Table of Content

20 October 2024, Volume 5 Issue 5

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Editorial

Advancing the management of latent tuberculosis infection and accelerating the goal of ending tuberculosis

Xiao Wenjing, Shen Xin

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  385-387.  doi:10.19983/j.issn.2096-8493.2024138

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Guideline·Standard·Consensus

Expert consensus on standardized diagnosis and treatment of pulmonary nodules

Yunnan Provincial Clinical Medical Center for Infectious Disease, Professional Committee of Respiratory Medicine of Yunnan Hospital Association, Professional Committee of Early Diagnosis and Treatment of Pulmonary Nodules of Kunming Medical Association

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  388-397.  doi:10.19983/j.issn.2096-8493.2024084

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With the promotion of pulmonary nodule screening program and the increasing popularity of low-dose chest CT, more patients with pulmonary nodules to get a preliminary diagnosis. However, the hot and difficult point of pulmonary nodule diagnosis and treatment is that how to accurately recognize high-risk pulmonary nodules, and enable patients get accurate and standardized diagnosis and treatment. After the publication of the first “Expert consensus on the diagnosis and treatment of pulmonary nodules” in 2015, various regions have successively improved the diagnosis and management strategies of pulmonary nodules based on local conditions. After several rounds of meetings and discussions held by experts in respiratory, infection, imaging, pathology and other fields, this expert consensus on the diagnosis and treatment of pulmonary nodules eventually has been formulated by referring to domestic and foreign literature results, expert consensus on diagnosis and treatment of pulmonary nodules as well as the clinical diagnosis and treatment experience of screening pulmonary nodules. By elaborating the diagnosis and treatment of pulmonary nodules, physicians of respiratory and related disciplines have a comprehensive understanding of the standardized diagnosis and treatment of pulmonary nodules, and it also provides reference for hospitals at all levels to carry out the plan of pulmonary nodules.

Interpretation of Standards

Interpretation of the 2023 U.S. Preventive Clinical Services Guidelines Workgroup Statement of Recommendations for Screening Adults for Latent Tuberculosis Infection

Wu Xiucen, Chen Guihua

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  398-403.  doi:10.19983/j.issn.2096-8493.2024105

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Individuals with latent tuberculosis infection constitute a substantial reservoir of potential tuberculosis cases, contributing to ongoing transmission within populations and posing a significant threat to public health and human life. In 2016, the U.S. Preventive Services Task Force introduced guidelines for the screening and treatment of latent tuberculosis infection. However, these guidelines did not clearly define the specific populations that should be targeted by the recommended treatment protocols. Drawing on the latest research evidence, the 2023 U.S. Preventive Services Task Force revised its recommendations on the screening of latent tuberculosis infection in adults. This update seeks to elucidate the screening pathways for latent tuberculosis infection, identify the specific populations that would benefit from treatment regimens, and establish a clear framework for the clinical management of latent tuberculosis infection in adults. This article aims to interpret these updated recommendations and offer guidance for the screening of latent tuberculosis infection in adults within the context of China.

Original Articles

The prevalence of latent tuberculosis infection among close contacts of active tuberculosis patients: a Meta-analysis

Li Xiaoxue, Xiao Xiao, Xu Chunhua, Dong Shulan, Wang Shanshan, Cao Jiayi, Wu Zheyuan, Hu Yi, Shen Xin

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  404-414.  doi:10.19983/j.issn.2096-8493.2024128

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Objective: To evaluate the latent tuberculosis infection prevalence among tuberculosis (TB) contacts across various regions with different TB burdens by utilizing different screening technologies and strategies. Methods: We screened studies by searching the Chinese Journal Full-text Database, Web of Science, Medline and Embase, selecting studies based on predetermined inclusion and exclusion criteria. A total of 214 articles were enrolled, 33 articles were used for extracting secondary incidence rate of tuberculosis and all articles provided prevalence of latent TB infection. Studies were categorized by study areas, screening techniques and screening strategies, respectively, then a meta-analysis was conducted to calculate and compare the prevalence of TB and latent tuberculosis infection among contacts of patients. Results: The prevalence of latent TB infection was 12.0% (95%CI: 9.0%-16.0%) among contacts from high TB burden settings, higher than those living in low-burden countries (7.0%, 95%CI: 5.8%-11.0%). Prevalence of latent infection detected by tuberculin skin test was higher than that detected by IFN-γ released assay (41.0%, 95%CI: 33.0%-49.0% vs. 36.0%, 95%CI: 26.0%-45.0%). Among contacts of smear-positive patients, the prevalence of latent infection was 34.0% (95%CI: 23.0%-45.0%), compared to 20.0% (95%CI:10.0%-30.0%) among the contacts of smear-negative patients. The prevalence of latent infection among household contacts was 24.0% (95%CI: 16.0%-33.0%), higher than that of the general population (13.0%-20.0%). The secondary incidence rate among close contacts aged under 15 years was as high as 4.6% (95%CI: 2.6%-7.1%), which exceeded those observed in individuals aged 15 to 60 years (2.6%, 95%CI: 0.9%-4.3%), and those over 60 years (3.3%, 95%CI: 0.9%-4.3%). The prevalence of latent infection among population aged above 60 years old was 31.0% (95%CI: 0.9%-60.0%), higher than that in children <15 years of age (25.0%, 95%CI: 18.0%-33.0%). Conclusion: In countries with a high burden of tuberculosis, the targeted screening strategies in close contacts of smear-positive patients and household contacts, constitutes an effective approach for early identification of tuberculosis cases. Children and the elderly should be the focus of screening.

Analysis of tuberculosis case detection in key areas of Yunnan Province during 2015—2022

Lu Kunyun, Tang Shunding, Wu Wei, Li Ling, Yang Rui, Xu Lin

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  415-421.  doi:10.19983/j.issn.2096-8493.2024115

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Objective: To analyze and compare the situation of tuberculosis (TB) case detection in key areas of Yunnan Province with other areas since the implementation of the 13th Five-Year Plan for National Tuberculosis Control and Prevention, and to provide a reference basis for the development of TB case-detection strategies and measures. Methods: The information of pulmonary TB patient notification, routine surveillance data and medical record information of TB patients registered for treatment in Yunnan Province from 2015 to 2022 were collected from the China Disease Control and Prevention Information System (CDCIS). The indicators on assessing TB case-detection work in 57 key districts/counties (27 national-level and 30 provincial-level counties for rural revitalization) and 72 other districts/counties were retrospectively evaluated, and the situation of TB case-detection were analyzed and compared. Results: Joinpoint regression (JPR) analysis showed that the reported incidence rates of TB in the key areas and other areas of Yunnan Province had a trend of “firstly rising and then declining” from 2015 to 2022. In the key areas, the rate was a significant increase from 2015 to 2020 (annual percentage change, APC=4.18, P=0.028) and an insignificant decline from 2020 to 2022 (APC=―6.28, P=0.247); in other areas, it was a period of insignificant increase (APC=5.12, P=0.097) from 2015 to 2017 and a period of significant decline (APC=―6.24, P=0.001) from 2017 to 2022. The reported incidence rate of pulmonary TB was 75.74 per 100000 (123980/163689089) in the key areas, higher than that in other areas (45.31 per 100000, 98587/217575588) with a statistically significant difference (t=2.564, P=0.010). The proportion of TB suspects who sought health care in the key areas was 4.72‰ (788137/167080059) among the total population, higher than that in other areas (3.86‰, 825392/213889708), the difference was statistically significant (χ²=16380.378, P<0.001). The incidence of delayed health care seeking in the key areas was 68.84% (77857/113102), which was higher than 57.58% (51287/89066) in other areas, the difference was statistically significant (χ²=2735.422, P<0.001). The etiological testing rate among TB suspected in the key areas was 72.99% (575241/788137), lower than that in other areas (78.11% (644706/825392)), the difference was statistically significant (χ²=5734.282, P<0.001). The etiological test positive rate was 41.78% (46673/111717) in the key areas, lower than that in other areas (45.45% (38887/85552)), the difference was statistically significant (χ²=266.613, P<0.001). Conclusion: Since the implementation of the 13th Five-Year Plan for National Tuberculosis Control and Prevention, the TB case detection in both key areas and other areas of Yunnan Province has been significantly improved. However, the efforts of case detection in the key areas are still insufficient. It needs to continue to adhere to the active screening strategy for detecting TB patients earlier, reducing the transmission of TB, and reducing the epidemic level of TB.

Analysis of tuberculosis screening results among college freshmen in Sichuan Province in 2023

Xiong Yan, Xiao Yue, Chen Chuang, Xia Yong, Li Yunkui, Lu Jia, Xia Lan

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  422-429.  doi:10.19983/j.issn.2096-8493.2024123

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Objective: To analyze the tuberculosis screening results of college freshmen in Sichuan Province in 2023, assess the prevalence of tuberculosis and Mycobacterium tuberculosis (MTB) infection among this population, and provide insights for future tuberculosis screening efforts targeting college freshmen. Methods: Basic information on new students enrolled in Sichuan Province in 2023 was obtained through the student registration management systems of various universities. Tuberculosis Screening Information Forms for freshmen enrolled in the autumn of 2023 were collected, and a database was established. Descriptive statistical analysis was conducted to examine the characteristics of tuberculosis screening, the detection of MTB infection, and other relevant factors among college freshmen. Results: In 2023, a total of 617087 new students were enrolled in ordinary colleges and universities in Sichuan Province, with a tuberculosis screening rate of 99.99% (617025/617087). The overall detection rate of tuberculosis in the province was 18.15/100000 (112/617025). Among Yi students, the detection rate was 136.82/100000 (30/21927), and among Tibetan students, it was 41.57/100000 (5/12029), both of which were significantly higher than the detection rate among Han students (14.16/100000 (74/522703)). This difference was statistically significant (χ²=79.802, P=0.001). The detection rate of MTB infection across the province was 4.01% (24507/611434). Among Yi students, the infection rate was 7.74% (1743/22522), among Tibetan students 5.95% (737/12377), among Qiang students 4.78% (141/2951), and among Hui students 4.16% (90/2164), all significantly higher than the rate among Han students (3.87% (20947/541856)) and other ethnic minority students (2.87% (849/29564)). These differences were statistically significant (χ²=1069.122, P<0.01). The preventive treatment rate for MTB infection among new students was 4.18% (330/7902). Conclusion: The tuberculosis screening rate among college freshmen in Sichuan Province in 2023 was high. However, the detection rate of tuberculosis and the infection rate of MTB were significantly higher among Yi and Tibetan students compared to Han students. The preventive treatment rate for MTB infection remains low.

Analysis of pulmonary tuberculosis registration and its characteristics in Guangzhou City from 2016 to 2023

Cai Xiaoting, Du Yuhua, Wu Guifeng, He Liqian, Su Bihui, Gong Fang, Wang Ting, Lai Keng, Wu Xiaoying

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  430-436.  doi:10.19983/j.issn.2096-8493.2024129

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Objective: To analyze the registration and characteristics of pulmonary tuberculosis in Guangzhou City from 2016 to 2023 and evaluate the effectiveness of tuberculosis control in Guangzhou, providing scientific basis for formulating tuberculosis control strategies. Methods: Using the “China Disease Prevention and Control Information System” subsystem “Tuberculosis Information Management System”, we extracted data on all clinically and laboratory-confirmed pulmonary tuberculosis and tuberculous pleurisy patients registered by their current residence in Guangzhou from January 1, 2016, to December 31, 2023, including information such as age, gender, occupation, current residence, diagnosis results, and disease type. We analyzed the data using descriptive statistics and chi-square test. Results: A total of 66716 tuberculosis cases were registered in Guangzhou from 2016 to 2023, and the annual average registration rate decreased from 59.12/100000 (9922/16783800) in 2016 to 35.92/100000 (6763/18827000) in 2023, showing a decreasing trend ($\chi_{\text {trend }}^2$=1999.652, P=0.000). There were 44892 cases of male and 21824 cases of female patients, the ratio of male to female was 2.1∶1. They were mainly 21-30 years old (24.18%, 16130/66716); highest number of cases were registered in April (6234 cases) among all months. The average annual registration rate was highest in Yuexiu District (66.73/100000, 5477/8207400) and lowest in Panyu District (39.07/100000, 8154/20872100). The highest etiologically positive rate was in Panyu District (58.20%,4746/8154), and the lowest was in Tianhe District (49.79%, 4029/8092). For patients’ occupation, the proportion of doing housework or unemployed was the highest (43.18%,28808/66716). Conclusion: From 2016 to 2023, the tuberculosis registration rate in Guangzhou showed a downward trend, and the high incidence season was in spring and summer. Men, 21-30 years old age group, Yuexiu District residents, household and unemployed people were the key groups for tuberculosis prevention and control.

Analysis of features of drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League of Inner Mongolia Autonomous Region, 2021—2023

Sun Bo, Feng Liping, Teng Chong, Zhu Hanfang, Zhao Bing, Feng Tao, Wang Qingkui, Zhou Hao, Gao Xinghai, Ou Xichao

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  437-444.  doi:10.19983/j.issn.2096-8493.2024124

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Objective: To analyze the drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League, Inner Mongolia from 2021 to 2023, and provide scientific evidence for preventing the occurrence and prevalence of drug-resistant tuberculosis in Hinggan League. Methods: The registration information of 615 culture positive patients in six counties (banners) of Hinggan League from January 1st, 2021 to December 30th, 2023 were collected from China National Notifiable Infectious Disease Reporting Information System, and the drug susceptibility tests of 615 strains of Mycobacterium tuberculosis to 16 anti-tuberculosis drugs were carried out using the microplate method and the influencing factors of multi-drug resistance of tuberculosis patients were analyzed using the logistic regression model. Results: (1) The drug susceptibility test results showed that the higher resistance rates to 16 anti-tuberculosis drugs were INH (13.01%, 80/615), Sm (11.71%, 72/615), Km (6.99%, 43/615), Cs (6.18%, 38/615), and RFP (5.37%, 33/615). There were statistically significant differences in the resistance rates of RFP, Km, Rfb, PAS, and PAS-INH (4.22% (20/474) and 9.22% (13/141), 5.49% (26/474) and 12.06% (17/141), 1.05% (5/474) and 4.26% (6/141), 1.69% (8/474) and 5.67% (8/141), 1.05% (5/474) and 4.26% (6/141)) between initial and retreatment patients (χ²=5.351,P=0.021;χ²=7.217,P=0.007;χ²=4.646,P=0.031;χ²=5.332,P=0.021;χ²=4.646,P=0.031). (2) There were 198 drug-resistant strains among 615 strains, with a overall drug resistance rate of 32.20% (198/615), RFP resistance rate of 2.28% (14/615), Mono-drug resistance rate of 20.33% (125/615), poly-resistance rate of 8.78% (54/615), multidrug-resistance rate of 3.09% (19/615). The drug resistance spectrum of the sixteen anti-tuberculosis drugs consisted of 46 different types of drug resistance, including 9 types of mono-drug resistance, 24 types of poly-resistance, 9 types of multidrug-resistance (not including pre-extensive drug resistance), and 4 types of extensive drug resistance.The poly-resistance rate (15.60%, 22/141) in retreatment patients was higher than that in initial patients (6.75%, 32/474)(χ²=10.631, P=0.001). (3) Retreated tuberculosis patients and key populations were risk factors for MDR-TB (OR=3.232, 95%CI: 1.187-8.805;OR=3.388, 95%CI: 1.211-9.479), and direct medical treatment was a protective effect against MDR-TB (OR=0.196, 95%CI: 0.043-0.885). Conclusion: From 2021 to 2023, the drug resistance spectrum presented complexity and diversity in Hinggan League. The treatment history, whether it was a key population, and the source of patients were the influencing factors of drug resistance.

Clinical characteristics of patients died of active tuberculosis with different ages in tuberculosis specialized hospital

Liu Weijian, Xu Yuxiang, Zhan Shenlin, Zhang Peize, Qin Hongjuan

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  445-452.  doi:10.19983/j.issn.2096-8493.2024098

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Objective: To analyze the clinical characteristics of patients who died of active tuberculosis, to provide a reference basis for reducing case fatality rate of tuberculosis patients. Methods: Demographic information (age, sex) and clinical data (number and days of hospitalizations, tuberculosis infection site, primary or retreatment, drug susceptibility test result, mechanical ventilation or not, comorbidities and complications) of patients who died of active tuberculosis at Shenzhen Third People’s Hospital from 1 January 2013 to 31 December 2022 were retrospectively collected. The patients were divided into young (<44 years), middle-aged (44-59 years), and elderly (≥60 years) groups, and their clinical characteristics were compared. Results: A total of 469 patients died of active tuberculosis, their median (quartile) age was 56 (40, 73) years, there were significantly more males (389 cases (82.94%)) than females (80 cases (17.06%)). Median days of hospitalization was 8.0 (3.0, 22.0) d. The elderly group was the largest group (208 cases (44.35%)), followed by the young group (150 cases (31.98%)), and the least cases were in the middle-aged group (111 cases (23.67%)); Highest number of cases only got pulmonary tuberculosis (351 cases (74.84%)), followed by those with concurrent multi-system tuberculosis (102 cases (21.75%)); Patients with malnutrition (185 cases (39.45%)), cardiovascular disease (159 cases (33.90%)), diabetes mellitus (102 cases (21.75%)), and central nervous system disease (85 cases (18.12%)), HIV infection (69 cases (14.71%)), and those who required mechanical ventilation (100 cases (21.32%)) were very common, whereas the occurrence of drug resistance (17 cases (3.62%)) and retreatment (44 cases (9.38%)), as well as getting both pulmonary tuberculosis and tuberculous meningoencephalitis (21 cases (4.48%)) were not much. Among patients in young, middle-aged and elderly groups, proportions of being male (125 (83.33%), 100 (90.09%) and 164 (78.85%)), getting pulmonary tuberculosis only (93 (62.00%), 83 (74.77%) and 175 (84.13%)) or having multi-system tuberculosis (50 (33.33%), 21 (18.92%) and 31 (14.90%)), combining with malnutrition (79 (52.67%), 44 (39.64%) and 62 (29.81%)), HIV infection (44 (29.33%), 20 (18.02%) and 5 (2.40%)), diabetes (11 (7.33%), 29 (26.13%) and 62 (29.81%)), cardiovascular disease (14 (9.33%), 25 (22.52%) and 120 (57.69%)), chronic lung disease (0 (0.00%), 7 (6.31%) and 39 (19.02%)), liver failure (11 (7.33%), 19 (17.12%) and 15 (7.21%)), stage 5 chronic kidney diseases (4 (2.67%), 9 (8.11%) and 31 (14.90%)), central nervous system diseases (17 (11.33%), 18 (16.22%) and 50 (24.04%)), neoplastic diseases (4 (2.67%), 18 (16.22%) and 38 (18.27%)), and pulmonary infections (121 (80.67%), 75 (67.57%), and 162 (77.88%)) were all significantly different (χ²=6.491, P=0.039; χ²=22.677, P<0.001; χ²=16.475, P<0.001; χ²=19.067, P<0.001; χ²=51.636, P<0.001; χ²=27.503, P<0.001; χ²=99.355, P<0.001; χ²=36.651, P<0.001; χ²=9.487, P=0.009; χ²=15.628, P<0.001; χ²=9.837, P=0.007; χ²=20.544, P<0.001; χ²=6.557, P=0.038). Conclusion: Patients who died of active tuberculosis in tuberculosis specialized hospital were mainly middle-aged and elderly male patients. Among them, young patients’ deaths were mostly due to combining malnutrition, HIV infection and multi-system tuberculosis, whereas for middle-aged and elderly patients, combining multiple underlying diseases may be an important factor of their deaths besides tuberculosis. Therefore, different prevention, control and diagnosis and treatment measures should be adopted for tuberculosis patients in different age groups which could help improving tuberculosis cure rate and lowering case fatality rate.

Knowledge of tuberculosis infection control and its associated factors among doctors in primary medical institutions in Zhongmu

Chen Yanxiao, Du Ying, Zhang Bin, Du Jiang, Cao Xuefang, Feng Boxuan, Guo Tonglei, He Yijun, Shen Lingyu, Huang Juanjuan, Di Yuanzhi, Liang Jianguo, Li Zihan, Liu Zisen, Duan Weitao, Gao Lei, Xin He’nan

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  453-460.  doi:10.19983/j.issn.2096-8493.2024087

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Objective: This cross-sectional study aimed to generate valuable evidence to improve tuberculosis infection control (TBIC) in primary health care institutions by assessing the level of TBIC knowledge and identifying its associated factors among doctors working in primary medical institutions in Zhongmu County, Henan Province. Methods: A questionnaire survey and interferon-gamma release assay (IGRA) were administered to all doctors in primary medical institutions in Zhongmu who met the inclusion criteria. A self-designed questionnaire comprising ten questions was then utilized to assess their knowledge of TBIC measures, including patient management, disinfection and ventilation procedures, the use of personal protective equipment, and health education initiatives. A quantitative scoring system (10 points being the full score) was applied to analyze factors associated with TBIC knowledge, with a score of 8 considered indicative of satisfactory mastery. Results: A total of 494 doctors from primary medical institutions participated in the survey. The median (interquartile range) score for TBIC knowledge was 6 (5, 7). Only 2.23% (11/494) of the doctors answered all questions correctly, while 21.66% (107/494) achieved a score of 8 or higher. The level of TBIC knowledge among doctors was significantly associated with gender (OR=1.68, 95%CI=1.03-2.76) and the number of villagers served (OR=1.68, 95%CI=1.05-2.69). Conclusion: The study highlights the need for improvement in TBIC knowledge among doctors in primary medical institutions in Zhongmu. Efforts in dissemination, training, and assessment must be strengthened to enhance TBIC awareness, reduce occupational exposure risks, and ultimately decrease the transmission of tuberculosis within the community.

The value of routine pathology microscopy, acid-fast staining, and TB-DNA in diagnosis of lymph node tuberculosis

Zeng Qin, Zeng Fanqing, He Kun, Yang Honghong, Liu Min

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  461-467.  doi:10.19983/j.issn.2096-8493.2024079

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Objective: To evaluate the value of acid-fast staining, routine pathology microscopy (short“pathology microscopy”), and TB-DNA in diagnosis of superficial lymph node tuberculosis, to seek the optimal diagnostic method of superficial lymph node tuberculosis. Methods: A retrospective study was conducted. Following the inclusion criteria, we collected basic information, biopsy methods, and acid-fast staining, pathology microscopy, TB-DNA of pathological tissues, and other data from 114 patients who underwent lymph node biopsy due to superficial lymph node enlargement at Chongqing Public Health Medical Center from January to September 2022, and were followed up in the outpatient department for more than 3 months (1 lymph node biopsy was taken from each patient). The diagnostic efficiency of different methods was compared based on the final clinical diagnosis as a reference standard. Results: Among 114 patients with lymphadenopathy, the positive rate of TB-DNA examination in pathological tissue (80.7% (92/114)) was higher than that of acid-fast staining (2.6% (3/114)) with significant difference (χ²=142.935, P=0.000), lower than that of pathology microscopy (91.2% (104/114)) with significant difference (χ²=5.235, P=0.022). The positive rate of combined pathology microscopy (98.2% (112/114)) was significantly higher than that of TB-DNA and pathology microscopy, and the difference was statistically significant (χ²=18.627, P=0.000; χ²=5.630, P=0.018). Finally, 104 patients were finally diagnosed as lymph node tuberculosis, and 10 patients were diagnosed as non tuberculous lesions. Among 104 patients with lymph node tuberculosis, 36 (34.6%) patients did not receive anti-tuberculosis treatment before admission, and 68 (65.4%) patients received anti-tuberculosis treatment outside the hospital, the positive rates of pathology microscopy were 88.9% (32/36) and 95.6% (65/68) with no significant difference (χ²=0.785, P=0.376), and the positive rates of TB-DNA were 80.6% (29/36) and 91.2% (62/68)(χ²=1.554, P=0.213). The positive rates of pathology microscopy in 79 (76.0%) patients who underwent ultrasound-guided biopsy and 25 (24.0%) patients who underwent surgical resection of the rates of lesion biopsy were 96.2% (76/79) and 84.0% (21/25)(χ²=2.770, P=0.096), of TB-DNA were 89.9% (71/79) and 80.0% (20/25), respectively, with no statistically significant differences (χ²=0.910, P=0.340). Using the final clinical diagnosis as the reference standard, the sensitivity of acid-fast staining, pathology microscopy, and TB-DNA were 2.9% (3/104), 93.3% (97/104), and 87.5% (91/104), the specificity were 100.0% (10/10), 30.0% (3/10), and 90.0% (9/10), the accuracy were 11.4% (13/114), 87.7% (100/114), and 80.7% (92/114), and the Kappa values were 0.005, 0.233, and 0.502. Conclusion: Superficial lymph node tuberculosis is mainly cervical lymph node tuberculosis, and is more common in middle-aged and young people. The positive rate of acid-fast staining is extremely low, and pathology microscopy and TB-DNA have higher diagnostic efficacy. Combining two examination methods can improve diagnostic performance. Although lymph node biopsy is equally effective in diagnosing general superficial lymph nodes as surgical lesion biopsy, considering factors such as cost and trauma, lymph node biopsy can be the first choice.

Analysis of factors affecting the onset age of asthma in children

Xue Min, Wei Xiaoling, Liu Miao, Wang Jing, Zhang Yun, Ma Xiang

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  468-475.  doi:10.19983/j.issn.2096-8493.2024089

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Objective: This study aims to explore the factors influencing the age of onset in children with asthma. Methods: A retrospective study was conducted on 412 pediatric asthma patients (aged 0-18 years) treated at Ji’nan Children’s Hospital between September 2020 and September 2022. Data were gathered through an asthma epidemiological questionnaire, which included information on basic demographics, age at first wheezing episode, age at asthma diagnosis, birth and feeding history, environmental factors, medical history, and family history of allergies. Multivariate logistic regression analysis was used to identify risk factors influencing the age of asthma onset in children. Results: The study included 412 children, of whom 208 (50.5%) experienced asthma onset at or before the age of 3, while 204 (49.5%) experienced onset after the age of 3. Multivariate logistic regression analysis identified several significant factors influencing the age of asthma onset: household smoking (OR=0.635, 95%CI: 0.411-0.983), cleaning the pillow core every 1-3 months (OR=2.352, 95%CI: 1.223-4.524), cleaning the pillow core every 3-6 months (OR=3.016, 95%CI: 1.244-7.310), predominantly meat-based diet (OR=0.427, 95%CI: 0.195-0.933), parity stage G2P2 (OR=0.276, 95%CI: 0.151-0.507), parity stage G3P3 or higher (OR=0.357, 95%CI: 0.159-0.800), and having a father with asthma (OR=0.321, 95%CI: 0.118-0.875). Conclusion: This study identified household smoking, paternal asthma, frequency of pillow cleaning, parity stage, and dietary habits as significant factors influencing the onset age of childhood asthma, offering valuable insights for the prevention and early intervention of the disease.

Effect of computerized cognitive behavioral therapy in the management of symptom cluster in patients with chronic obstructive pulmonary disease: a randomized controlled trial

Yuan Lirong, Yang Qinglong, Li Yuling, Li Lin, Deng Shasha, Li Shuhua

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  476-483.  doi:10.19983/j.issn.2096-8493.2024117

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Objective: To explore the intervention effects of computerized cognitive behavioral therapy (CCBT) for patients with chronic obstructive pulmonary disease (COPD) in terms of the diversity of symptoms, the lack of self-management ability and the complexity of mental health. Methods: A single-center, double-blind, randomized controlled trial was conducted in this study. Seventy-two patients with acute exacerbation COPD who were admitted to the First Hospital of Shanxi Medical University from March to October 2023 were included in the study, and 72 patients were randomly assigned to the experimental group (n=37) and the control group (n=35) by using random number table method. The control group received conventional care and telephone follow-up, and the experimental group received CCBT for 6 weeks. Major indicators (anxiety and depression) and secondary indicators (dyspnea, 6-minute walking distance (6MWD), insomnia and fatigue) were used as evaluation indicators and were compared before, during and after treatment. Results: The anxiety score (55.14±2.37), depression score (58.55±2.33), dyspnea score (2.72±0.45), insomnia score (7.97±1.57) and fatigue score (46.09±0.26) after 3 weeks of CCBT intervention in the experimental group were higher than that of the anxiety score (53.64±1.46), depression score (56.59±3.52), dyspnea score (2.14±0.67), insomnia score (6.19±1.65), fatigue score (40.65±0.33) after 6 weeks of intervention. The 6MWD ((280.00±8.33) m) after 6 weeks of intervention was higher than the 6MWD (268.59±7.86) after 3 weeks of intervention, and the differences were statistically significant. The F values of experimental groups were 16.141, 76.745, 14.976, 46.250, 42.337, 11.700, respectively, and the P values were <0.001, <0.001, <0.001, <0.001, <0.001, 0.001. After 3 weeks of intervention, the anxiety score (57.43±2.33), depression score (62.46±2.39), dyspnea score (3.06±0.42), insomnia score (9.83±1.65) and fatigue score (47.49±0.33) of the control group were all higher than those of the experimental group, and 6MWD ((262.14±9.11) m) was lower than that of the experimental group, and the differences were statistically significant. The t values were ―4.564, ―7.673, ―3.200, ―4.881, ―3.334, 2.992, respectively, and the P values were <0.001, <0.001, 0.002, <0.001, <0.001, 0.004. The anxiety score (55.04±2.36), depression score (59.89±2.42), dyspnea score (2.74±0.56), insomnia score (9.00±1.77) and fatigue score (43.11±0.33) in the control group were all higher than those in the experimental group after 6 weeks of intervention ((53.64±1.46), (56.59±3.52), (2.14±0.67), (6.19±1.65), and (40.65±0.33) respectively), and 6MWD ((275.29±7.85) m) was lower than that of the experimental group ((280.00±8.33) m), the differences were all statistically significant, and the t values after 3 and 6 weeks of intervention were ―2.354, ―4.917, ―4.149, ―6.988, ―5.305, 2.467, respectively. The P values correspond to 0.021, <0.001, <0.001, <0.001, <0.001, 0.016. Conclusion: Non-drug-assisted treatment based on CCBT can significantly improve the symptoms related to COPD patients and effectively improve patients’ quality of life; increasing the duration of the intervention can significantly improve the patients’ treatment effect.

Review Articles

Research progress on the regulation of TLR4 signaling pathway by miR-451a in the pathogenesis of tuberculosis

Zhao Fei, Zhan Lu

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  484-488.  doi:10.19983/j.issn.2096-8493.2024097

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MicroRNAs (miRNAs) play a pivotal role in immune regulation and inflammatory responses, contributing to the onset and progression of various diseases. miR-451a, a specific microRNA, is predominantly expressed in erythroid precursors and has been implicated in the pathogenesis of hematological disorders such as leukemia, as well as in non-hematological diseases including congenital heart disease, esophageal cancer, multiple myeloma, and sepsis. Furthermore, miR-451a modulates the TLR4 signaling pathway, thereby influencing the pathogenesis of tuberculosis. The authors investigated the mechanism by which miR-451a regulates the TLR4 signaling pathway, with the goal of examining recent advancements in understanding the role of miR-451a in tuberculosis pathogenesis. This study aims to provide novel theoretical insights for the identification of potential targets in anti-tuberculosis drug development.

Research progress on the concept discrimination and treatment of type 2 inflammation in asthma

Shi Xu, Chen Ruchong, Li Jing

Journal of Tuberculosis and Lung Disease. 2024, 5(5):  489-494.  doi:10.19983/j.issn.2096-8493.2024107

Abstract ( 114 )   HTML ( 6 )   PDF (1778KB) ( 46 )   Save

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Bronchial asthma (asthma) is a heterogeneous disease with multiple phenotypes based on differences in clinical features, triggers, airway inflammation, physiological and pathological features. The Global Initiative for Asthma (GINA) guidelines suggest that type 2 inflammation exists in asthma and can be diagnosed by testing for eosinophils, exhaled nitric oxide, and allergens. It has been found that 50% to 70% of asthma patients are related to type 2 inflammation, and the proportion of type 2 inflammation in severe asthma patients in China is more than 75%. Therefore, drug development and treatment for type 2 inflammation are critical. The authors review the concept, classification, pathogenesis, biomarkers and judgment criteria, asthma and the research progress of targeted therapy of type 2 inflammatory, and provides reference for the diagnostic and treatment of asthma biologics.