Table of Content

30 September 2019, Volume 8 Issue 3

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Original Articles

Application value of GeneXpert MTB/RIF in the detection of MTB rifampicin resistance

YU Da-wei,SONG Hua-feng,QIU Wen-na,XUE Jing,LI Fang-hua,XU Ping

Journal of Tuberculosis and Lung Health. 2019, 8(3):  160-162.  doi:10.3969/j.issn.2095-3755.2019.03.002

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Objective To evaluate the application value of GeneXpert MTB/RIF (GeneXpert) technology in the detection of MTB rifampicin resistance.Methods A total of 414 sputum specimens from patients with suspected pulmonary tuberculosis admitted to the Fifth People’s Hospital of Suzhou from January to December 2018 were collected. Meanwhile, acid fast staining of sputum smear, BACTEC MGIT 960 (MGIT 960) liquid culture and GeneXpert test were conducted to compare the positive detection rates of different methods. Based on the results of MGIT 960 liquid culture and improved roche drug sensitivity test (referred to as “drug sensitivity test”) as references, the efficacy of GeneXpert in the detection of MTB rifampicin resistance was analyzed.Results The positive detection rate of sputum smear was 18.6% (77/414), the positive detection rate of MGIT 960 culture was 31.4% (130/414), and the positive detection rate of GeneXpert test was 35.3% (146/414). The positive detection rate of GeneXpert or MGIT 960 culture was significantly higher than that of sputum smear (χ ²=29.22, P<0.001; χ ²=18.09, P<0.001). No statistically significant difference was observed between the positive detection rates of GeneXpert and MGIT 960 culture (χ ²=1.39, P=0.238). Among the 146 positive samples detected by GeneXpert, the detection rate of rifampicin resistance was 9.6% (14/146), and the detection rate of rifampicin resistance among the 130 positive samples detected by MGIT 960 culture was 9.2% (12/130), without statistical significant difference (χ ²=0.01, P=0.919). Based on the results of MGIT 960 culture and drug sensitivity test as references, the sensitivity, specificity, coincidence rate, and the Kappa value of GeneXpert test were 81.8% (9/11), 98.9% (87/88), 96.9% (96/99) and 0.84, respectively. Conclusion Compared with MGIT 960 liquid culture method and drug sensitivity test, GeneXpert technology has better detection efficiency for MTB rifampicin resistance.

Spoligotyping technology in the rapid identification of Mycobacterium tuberculosis

ZHU Xiao-yan,SONG Hua-feng,CHEN Hui,WU Min-juan,ZHAO Ni-na,XU Ping.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  163-167.  doi:10.3969/j.issn.2095-3755.2019.03.003

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Objective Clinical symptoms of non-tuberculous mycobacterium (NTM) diseases are similar to Mycobacterium tuberculosis (MTB) diseases, while the medication regimens are different, and it is difficult for differential diagnosis between NTM diseases and tuberculosis. How to identify NTM and MTB quickly and effectively is of great significance for the correct diagnosis and treatment of diseases.Methods Collecting sputum specimens from 495 outpatient and inpatient participants. The specimens were analyzed by spoligotyping and rapid culture of BACTEC MGIT 960 Mycobacterium tuberculosis (BACTEC MGIT 960 culture method ), respectively, and compared the two methods. Evaluated the diagnostic value including the sensitivity, specificity and accuracy of spoligotyping using culture as golden standard.Results Of 495 cases with suspected tuberculosis sputum specimens, specimens of 426 cases (86.1%,426/495) were detected with Mycobacterium tuberculosis and 69 cases (13.9%,69/495) with non-tuberculosis mycobacteria by using culture, and 420 cases (84.8%,420/495) were Mycobacterium tuberculosis and 75 cases (15.2%,75/495) with non-tuberculosis mycobacteria by using spoligotyping. Compared with the MGIT 960 culture method, the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic coincidence rate and Kappa value of the spacer oligonucleotide microarray classification technology were 96.7% (412/426), 88.4% (61/69), 98.1% (412/420), 81.3% (61/75), 95.6% (473/495) and 0.821, respectively.Conclusion Compared with the MGIT 960 culture method, spoligotyping can quickly and accurately identify Mycobacterium tuberculosis and non-tuberculosis mycobacterium with high sensitivity and specificity. This method can provide effective results for timely diagnosis and treatment of patients and has a certain value of clinical promotion.

Evaluation of two molecular diagnostic tests in improving the pathogenic positive rate for detection of tuberculosis

SONG Hong-huan,SHAO Yan,LI Yan,LI Guo-li,CHEN Cheng,ZHU Li-mei,LU Wei.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  168-171.  doi:10.3969/j.issn.2095-3755.2019.03.004

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Objective To evaluate the effect of two molecular diagnostic tests (GeneXpert Assay and Isothermal Amplification Technology) on improving the pathogenic positive rate for detection of tuberculosis.Methods Information of active tuberculosis (TB) patients in 23 Counties (Districts) in Jiangsu Province using GeneXpert technology (As Class A) and 46 Counties (Districts) using Isothermal Amplification Technology (As Class B) in 2018 (except for simple pleurisy), and the total number of patients diagnosed as active pulmonary tuberculosis was obtained from China Disease Prevention and Control TB Special Reporting System. The suspected tuberculosis patients from two classes of Counties (Districts) were detected by sputum smear first, and the negative patients were detected by molecular diagnostic test. The L-J solid Roche culture was used simultaneously, and the TB patients were diagnosed by radiography, immunology and clinical symptoms. The pathogenic positive patients means detected by sputum smear, sputum culture or molecular biology,at least one technology positive (molecule detection positive and culture positive patients were included in the positive number of molecule detection, not duplicate record in the number of culture positive patients), obtains the number of pathogenic positive patients from two kinds of counties (districts) in 2018, as well as three kinds of technology positive patients, and compared with 2015 (when the application of molecular biology technology had not yet begun.Results The pathogenic positive rate was increased from 27.8% to 52.9% in the class A and from 33.0% to 50.6% in the class B. There was significant differences in pathogenic positive rates between the two types of Counties (Districts) in 2015 and 2018 (χ ²=1270.00, P=0.000; χ ²=860.00, P=0.000); the pathogenic positive rates of the two classes of Counties (Districts) in 2015 and 2018 were compared, respectively. The pathogenic positive rates of in the class B in 2015 were higher than those of the class A, and the difference was statistically significant. (In 2018, the pathogenic positive rate in the class A was significantly higher than that in the class B (χ ²=10.60, P=0.001). In 2018, 8176 active pulmonary TB patients were diagnosed in the class A. Among them, 4327 were pathogenic positive (including 3117 smears, 116 sputum cultures and 1094 GeneXpert techniques). The pathogenic positive rate was 52.9% (38.1% smears, 1.4% sputum cultures and 13.4% GeneXpert techniques). The positive rate of GeneXpert technique was accounted for 13.4% of the total pathogenic positive cases. The ratio was 25.3% (1094/4327); 12196 patients with active pulmonary tuberculosis were diagnosed in B counties (districts). Among them, 6171 patients (including 4823 smears, 461 sputum cultures and 887 Isothermal Amplification Technology) were pathogenic positive, with 50.6% (39.5% smears, 3.8% sputum cultures and 7.3% Isothermal Amplification Technology), respectively. The positive rate of technical test was 14.4% (887/6171). Conclusion GeneXpert and Isothermal Amplification Technology can improve the pathogenic positive rate of TB to a certain extent, and both of them are fast and safe. The appropriate molecular biological detection technology can be selected and popularized in County (District) level tuberculosis laboratories according to local conditions.

Evaluation of clinical value of GeneXpert MTB/RIF in diagnosis and drug resistance detection of pulmonary tuberculosis

WU Hai-yan,YE Zhi-jian,WANG Xia-fang,YU Xin,WU Mei-ying.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  172-177.  doi:10.3969/j.issn.2095-3755.2019.03.005

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Objective To explore the clinical value of GeneXpert MTB/RIF detection in the diagnosis of pulmonary tuberculosis and its drug resistance.Methods A total of 981 patients admitted to the Department of Tuberculosis of Suzhou Fifth People’s Hospital from August 2017 to November 2018 were selected. The results of acid fast staining microscopic examination(Abbreviated as “smear method”),GeneXpert MTB/RIF(Abbreviated as “GeneXpert”), BACTEC MGIT 960 tuberculosis culture(Abbreviated as“MGIT 960”) and proportional drug sensitivity test of sputum(Abbreviated as“drug sensitive test”)and alveolar lavage fluid (Bronchoalveolar lavage fluid, BALF) were analyzed to evaluate the diagnostic efficacy of the three methods.Results According to the standard of clinical diagnosis, the sensitivity of sputum smear, GeneXpert and BACTEC MGIT 960 in the diagnosis of pulmonary tuberculosis was 32.02% (276/862),53.02% (457/862) and 53.25% (459/862),respectively.The sensitivity of the three methods was 31.32% (270/862), 72.97% (629/862) and 69.37% (598/862). Among the 527 patients with pulmonary tuberculosis who were both positive for BACTEC MGIT 960 and GeneXpert, 28 cases were RFP resistant by proportional drug sensitivity test,26 cases were drug resistant by GeneXpert, and the other 2 cases were sensitive. The results of proportional assay showed that rifampicin was sensitive in 499 cases, GeneXpert was sensitive in 497 cases, and the remaining 2 cases suggested drug resistance. The Kappa showed that those has good consistency (K=0.612, P<0.001). Take the solid proportional drug sensitivity test as standard, the sensitivity and specificity of GeneXpert in detecting RFP resistance were 92.86% (26/28) and 99.60% (497/499).Conclusion GeneXpert has high sensitivity and specificity. At the same time, the detection of RFP, resistance has a good application prospect in the early diagnosis and drug resistance detection of pulmonary tuberculosis. It is also found that the spiritual sensitivity of BALF GeneXpert is significantly higher than that of sputum samples, so electronic tracheoscopy should be performed in the early stage.

Effect of different expressions of ERCC1 and LRP performed on the effectiveness of cisplatin in the treatment of malignant pleural effusion

CHANG Li,LIN Hong,SUN Su-qin,PANG You-quan,BIAN Nan-nan,ZHEN Chun-ying,GUAN Xue-qing,YANG Hao,LIU Xue-mei

Journal of Tuberculosis and Lung Health. 2019, 8(3):  178-182.  doi:10.3969/j.issn.2095-3755.2019.03.006

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Objective To investigate the effect of different expressions of excision repair cross complementing 1 (ERCC1))and lung resistance protein (LRP) genes in the treatment of malignant pleural effusion with cisplatin.Methods One hundred and thirty-seven cases with malignant pleural effusion treated in the Oncology Department of Harbin Chest Hospital from January 2016 to June 2019 who refused systemic chemotherapy and received cisplatin injection only into the chest cavity were selected. Within them, 124 cases with tumor cells found in buried section of their pleural effusion samples were enrolled in this study. We used immunohistochemical staining of Streptomyces antibiotin protein-peroxidase ligation(SP method)(abbreviated as “immunohistochemical”) method to detect ERCC1 and LRP genes, then divided patients into 4 groups: 28 cases in group A (low expression of ERCC1 and LRP),38 cases in group B(high expression of ERCC1 and LRP), 35 cases in group C (low expression of ERCC1 and high expression of LRP) and 23 cases in group D(high expression of ERCC1 and low expression of LRP). Defining complete and partial remission as effective treatment, we compared therapeutic effectiveness among groups with different gene combinations. SPSS 18.0 statistical software was used for analysis. Comparison of metrological data between groups was conducted using single factor variance analysis;Comparison of counting data between groups was done with χ ² test. Difference less than 0.05 were considered as statistically significant. Results The topical medication effectiveness of cisplatin in group A, group B, group C, and group D were 85.71% (24/28),26.32% (10/38),51.44% (18/35) and 56.52% (13/23) respectively. Difference between those four groups was statistically significant (χ ²=22.995,P=0.000).The curative rate of group A was higher than that of groups B, C and D (χ ²=22.772,8.229,5.403;P=0.000,0.007,0.029). Curative rate of group B was significantly lower than groups C and D (χ ²=4.860,5.566;P=0.033,0.029).Group C and group D were of equivalent effectiveness (χ ²=0.145,P=0.197). Conclusion The curative effectiveness of 4 groups showed that group A got the best effectiveness, group C and group D had the second best curative effect, and group B had the lowest curative effect. For patients with highly expressed ERCC1 and LRP, we should consider resistance to cisplatin and recommend replacing cisplatin with other drugs.

Analysis of hypokalemia caused by capreomycin in patients with multidrug-resistant tuberculosis

MA Jin-bao,MA Ting-ting,REN Fei,YANG Hong.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  183-187.  doi:10.3969/j.issn.2095-3755.2019.03.007

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Objective To analyze clinical characteristics, prognosis and possible influencing factors of capreomycin-induced hypokalemia in patients with multidrug-resistant tuberculosis.Methods One hundred and twenty-nine patients with MDR-TB treated with capreomycin from January 2016 to January 2018 in Xi’an Chest Hosipital were selected. Among them, 56 (43.4%) patients suffered from capreomycin-induced hypokalemia and 73 (56.6%) patients did not get hypokalemia. The severity, onset time, prognosis of hypokalemia and its possible influencing factors were analyzed. Student’s t test and χ ² test were used separately to compare the difference of continuous measurements and categorical variables for hypokalemia and non-hypokalemia groups, P-value <0.05 was considered as statistically significant. Logistic regression analysis was done to identify risk factors. All statistical analyses were conducted on a personal computer with the SPSS of windows (version 18.0) software package. Results (1) Incidences of mild, moderate and severe hypokalemia caused by capreomycin were 69.6% (39/56), 23.2% (13/56) and 7.2% (4/56) respectively. Hypokalemia occurred during the whole course of using capreomycin, mainly in the first 16 weeks (89.3%, 50/56). (2) 52 of 56 patients with hypokalemia recovered after receiving potassium supplementation treatment, the other four patients recovered gradually after stopping using capreomycin due to severe hypokalemia. (3) The Univariate analysis revealed that 4 factors were associated with capreomycin-induced hypokalemia: age (χ ²=5.130,P=0.024), body mass index (χ ²=7.087,P=0.029),diabetes (χ ²=13.830, P=0.000) and serum albumin (t=2.150, P=0.034); Taking these factors and whether renal impairment existed into the logistic regression model, the result showed that serum albumin (Wald χ ²=6.261,P=0.012,OR=0.362)and diabetes (Wald χ ²=10.310,P=0.001,OR=6.394) were independent high risk factors for capreomycin-induced hypokalemia. Conclusion The incidence of capreomycin-induced hypokalemia was high. Serum electrolyte should be monitored intensively throughout capreomycin using process. Most patients with hypokalemia could stand to continually using capreomycin after receiving potassium supplementation treatment. Hypoproteinemia, diabetes were risk factors for hypokalemia.

Clinical effect of inhaled budesonide suspension for the treatment of asthma in children

ZHANG Hong-hui,HUANG Wei.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  188-191.  doi:10.3969/j.issn.2095-3755.2019.03.008

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Objective To explore the clinical effect of inhalation budesonide suspension (Pulmicort Respules) for the treatment of asthma in children.Methods One hundred and seven children with asthma treated in Shenyang 245 Hospital from May 2017 to May 2019 were included as subjects, among which, 52 cases (2 cases were lost to follow-up) in the control group received conventional basic treatment, and 55 cases (3 cases were lost to follow-up) in the experimental group were given inhalation treatment of budesonide suspension combined with conventional treatment. Then the clinical therapeutic effects as well as the changes in CD4 ⁺ T lymphocytes, C-reactive protein (CRP), interleukin-6 (IL-6), forced expiratory volume in 1 second (FEV₁), and forced vital capacity (FVC) levels between the two groups were compared. Results After 7 days of treatment, the total effective rate of the experimental group (96.2%, 50/52) was significantly higher than that of the control group (80.0%, 40/50), with the significant statistical difference (χ ²=4.94, P<0.05). In addition, after 7 days of treatment, the percentage of CD4 ⁺ T lymphocyte in total lymphocyte ((34.32±4.15) %), the ratio of CD4 ⁺/CD8 ⁺ (1.20±0.28), CRP level ((12.38±2.98) mg/L), and IL-6 level ((54.23±6.54) ng/L) in the experimental group were obviously lower than those in the control group ((45.37±3.08) %, 1.67±0.16, (35.82±7.31) mg/L, and (74.24±8.11) ng/L, respectively), all with the significant statistical differences (t=13.35, 9.10, 18.54, and 11.99, respectively, all P<0.05). Furthermore, after 7 days of treatment, the levels of FEV₁ and FVC in the experimental group ((2.41±0.32) L and (1.45±0.28) L) were remarkably higher than those in the control group ((2.08±0.47) L and (1.23±0.22) L), with the significant statistical differences (t=3.62, and 3.86, both P<0.05). Conclusion Inhalation budesonide suspension is effective for the treatment of children with asthma, which can effectively regulate the levels of CD4 ⁺ T lymphocyte and CD4 ⁺/CD8 ⁺ in children with asthma, improve pulmonary function and accelerate the recovery of children’s condition.

Evaluation of the human resources status and allocation of tuberculosis prevention and cure institutions in counties (districts) of Hunan Province

BAO Chang-lin,TANG Yi,WANG Chun-ting,LIU Li-qin,WAN Yan-ping,TANG Xiong-lue,WANG Qiao-zhi.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  192-196.  doi:10.3969/j.issn.2095-3755.2019.03.009

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Objective This study aimed to understand current situation of human resourses and allocation fairness of Tuberculosis Prevention and Cure Institutions (TPCIs) in counties (districts) of Hunan Province, and provide the basis for optimizing the allocation of human resources.Methods A total of 128 TPCIs in 128 counties (districts) were investigated by a combination of census and spot check. According to Hunan Provincial Statistical Yearbook (2017), the counties (districts) of Hunan Province were divided into 77 (60.1%) non-poverty counties (districts) and 51 (39.8%) poverty counties (districts). Then, based on Comprehensive Questionnaire of Hunan Provincial Service System of Tuberculosis Prevention and Cure reported in June 2018 and Report Forms of Hunan Provincial Information Management System of Tuberculosis Prevention and Cure in 2017, relevant information of staff in TPCIs was collected, and human resources allocation of TPCIs in counties (districts) of Hunan Province was invesgated and analyzed.Results Among the 128 surveyed counties (districts), 71 (55.5%) TPCIs lacked organizations, including 44 (62.0%) non-poverty counties (districts) and 27 (38.0%) poverty counties (districts); 89 (69.5%) TPCIs had independent tuberculosis prevention and control departments, and 10 (7.8%) TPCIs attained the required standards in human resources allocation. In total, 579 staffs in TPCIs were investigated in this study, including 304 males (52.5%) and 275 females (47.5%); the age distribution mainly ranged from 30 to 50 years old, with a total of 373 (64.4%) staffs; the academic qualifications were mainly undergraduate (212, 36.6%) and specialist (277, 47.8%); the professional titles were mainly intermediate (227, 39.2%) and junior (250, 43.2%); there were 506 (87.4%) regular employees and 419 (72.4%) full-time staffs; and 25.4% (147/579) staffs engaged in tuberculosis prevention and cure for less than 2 years. The per capita service population of staffs of TPCIs in counties (districts) of the province was 118 000, the radius of per capita service area was 10.8 km, and per capita patients were 86. The Gini coefficients of the service population, regional radius and number of tuberculosis patients of staffs of TPCIs in counties (districts) of the province were 0.34, 0.29 and 0.36, respectively.Conclusion The human resources allocation of TPCIs in counties (districts) of Hunan Province is moderately equitable. However, there is a lack of the manpower and high-level talents, and most of the staff have short working period and heavy workload.

Analysis of clinical features and outcome of treatment in 41 children with tuberculous meningitis

CHEN Yu,LI Qiao-si,FAN Li-chao,ZHU Ya-juan,LYU Yue-qiu.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  197-202.  doi:10.3969/j.issn.2095-3755.2019.03.010

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Objective To analyze the clinical characteristics and treatment outcome in children with tuberculous meningitis (TBM) and provide reference for the diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical data of 41 pediatric TBM patients admitted to Shenyang Chest Hospital from January 2013 to January 2018. Among 41 cases, 29 cases (70.7%) were rural children, 12 cases (29.3%) were urban children, 8 cases (19.5%) had close contact with pulmonary tuberculosis, 11 cases (26.8%) were diagnosed by Mycobacterium tuberculosis cultured with MGIT 960 or L?wenstein-Jensen medium, and 30 cases (73.2%) were diagnosed as composite reference standard (CRS).Results The main clinical manifestations were fever in 39 cases (95.1%), headache in 34 cases (94.4%, 34/36), vomiting in 27 cases (65.9%), emaciation in 23 cases (56.1%), disturbance of consciousness in 17 cases (41.5%) and convulsions in 8 cases (19.5%). The main clinical signs were neck rigidity in 39 cases (95.1%), Kernig sign positive in 21 cases (51.2%), pupil light reflex insensitive or disappeared in 18 cases (43.9%), tuberculin skin test positive in 22 cases among 37 cases (59.5%), blood tuberculosis infection T cell spot test (T-SPOT.TB) positive in 17 cases among 27 cases (63.0%). Erythrocyte sedimentation rate (ESR) was more than 20 mm/1h in 21 cases among 37 cases (56.8%), C-reactive protein (CRP) was abnormal in 18 cases among 33 cases (54.5%). GeneXpert MTB/RIF was positive in 8 cases among 19 cases (42.1%). The culture of Mycobacterium tuberculosis in cerebrospinal fluid using MGIT 960 was performed in 30 cases, and 11 cases (36.7%) were positive. In 29 cases, 18 cases (62.1%) were abnormal by enhanced MR, of which 9 cases showed tuberculosis nodules and tuberculoma, 5 cases (17.2%) showed tuberculous encephalitis, 16 cases (39.0%) complicated with extracranial tuberculosis, of which secondary pulmonary tuberculosis and tuberculous pleurisy were the most common. There were 22 cases (53.7%) with abnormal liver function and 23 cases (56.1%) with hyperuricemia after chemotherapy. Among 41 cases, 39 cases completed chemotherapy for 18 months including 35 cases (85.4%) showed improvement and 4 cases (9.8%) did not improve, the other 2 cases (4.9%) gave up treatment within 1 week and lost follow-up.Conclusion The clinical manifestations of nervous system in children with TBM are typical. Children can be complicated with extracranial tuberculosis. Laboratory examination is typical in cerebrospinal fluid, the positive rate of GeneXpert MTB/RIF is higher than that of cerebrospinal fluid culture. The skin test of tuberculosis, T-SPOT.TB,ESR and CRP are helpful to diagnosis. The skull imaging examination is not specific. Liver function abnormality and hyperuricemia is more common after chemotherapy, but the prognosis is better.

Analysis of characteristics of tuberculosis cases in schools in Dongguan city from 2015 to 2017

ZHONG Ming-hao,MEI Yue-zhi.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  203-208.  doi:10.3969/j.issn.2095-3755.2019.03.011

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Objective To provide the basis for improving the prevention and control measures of tuberculosis in schools, epidemiological characteristics of tuberculosis in dongguan schools were analyzed.Methods The total number and incidence of TB patients in schools who completed anti-TB drug treatment courses were collected from 2015 to 2017, and reported the patient’s gender, age, school distribution, disease classification, onset and education stage from the sub-systems of “Infectious Disease Report Information Management System”and “Tuberculosis Information Management System”in the Chinese Information System for Disease Control and Prevention. The whole population statistics of 2017 and before were obtained from Dongguan statistical yearbook 2017 of Dongguan municipal bureau of statistics. The demographic data of students and teachers in Dongguan city were obtained from the general table of basic conditions of various schools in Dongguan city in the academic year 2015/2016-2017/2018 issued by Dongguan education bureau. SPSS 21.0 software was used to conduct statistical analysis of demographic characteristics and disease characteristics of the data of tuberculosis patients reported by the school. P<0.05 was considered statistically significant.Results rom 2015 to 2017, a total of 224 TB patients were reported in Dongguan, and the annual reported incidence was 4.54/100000 (224/4929416). The average annual incidence of student patients (3.97/100000, 186/4682822) was lower than that of teacher patients (15.41/100000, 38/246594) (χ ²=67.45, P=0.000). From 2015 to 2017, the student reported incidence of the disease (2.85/100000 (43/1506393), 4.38/100000 (68/1554199) and 4.62/100000 (75/1622230), respectively) had an increasing trend year by year (χ ²=6.05, P<0.01). However, the teacher reported incidence of the disease (12.78/100000 (10/78219), 17.21/100000 (14/81343), and 16.09/100000 (14/87032)) did not increase year by year (χ ²=0.28, P=0.600). The ratio of male and female were 1.55∶1 (113 cases and 73 cases, respectively) and 0.65∶1 (15 cases and 23 cases, respectively), the difference was not statistically significant (χ ²=1.62, P=0.445; χ ²=0.63, P=0.730). Students aged 15-19 years accounted for 67.74% (126/186) of the total number of reported students. The proportion of patients in general middle schools was higher than that in other education stages (53.76% (100/186) vs. 46.24% (86/186))(χ ²=144.78, P<0.05). The incidence of secondary vocational and technical school students (4.30/100000 (3/69734), 17.40/100000 (13/74700), 32.38/100000 (26/80294)) showed an increased trend (χ ²=15.82,P<0.01). The reported TB in students was mainly pathogen negative (72.04%,134/186), and the incidence peak was in April (17.74%,33/186).Conclusion From 2015 to 2017, the incidence of TB reported by students increased year by year in Dongguan city, with more males than females. School TB control is focused on the secondary level, especially in high schools and vocational and technical schools.

Analysis of epidemic features of smear-positive pulmonary tuberculosis in Xinjiang Uygur Autonomous Region from 2010 to 2017

WANG Xi-jiang,WANG Sen-lu,ZHAO Zhen,ZHANG Jing, ,TAI Xin-rong,CUI Yan.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  209-217.  doi:10.3969/j.issn.2095-3755.2019.03.012

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Objective To analyze the epidemiological characteristics and spatial distribution of smear-positive tuberculosis (TB) patients registered in Xinjiang Uygur Autonomous Region (Xinjiang) from 2010 to 2017, to provide evidence for further exploring and developing TB prevention strategy in high TB burden areas.Methods Of the 71172 case reports of smear-positive pulmonary tuberculosis patients registered in 96 counties/cities/districts of Xinjiang from 2010 to 2017 were obtained from China Disease Prevention and Control Information System. Then general disease distribution features were analyzed using SPSS 22.0, while spatial clustering of smear-positive pulmonary tuberculosis were demonstrated using GIS and SaTScan 9.5.Results From 2010 to 2017, 71172 registered smear positive pulmonary tuberculosis patients were registered in Xinjiang, of which 54450 were new patients, accounting for 29.01% (71172/245339) of all patients. The average annual smear positive registration rate was 39.32/100000 (71172/181024701), showing a gradually descending trend (52.87/100000-30.69/100000). Spatial scanning analysis showed that those new smear positive patients mainly aggregated in 7 clustering areas, within which one cluster area including 29 counties/cities/districts in Kashgar, Aksu and Hotan was the largest (35.5/100000;RR=3.4, LLR=2701.28, P<0.01).Conclusion The registration rates of smear-positive pulmonary tuberculosis in Xinjiang from 2010 to 2017 were declining. New cases in Kashgar, Aksu and Hetian prefectures showed a spatial aggregation, which should be the focus area for prevention and control in the future.

Value of colloidal gold enhanced immunochronmtography assay in evaluation of therapeutic effect of non-HIV-infected pulmonary cryptococcosis

FANG Su-fang,ZHANG Hong-ying,HUANG Ming-xiang.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  218-224.  doi:10.3969/j.issn.2095-3755.2019.03.013

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Objective To explore the value of lateral flow assay (LFA) in evaluating therapeutic effect of cryptococcal capsular antigen in non-HIV-infected pulmonary cryptococcosis.Methods Twenty-seven from 33 non-HIV-infected pulmonary cryptococcosis patients, who were diagnosed based on HIV test, pathological biopsy and fungal culture in Fuzhou Pulmonary Hospital of Fujian Province from March to September 2017, were collected. Their serum capsular antigen (CrAg) were positive by LFA, and all of them consent to standard treatment in our hospital and regular follow-up with voluntary signature of informed consent. Of the 27 patients, 25 were diagnosed based on pathological examination, and the other 2 were based on cryptococcus neoformans cultured from bronchoalveolar lavage fluid. Qualitative and semi-quantitative data of CrAg, clinical symptoms and chest CT, in 1 month, 3 months, 6 months, 9 months, 12 months, 15 months and 18 months after treatment, were collected. Cumulative response rate and confidence interval of low titer group (<160, n=13) and high titer group (≥160, n=14) before treatment were analyzed by Log-rank test using SPSS 19.0, in order to detect relationship of CrAg changes tested by LFA and complete clinical remission. P<0.05 was considered statistically significant.Results Twenty-four patients underwent anti-fungal treatment, and the other 3 were anti-fungal combined with surgery. After 3-month treatment of anti-fungal, symptoms of 23 patients with clinical symptoms before treatment, were disappeared. During the 18-month follow-up, chest CT showed that most lesions were absorbed, and only few strip shadow were found in 12 patients, the complete response rate was 44.4 (12/27); gradually absorbed in 14 patients, and the partial response rate was 51.9% (14/27); there was no change of lesion found in only one patient. CrAg was negative after treatment, and the change of semi-quantitative titer (from 40 (10, 160) to 5 (1,10)) showed a downward trend in the 27 patients. Analysis between semi-quantitative titer of CrAg before treatment and complete response rate in clinical showed that cumulative response rate in low titer group was higher than that in high titer group (74.2% vs. 21.4%,χ ²=6.808, P=0.009). CrAg in serum tested by LFA 3, 6, and 9 months after treatment (CrAg₃/CrAg₀:12.5 (6.3, 25.0), CrAg₆/CrAg₀: 6.3 (0.0, 12.5),and CrAg₉/CrAg₀:3.1 (0.0, 12.5), respectively) were highly related to clinical response 6, 9 and 12 months after predictive treatment (CR₆: 29.6% (8/27); CR₉: 40.7% (11/27); CR₁₂: 44.4% (12/27), respectively) (95%CI of AUC were 0.845 (0.660-1.000), 0.807 (0.605-1.000), and 0.836 (0.653-1.000), respectively; Z=2.787, 2.665, 2.952, respectively; P=0.005, 0.008, 0.003, respectively; sensitivity were 89.5%, 93.8%, and 93.3%, respectively;specificity were 75.0%, 72.7%, and 83.3%, respectively). The antifungal drugs were discontinued after 18-month treatment in total 27 patients; however, the CrAg was still positive in 9 patients (titer: 5-20). Conclusion Monitoring of CrAg in serum by LFA is an important to evaluate the efficacy of treatment for non-HIV-infected pulmonary cryptococcosis, but it could not be used as a basis for withdrawal.

Analysis on the effect of benchmarking management on health education for inpatients with tuberculosis

YAN Xiang-qin,SHAO Guo-hui.

Journal of Tuberculosis and Lung Health. 2019, 8(3):  225-228.  doi:10.3969/j.issn.2095-3755.2019.03.014

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Objective To explore the application effect of the standard management method in health promotion and education of hospitalized tuberculosis patients (abbreviated as “interpretation and education”).Methods One hundred and sixty inpatients in tuberculosis wards from June 2016 to June 2017 were selected as the study subjects, 98 were men (61.2%) and 62 were women (38.8%). The age range was 18-66 years old and the average age was 46.6±8.5 years old. The patients were randomly divided into control groups (80 cases) and study groups (80 cases) according to the numerical table method. In the control group, the patients were taught regularly, and in the study group, the patients were treated with the standard management method, the quality of life scores and anxiety and depression scores were compared between the two groups after health education.Results The total quality life score of the research group after the interpretation and education was 72.5±3.6, and the total quality life score of the control group was 56.8±4.1. The difference of the total quality life score between the two groups has statistically significant (t=8.885,P<0.05).After interpretation and education, the anxiety score of the study group was 36.2±2.9, the depression score was 34.2±3.8, and the anxiety score of the control group was 42.3±2.6, and the depression score was 39.9±4.9. There were significant differences in anxiety and depression scores between the two groups (t=11.240,6.570,P<0.001).Conclusion The application of standard management method used for tuberculosis patients in health education can improve the life quality and ease the anxiety and depression of patients.

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Analysis on epidemic characteristics of pulmonary tuberculosis among students in Tengchong City of Yunnan Province, 2014—2018

LIU An-heng,GUO Chao,HUANG Zheng-qin,CAI Ling-ling

Journal of Tuberculosis and Lung Health. 2019, 8(3):  229-231.  doi:10.3969/j.issn.2095-3755.2019.03.015

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Descriptive analysis of incidence of pulmonary tuberculosis among students in Tengchong City of Yunnan Province from 2014 to 2018 was conducted basing on data from Chinese Tuberculosis Information Management System. Characteristics of disease onset time, patients’ age, sex and method of detection were described qualitatively. A total of 53 student tuberculosis patients in Tengchong City were reported from 2014 to 2018. Annual reporting rates were 2.73/100000 (3/109781), 4.57/100000 (6/131259), 9.23/100000 (12/130051), 3.09/100000 (4/129616), 21.72/100000 (28/128936) respectively, which showed an overall upward trend (χ2= 38.093, P<0.05). The proportion of pulmonary tuberculosis in primary school, junior middle school and senior high school were 9.43% (5/53), 18.87% (10/53) and 71.70% (38/53) respectively. 75.47% (40/53) cases were detected by symptomatic visits to hospitals/clinics, 38.85% (19/53) cases were smear positive.