum culture conversion rate in the B-Pa-L/M group (96.67%, 29/30) was significantly higher than that in the B-D-L-Lfx/C group (80.00%, 48/60)(χ²=4.495,P=0.034). At week 24, both groups achieved high sputum culture conversion rates: 96.67% (29/30) in the B-Pa-L/M group and 91.67% (55/60) in the B-D-L-Lfx/C group. The median time to sputum culture conversion was significantly shorter in the B-Pa-L/M group (4 weeks) than in the B-D-L-Lfx/C group (8 weeks)(log-rank χ²=4.063, P=0.044). Safety results showed that the incidence of headache in the B-Pa-L/M group was 0/30 (0%), which was significantly lower than that in the B-D-L-Lfx/C group (13/60, 21.67%), and the difference was statistically significant (Fisher’s exact test, P=0.004). Conclusion: Both the B-Pa-L/M and B-D-L-Lfx/C short-course regimens demonstrate favorable efficacy and safety in the treatment of rifampicin-resistant pulmonary tuberculosis. Compared with the B-D-L-Lfx/C regimen, the B-Pa-L/M regimen exhibits superior mid-term mycobacterial clearance and a lower incidence of headache, suggesting better intermediate efficacy and neurological tolerability.

Efficacy and safety of 6-month short-course regimen B-Pa-L/M versus 18-month long-course regimen for treating rifampicin-resistant pulmonary tuberculosis

Huang Pengfei, Xiao Yu, Peng Yi, Xiong Yanjun, Guo Shanshan, Nadila Abulizi, Malipati Aierkenjiang, Wang Hua, Rukeyamu Abudushalamu

Chinese Journal of Antituberculosis. 2026, 48(10):  1506-1514.  doi:10.19982/j.issn.1000-6621.20260361

Abstract ( 41 )   HTML ( 3 )   PDF (1885KB) ( 14 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate clinical effectiveness and safety of 6-month B-Pa-L/M short-course regimen compared with 18-month long-course all-oral regimen containing bedaquiline (Bdq) on patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB), to provide real-world evidence for the application of 6B-Pa-L/M short-course regimen. Methods: A retrospective study was conducted, enrolling 142 patients with RR-PTB from Anhui Province and Xinjiang Uygur Autonomous Region. Among them, 66 received 6B-Pa-L/M short-course regimen (B-Pa-L/M group), and 76 received 18-month all-oral long-course regimen containing Bdq (long-course group). The efficacy and safety of the two regimens was assessed by sputum culture conversion rate, comprehensive clinical effectiveness, and adverse drug reactions during treatment. Results: The treatment success rate of B-Pa-L/M group (96.97%, 64/66) was significantly higher than that of the long-course group (82.89%, 63/76; χ²=7.407, P=0.006). Among the 92 patients with positive baseline sputum cultures, the sputum conversion rates of B-Pa-L/M group at 4, 8, 12, and 16 weeks were significantly higher than those of the long-course group (4 weeks: 59.09% (26/44) vs. 27.08% (13/48), χ²=9.630, P=0.002; 8 weeks: 84.09% (37/44) vs. 43.75% (21/48), χ²=16.035, P<0.001; 12 weeks: 93.18% (41/44) vs. 70.83% (34/48), χ²=7.611, P=0.006; 16 weeks: 95.45% (42/44) vs. 79.17% (38/48), χ²=5.370, P=0.020). Kaplan-Meier analysis showed that the median time to sputum culture conversion of B-Pa-L/M group (4 (4, 8) weeks) was significantly shorter than that of the long-course group (12 (4, 16) weeks; log-rank χ²=12.936, P<0.001). In terms of safety, the overall incidence of adverse reactions, gastrointestinal adverse reactions, and psychiatric symptoms of B-Pa-L/M group (specifically 45.45% (30/66), 7.58% (5/66), and 0 (0/66), respectively) were significantly lower than those of long-course group (specifically 68.42% (52/76), 21.05% (16/76), and 14.47% (11/76), respectively), all differences were statistically significant (χ²=7.636, P=0.006; χ²=5.091, P=0.024; Fisher’s exact test, P=0.001). However, compared with that in the long-term group, the difference in the incidence of adverse events rated as grade 3 or higher (6.06% (4/66) vs. 10.53% (8/76)) was not statistically significant (χ²=0.905, P=0.341). Conclusion: The B-Pa-L/M short-course regimen achieves faster sputum culture conversion in the treatment of RR-PTB. The treatment success rate is higher than that of the long-course all-oral regimen containing Bdq, and the regimen demonstrated a favorable safety profile.

Research on the safety of the B-Pa-L/M regimen in the treatment of rifampicin-resistant pulmonary tuberculosis in elderly patients (≥65 Years)

Li Rong, Wang Hua, Zhang Xuejue, Jin Long, Rukeyamu Abudushalamu, Jin Xiuye, Jing Yangfei, Yang Hong, Wu Yanqin, Ren Fei, Nie Wenjuan

Chinese Journal of Antituberculosis. 2026, 48(10):  1515-1522.  doi:10.19982/j.issn.1000-6621.20260355

Abstract ( 37 )   HTML ( 3 )   PDF (1200KB) ( 13 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the safety of the B-Pa-L/M regimen containing bedaquiline (Bdq), pretomanid (Pa), linezolid (Lzd), and/or moxifloxacin (Mfx) in elderly patients (≥65 years) with rifampicin-resistant pulmonary tuberculosis (RR-PTB). Methods: This prospective, multicenter, clinical cohort study was conducted from March to November 2025. According to the inclusion criteria, RR-PTB patients receiving the B-Pa-L/M regimen were enrolled from six designated tuberculosis medical institutions nationwide, including Xi’an Chest Hospital, Anhui Chest Hospital, Jiangxi Chest Hospital, Heilongjiang Provincial Infectious Disease Hospital, the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, and Beijing Chest Hospital, Capital Medical University. Patients were divided into an elderly group (≥65 years) and a control group (<65 years) using age 65 as the cutoff. All adverse events (AEs) during treatment, including myelosuppression, QTc interval prolongation, gastrointestinal reactions, neurological impairment, and hepatic injury, were collected and analyzed. The overall incidence of AEs, the incidence of grade ≥3 AEs, and the distribution of AE types were calculated. Results: A total of 51 patients were enrolled. Among them, 35 patients (68.6%) experienced 65 AE episodes (127.5%), and 8 patients (15.7%) developed 10 episodes (19.6%) of grade ≥3 AEs. Among the 22 patients in the elderly group, 18 (81.8%) experienced 35 AE episodes (159.1%), and 5 (22.7%) developed 7 episodes (31.8%) of grade ≥3 AEs. Among the 29 patients in the control group, 17 (58.6%) experienced 30 AE episodes (103.4%), and 3 (10.3%) developed 3 episodes (10.3%) of grade ≥3 AEs, no statistically significant differences were observed between the two groups in the overall incidence of AEs, the incidence of grade and the episode rate ≥3 AEs (all P>0.05). The incidence rates of bone marrow suppression, and other adverse events (number of cases/frequency) in the elderly group and the control group were 5 cases (22.7%) and 1 case (3.4%) per 10 frequency (45.5%) and 4 frequency (13.8%), and 4 cases (18.2%) and 1 case (3.4%) per 4 frequency (18.2%) and 1 frequency (3.4%), respectively, after Bonferroni correction, no significant differences were found in the incidence of two AE types between the two groups (all P>0.004). Regarding temporal distribution, QTc interval prolongation and gastrointestinal reactions predominantly occurred within the first 8 weeks of treatment, myelosuppression peaked at weeks 9-16, and neurological impairment was concentrated at weeks 17-24, and the distribution patterns in the elderly group were essentially consistent with those in the control group. Conclusion: Although the incidence of various AEs was higher in elderly RR-PTB patients treated with the B-Pa-L/M regimen compared to younger patients, these differences were not statistically significant; overall, the safety profile was favorable. In clinical practice, intensified monitoring strategies should still be implemented for elderly patients, particularly regarding the occurrence of myelosuppression, and therapeutic drug monitoring along with individualized dose adjustments should be performed when necessary, so as to minimize the risk of severe AEs while ensuring treatment efficacy.

Analysis of drug resistance to bedaquiline, delamanid and linezolid in patients with pulmonary tuberculosis

Su Dahong, Li Xiaoli, Yang Bin, Shi Yiheng, Lin Weibing, Miao Tiantian, Zhao Jinfeng, Ma Shang, Huo Fengmin, Wang Guirong

Chinese Journal of Antituberculosis. 2026, 48(10):  1523-1530.  doi:10.19982/j.issn.1000-6621.20260349

Abstract ( 40 )   HTML ( 3 )   PDF (958KB) ( 16 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the characteristics of drug resistance to bedaquiline (Bdq), delamanid (Dlm) and linezolid (Lzd) in patients with pulmonary tuberculosis, and to provide evidence for clinicians to develop individualized treatment regimens for drug-resistant pulmonary tuberculosis cases. Methods: A retrospective study was conducted. Clinical data of 445 outpatient and inpatient pulmonary tuberculosis patients admitted to Beijing Chest Hospital, Capital Medical University from March to December 2025 were collected, including gender, age, occupation, residential area, medical history, treatment regimens and drug susceptibility testing (DST) results. DST was performed with the mycobacterial microplate drug susceptibility testing technique to determine the susceptibility of clinically isolated Mycobacterium tuberculosis strains to 16 anti-tuberculosis agents: isoniazid, rifampicin, ethambutol, Dlm, Bdq, rifabutin, levofloxacin, moxifloxacin, kanamycin, amikacin, cycloserine, protionamide, para-aminosalicylic acid, Lzd, pyrazinamide and clofazimine. We analyzed the baseline characteristics, initial/retreatment status and overall drug resistance profile of the enrolled patients, as well as the resistance rates to Bdq, Dlm and Lzd among patients with prior exposure to these drugs. Results: Among the 445 patients, the overall drug resistance rate to the 16 anti-tuberculosis drugs was 47.9% (213/445), with a rifampicin-resistant tuberculosis rate of 30.1% (134/445),a multidrug-resistant tuberculosis rate of 23.4% (104/445) and an extensively drug-resistant tuberculosis rate of 3.8% (17/445). The resistance rates to Bdq, Dlm and Lzd were 2.7% (12/445), 4.0% (18/445) and 3.8% (17/445), respectively. Retreated patients had significantly higher resistance rates to all three drugs than treatment-naive patients (Bdq: 6.4% (11/171) vs. 0.4% (1/274); Dlm: 7.0% (12/171) vs. 2.2% (6/274); Lzd: 8.8% (15/171) vs. 0.7% (2/274)), with statistically significant differences (χ²=12.552, 6.323 and 16.409, respectively; all P<0.05). The resistance rates to Bdq, Dlm and Lzd in MDR/RR-TB patients were significantly higher than those in non-rifampicin-resistant patients (Bdq: 6.7% (9/134) vs. 1.0% (3/311); Dlm: 7.5% (10/134) vs. 2.6% (8/311); Lzd: 11.9% (16/134) vs. 0.3% (1/311)), with statistically significant differences (χ²=9.717, 5.770 and 31.318, respectively; all P<0.05). Among MDR/RR-TB patients, the co-resistance rates of Bdq+Dlm, Bdq+Lzd, Dlm+Lzd and Bdq+Dlm+Lzd were 4.5% (6/134), 3.7% (5/134), 5.2% (7/134) and 3.0% (4/134), respectively. The Bdq resistance rate in patients with prior Bdq exposure was 8.4% (8/95), significantly higher than that in Bdq-naive patients (1.1% (4/350)). The Dlm resistance rate in patients with prior Dlm exposure reached 9.1% (7/77), significantly higher than that in Dlm-naive patients (3.0% (11/368)). The Lzd resistance rate in patients with prior Lzd exposure was 13.8% (11/80), significantly higher than that in Lzd-naive patients (1.6% (6/365)). All above differences were statistically significant (χ²=12.438, 6.108 and 26.174, respectively; all P<0.05). Conclusion: The overall resistance rates to Bdq, Dlm and Lzd remain relatively low in pulmonary tuberculosis patients. However, higher resistance rates are observed in retreated patients, MDR/RR-TB patients and patients with prior exposure to these new agents. The resistance rate in drug-exposed patients is significantly higher than that in drug-naive patients, indicating that drug resistance monitoring should be intensified during the clinical application of new anti-tuberculosis drugs.

Assessment of depressive, anxious, and insomnia symptoms in patients with rifampicin-resistant pulmonary tuberculosis receiving a pretomanid-containing short-course regimen

Xiang Jingling, Li Rong, Wang Furong, Tong Dongyi, Nie Wenjuan, Pang Yu

Chinese Journal of Antituberculosis. 2026, 48(10):  1531-1537.  doi:10.19982/j.issn.1000-6621.20260460

Abstract ( 33 )   HTML ( 4 )   PDF (889KB) ( 12 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To describe the prevalence of depressive, anxiety, and insomnia symptoms among patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) receiving a pretomanid (Pa)-containing short-course regimen and to explore the association between positive psychological symptom screening and treatment-emergent adverse events (AEs). Methods: The prospective, single-arm, multicenter study enrolled 34 RR-PTB patients from 15 centers in China between March 20, 2025 and November 20, 2025. All patients were treated with either the B-Pa-L (bedaquiline-pretomanid-linezolid) or B-Pa-L-M (bedaquiline-pretomanid-linezolid-moxifloxacin) regimen. Each patient underwent a single assessment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) at a non-fixed time point during treatment. Cut-off values were set at PHQ-9 ≥5 for depression, GAD-7 ≥5 for anxiety, and ISI ≥8 for insomnia; positivity on any scale defined an overall positive psychological screening. AEs were collected via a standardized case report form. Fisher’s exact test was used to compare the positive screening rates between patients with and without AEs. Results: Positive screening rates were 5.9% (2/34) for PHQ-9, 2.9% (1/34) for GAD-7, and 5.9% (2/34) for ISI; only 2 patients (5.9%) screened positive on at least one scale. During treatment, 6 patients (17.6%) experienced AEs, including bilateral foot numbness (2 cases), anemia (2 cases), mild transaminase elevation (1 case), and nausea (1 case). None of these events led to permanent discontinuation of the entire treatment regimen. Among patients who experienced AEs, the positive psychological screening rate was 2/6. Conclusion: In a single, non-fixed time-point screening during therapy, the majority of RR-PTB patients treated with Pa-containing short-course regimens did not meet the threshold for clinically significant depression, anxiety, or insomnia. However, patients with adverse events had a notably higher rate of positive psychological screening, suggesting a possible correlation between psychological distress and treatment-related toxicity.

Establishment and application of a physiologically based pharmacokinetic model for pretomanid in the B-Pa-L/M regimen for drug-resistant pulmonary tuberculosis

Wang Zhongjian, Wang Yunji, Niu Yulan, Huang Yan, Kong Jun, Cao Hui, Jiao Fang, Zhang Xia, Zhang Xiangrong

Chinese Journal of Antituberculosis. 2026, 48(10):  1538-1551.  doi:10.19982/j.issn.1000-6621.20260140

Abstract ( 35 )   HTML ( 3 )   PDF (6145KB) ( 15 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To establish a human physiologically based pharmacokinetic (PBPK) model of pretomanid, and conduct external validation of its predictive performance under different dosage regimens based on clinical data, so as to provide evidence for individualized precision pharmacotherapy for drug-resistant pulmonary tuberculosis. Methods: The PBPK model of pretomanid was developed based on plasma concentration data from 6 patients with drug-resistant pulmonary tuberculosis. WinNonlin and NLME software were applied for model construction, fitting and simulation, and pharmacokinetic parameters were calculated via non-compartmental analysis. For external validation, we integrated published data from healthy subjects and phase Ⅰ clinical studies (a total of 221 observed plasma concentration points), covering single oral doses (50-1000 mg) and a 200 mg multiple-dose regimen. Sensitivity analysis was performed on key parameters including plasma unbound fraction, effective intestinal permeability coefficient and hepatic intrinsic clearance. Results: The established pretomanid PBPK model could satisfactorily predict clinical plasma concentration-time profiles, with good consistency between predicted and observed values of major PK parameters. Validated with 221 external clinical plasma concentration data points, 92.20% of the observed values fell within the 90% confidence interval of model predictions, and the mean fold errors of main pharmacokinetic parameters all ranged from 0.5 to 2.0, indicating favorable predictive performance of the model. Multiple-dose simulation showed that effective steady-state trough concentration could be achieved after approximately 3 days of continuous administration; steady-state peak concentration was reached on day 7, with predicted exposure levels within the safe range. Sensitivity analysis revealed that plasma unbound fraction, effective intestinal permeability coefficient, hepatic portal blood flow and hepatic intrinsic clearance all affected drug exposure; among them, effective intestinal permeability coefficient exerted a significant effect on time to peak concentration, while hepatic intrinsic clearance had a substantial impact on drug exposure levels. Conclusion: The pretomanid PBPK model established in this study has satisfactory external predictive performance and can accurately simulate in vivo exposure characteristics under different dosage regimens. For pretomanid administered at 200 mg once daily, steady-state effective exposure can be achieved after approximately 3 days of treatment. It is recommended to monitor trough concentration (approximately 770 ng/ml) on the morning of day 4, and peak concentration (safety threshold of approximately 5000 ng/ml) at 4-6 hours after dosing on day 7, to guide efficacy and safety evaluation. The model can support dose optimization, selection of monitoring time points and individualized medication guidance for special populations in pretomanid-based treatment of drug-resistant pulmonary tuberculosis, and holds important reference value for the rational clinical application of the B-Pa-L regimen.

Study on the rationality of reading time points and positive criteria for recombinant Mycobacterium tuberculosis fusion protein (EC) skin test: A phase Ⅳ clinical trial

Chen Junji, Qi Pingping, Lyu Bangjun, Qin Yuling, Zhong Zaixin, Wang Xilu, Bai Xiangjian, Mo Yi, Shao Jie

Chinese Journal of Antituberculosis. 2026, 48(10):  1552-1560.  doi:10.19982/j.issn.1000-6621.20260270

Abstract ( 26 )   HTML ( 3 )   PDF (1349KB) ( 13 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the rationality of different result reading time points and positive criteria for the recombinant Mycobacterium tuberculosis fusion protein (ESAT6/CFP10, EC) skin test based on data from a phase Ⅳ clinical trial among community population, and analyze its diagnostic agreement with the interferon-gamma release assay T-SPOT.TB, to provide evidence for standardized reading and interpretation of the EC skin test. Methods: From April 17, 2023 to May 13, 2024, a prospective, multi-cohort phase Ⅳ clinical trial of the EC skin test targeting community residents aged ≥6 months was carried out by Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention at two study sites: Liuzhou Center for Disease Control and Prevention and Liuzhou Liujiang District Center for Disease Control and Prevention. According to study setting, participants were divided into two cohorts. Cohort 1 received T-SPOT.TB before skin testing, followed by intradermal injection of EC and tuberculin purified protein derivative (TB-PPD) into separate forearms of the same person. This cohort was used to evaluate the reading time and positive criteria of EC, as well as its diagnostic agreement with T-SPOT.TB. Cohort 2 received one dose of EC from the same batch on the same day, and was used to observe the 48-72 h reading results and safety of EC skin test in large-scale community population. Results: A total of 7498 subjects were enrolled according to inclusion and exclusion criteria, including 500 subjects in Cohort 1 and 6998 subjects in Cohort 2. Among the 498 evaluable participants in Cohort 1, the diagnostic agreement rates between EC skin test results and T-SPOT.TB results at 24 h, 48 h and 72 h (91.06% (Kappa=0.62), 94.39% (Kappa=0.80), and 96.05% (Kappa=0.86), respectively) showed a gradual upward trend as the reading time was prolonged. However, the diagnostic agreement rate within the 48-72 h reading window (95.84%, Kappa=0.86) was basically consistent with that obtained by single reading at 72 h. When the large of the mean diameter of erythema and induration was ≥5 mm (as the positive criterion), the diagnostic agreement rates between EC skin test and T-SPOT.TB (95.84% (Kappa=0.86) and 95.63% (Kappa=0.84), respectively) were superior to those of TB-PPD (54.26% (Kappa=0.20) and 65.70% (Kappa=0.29), respectively). In addition, the diagnostic agreement rates between EC skin test read at 48-72 h and T-SPOT.TB under skin reaction thresholds of 3-6 mm and ≥7 mm were both roughly consistent (95.84% (Kappa=0.86) and 95.63% (Kappa=0.85), respectively). Subgroup analysis demonstrated that among key populations including elderly adults aged ≥65 years, close contacts of bacteriologically confirmed pulmonary tuberculosis patients and patients with diabetes mellitus, the EC skin test exhibited high diagnostic agreement with T-SPOT.TB results in the 498 evaluable participants of Cohort 1, with diagnostic agreement rates ranging from 86.67% (Kappa=0.72) to 100.00% (Kappa=1.00). The lower and upper bounds of this range was higher than those of the TB-PPD skin test, which varied from 60.00% (Kappa=0.18) to 76.67% (Kappa=0.52). In Cohort 2, the positive rate of EC skin test read at 48-72 h was 20.04% (1398/6975). The corresponding positive rates of EC skin test in people aged ≥65 years, individuals aged under 18 years, close contacts of bacteriologically confirmed pulmonary tuberculosis patients, patients with diabetes mellitus, and people living with HIV were 29.94% (595/1987), 2.16% (23/1066), 27.43% (65/237), 28.98% (91/314) and 2/6, respectively. The incidence of adverse reactions to EC skin test was 4.13% (289/6998), predominantly mild-to-moderate local reactions. The incidence of Grade ≥3 adverse reactions was 0.04% (3/6998). No serious adverse events related to the EC skin test were observed. Conclusion: Local erythema and induration after EC skin test administration reflect specific immune responses, and both demonstrate higher diagnostic agreement with T-SPOT.TB results compared with TB-PPD skin testing. Using the large of the mean diameter of erythema and induration ≥5 mm as positive criterion and reading results within 48-72 h achieves favorable diagnostic consistency and clinical operability, the EC skin test shows good tolerability and safety across the general population, elderly individuals, and special populations, making it suitable for use in primary medical institutions and for large-scale population screening.

Impact of nutritional status on early efficacy and adverse drug reactions in patients with drug-resistant pulmonary tuberculosis and construction of a risk scoring model

Huang Pengfei, Xiao Yu, Xiong Yanjun, Liang Yaxue, Wang Hua, Zhao Dahai

Chinese Journal of Antituberculosis. 2026, 48(10):  1561-1570.  doi:10.19982/j.issn.1000-6621.20260396

Abstract ( 24 )   HTML ( 4 )   PDF (916KB) ( 9 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the impact of nutritional status on early efficacy and adverse drug reactions in patients with drug-resistant pulmonary tuberculosis (DR-PTB), and to construct a simplified risk scoring model to assist clinical assessment. Methods: A retrospective analysis was conducted on clinical data of patients with DR-PTB admitted to Anhui Chest Hospital from January 1, 2023 to January 1, 2025. Multivariate logistic regression was used to identify factors influencing sputum culture conversion at the end of the second month of treatment and adverse drug reactions (ADRs). Independent influencing factors were then selected to construct a simplified risk scoring model. Results: A total of 276 patients were enrolled, with a 2-month sputum conversion rate of 75.4% (208/276). Multivariate logistic regression analysis showed that body mass index (BMI)≥18.5 kg/m² (OR=3.043, 95%CI: 1.475-6.277), serum albumin ≥35 g/L (OR=3.610, 95%CI: 1.821-7.155), and hemoglobin ≥90 g/L (OR=4.464, 95%CI: 1.103-18.068) were independently positively associated with 2-month sputum conversion, indicating that patients meeting these criteria were more likely to achieve early conversion. In contrast, a Nutritional Risk Screening 2002 (NRS 2002) score ≥3 (OR=0.376, 95%CI: 0.175-0.808) was independently negatively associated with conversion, suggesting that patients with nutritional risk were less likely to achieve conversion. In terms of ADRs, for liver dysfunction, serum albumin ≥35 g/L was a protective factor (OR=0.286, 95%CI: 0.166-0.494), while an NRS 2002 score of ≥3 was a risk factor (OR=2.871, 95%CI: 1.470-5.608); For bone marrow suppression, an NRS 2002 score of ≥3 was a risk factor (OR=2.422, 95%CI: 1.312-4.472), a CD4⁺ T-cell count ≥410 cells/μl (OR=0.218, 95%CI: 0.081-0.584, P=0.002) and serum albumin ≥35 g/L (OR=0.550, 95%CI: 0.304-0.993) were protective factors. A simplified risk scoring model based on BMI, serum albumin, hemoglobin, and the NRS 2002 score showed that as the risk score increased, the rate of patients failing to achieve sputum culture conversion (${\chi }_{trend}^{2}$=48.733), the incidence of liver dysfunction (${\chi }_{trend}^{2}$=21.396), and the incidence of bone marrow suppression (${\chi }_{trend}^{2}$=11.272) all showed a gradual upward trend (all P-values <0.001). Conclusion: Nutritional status plays an important role in early efficacy and adverse drug reactions in patients with DR-PTB. The simplified risk scoring model based on BMI, serum albumin, hemoglobin, and NRS 2002 score has good clinical applicability and can be used for early risk identification, guiding individualized nutritional interventions and ADRs monitoring.

Clinical efficacy evaluation of probiotics combined with enteral nutrition in the adjuvant treatment of intestinal tuberculosis: a prospective randomized controlled study

Liu Xin, Gulijianati Nuermaimaiti, Li Jian, Wang Quan, Lyu Wenjuan, Ding Lina

Chinese Journal of Antituberculosis. 2026, 48(10):  1571-1578.  doi:10.19982/j.issn.1000-6621.20260360

Abstract ( 25 )   HTML ( 3 )   PDF (897KB) ( 12 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To evaluate the intervention effects of probiotic supplementation based on standardized antituberculosis regimens combined with enteral nutrition on nutritional status, clinical symptoms and treatment related gastrointestinal adverse reactions in patients with intestinal tuberculosis. Methods: A prospective, randomized, controlled, openlabel trial was performed. A total of 235 hospitalized patients diagnosed with intestinal tuberculosis at The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to December 2021 were enrolled and randomly assigned to the observation group (118 cases) and the control group (117 cases). The control group received the standardized antituberculosis regimen 2H-R-Z-E/4H-R (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol) plus routine enteral nutrition support (intactprotein formula, caloric supply 30-40 kcal·kg^-1·d^-1 for 28 days). On the basis of the control group regimen, the observation group was additionally given compound probiotic preparation (containing Lactobacillus acidophilus, Bifidobacterium longum, Lactobacillus rhamnosus, Lactobacillus paracasei) at 4 g/d for 28 days. Serum total protein, albumin, hemoglobin, body mass index, abdominal pain and diarrhea symptoms, inflammatory factors (tumor necrosis factorα, interleukin-1, interleukin-10, C-reactive protein), and the incidence of gastrointestinal adverse reactions were compared between the two groups before and after treatment. Results: After 28 day treatment, serum total protein, albumin, hemoglobin and body mass index in the observation group were significantly higher than those in the control group ((70.56±5.48) g/L vs. (65.38±5.92) g/L, (38.92±5.63) g/L vs. (33.27±4.85) g/L, (106.83±15.46) g/L vs. (99.85±17.62) g/L, (19.35±2.28) kg/m² vs. (18.21±2.58) kg/m², respectively), with statistically significant differences (t=6.918, 8.120, 3.186, 3.552; all P<0.001); the changes of these indicators were also significantly greater in the observation group. The markedresponse rate of clinical symptoms in the observation group was significantly higher than that in the control group (47.5% (56/118) vs. 20.5% (24/117)), with statistically significant difference (χ²=19.285, P<0.001). Repeatedmeasures analysis of variance revealed significant differences in the timedependent trends of serum tumor necrosis factorα, interleukin-1, interleukin-10 and C-reactive protein between the two groups (timebygroup interaction effect, all P<0.01). Levels of these inflammatory factors were significantly lower in the observation group at day 14 and day 28 of treatment (all P<0.001). The incidences of abdominal distension (4.2% (5/118) vs. 16.2% (19/117)), newonset or aggravated diarrhea (2.5% (3/118) vs. 12.8% (15/117)) and constipation (3.4% (4/118) vs. 14.5% (17/117)) in the observation group were markedly lower than those in the control group (χ²=9.151, 9.211, 9.022; P=0.003, 0.002, 0.003, respectively). The length of hospital stay in the observation group was (21.5±6.8) d, which was significantly shorter than (26.8±7.5) d in the control group (t=5.684, P<0.001). Conclusion: Probiotic supplementation on the basis of enteral nutrition support can remarkably improve nutritional status, accelerate the relief of clinical symptoms, reduce systemic inflammatory burden, and mitigate antituberculosisrelated gastrointestinal adverse reactions in patients with intestinal tuberculosis.

Differential analysis of subspecies distribution and antimicrobial resistance profiles of 91 acid-fast bacilli smear-negative clinical Mycobacterium abscessus complex isolates

Wen Shufang, Ren Weicong, Shang Yuanyuan, Su Biyi, Li Haoran, Pang Yu, Liu Yi

Chinese Journal of Antituberculosis. 2026, 48(10):  1579-1589.  doi:10.19982/j.issn.1000-6621.20260022

Abstract ( 30 )   HTML ( 3 )   PDF (3169KB) ( 11 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the subspecies distribution characteristics and differences in drug resistance profiles of acid-fast bacilli (AFB) smear-negative clinical Mycobacterium abscessus complex (MABC) isolates from multiple regions in China, and to explore their clinical significances. Methods: A retrospective study was conducted on 103 patients with non-tuberculous mycobacteria (NTM) lung disease (preliminarily identified as MABC infection) admitted to tuberculosis-designated hospitals across eight provinces/autonomous regions/municipalities in China between January 1st and May 31st, 2020. Whole genome sequencing (WGS) was employed for precise subspecies identification of the isolates. The minimum inhibitory concentrations (MICs) of 15 antimicrobial agents were determined using the broth microdilution method. Results: Among the 103 isolates preliminarily identified as MABC, 91 were confirmed as MABC by WGS. Among them, 64 (70.33%) were identified as Mycobacterium abscessus (M.ab) and 27 (29.67%) as Mycobacterium massiliense (M.mas). Among the 91 MABC-infected patients, the distribution of the two subspecies across the three age groups (<45, 45-59, ≥60 years) showed a statistically significant difference (χ²=10.144, P=0.006). Further pairwise comparisons of the proportions of the two subspecies within each age group revealed that in the middle-aged group (45-59 years), the proportion of M.ab was 10.94% (7/64), significantly lower than that of M.mas (37.04%, 10/27; χ²=8.515, P=0.004). In the elderly group (≥60 years), the proportion of M.ab was 37.50% (24/64), significantly higher than that of M.mas (14.81%, 4/27; χ²=4.587, P=0.032). Regarding clinical symptoms, the incidence of hemoptysis in patients with M.ab infection was 26.56% (17/64), significantly higher than in those with M.mas (7.41%, 2/27; χ²=4.221, P=0.040), whereas the incidence of cough in patients with M.mas was 96.30% (26/27), significantly higher than in those with M.ab (70.31%, 45/64; χ²=7.373, P=0.007). Furthermore, the resistance rate of M.ab to clarithromycin was 28.12% (18/64), which was significantly higher than that of M.mas (7.41%, 2/27; χ²=4.673, P=0.031). Conclusion: M.ab is the dominant pathogenic subspecies among MABC clinical isolates. There are significant differences between subspecies in terms of age distribution, clinical symptoms, drug resistance phenotypes, and resistance risks. Accurate identification at the subspecies level should be advocated in clinical diagnosis to enable the adoption of tailored therapeutic regimens, thereby achieving differentiated precision treatment for MABC infections.

Recurrence influencing factors and active case-finding efficacy analysis among pulmonary tuberculosis patients after successful initial treatment in Jinshan District, Shanghai

Zhang Rui, Hao Yanxing, Song Canlei, Zhu Weitao, Zhu Shiyu

Chinese Journal of Antituberculosis. 2026, 48(10):  1590-1596.  doi:10.19982/j.issn.1000-6621.20260051

Abstract ( 31 )   HTML ( 4 )   PDF (937KB) ( 11 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To know the recurrence and influencing factors of pulmonary tuberculosis (PTB) after patients finished a successful initial treatment, and explore the implementation efficacy of active case-finding screening strategy. Methods: Using retrospective cohort study method, data of new PTB cases registered in Jinshan District between January 1, 2015 and August 31, 2024 with successful treatment was collected from “The Tuberculosis Information Management System”, a subsystem of the “China Disease Prevention and Control Information System”. These patients were then matched against all PTB patients registered in Jinshan District during 2016 to 2025 to identify relapse cases. The recurrence of PTB and its influencing factors were analyzed. Active case-finding was conducted for PTB patients who have been registered between January 1, 2022 and August 31, 2024 in seven towns participating in “Zero Tuberculosis Community” project, to assess the efficacy of active screening. Results: A total of 1579 successfully treated PTB patients were included in this study. After comparison with all registered tuberculosis cases in Jinshan District during 2016—2025, a total of 44 recurrent cases were observed, the recurrent rate was 2.79%. The proportion of recurrence within 2 years, 3 years were 61.36% (27/44) and 84.09% (37/44), and the cumulative recurrence rates within 1 year, 3 years, 5 years, and 10 years were 0.51%, 2.45%, 2.51% and 2.94%, respectively. Multivariable Cox regression analysis showed that ≥60 age group (HR=9.832, 95%CI: 1.323-73.054, P=0.026), comorbid diabetes (HR=2.241, 95%CI: 1.149-4.365, P=0.018) were independent risk factors for PTB recurrence. Active case-finding was conducted on 117 patients with previously successfully treated PTB, identifying 8 etiologically positive cases among whom 4 patients were confirmed with recurrent PTB (including 2 cases within 1 year and 2 cases within 2 years). The detection rate of active screening was 3.42%. Conclusion: Recurrence in successfully treated PTB patients mainly occurs within 3 years, with age over 60 and comorbid diabetes being the main risk factors for recurrence. It is recommended to strengthen follow-up efforts and increase pathogenic examination frequency for PTB patients within 3 years after their initial treatment completion, especially for those who aged over 60 or have comorbid diabetes, make active screening one of the methods for determining whether a recurrence has occurred.

Application value of TB-RNA in early effectiveness evaluation of anti-tuberculosis treatment in patients with pulmonary tuberculosis

Lu Fengyue, Su Biyi, Zhao Wei, Guan Ping, Zhu Jialou, Tan Yaoju

Chinese Journal of Antituberculosis. 2026, 48(10):  1597-1603.  doi:10.19982/j.issn.1000-6621.20260192

Abstract ( 26 )   HTML ( 4 )   PDF (879KB) ( 13 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To explore the application value of Mycobacterium tuberculosis ribonucleic acid (TB-RNA) detection in evaluating early effectiveness of anti-tuberculosis treatment in patients with pulmonary tuberculosis. Methods: A retrospective analysis was conducted on data of 186 patients admitted to Guangzhou Chest Hospital from January to December 2023, who were diagnosed with pulmonary tuberculosis by BACTEC MGIT 960 liquid culture and had imaging features consistent with active pulmonary tuberculosis lesions. The observation time was 2 months after treatment. TB-RNA test and MGIT 960 culture were performed on sputum/bronchoalveolar lavage fluid (BALF) at the end of 1st and 2nd months of treatment. The consistency between these two tests was analyzed; the differences of imaging improvement between TB-RNA positive and negative patients were compared. The correlations of variables were analyzed using Spearman rank correlation analysis. Results: The positive rate of TB-RNA at admission was 100.00% (186/186); the positive rates of TB-RNA at the end of 1st and 2nd months of treatment were 53.76% (100/186) and 19.35% (36/186), respectively; The positive rates of MGIT 960 were 49.46% (92/186) and 18.28% (34/186), respectively, both showing a downward trend (TB-RNA: χ²=47.474, P<0.001; MGIT 960: χ²=40.373, P<0.001). Using MGIT 960 result as standard, the sensitivity of TB-RNA detection in the 1st month was 93.48% (86/92), the specificity was 85.11% (80/94), and the Kappa value was 0.785; the sensitivity in the 2nd month was 88.24% (30/34), the specificity was 96.05% (146/152), and the Kappa value was 0.824. The effective lesion absorption rate and cavity closure rate of TB-RNA-negative patients were significantly higher than those of TB-RNA-positive patients (effective lesion absorption rate at the 1st month: 69.77% (60/86) vs. 40.00% (40/100), cavity closure rate: 27.91% (24/86) vs. 6.00% (6/100); effective lesion absorption rate at the 2nd month: 86.67% (130/150) vs. 50.00% (18/36), cavity closure rate: 56.00% (84/150) vs. 27.78% (10/36); χ²=16.481, 16.403, 24.011, 9.251, P<0.001, <0.001, <0.001, 0.002); The TB-RNA results were positively correlated with lesion absorption and cavity closure (r=0.428, 0.403 at the 1st month, r=0.451, 0.422 at the 2nd month, all P<0.001). Conclusion: TB-RNA can specifically identify viable bacteria, rapidly and sensitively reflects bacteriological outcome at the early stage of anti-tuberculosis treatment (1-2 months), and is highly correlated with imaging improvement, which can be used as an important marker for the early effectiveness evaluation of pulmonary tuberculosis.

Risk analysis of post-treatment bronchial stenosis in patients with lymph node fistula-type tracheobronchial tuberculosis

Yin Quhua, Ou Guojian, Zhou Lei, Luo Li, Ling Jie, Xiao Yangbao, Liu Zhenguo, Rong Pengfei

Chinese Journal of Antituberculosis. 2026, 48(10):  1604-1611.  doi:10.19982/j.issn.1000-6621.20260334

Abstract ( 26 )   HTML ( 3 )   PDF (2988KB) ( 12 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To investigate the independent risk factors for post-treatment bronchial stenosis in patients with lymph node fistula-type tracheobronchial tuberculosis (TBTB), construct and validate a risk prediction nomogram model, and provide evidence for early clinical identification of high-risk patients and formulation of individualized intervention strategies. Methods: A retrospective study was conducted, and 914 patients with lymph node fistula-type TBTB diagnosed at Hunan Chest Hospital from January 2019 to December 2023 were enrolled as study subjects. Data including demographic characteristics, clinical symptoms, laboratory indicators, imaging features, etiological test results and bronchoscopic findings were collected. The subjects were divided into the stenosis group and the non-stenosis group according to the presence of post-treatment bronchial stenosis. Post-treatment bronchial stenosis was defined as airway lumen stenosis >25% observed by follow-up bronchoscopy, accompanied by dyspnea or obstructive changes on imaging. Predictive variables were sequentially screened using LASSO regression, variance inflation factor test and recursive feature elimination (RFE). A multivariate logistic regression prediction model was constructed and visualized as a nomogram. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis. Results: The incidence of post-treatment bronchial stenosis among the included patients was 24.95% (228/914). Five key predictive variables were screened out by LASSO regression and RFE. Multivariate analysis showed that each 1-year increase in age (OR=1.06, 95%CI: 1.04-1.08), endoscopic ulceration (OR=2.42, 95%CI: 1.41-4.17), absence of hemoptysis (OR=3.48, 95%CI: 1.28-9.48) and absence of lymph node tuberculosis at other sites (OR=2.67, 95%CI: 1.52-4.70) were independent risk factors for bronchial stenosis, while male sex (OR=0.56, 95%CI: 0.37-0.86) was a protective factor. The AUC of the nomogram model was 0.806 in the training cohort and 0.720 in the validation cohort. The calibration curve demonstrated high consistency between the predicted probability of the nomogram and actual observed outcomes. Decision curve analysis confirmed that the model had favorable clinical utility across a wide range of threshold probabilities. Conclusion: The nomogram model constructed with 5 predictors including age, sex, hemoptysis, endoscopic ulceration and lymph node involvement at other sites has favorable discriminative ability and clinical practical value, which can provide quantitative evidence for early risk stratification and individualized follow-up of post-treatment bronchial stenosis in patients with lymph node fistula-type TBTB.

A single-center retrospective analysis of treatment course characteristics and duration distribution in inpatients with lymph node tuberculosis

Ding Guangzhao, Zhao Liping, Wu Zhuoran, Wu Xueting, Liu Rongmei

Chinese Journal of Antituberculosis. 2026, 48(10):  1612-1617.  doi:10.19982/j.issn.1000-6621.20260242

Abstract ( 27 )   HTML ( 3 )   PDF (865KB) ( 10 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To describe the real-world treatment characteristics of inpatients with lymph node tuberculosis at a single center, with a focus on the distribution of total anti-tuberculosis treatment duration, local lesion complexity, indications for surgical intervention, and their relationship with prolonged treatment duration, thereby providing a reference for standardized clinical management. Methods: Medical records of 290 inpatients with lymph node tuberculosis treated at Beijing Chest Hospital, Capital Medical University, from 2019 to 2024 were retrospectively collected to analyze treatment modalities and total treatment duration. Among them, 288 patients had more detailed records of the diagnostic and treatment process and were further included in supplementary analyses of relapse, newly developed lesions during treatment, multiple lesions, reasons for surgery, and events occurring during treatment. A simplified stratification of lesion complexity was constructed based on three indicators—relapse, newly developed lesions, and multiple lesions—and treatment duration was descriptively compared among different subgroups. Results: Among the 290 patients, 245 underwent surgical treatment, corresponding to a surgical rate of 84.5%. Among 274 patients with evaluable total treatment duration, the median total treatment duration was 13.00 (8.00, 19.00) months. Treatment duration was ≥10 months in 186 patients (67.9%), ≥18 months in 97 patients (35.4%), and ≥24 months in 30 patients (10.9%). The median total treatment duration was 12.50 (7.00, 19.00) months in the surgical group and 17.50 (12.00, 19.25) months in the non-surgical group. Among the 288 patients included in the supplementary analyses, relapse occurred in 20 cases (6.9%), newly developed lesions during treatment in 24 cases (8.3%), and multiple lesions in 62 cases (21.5%); 81 patients (28.1%) had at least one complex manifestation. The median treatment duration was 15.00 (12.00, 24.00) months in patients with relapse and 15.00 (10.00, 20.25) months in those with multiple lesions, both of which were longer than those in patients without relapse (13.00 (7.50, 18.00) months) and those without multiple lesions (13.00 (7.00, 18.00) months), respectively. The median treatment duration was 15.00 (10.00, 21.00) months in patients with at least one complex manifestation, compared with 12.00 (7.00, 18.00) months in those without complex manifestations. Among 247 patients with documented reasons for surgery, rupture/liquefaction/wound-related complications, relapse/newly developed/multiple lesions, mass enlargement or lesion progression, and poor response to drug treatment/prolonged non-healing together accounted for 67.6% (167/247), suggesting that the high rate of surgical intervention was closely related to the concentration of patients with complex local lesions. Conclusion: The duration of anti-tuberculosis treatment among inpatients with lymph node tuberculosis at our center was overall longer than the routinely recommended regimen and showed a prominent long-tail distribution. Relapse, newly developed lesions, multiple lesions, and local lesion progression were closely associated with longer treatment duration and may serve as important clinical indicators of treatment difficulty. The high surgical rate observed in this study more likely reflects the concentration of patients with complex lesions among hospitalized and surgically managed cases and should not be interpreted as representing a routine treatment choice for patients with lymph node tuberculosis.

Trend analysis of patient delay and its associated factors among pulmonary tuberculosis patients in Yunnan Province, 2005—2024

Zhou Lijuan, Wu Wei, Chen Jin’ou, Yang Yunbin, Liu Liangli, Li Ling, Xu Lin

Chinese Journal of Antituberculosis. 2026, 48(10):  1618-1626.  doi:10.19982/j.issn.1000-6621.20260175

Abstract ( 23 )   HTML ( 4 )   PDF (951KB) ( 12 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the trend and associated factors of patient delay among pulmonary tuberculosis (PTB) patients in Yunnan Province from 2005 to 2024, evaluate tuberculosis prevention and control effectiveness, and provide evidence for reducing patient delay. Methods: Medical records of PTB patients registered in Yunnan Province in 2005, 2010, 2015, 2020, and 2024 were extracted from the Tuberculosis Management Information System, a subsystem of the China Disease Prevention and Control Information System. The patient delay rates and delay intervals of the five time points were analyzed to describe changes over the 20-year period. Multivariable logistic regression was used to identify factors associated with patient delay. Results: The patient delay rate in Yunnan Province decreased from 80.59% (13060/16205) in 2005 to 66.86% (12853/19223) in 2024, and the median delay interval declined from 53 (Q₁=21, Q₃=121) days to 25 (Q₁=11, Q₃=52) days, both showing significant downward trend (${\chi }_{trend}^{2}$=2117.178, P<0.001; J-T statistic=-67.150, P<0.001). Multivariable logistic regression revealed that patients aged <65 years (OR=1.120, 95%CI: 1.079-1.162), detected by passive case finding (OR=1.400, 95%CI: 1.328-1.475), from high-epidemic areas (OR=1.574, 95%CI: 1.526-1.623), being Han ethnicity (OR=1.270, 95%CI: 1.234-1.307), farmers (OR=1.817, 95%CI: 1.719-1.920), bacteriologically positive (OR=1.245, 95%CI: 1.211-1.279), local residents (OR=1.169, 95%CI: 1.114-1.228), and non-key populations (OR=1.273, 95%CI: 1.199-1.352) had higher risk of patient delay. Conclusion: Although the overall status of patient delay among PTB patients in Yunnan Province improved from 2005 to 2024, patients who were aged <65 years, Han ethnicity, farmers, local residents, from high-epidemic areas, and non-key populations still faced higher risks of delay.

Visual analysis of the economic burden of tuberculosis patients based on CiteSpace

Man Yi, Wu Yanlong, Li Shuanglin, Li Xinyi, Pei Qiongyun, Niu Lingpu, Wu Tengyan

Chinese Journal of Antituberculosis. 2026, 48(10):  1627-1634.  doi:10.19982/j.issn.1000-6621.20260049

Abstract ( 25 )   HTML ( 3 )   PDF (5612KB) ( 12 )   Save

Figures and Tables | References | Related Articles | Metrics

Objective: To analyze the hotspots and trends of research on the economic burden of tuberculosis patients at home and abroad from 2010 to 2025, and to provide reference for research in this field. Methods: Relevant Chinese and English literatures published from January 1, 2010 to December 31, 2025 in CNKI, Wanfang, VIP, SinoMed, Web of Science and PubMed databases were retrieved. CiteSpace software was used to visualize the number of publications, countries (regions), authors, institutions and keywords. Results: A total of 623 Chinese articles and 1891 English articles were included. The annual number of Chinese and English articles increased from 30 and 57 in 2010 to 48 and 142 in 2025, respectively. The top five countries in terms of total number of publications were the United States (517 papers), the United Kingdom (172 papers), South Africa (116 papers), China (107 papers) and India (78 papers). The network analysis of authors and institutions showed that the high-yield authors in China were Wang Lixia (20 papers), Zhang Hui (14 papers), Li Renzhong (12 papers) and so on. The National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention occupied a central position in the Chinese literature, with 31 publications. The foreign high-yield authors were Anna Vassall (24 papers), Knut L?nnroth (20 papers), Robert G·White (18 papers) and so on. The University of London occupied a core position in English-language literature, with 101 publications. Keyword analysis showed that Chinese literature focused on patients and policy issues such as “multidrug-resistant tuberculosis” and “medical insurance”, while English literature focused more on systematic and evaluation methods such as “cost-effectiveness analysis” “catastrophic expenditures” and “health expenditure”. Conclusion: The number of Chinese and English publications is on the rise from 2010 to 2025. The research perspective on the economic burden of tuberculosis patients in the world is becoming more and more comprehensive, from single cost measurement to multi-dimensional assessment of economy, health and policy. In the future, we should strengthen interdisciplinary cooperation, focus on vulnerable groups and promote the transformation of research into policy.

Review Articles

Research progress of short-course treatment regimens for multidrug-resistant/rifampicin-resistant tuberculosis

Liu Shuya, Yang Dan, Chu Naihui, Ruan Yunzhou, Ren Jingjuan, Wang Ni, Cheng Shiming

Chinese Journal of Antituberculosis. 2026, 48(10):  1635-1644.  doi:10.19982/j.issn.1000-6621.20260390

Abstract ( 25 )   HTML ( 3 )   PDF (1000KB) ( 15 )   Save

Figures and Tables | References | Related Articles | Metrics

Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) remains a critical public health challenge for global tuberculosis prevention and control. In recent years, the development and clinical application of novel anti-tuberculosis agents, particularly bedaquiline, delamanid, and pretomanid, have brought revolutionary breakthroughs for short-course regimens. Compared with conventional 18-24-month regimens, short-course regimens have demonstrated significant advantages in improving treatment outcomes, reducing loss to follow-up, and lowering drug-related adverse events. The B-Pa-L-M regimen (B: bedaquiline; Pa: pretomanid; L: linezolid; M: moxifloxacin) has now been recommended by the World Health Organization as the preferred standardized treatment regimen for MDR/RR-TB, marking a new era of all-oral short-course treatment. The authors systematically summarize recent advances in the development of novel anti-tuberculosis drugs, outline the evolution of short-course regimens for MDR/RR-TB alongside their pivotal clinical trial evidence, and discuss future research directions. It aims to provide evidence to support the optimization of MDR/RR-TB treatment strategies and public health decision-making.

Research progress on blood drug concentration monitoring of therapeutic drugs for drug-resistant tuberculosis

Shi Wenhui, Nie Wenjuan, Chu Naihui

Chinese Journal of Antituberculosis. 2026, 48(10):  1645-1658.  doi:10.19982/j.issn.1000-6621.20260381

Abstract ( 24 )   HTML ( 3 )   PDF (1063KB) ( 13 )   Save

References | Related Articles | Metrics

Tuberculosis remains a major public health threat to human health. The emergence and spread of drug-resistant tuberculosis (DR-TB) have significantly increased treatment difficulty. Optimizing DR-TB treatment regimens and improving therapeutic efficacy are key priorities in current clinical research. Anti-tuberculosis drug concentrations directly affect treatment outcomes and safety; precise therapeutic drug monitoring (TDM) with subsequent dose adjustment is essential for individualized DR-TB therapy. The authors systematically review research advances in TDM for DR-TB treatment, summarizing methodological innovations in assay technologies, limited sampling strategies, and diversified biological sample matrices. This review also consolidates the pharmacokinetic characteristics of bedaquiline, pretomanid, linezolid, delamanid, fluoroquinolones, and clofazimine, as well as metabolic interactions and plasma concentration changes associated with combination therapy, to provide evidence-based guidance for rational clinical prescribing.