Table of Content

30 June 2013, Volume 2 Issue 2

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Expert Forum

Interpretation of expert consensus on diagnosis and treatment of adult bronchiectasis

MA Yan-liang

Journal of Tuberculosis and Lung Health. 2013, 2(2):  79-82. 

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Bronchiectasis is a common chronic respiratory disease. The expert consensus on diagnosis and treatment of adult bronchiectasis published in 2012 provides detailed guidelines on diagnosis,investigation and parti-cularly treatment of bronchiectasis. Long-term treatment such as airway clearance techniques,use of anti-inflammation medications and bronchodilators and rehabilitation are emphasized. Antibiotic therapy should be standardized with regular airway bacterial colonization and antimicrobial resistance monitoring. Policies for rotational use of antibiotics should be implemented to prevent and improve antibiotic resistance.

Original Articles

Respiratory manifestation and imageology in patient with hemophagocytic lymphohistiocytosis

TAO Lian-qin,WANG Yi-jia,SHI Guo-chao

Journal of Tuberculosis and Lung Health. 2013, 2(2):  86-91. 

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Objective Hemophagocytic lymphohistiocytosis(HLH)is a nonmalignant disorder of immune re-gulation,with nonspecific symptoms and multiple organs affected. Aim of our study is to investigate the clinical and imaging charateristics of respiratory system in HLH patients so as to help to improve the early diagnosis of HLH.Methods Clinical features and radiological manifestations of confirmed HLH patients in Ruijin Hospital since 2006 were retrospectively reviewed.Results Eleven cases of HLH were enrolled in our study,whose major signs and symptoms of respiratory system are cough,dyspnea and tachypnea. Ground-glass opacities(2 cases)and nodular lesion(3 cases)were the main features of chest radiographs(3 cases totally),meanwhile ground-glass opacities(3 cases),mediastinal lymphadenectasis(5 cases),pleural effusion(7 cases)and pleural thickening(6 cases)were also the main features of chest CT(8 cases totally).Conclusion Although both clinical features and radiological changes of respiratory system are nonspecific,respiratory failure and diffused ground-glass opacity are recognized as important features in severe HLH.

Clinical characteristics of obstructive sleep apnea hypopnea syndrome in different age

LIN Jie-ru,WAN Zi-fen,LIU Wei-jia,ZHANG Xiang-yan,YE Xian-wei,XIA Jing,YAO Hong-fang

Journal of Tuberculosis and Lung Health. 2013, 2(2):  92-94. 

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Objective To investigate the clinical characteristics of obstructive sleep apnea hypopnea syndrome(OSAHS)of male adults in different age groups.Methods A retrospective study of 223 adult male OSAHS patients was implemented,all patients were divided into youth group(≥18 years old and <40 yearsp old,72 cases),middle-aged group(≥40 years old and<60 years old,90 cases),senile group(≥60 years old,61 cases).Polysomno-graphy(PSG)and the clinical characteristics of each group were analyzed.Results Apnea hypopnea index(AHI)of youth group(52.7±16.8 times per hour)was higher compared with middle-aged group(43.3±25.2 times per hour)and senile group(33.6±18.1 times per hour)(F=9.171,P<0.05). The oxygen saturation(SaO₂)was the lowest in the youth group(68.6±14.1)% among three groups(middle-aged group(74.2±10.3)%,senile group(78.7±12.7%)(F=14.764,P<0.05).Complication rate of middle-aged group(55.6%,50/90)and senile group(73.8%,45/61)were higher than the youth group(8.3%,6/72)(χ²=63.483,P=0.000). The differences were statistically significant.Conclusion Young patients have the most serious sleep disorder and low blood oxygen among the adult male with OSAHS. Elderly patients with OSAHS have higher incidence of complications.

Characteristics of clinical and airway inflammation in patients with acute exacerbation of COPD complicated by bronchiectasis showed on lung HRCT

WANG Yu-hong, SUN Yong-chang

Journal of Tuberculosis and Lung Health. 2013, 2(2):  95-99. 

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ObjectiveTo study the clinical features and airway inflammation in patients with acute exacerbation of COPD (AECOPD) complicated by bronchiectasis or not showed on lung HRCT.Methods Fifty-one patients (male 27, female 24) with AECOPD from the outpatient clinic and the respiratory ward were consecutively enrolled from November 1st 2011 to February 29 2012. According to Smith’s standard, each lobe of the lung on the CT scans was interpreted for the presence and grade of bronchiectasis by 2 radiologists for each patient performed by HRCT . Patients with a bronchiectasis score ≥1.5 were defined as the bronchiectasis group, while those with a score of 0-1 as the non-bronchiectasis group. The clinical data, pulmonary function tests and the cell counting and cytokines in the sputum were compared, and the association of bronchiectasis with inflammatory markers and pulmonary functions was analyzed.Results HRCT bronchiectasis was present in 17 (17/51, 33.3%) patients. There were no significant differences in age(t=0.911,P=0.367), body mass index(t=0.507,P=0.615), smoking history(χ²=－0.916,P=0.360),disease history(t=－0.768,P=0.442)and the frequency of exacerbations(χ²=1.138,P=0.286). The total number of cell count of the induced sputum is 5420(1250～13240)×10⁶/L in bronchiectasis group and 4880(3180～18140)×10⁶/L in the non-bronchiectasis group(Z=－0.52,P=0.603), neutrophils is 3490(820～8870)×10⁶/L in bronchiectasis group and 2200(1020～12160)×10⁶/L in non-bronchiectasis group(Z=－0.200,P=0.842), lymphocytes is(1200±860)×10⁶/L in bronchiectasis group and (1430±1250)×10⁶/L in non-bronchiectasis group(t=0.715,P=0.478),and there were no significant differences in the 2 groups. Patients with bronchiectasis[760.5(400.4,932.1) pg/ml] had a higher level of sputum IL-8 than that in the non-bronchiectasis group[396.3(12.7,964.2) pg/ml] (Z=－2.278,P=0.023), and they had more severe airway obstruction; The value of FEV₁% predicted value and FEV₁/FVC was (47.5±11.8)% and (51.3±12.1)% respectively in the bronchiectasis group, and the value of FEV₁% predicted value and FEV₁/FVC was (55.9±14.7)% and (58.1±10.3) % respectively in non-bronchiectasis group. The differences were significant statistically( t=2.049、2.111,P=0.046、0.040). More patients in the bronchiectasis group(52.9%,9/17) had yellow sputum as compared to the non-bronchiectasis group(17.6%, 6/34) (χ²=6.8,P=0.009).Conclusion This study shows that COPD patients with bronchiectasis on lung HRCT has more severe airway obstruction and increased level of sputum IL-8.

The prevalence of blood Thl7 and CD4⁺CD25⁺Treg cells in patients with non-small-cell lung cancer

ZHU Hai-xing,ZHOU Ling,SHI Guo-chao,WANG Lin-lin,PAN Li-na,WAN Huan-ying

Journal of Tuberculosis and Lung Health. 2013, 2(2):  100-105. 

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Objective To investigate not only the prevalence of Th17 and Treg cells related cytokines but also mRNA expression of RORγt and FoxP3 in patients with non-small-cell lung cancer.Methods We analyzed peri-pheral blood mononuclear cell(PBMC)of 57 patients with non-small-cell lung cancer and 25 healthy volunteers. Expressions of RORγt and FoxP3 mRNA in PBMC were determined by quantitative fluorescence PCR. The level of plasma TGF-β,IL-17A and IL-6 were measured by ELISA.Results The level of RORγt mRNA in patients with Stage Ⅳ((11.30±4.07)×10^-4) were higher than those in healthy volunteers ((7.50±2.75)×10^-4) and in patients with non-small cell lung cancer stage Ⅰ-Ⅲ ((5.18±2.10)×10^-4)(q=7.53,q=6.82;all P<0.01). The level of plasma TGF-β [(69.52±10.04)pg/ml] in patients with Stage Ⅳ was higher than that in patients with Stage Ⅰ-Ⅲ [(42.24±16.64)pg/ml] and healthy volunteers [(24.51±10.96)pg/ml](q=3.91,q=3.87;all P<0.05). However,there was no difference in the level of plasma IL-17A and IL-6 among these three groups(q=1.19,1.76,1.06; all P>0.05).Conclusion The elevated RORγt mRNA expression and level of plasma TGF-β were associated with disease progress,which indicated Th17 and Treg cells may play an important role in the antitumor immunity of non-small cell lung cancer.

Diagnostic value of different methods combination of bronchoscopy combination on culture negative pulmonary tuberculosis with tracheobronchial tuberculosis

MIN Chun-yan,SHI Cui-lin,YE Zhi-jian,CHEN Xing-nian,WU Mei-ying

Journal of Tuberculosis and Lung Health. 2013, 2(2):  106-108. 

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Objective To evaluate the diagnostic value of electronic bronchoscopy in diagnosis of culture ne-gative pulmonary tuberculosis with tracheobronchial tuberculosis(TBTB).Methods The data of 78 patients of culture negative pulmonary tuberculosis with TBTB who were hospitalized in our hospital from January 2010 to August 2012 were analyzed,including the pathological classification of electronic bronchoscope and intratracheal lesions distribution before treatment. The results of brush examination,bronchoalveolar lavage fluid(BALF)smear,BALF culture,pathological biopsy and 3 sputum smear examinations after bronchoscope were compared.Results Seventy-two out of 78 cases’ electronic bronchoscope had abnormal display. And the main pathological classification were inflammatory infiltration(type Ⅰ100.0%,78/78),granulation hyperplasia(type Ⅲ 37.2%,29/78)and scar stricture(type Ⅳ34.6%,27/78).The positive rates of single test by brush,BALF smear,BALF culture,sputum smear after bronchoscope and pathological biopsy were 33.3％(26/78),39.7％(31/78),12.8％(10/78),26.9％(21/78)and 66.7%(28/42)respectively,and the differences among these five methods had statistically significance(χ²=38.94,P<0.01).The positive rate of bacteriology joint detection was 62.8%(49/78),and in biopsy combined increased significantly to 78.2％(61/78).Conclusion Comparing to single methods,different methods of bronchoscopy combination can improve the diagnosis of culture negative pulmonary tuberculosis with TBTB.

A study on the clinical efficacy of a combination regimen with sparfloxacin and capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis

CHEN En-tai, SU Li-fang, LI Jin-sheng

Journal of Tuberculosis and Lung Health. 2013, 2(2):  109-111. 

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Objective To observe and evaluate the clinical efficacy of a combination regimen with sparfloxacin(Sfx),capreomycin(Cm)in the treatment of multi-drug resistant pulmonary tuberaulosis(MDR-TB).Methods One hundred and four patients with MDR-TB were enrolled and divided randomly into the treatment group (3(Cm+Sfx+L₂+D+TH)/15(Sfx+L₂+D+TH)) (52 cases)and the control group (3(L₂ZED+Am)/15L₂ED) (52 cases). The sputum negative conversion rate,chest X-ray improvement rate,cavity closure rate and the side effects of anti-tuberculosis drugs were observed. Statistics analysis were using χ² test,the P<0.05 was considered statistical significance.Results The sputum negative conversion rates in the treatment group were 53.8%(28/52)at the 3rd month,73.1%(38/52)at the 6th month,80.8%(42/52)at the 12th month,and 88.5%(46/52)at the end of therapeutic course,while those of the control group were 15.4%(8/52),42.3%(22/52),57.7%(30/52)and 65.4%(34/52)respectively with statistically significant difference(χ²1=17.0,P<0.01;χ²₂=10.1,P<0.01;χ²3=6.5,P<0.05;χ²4=7.8,P<0.01).The improvement rates of chest X-ray were 90.4%(47/52)and the cavity closure rates were 81.6%(31/38)in the treatment group,while those of the control group were 67.3%(35/52)and 57.1%(20/35)respectively with statistically significant difference(χ²1=8.3,P<0.01;χ²₂=4.7,P<0.05)at the end of therapeutic course.Conclusion The regimen which contains sparfloxacin and capreomycin is helpful to the sputum smear negative conversion and absorption of the focus.

Comparative study for detecting Mycobacterium tuberculosis with methods of fluorogenic quantitative PCR and double antigen sandwich colloidal gold immunochromatography

LIANG Shao-bi

Journal of Tuberculosis and Lung Health. 2013, 2(2):  112-114. 

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Objective To compare the diagnostic value of detecting Mycobacterium tuberculosis(Mtb)with fluorogenic quantitative PCR(polymerase chain reaction)and double antigen sandwich colloidal gold immunochromatography.Methods Seventy cases with culture-positive pulmonary tuberculosis were selected to compare the sensitivities,specificities and accuracies of fluorogenic quantitative PCR and double antigen sandwich colloidal gold immunochromatography respectively. SPSS 12.0 software was applied for data cleaning and analysis,and P<0.05 was set as the criteria of statistical significance.Results The bacterial culture results were regarded as the gold stan-dard, the results of fluorogenic quantitative PCR(the former)and double antigen sandwich colloidal gold immunochromatography(the latter)were compared. The false-positive rate of the former was significantly lower than the latter [the former:1.7%(1/59),the latter:8.8%(6/68). χ²=5.46,P<0.05]. It meant the specificity of the former was relative higher. The false-negative rate of the former was significantly higher than the latter [the former:15.7%(11/70),the latter:2.9%(2/70). χ²=9.71,P<0.05]. The sensitivity of the latter was higher. There was no statistical significance of the difference between the accuracies of the two methods [the former:82.9%(58/70),the latter:88.6%(62/70). χ²=1.33,P>0.05].Conclusion Both methods are effective and rapid clinical methods to detect Mtb. The fluorogenic quantitative PCR has a more remarkable effect in primary screening with its higher sensitivity, and the double antigen sandwich colloidal gold immunochromatography technique can be a reference for diffe-rential diagnosis with its higher specificity. Both of them have advantages and disadvantages,and they should be selected according to the clinical practice.

Multivariate statistical analysis on treatment compliance of tuberculosis patients in special hospital

WANG Xu,CHEN Shi-qiang

Journal of Tuberculosis and Lung Health. 2013, 2(2):  115-118. 

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Objective To explore the influencing factors of treatment compliance of tuberculosis(TB)cases in special hospital,and to explore the appropriate treatment and management measures in order to improve the comp-liance of TB patients in special hospital.Methods Questionnaire survey by telephone was used to investigate 100 TB patients in special hospital, 100 effective questionnaires were collected which includes 3 parts:basic information,diagnostic and treatment information and health education information. Logistic regression was used to analyze the influencing factors of the compliance.Results The result of single factor logistic regression showed that education level(χ²=7.335,P=0.007),marital status(χ²=10.576,P=0.005),and health education conducted by doctors(χ²=7.055,P=0.008)had significant differences(P<0.05). Multifactor logistic regression analysis showed that marital status(Wald χ²=4.765,OR=0.133,95%CI=0.022～0.814,P=0.029)and health education(Wald χ²=5.568,OR=0.127,95%CI=0.023～0.705,P=0.018)had significant differences(P<0.05).Conclusion As treatment compliance depends on many factors,the special hospital should strengthen TB health education and attach great importance to the support provided by family members to tuberculosis patients,which will eventually improve the treatment compliance.

Misdiagnosis analysis of 37 cases with pulmonary disease caused by nontuberculosis mycobacteria

CHEN Xiao-hong,WANG Lin,ZHENG Xiao-hu,YU Wei,LIN Zhong-hui,LIU Tan-ye

Journal of Tuberculosis and Lung Health. 2013, 2(2):  119-121. 

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Objective To improve the clinical recognition of nontuberculsis mycobacteria(NTM)pulmonary disease.Methods We analyzed retrospectively 37 cases of NTM pulmonary disease misdiagnosed by other diseases. All patients were admitted in our hospital during January 2008 and October 2011.Results Thirty-seven cases with NTM pulmonary disease were diagnosed through identification of mycobacterium strains by culture. These cases were misdiagnosed as pulmonary tuberculous in 20(54.1%)cases,bronchiectasis or pulmonary tuberculous complicated by bronchiectasis in 18(48.6%)cases,chronic bronchitis in 8(21.6%)cases,pneumoconiosis combined with tuberculosis in 3(8.1%)cases,bronchial asthma in 2 cases and pneumonia in 2 cases. Main clinical symptoms included cough in 37(100.0%),productive cough in 34(91.9%),haemoptysis in 30(81.1%),cavity 12(32.4%). Lesions distribution of chest radiology showed 31 cases in bilateral lung field and 6 cases in unilateral lung field. There were 12 cases with cavities in chest radiology. Among 29 cases completed chemotherapy duration,24 cases achieved sputum negative conversion. The sputum conversion rate was 82.8%.Conclusion NTM pulmonary disease is characterized by long course of disease and nonspecific symptoms. Most cases are commonly misdiagnosed by pulmonary tuberculosis and bronchiectasis. The efficacy with antituberculous therapy is poor.

Analysis of 70 cases of diabetes combined with pulmonary tuberculosis

XIE Yu-qin,CHEN Guang-xing,ZENG Shao-yi,WU Jia-wen,ZHOU Zhan-bo,YE Wei-nan

Journal of Tuberculosis and Lung Health. 2013, 2(2):  122-124. 

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Objective To explore the clinical features and treatment of diabetes combined with pulmonary tuberculosis.Methods Seventy cases of diabetes complicated with pulmonary tuberculosis admitted from December 2009 to December 2011 were analyzed retrospectively.Results The condition of patients of diabetes complicated with TB was often complex and serious,60 cases were acute onset with symptoms of cough,expectoration and fever,which accounted for 85.7%. Thirty cases had the symptom of hemoptysis(42.9%),40 cases(57.1%)were weight loss. The positive rate of smear culture was 74.3%(52/70),and the lesions were more wide and mainly caseous lesion-based with cavity. Forty-eight cases(68.6%)had the overall lesions covered more than 2 intercostal space,and 40 cases(57.1%)had cavity.Conclusion Diabetes and tuberculosis are interacted and caused by. Anti-tuberculosis treatment should be conducted based on the effective control of blood glucose in order to obtain a better effect.

Analysis of detection and treatment outcome of pulmonary tuberculosis patients in Pingxiang city,2005—2010

LING Zhi-qiang

Journal of Tuberculosis and Lung Health. 2013, 2(2):  125-128. 

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Objective To analyze the case detection and treatment outcome of pulmonary tuberculosis(PTB)patients in Pingxiang city from 2005 to 2010,providing the basis for the formulation of prevention and control policies.Methods According to the TB control working report and the TB specific information system,we made analysis on the detection and treatment of TB patients registered from 2005 to 2010 in Pingxiang city. The population data is sourced from statistical department. The differences of TB patients registration rates and cure rates are analyzed by Chi-square test.Results A total of 8754 active PTB patients were detected in 6 years,the overall cure rate of smear positive PTB patients was 95.06%(5098/5363);In 2010,the cure rate was 95.99%(767/799),higher than 89.75%(876/976)in 2005,the difference is statistically significant(χ²=24.86,P<0.01);Registration rate of new smear-positive patients descended from 46.69/100000(847/1814010)in 2005 to 39.43/100000(735/1864273)in 2010,and the difference is statistically significant(χ²=11.29,P<0.01);Registration rate of active TB patients descended from 83.85/100000(1521/1814010)in 2005 to 62.17/100000(1159/1864273)in 2010,and the difference is statistically significant(χ²=59.34,P<0.01).Conclusion Since the full implementation of TB control strategy,Pingxiang city had made continuous improvement and remarkable achivements in detection and treatment management of PTB patients.

Review Articles

The research progress of non pathogenic biological risk factors affecting TB occurrence

ZHANG Yu-hua,ZHONG Da,CHEN Sheng-yu,ZHANG Guo-qin,FU Yan-yong

Journal of Tuberculosis and Lung Health. 2013, 2(2):  129-131. 

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It is of great significance to study the non pathogenic biological risk factors affecting the occurrence of TB in developing more effective interventions. Gender and age,malnutrition,socioeconomic status,smoking,alcohol abuse,diabetes mellitus,indoor air pollution,silicosis and some chronic systemic disease,and under immunosuppressive therapy,household or school TB contact history,may all be the risk factors of TB occurrence. Therefore,in the development of the TB control policies,we should focus on more targeted measures,pay attention to low-income and less-educated population,strengthen alcohol and smoke abstaining,keep indoor air circulation and good attitude,concern the impact of diabetes mellitus and pneumoconiosis on tuberculosis,strengthen contact screening management.

Effects of nutrition supplement on ameliorating health effects of secondhand smoke on infants

CAI Shuo^*,YE Tian-min

Journal of Tuberculosis and Lung Health. 2013, 2(2):  132-134. 

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It is well known that secondhand smoke(SHS)has serious effect on infants’ health. Current policies which focus on SHS exposure in public places and workplaces reduction can successfully prevent the adults from SHS exposure other than infants,who are actually more sensitive and susceptible to SHS. SHS exposure reduction is particularly important for infants. There is a serious need for novel strategies to protect children from SHS. This review focuses on the mechanism of nutrition supplement on ameliorating the adverse health effects and the nutrition intervention measures to reduce the SHS-related health outcome and problem for infants. The main objective should be reducing and avoiding children’s exposure from SHS.