Table of Content

30 June 2021, Volume 2 Issue 2

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Expert Forum

Recent advances in molecular diagnostics of nontuberculous mycobacterial diseases

LIAO Xin-lei, WANG Gui-rong

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  98-101.  doi:10.3969/j.issn.2096-8493.2021.02.002

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Recently human infections caused by nontuberculous mycobacteria (NTM) are increasing. NTM diseases are mainly diagnosed by laboratory bacteriological assays. As a result of an increasing emphasis on the importance of differential identification of NTM species, several molecular tools have recently been introduced in clinical settings. In this paper, we summarized frequently used molecular diagnostics for identification and differentiation of NTM species and their relevant strengths and weaknesses to facilitate the choice of related assays.

The risk of aerosol transmission of respiratory infectious diseases and suggestions for prevention and control

LYU Ke-yang, XU Dong-qun

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  102-107.  doi:10.3969/j.issn.2096-8493.2021.02.003

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The COVID-19 pandemic is still ravaging around the world. Respiratory viruses can be transmitted via different modes of transmission with strongly contagious. People stay in the indoor environment for a long time, in a relatively confined space, the risk of aerosol transmission is extremely high. The paper summarizes the risk, influencing factors as well as prevention and control measures of aerosol transmission of respiratory infectious diseases in different settings in daily life. It hopes to provide a reference for the prevention and control of respiratory infectious diseases under the new situation in China.

Interpretation of Standards

Interpretation of the Guidelines for diagnosis and treatment of non-tuberculous mycobacteria disease (2020 edition)

LIU Sheng-sheng, TANG Shen-jie

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  108-115.  doi:10.3969/j.issn.2096-8493.2021.02.004

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In recent years, non-tuberculous mycobacteria (NTM) disease is increasing rapidly, which has become one of the important public health problems threatening human health and has been widely concerned. Therefore, based on the Chinese expert consensus on diagnosis and treatment of non-tuberculous mycobacteria disease, the Tuberculosis Branch of the Chinese Medical Association organized experts in related fields to develop the Guidelines for diagnosis and treatment of non-tuberculous mycobacteria disease (2020 edition) by referring to the Treatment of non-tuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline issued in 2020, the British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) issued in 2017, as well as the research achievements and diagnosis and treatment experience of NTM disease at home and abroad in recent years. The guidelines has important guiding significance for the standardization of the clinical diagnosis and treatment practice of NTM in China. In order to help the fellow peers to better understand this guideline and improve the clinical practice, the authors interpreted its main contents for reference.

Interpretation of the Diagnosis of Non-tuberculous Mycobacteria Disease

LUO Xue-jiao, SHA Wei

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  116-119.  doi:10.3969/j.issn.2096-8493.2021.02.005

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To further standardize the diagnosis of non-tuberculous mycobacteria (NTM) diseases in China, Chinese Anti-tuberculosis Association developed a consortium standard The Diagnosis of Non-tuberculous Mycobacterial Disease which was launched and put it into force from July 7th, 2020. In this paper, the background and main content of the standard are explained in detail to provide references for the majority of health care workers,and to further improve the general understanding and diagnosis capability of NTM disease.

Original Articles

Analysis of the clinical characteristics of Mycobacterium avian complex pulmonary disease and the risk factors of treatment effect

LIAO Xiao-qin, LIN Jian-dong, WU Di, CHEN Xiao-hong

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  120-124.  doi:10.3969/j.issn.2096-8493.2021.02.006

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Objective To analyze the clinical characteristics of Mycobacterium avium complex (MAC) lung disease, and to explore the risk factors of the therapeutic effect. Methods Seventy-five patients with MAC lung disease hospitalized in Fuzhou Pulmonary Hospital of Fujian Province from October 2017 to December 2018 and treated and followed up regularly more than one year were retrospectively analyzed. Medical history of all the patients was complete, sputum or bronchoalveolar lavage fluid samples were positive by mycobacterium culture, and the species identification was clear. The patients were divided into different groups by results of the mycobacterium sputum culture 1-year after anti-nontuberculous mycobacteria (NTM) treatment. Single factor analysis was used to explore the effects of gender, age, nutritional status, basic disease/comorbidity, with or without cavity, with or without bronchiectasis, regular treatment or not and four empirical combination regimens of regular treatment. Results Among the 75 patients with MAC lung disease, intracellular subtypes accounted for 78.7% (59/75); and bird subtypes accounted for 21.3% (16/75). 54.7% (41/75) were female, and 61.3% (46/75) aged over 60 years old. Of the patients, 97.3% suffered underlying diseases/comorbidities, among them, bronchiectasis accounted for 76.0% (57/75), previous history of tuberculosis accounted for 32.0% (24/75), pneumoconiosis accounted for 16.0% (12/75), and chronic obstructive pulmonary disease (COPD) accounted for 12.0% (9/75). The main clinical symptoms were cough and expectoration (96.0%, 72/75), shortness of breath (44.0%, 33/75), hemoptysis (34.7%, 26/75), fever (21.3%, 16/75), and chest tightness (16.0%, 12/75). As for imaging manifestations, nodular bronchiectasis was the most common type (76.0%, 57/75), followed by fibrous cavity type (68.0%, 51/75) and solitary nodule type (4.0%, 3/75). The negative conversion rate of mycobacterium sputum culture in MAC lung disease after 1-year-treatment was 60.0% (45/75); male, history of COPD and irregular treatment (sputum negative conversion rates were 47.1% (16/34), 2/9, and 1/6, respectively) were the risk factors of sputum bacteria without negative conversion. Conclusion The patients with history of bronchiectasis, tuberculosis, COPD, pneumoconiosis, diabetes and low immunity were mostly likely to suffer MAC lung disease, the bacteria should be identified in time; MAC lung disease has a low sputum bacteria negative conversion rate. The understanding of NTM lung disease should be strengthened for male patients, patients with COPD history and irregular treatment. The patients’ doubts should be removed in time, and the adverse drug reactions in treatment should be actively dealt with.

Comparative analysis of CT signs of Mycobacterium kansasii pulmonary disease and pulmonary tuberculosis

ZHOU Bi-xia, YUAN Gong-ling, ZENG Ling-wu, ZHU Yi, CHENG Xi, LI Min, WU Mei-ying

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  125-130.  doi:10.3969/j.issn.2096-8493.2021.02.007

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Objective To analyze the similarities and differences of CT signs of cavity due to Mycobacterium kansasii lung disease and pulmonary tuberculosis. Methods A retrospective study was conducted, 45 patients with cavity due to Mycobacterium kansasii lung disease diagnosed by clinical and laboratory examinations of Suzhou Fifth People's Hospital from January 2018 to June 2020 were selected as the observation group; 50 patients with cavity due to pulmonary tuberculosis of the same period were selected as the control group. The image signs, such as number of cavities in the lungs, the extent of pulmonary lobes involved, the distribution location, shape, size, wall thickness, internal and external wall smoothing, contents and surrounding structures, of the two groups were compared and analyzed. Results A total of 60 cavities appeared in 45 patients in the observation group, and there were 75 cavities appeared in 50 patients in the control group. The proportion of patients with 3 or more cavities in the observation group was significantly lower than that of the control group (2.2% (1/45) vs. 14.0% (7/50), χ ²=4.26, P=0.039). In the observation group, the proportions of cavities in the upper lobe of the right lung and in the outer zone were both significantly higher than those in the control group (70.0% (42/60) vs. 36.0% (27/75), χ ²=15.42, P=0.000; 91.7% (55/60) vs. 58.7% (44/75), χ ²=18.56, P=0.000); the proportion of irregular voids was significantly higher than that in the control group ((25.0% (15/60) vs. 2.7% (2/75), χ ²=15.11, P=0.000). The cavity wall thickness of the observation group was significantly lower than that of the control group (M(Q₁,Q₃), 2.3 (0.9, 8.3) mm vs.3.6 (1.0,10.8) mm, U=-4.34, P=0.000). In the observation group, the smoothing ratio of the inner wall of the cavity was significantly lower than that of the control group (85.0% (51/60) vs. 96.0% (72/75), χ ²=4.98, P=0.026), and the ratio of smoothing the outer wall was more than that of the control group (85.0% (51/60) vs. 57.3% (43/75), χ ²=12.07, P=0.001), the incidence of satellite foci around the cavity was significantly lower than that in the control group (38.3% (23/60) vs. 70.7% (53/75), χ ²=14.16, P=0.000); the incidence of pleural thickening adjacent to the cavity was significantly higher than that in the control group (91.7% (55/60) vs. 69.3% (52/75), χ ²=10.11, P=0.001). Conclusion There were differences in CT signs between the cavity lesions of Mycobacterium kansasii lung disease and the cavities of tuberculosis, which could provide a basis for clinical diagnosis.

Clinical analysis of 36 cases of pulmonary Langerhans cell histiocytosis

HUANG Wei-hua, WANG Chun-yan, LUO Qun, GU Ying-ying, XIE Jia-xing, XIA Ting-ting, ZHANG Qing-ling, ZHANG Xiao-xian

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  131-138.  doi:10.3969/j.issn.2096-8493.2021.02.008

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Objective To improve the clinical understanding for pulmonary Langerhans cell histiocytosis (PLCH), including their clinical, radiological and pathological features and prognosis. Methods Retrospective analysis of 36 patients diagnosed with PLCH and hospitalized in The First Affiliated Hospital of Guangzhou Medical University between September 2009 and August 2019 was conducted. HRCT scores (using the Muller scoring method) of nodular lesions, cystic lesions and pulmonary interstitial lesions were compared. According to results of transbronchial lung biopsy (TBLB) at the first time,the patients were divided into two groups: positive TBLB result group (11 patients) and negative TBLB result group (8 patients). According to the level of eosinophilic infiltration in lung pathology,the patients were divided into two groups:higher eosinophilic infiltration group (18 patients) and lower eosinophilic infiltration group (13 patients). According to the prognosis, PLCH patients were divided into two groups: survival group (32 patients) and death group (4 patients).The clinical characteristics of those groups were compared. Results The median age of 36 patients with PLCH was 27.50 (19.50,36.75) years old. 55.56% (20/36) patients had spontaneous pneumothorax. The median HRCT total score of 36 patients was (6.71±2.84). The median HRCT scores of nodular lesions, cystic lesions and pulmonary interstitial lesions were 2.67 (0.67,4.33), 3.67 (1.75,4.33) and 0.00 (0.00,1.92), respectively, and the difference between them was statistically significant (χ²=18.000,P<0.001). HRCT score of cystic lesions was negatively correlated with the percentage of predicted value of forced expiratory volume in 1 second (FEV₁%pred) and forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) (r_s=-0.527,P=0.008;r_s=-0.440,P=0.032, respectively). Nineteen patients underwent TBLB, and 57.89% (11/19) patients obtained positive pathological results of PLCH at the first time of TBLB. The average percentage of predicted value of diffusion capacity for carbon monoxide of lung-single breath method (DLCO SB%pred) among this positive TBLB result group was (75.19±11.91) %, significantly higher than that of the negative group ((55.43±17.10) %, t=2.449, P=0.032). The average HRCT score of pulmonary interstitial lesions in the positive group was 0.00, significantly lower than that in the negative group (4.50 (0.00, 4.92),P=0.020). In the lung pathological tissues of PLCH, 61.11% (11/18) of the patients with higher eosinophilic infiltration had nodular lesions, significantly higher than those with lower eosinophilic infiltration (15.38% (2/13),P=0.025). 4 (11.11%, 4/36) patients died and all the dead patients (100.00%) were diagnosed as multi-system PLCH, which was significantly higher than that in the survival group (31.25% (10/32),P=0.017). Conclusion For patients with pneumothorax as the main clinical manifestation, cystic and nodular lesions as the main radiological findings, with/without multi-system involvement, the possibility of PLCH should be considered. TBLB was recommended for suspected PLCH patients with better diffusion function and no interstitial lesions in HRCT. Multi-system involvement was the adverse factor of prognosis.

The application of video microclass combined with teach-back health education model in the prevention of disability progression in patients with chronic obstructive pulmonary disease

WANG Ya-qian

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  139-143.  doi:10.3969/j.issn.2096-8493.2021.02.009

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Objective To explore the role of video micro-lesson combined with teach-back health education model in preventing disability progression of patients with chronic obstructive pulmonary disease (COPD). Methods One hundred and seven COPD patients admitted to Jingshan People’s Hospital from May 2020 to January 2021 were selected as the research objects. Among them, 53 COPD patients admitted from May to October 2020 were intervened by routine health education mode as control group, while 54 COPD patients admitted from November 2020 to January 2021 were intervened by video micro-lessons combined with teach-back health education mode as observation group. The adult disability assessment tool (DATA Scale) was used to compare the disability scores of the two groups after discharge, including the ability of daily activities, mental state, perception and social participation. Self-made questionnaire was used to calculate the satisfaction of the two groups of patients with two types of health education methods. Results The score of daily activities in the observation group was 81.21±1.81, which was higher than that in the control group (75.13±2.82). The mental state score of the observation group was 1.07±0.14, which was lower than that of the control group (2.22±0.21). The score of perception and social participation of the observation group was (2.14±0.23), which was lower than that of the control group 4.52±0.32. The total score of the observation group was (78.60±2.10), which was higher than that of the control group (64.50±4.30), and the differences were statistically significant (t values were 14.351, 12.564, 11.954, 5.846, P values were 0.000, 0.031, 0.025 and 0.000, respectively). After intervention, the satisfaction of health education in the observation group was 87.0% (47/54), which was significantly higher than that in the control group (60.4% (32/53)) (χ²=4.526, P=0.033). Conclusion Video micro-lesson combined with teach-back health education model is an effective health education model, which plays a positive role in preventing the progress of COPD disability.

Analysis of epidemiological characteristics of tuberculosis in schools in Guangxi from 2017 to 2019

ZHOU Ling-yun, LIANG Da-bin, LI Juan, HUANG Min-ying, ZHAO Jin-ming, LIANG Xiao-Yan

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  144-149.  doi:10.3969/j.issn.2096-8493.2021.02.010

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Objective To analyze the epidemiological characteristics of tuberculosis in schools in Guangxi Zhuang Autonomous Region, and to provide reference for effective prevention and control measures. Methods A retrospective study was conducted. Data of tuberculosis patients classified as “students” and “teachers” in school in Guangxi Zhuang Autonomous Region between 2017 and 2019 were annually derived from the “tracking information management” of Tuberculosis Management Information System of China Center for Disease Control and Prevention. From the Tuberculosis Prevention and Control Institute, GuangXi Zhuang Autonomous Region Center for Disease Prevention and Control, the registration form of tuberculosis epidemic situation in schools, the questionnaire of tuberculosis patients, the initial report, process report and closing report of tuberculosis epidemic situation in Guangxi (each city, districts or county) from 2017 to 2019 were consulted to collect the number of tuberculosis outbreaks (including aggregated epidemic situation and public health emergencies), number of patients, year of the outbreak, location of the school, nature of the school, disposal of the epidemic, screening of close contacts, and the prevention and control measures of tuberculosis in the school. The epidemiological characteristics of the epidemic situation was descriptively analyzed, and differences of indicators of the characteristics of the clustered epidemic situation and public health emergencies were compared. Results From 2017 to 2019, a total of 70 outbreaks of tuberculosis in schools in Guangxi were reported, the number of patients was 415, and accounted for 7.6% (116/1535), 8.9% (169/1896) and 12.9% (130/1009) of the tuberculosis cases in schools in Guangxi every year, respectively, showing an increasing trend year by year ( {\chi }_{\mathrm{trend}}^2 =18.969, P=0.000). Among them, there were 65 clustered outbreaks (331 cases) and 5 public health emergencies (84 cases). In south, southwest and northeast of Guangxi, patients accounted for 66.7% (277/415) of the total cases, clustered outbreaks accounted for 70.0% (49/70) of the total outbreaks; and patients aged 15-19 years accounted for 73.5% (305/415) of all the patients. Compared indicators of characteristics between the clustered epidemic situation and the public health emergencie, spring, secondary school, male indicated cases, delayed treatment in indicated cases, delayed investigation in indicated cases, positive etiological results in indicated cases, delay screening of close contacts nonstandard screening of close contacts, no tuberculosis screening for physical examination of staff, no tuberculosis screening for freshmen, morning and afternoon inspection system not implemented, ventilation system not implemented in dormitories and classrooms and so on in public health emergencies were significantly more than in clustered epidemic situation (69.0% (58/84) vs. 54.7% (181/331),χ ²=5.660, P=0.017; 83.3% (70/84) vs. 72.5% (240/331), χ ²=4.155, P=0.042; 62.6% (61/84) vs. 50.5% (167/331), χ ²=13.297, P=0.000; 100.0% (84/84) vs. 60.4% (200/331), Fisher test, P=0.000; 44.0% (37/84) vs. 13.3% (44/331), χ ²=40.341, P=0.000; 57.1% (48/84) vs. 43.8% (145/331), χ ²=4.790, P=0.029; 40.5 (34/84) vs. 29.0% (96/331), χ ²=4.100, P=0.043; 88.1% (74/84) vs. 49.5% (164/331), χ ²=40.702, P=0.000; 72.6% (61/84) vs. 57.1% (189/331), χ ²=6.737, P=0.009; 72.6% (61/84) vs. 40.2% (133/331), χ ²=28.318, P=0.000; 88.1% (74/84) vs. 9.4% (31/331), χ ²=219.726, P=0.000; 47.6% (40/84) vs. 11.2% (37/331), χ ²=58.874, P=0.000; respectively). Conclusion The proportion of tuberculosis patients in schools in Guangxi increased year by year. The epidemic mainly occurred in the south, southwest and northeast of Guangxi, and the incidence was high in those who aged 15-19 years. Early detection and early screening should be strengthened in spring, secondary schools, male students and indicated cases, and the implementation of standardized management measures of tuberculosis in schools should be strictly monitored.

Analysis on the operation of tuberculosis automated-alert system in schools in Beijing

LI Ya-min, GAO Zhi-dong, ZHAO Xin

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  150-155.  doi:10.3969/j.issn.2096-8493.2021.02.011

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Objective To analyze the current operation status of automated-alert system for tuberculosis in schools in Beijing, and to provide a basis for further improving the application of the system. Methods The information of early warning of tuberculosis from July 2018 to December 2020 was derived from the Automated-alert System for Tuberculosis, including the number of early warning signals, response and response results of the early warning signals of tuberculosis, and was analyzed and evaluated according to the temporal distribution, regional distribution and diagnosis results. Results A total of 6476 warning signals were issued by Automated-alert System for Tuberculosis from July 2018 to December 2020 with a signal response rate of 99.98% (6475/6476), and 99.24% (6426/6475) of signals were responded in 24 hours. The median responding time was 0.84 hours (Q₁-Q₃:0.23-3.38 h), finally 34.02% (2203/6476) early warning signals were identified as suspected events. As time went by, the proportion of signal response decreased from 99.51% (1617/1625) to 99.14% (1967/1984), the overall signal response time decreased from 1.09 (0.30, 4.60) h to 0.75 (0.21, 2.88) h, and the suspected event rate decreased from 36.31% (590/1625) to 29.12% (578/1985). Chaoyang District had the largest number of warning signals (1219), and Haidian District had the highest suspected incident rate (67.19%, 723/1076). With the improvement of the diagnostic level of pulmonary tuberculosis (from low to high, followed by no etiological results, etiological negative, etiological positive, rifampicin resistance), the number of early warning signals decreased from 4519 to 57, in which the suspected event rate of etiological negative pulmonary tuberculosis was the highest, which was 35.69% (439/1230). The positive predictive value and sensitivity of school tuberculosis outbreak epidemic was 0.23% (15/6476) and 46.88% (15/32). Conclusion The Automated-alert System for Tuberculosis in Beijing has a high response rate and response timeliness, but still has room to improve. District level tuberculosis prevention and control institutions need to improve the accuracy of early warning system and further improve the quality of early warning information disposal.

Knowledge, attitude and practice towards tuberculosis prevention and control among elderly people in Nanshan district, Shenzhen: a cross-sectional study

ZHONG Tao, WU Li-juan, FAN Yu-zheng, GUO Xu-jun, Wang Jian, LIU Sheng-yuan

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  156-163.  doi:10.3969/j.issn.2096-8493.2021.02.012

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Objective To assess the current status of tuberculosis knowledge, attitude, and practice (KAP) and their relationships among elderly people in Nanshan District, Shenzhen. Methods With simple random sampling, we selected 2517 elderly people aged 65 years or older who were registered in communities of Nanshan District, Shenzhen in 2018, conducted a cross-sectional survey on KAP towards tuberculosis prevention and control among them. 2517 questionnaires were sent out and 2360 valid questionnaires were retrieved, with a valid rate of 93.8%. Descriptive analysis was done to describe the KAP status, univariate analysis was conducted to analyze KAP scores among people with different sociodemographic characteristics, and Spearman’s correlation and four-quadrant analysis were done to explore the correlations among KAP scores. The statistical significance was set as α=0.05. Results The total awareness rate of tuberculosis prevention knowledge was 56.3% (7970/14160), the total correctness of tuberculosis attitude was 75.0% (8853/11800), and the total correctness of tuberculosis behavior was 61.4% (8689/14160) among elderly people in Nanshan District, Shenzhen. Univariate analysis showed that there were statistically significant differences in belief scores (t=2.386, P=0.017) and behavior scores (t=2.131, P=0.033) among different genders. The KAP scores among people with different educational levels were all statistically significant (F=36.561,P=0.000;F=65.586,P=0.000;F=39.126,P=0.000). The KAP scores among people with different marital status were all statistically significant (F=36.561,P=0.000;F=65.586,P=0.000;F=39.126,P=0.000);The KAP scores among people with different household registration locations (local or migrant) were statistically significant (t=5.536,P=0.000,t=10.062,P=0.000,t=8.080,P=0.000). The KAP scores among people with different income levels were statistically significant (F=34.483,P=0.000;F=54.469,P=0.000;F=33.238,P=0.000). Spearman correlation coefficient analysis showed that there were correlations among KAP scores. The correlation coefficient between knowledge score and belief score was 0.387 (P<0.05), the correlation coefficient between knowledge score and behavior score was 0.397 (P<0.05), and the correlation coefficient between belief score and behavior score was 0.442 (P<0.05). The four-quadrant analysis showed that there was 0.7% (16/2360) of people who had better knowledge and behavior(quadrant Ⅰ), 8.7% (206/2360) of people who did not have relevant knowledge but perform better behaviors(quadrant Ⅱ), 86.4% (2040/2360) of people who had poor knowledge and behavior(quadrant Ⅲ), and 4.2% (98/2360) of people who had better knowledge and poor behavior(quadrant Ⅳ). Conclusion The KAP scores towards tuberculosis prevention and control among the elderly in the Nanshan District is relatively low. To improve KAP scores, we should develop different health education programs towards tuberculosis prevention and control based on their sociodemographic characteristics.

Treatment and outcomes of rifampicin-resistant pulmonary tuberculosis in Beijing, 2016—2020

ZHANG Hong-wei, SUN Shan-hua, GAO Zhi-dong, XU Yan, TAO Li-ying, CHEN Xi

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  164-168.  doi:10.3969/j.issn.2096-8493.2021.02.013

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Objective To analyze the treatment and outcomes of rifampicin-resistant pulmonary tuberculosis in Beijing from 2016 to 2020, so as to provide the basis for improving the prevention and control strategy of drug-resistant tuberculosis in Beijing. Methods Information of patients with rifampicin-resistant pulmonary tuberculosis was extracted from the “TB Management Information System”. Descriptive analysis was conducted to interpret patients’ characteristics, treatment and outcomes. Results From 2016 to 2020, a total of 592 patients with rifampicin-resistant pulmonary tuberculosis were notified in Beijing, 69.43% (411/592) of them were male, and 77.03% (456/592) were young adults aged 25-64 years. The treatment initiation rates of patients increased year by year, from 74.29% (52/70) in 2016 to 97.79% (133/136) in 2020 ( {\chi }_{\mathrm{trend}}^2 =44.831, P<0.001). Treatment initiation rates of female and registered residents were 96.69% (175/181) and 94.55% (312/330), which were higher than those of male (90.27%, 371/411) and non-registered residents (89.31%, 234/262), and the differences were statistically significant (χ ²=7.221, P=0.007; χ ²=5.580, P=0.018). Treatment initiation rate of new patients was 95.37% (391/410), higher than patients classified as “sputum smear-positive at the end of 2nd and 3rd month” (68.18%, 15/22), recurrence (88.73%, 126/142), the difference was statistically significant (P<0.001, Fisher exact probability). The treatment success rate for the 228 patients with rifampicin resistance who started treatment before 2018 was 81.58% (186/228). The treatment success rate decreased with age increasing, from 8/8 in 15-24 years group to 74.19% (23/31) in 65-93 years group ( {\chi }_{\mathrm{trend}}^2 =7.479, P=0.006). Conclusion From 2016 to 2020, the treatment initiation rate of patients with rifampicin-resistance pulmonary tuberculosis in Beijing increased year by year, and the treatment success rate was high. However, attention should be paid to the detection and treatment of migrant and male patients with rifampicin-resistance.

Analysis of drug resistance of multidrug-resistant Mycobacterium tuberculosis to multiple drugs in Changping District of Beijing

LIU Xin-yu, ZHANG Qian, SUN Qian

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  169-173.  doi:10.3969/j.issn.2096-8493.2021.02.014

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Objective To explore the drug susceptibility of levofloxacin (Lfx), moxifloxacin (Mfx), bedaquiline (Bdq), linezolid (Lzd), clofazimine (Cfz) and delamanid (Dlm) against multidrug-resistant tuberculosis (MDR-TB) isolates from Changping District, and to illustrate the genetic characteristics of MDR-TB isolates with acquired drug resistance, further to provide the basis for clinical drug use, the results of drug resistance gene sequencing were compared with the standard strain. Methods A total of 83 MDR-TB isolates were collected from 2011—2015 in Beijing Changping Center for Tuberculosis Control after culture and strain identification. The minimum inhibitory concentrations (MICs) were used to detect the drug sensitivity of MDR-TB strains, and genes sequence related to drug resistance related genes were amplified and compared with the standard strains. Results Of the 83 MDR-TB isolates, Lfx and Mfx both had the highest resistance rate (41.0%, 34/83). The resistance rate to Bdq was the lowest (2.4%, 2/83). The resistance rate to Lzd, Cfz, and Dlm was 4.8% (4/83), 3.6% (3/83), and 4.8% (4/83), respectively. Among the 39 isolates resistant to Lfx and Mfx, the most prevalent resistance mutation was found in gyrA with the substitution of codon 94 (87.2%, 34/39). All 2 Cfz-Bdq cross resistant strains had a mutation in the Rv0678 gene, 2 of 4 Lzd resistant isolates carried mutations in rplC gene. Of the 4 isolates resistant to Dlm, 1 isolate with mutation in codon 318 of fbiC gene and 2 isolates in codon 81 of ddn gene. Conclusion The resistance of MDR-TB isolates to Lfx/Mfx was high while the lowest resistance rate was observed in Bdq in Beijing Changping District. The anti-TB drug with a low resistance rate should be selected according to the characteristics of MDR-TB patients in this region.

Analysis of smoking status and influencing factors of employees in enterprise in Shenzhen

CAO Li, ZHUANG Run-sen, ZHANG Yuan, HAN Tie-guang

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  174-178.  doi:10.3969/j.issn.2096-8493.2021.02.015

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Objective To analyze the current status and influencing factors of smoking among employees in enterprises in Shenzhen. Methods Using a multi-stage random sampling method, a total of 2269 employees of 21 companies from 10 districts in Shenzhen between August and November 2018 were selected with average of 100 employees from each company. If companies had less than 100 employees, all employees were participated in the survey. A questionnaire survey was conducted, 2269 questionnaires were distributed, and all the questionnaires were returned, 2018 questionnaires were valid. The questionnaire validity rate was 88.94%. The demographic characteristics, smoking status, drinking status, and health status of the subjects were collected, and multi-factor logistic regression was used to analyze the influencing factors of the smoking behaviors. Results The current smoking rate of survey subjects was 18.04% (364/2018), and males was significantly higher than females (34.55% (341/987) vs.2.23% (23/1031)); subjects aged ≤24 years had the highest current smoking rate (25.75% (77/299)); the current smoking rate in married people (14.54% (195/1341)) was significantly lower than that in non-married people (24.96% (169/677)); those with college degree or above had the lowest current smoking rate (15.18% (97/639)); the current smoking rate increased with increasing frequency of drinking (the smoking rate of non-drinkers was 6.86% (94/1370), and the smoking rate of daily drinkers was 69.23% (27/39)); those with poor self-evaluated health status had the highest current smoking rate (40.24% (33/82)). The differences were statistically significant (χ ² values were 356.252, 9.420, 33.050, 5.639, 396.183 and 9.854, respectively; P values were 0.000, 0.002, 0.000, 0.018, 0.000 and 0.002, respectively). Logistic regression analysis showed that female (OR=0.073, 95%CI: 0.045-0.118), college degree or above (OR=0.379, 95%CI: 0.172-0.837) were protective factors of smoking behavior. Non-married (OR=1.496, 95%CI: 1.123-1.993), poor self-evaluated health status (OR=3.423, 95%CI: 1.882-6.228) were risk factors of smoking behavior. The risk of smoking behavior increased with increasing frequency of drinking, and daily drinkers had the highest risk of smoking behavior (OR=12.227, 95%CI: 5.398-27.695). Conclusion For enterprise employees, male, non-married, low-educated, drinking alcohol and poor self-evaluated health status were risk factors of smoking behavior.

Evaluation of smoking cessation by family support methods

CHEN Wen-han, TAN Shou-yong, LIANG Min-qing, LI Hui-fen, ZHENG Min-li, WU Gui-feng, XIE Wei, LAI Keng, LI Li-tao, HUO Jin-rong

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  179-183.  doi:10.3969/j.issn.2096-8493.2021.02.016

Abstract ( 459 )   HTML ( 12 )   PDF (741KB) ( 663 )   Save

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Objective To evaluate the effectiveness of family support methods for smoking cessation. Methods A prospective intervention study design was used, 80 outpatients of smoking cessation clinics who met the inclusion criteria were selected, and each patient was evaluated with a standard baseline questionnaire at the first consultation, and followed up 1, 3, and 6 months after the first consultation. Trained physicians provided face-to-face psychological intervention and smoking cessation counselling for each patient. The patients were divided into control group (43 patients) and family support group (37 patients) according to whether their family members were accompanied at the first consultation. The control group was only given psychological intervention, and the family support group was given support and supervision for smoking cessation in the family on the basis of psychological intervention. The differences of the smoking cessation rates at the 7 days treatment, the relapse rates of patients who had quit smoking, and the degree of nicotine dependence at the end of the intervention of between the two groups were compared. Results At 1, 3, and 6 months of follow-up, the 7-day point prevalence on abstinence rate in the family support group (83.3% (30/36), 68.6% (24/35) and 48.6% (17/35)) were significantly higher than those in the control group (58.5% (24/41), 37.5% (15/40) and 17.5% (7/40)) (χ²=5.627, P=0.018; χ ²=8.142, P=0.017; χ ²=10.174, P=0.006). At the 3-month follow-up, the relapse rate in the family support group (20.0% (6/30)) was lower than that in the control group (37.5% (9/24)) without significant difference (χ ²=2.035, P=0.154). At the 6-month follow-up, the relapse rate in the family support group was significantly lower than that in the control group (43.3% (13/30) vs 70.8% (17/24), χ ²=4.084, P=0.043). At the end of the intervention, patients with severe nicotine dependence scores had significantly fewer in the family support group than controls (28.6% (10/35) vs 52.5% (21/40), χ ²=4.408, P=0.036). Conclusion In smoking cessation interventions, the use of family support methods can effectively increase the rate of quitting, reduce the rate of relapses, and have a positive effect on reducing smoking dependence among non-quitting smokers.

Review Articles

The progress of non-tuberculous mycobacterium disease in children

GUO Qian, SHEN Chen

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  184-188.  doi:10.3969/j.issn.2096-8493.2021.02.017

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Non-tuberculous mycobacteria (NTM) belong to Mycobacterium except for Mycobacterium tuberculosis complex (MTBC) and Mycobacterium leprae. Owing to the various kinds of NTMs and the varied drug sensitivity and resistance, clinical and pathological manifestations are atypical, which often lead to misdiagnosis and missed diagnosis of NTM disease in children. To have a comprehensive understanding of NTM disease and to improve the clinical diagnosis and treatment, this article reviews the NTM in classification, epidemiological characteristics, pathogenic mechanism, diagnosis and treatment based on the recent research.

Short Articles

Investigation of knowledge of Global Initiative for Asthma in physicians

ZHOU Jie, QI Qing, CHEN Long, WU Rui, SHI Guang-shuo, DU He, LIU Ya-xin, XIONG Lei, WU Zhi-le, WU Guo-xia

Journal of Tuberculosis and Lung Disease. 2021, 2(2):  189-192.  doi:10.3969/j.issn.2096-8493.2021.02.018

Abstract ( 356 )   HTML ( 2 )   PDF (787KB) ( 569 )   Save

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To investigate the knowledge of the Global Initiative for Asthma (GINA) in physicians, a questionnaire survey was conducted randomly among 194 physicians from Peking University Third Hospital Yanqing Hospital and 8 district hospitals between August 5, 2020 and March 16, 2021. A total of 194 questionnaires were distributed and 163 valid question aires were collected, with an effective rate of 84.0%. The survey showed that only 38.7% (n=63) of the subjects knew that the pathological basis of asthma is “nonspecific airway inflammation”, while 52.1% (n=85) of them chose “bronchospasm”. As to the main treatment drugs, 42.9% (n=70) chose “inhaled β2 receptor agonists”and 44.8% (n=73) chose “inhaled corticosteroids”; 62.6% (n=102) chose “inhalation method” as the best way of administration during the acute attack of non-severe asthma. Only 18 physicians (11.0%) had ever used the peak flow meter, but only 2 (1.8%) could correctly use and record the curve, 47.9% (n=78) even had never heard of it. Of the physicians, 11.0% (n=18) and 12.9% (n=21) did not know “hold their breath for 10 s” and “gargle the pharynx 2 to 3 times” when using glucocorticoids; only 63.8% (n=103) chose the correct choice of the interval between sprays; and 63.8% (n=103) had never heard of the GINA program, and only 5 (3.1%) had implemented it. The insufficient understanding of the new knowledge of bronchial asthma, inhalation therapy and application of peak flow meter was found in primary physicians, the promotion and application of GINA program in primary hospitals need to be urgently strengthened.