Table of Content

20 February 2022, Volume 3 Issue 1

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Original Articles

CT features of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis patients with different Traditional Chinese Medicine syndromes

REN Hui-li, PAN Jing-jie, ZHANG Hong, LIANG Rui-run, FANG Wei-jun

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  4-8.  doi:10.19983/j.issn.2096-8493.20210143

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Objective: To explore the CT features of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) patients with different Traditional Chinese Medicine (TCM) syndrome, to provide basis for TCM syndrome differentiation of tuberculosis patients. Methods: Thirty-seven MDR-TB patients and 23 XDR-TB cases diagnosed by Guangzhou Chest Hospital from July 2019 to December 2020 were studied with TCM Syndrome classification and CT examination. Correlation of TCM syndromes and chest CT image features was analyzed. Results: Among those 60 patients, 28 cases (46.67%) had Hyperactivity of Fire and Yin Deficiency (HFYD) syndrome, 24 cases (40.00%) had Deficiency of Qi and Yin (DQY) syndrome, 6 cases (10.00%) had Deficiency of Yin and Yang (DYY) syndrome, 2 cases (3.33%) had Pulmonary Yin Deficiency (PYD) syndrome. There were 2 cases (3.34%) with single lung lobe lesion, 8 cases (13.33%) with lesions in 2, 3 and 4 lung lobes for each, and 34 cases (56.67%) with lesions in all lung lobes. For patients with HFYD syndrome, there were 8 cases with single lobe lesion and 2 lobes, 9 cases with lesions in 3 lobes and 4 lobes, and 11 with lesions in all lung lobes; For patients with PYD syndrome, there were 2 cases with lesions in all lung lobes. There was significant differences in the distribution of lung lobes between those two TCM syndrome groups (χ²=10.100,P=0.031). Thirty-six cases (60.00%) had pulmonary cavities, among whom 1 case (2.78%) showed PYD, 15 cases (41.67%) showed HEYD, 14 cases (38.89%) showed DQY, and 6 cases (16.66%) showed DYY. For patients with HFYD syndrome, there were 4 cases having thick wall cavities, 3 cases having wormlike cavities, 3 cases having thin wall and wormlike cavities, 2 cases having thick wall, thin wall and wormlike cavities, 2 cases having thin wall cavities, 1 case having thick wall and wormlike cavities; One case with PYD syndrome had thick wall and thin wall cavities. There was significant differences in the shape of cavity between those two TCM Syndrome groups (χ²=11.929,P=0.026). For patients with HFYD syndrome, there were 19 cases having patch shadows, 17 cases having small nodule shadows, 15 cases having big nodule shadows, 15 cases having striate shadows, 14 cases having spot shadows, 8 cases having flaky shadows, 4 cases having block shadows and 3 cases having tree-bud sign. For patients with PYD syndrome, there were 2 cases having small nodule shadows, 2 cases having striate shadows, 1 case having patch shadows and 1 case having large nodule shadows, there was significant difference in pulmonary lesion morphology between those two TCM syndrome groups (χ²=15.600,P=0.015). Conclusion: Lesions of MDR-TB and XDR-TB were widely distributed in patient’ lungs and cavities were quite common. The TCM syndromes of HEYD and DQY were major TCM manifestations.There were significant differences in lung lesion distribution, morphology, cavity between the PYD syndrome and HFYD syndrome groups which could provide certain guidance for TCM clinical practice.

The diagnostic value of ultrasound-guided pleural biopsy and medical thoracoscopy on detecting tuberculous pleurisy

TAO Tao, WU Peng, BAO Xiao-li, TANG Nan

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  9-13.  doi:10.19983/j.issn.2096-8493.20210149

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Objective: To evaluate the diagnostic value of ultrasound-guided pleural biopsy (USPB) and medical thoracoscopic pleural biopsy (MTPB) in detecting tuberculous pleurisy. Methods: The keyword “tuberculous pleurisy” was searched in Lianzhong Electronic Medical Record Database. According to the inclusion criteria, electronic medical records of 139 patients (43 cases of USPB and 96 cases of MTPB) were collected. These patients were hospitalized in the Department of Respiratory and Critical Care Medicine, Chongqing Fuling Central Hospital from January 2014 to December 2019 and diagnosed with tuberculous pleurisy with biopsy pathology reports. Performing 1∶1 propensity score matching, 31 patients in USPB group and 31 patients MTPB group were successfully matched. We compared the biopsy sampling success rate, the pathological diagnosis rate, postoperative complications, and the length of hospital stays. Results: In USPB group and MTPB group, there were no significant differences in the pathological diagnosis rate (74.2% (23/31) and 64.5% (20/31), χ²=2.018, P=0.402), the sampling success rate (96.8% (30/31) and 100.0% (31/31), χ²=1.016, P=1.000), and postoperative complications of subcutaneous hematoma (9.7% (3/31) and 0.0% (0/31), χ²=3.153, P=0.238) and medical pneumothorax (0.0% (0/31) and 9.7% (3/31), χ²=3.153, P=0.238); The incidences of subcutaneous emphysema and pain in the USPB group (6.5% (2/31) and 6.5% (2/31), respectively) and average hospital stays (8 (7, 9) d) were lower or shorter than that in the MTPB group (35.5% (11/31), 58.1% (18/31), 11 (8, 12) d), the differences were statistically significant (χ²=7.784, P=0.011; χ²=18.895, P=0.000; Z=3.851, P=0.000). Conclusion: Both USPB and MTPB had high sampling success rate and pathological diagnosis rate in tuberculous pleurisy patients, while USPB was superior than MTPB in lowering postoperative subcutaneous emphysema, pain and shortening hospital stays.

Clinical efficacy and safety evaluation of cryointerventional therapy under electronic bronchoscope for patients with bronchial tuberculosis

ZHAO Guang-qiang, WANG Bin, CHEN Yun-ting, LIANG Wen-xiao, LIANG Gui-lin, LIN Rong

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  14-18.  doi:10.19983/j.issn.2096-8493.20210098

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Objective: To evaluate the clinical efficacy and safety of cryointerventional treatment under electronic bronchoscope for patients with bronchial tuberculosis. Methods: Patients with bronchial tuberculosis, who were treated in Sanya People’s Hospital from December 2016 to November 2019, were enrolled in this study. By random number table method, 30 patients were selected as the control group from 59 patients who were treated in the hospital before January 2018 and electronic bronchoscopic cryotherapy had not been used at that time; 30 patients were selected as the observation group from 75 patients who received treatment of cryotherapy under electronic bronchoscope in our hospital after February 2018. The patients in the control group received standard anti-tuberculosis drug treatment, while the pateints in the observation group received a combined treatment of cryotherapy under electronic bronchoscope and anti-tuberculosis drug treatment. The clinical treatment outcomes of the patients was evaluated after 3 months of treatment. The overall treatment effectiveness rate, the negative conversion rate of acid fast staining smear examination with deep sputum, the improvement of airway diameter and the incidence of complications before and after treatment were compared between the two groups. Results: The overall effectiveness rate (96.7%, 29/30) and the negative conversion rate of deep sputum (90.0%, 27/30) in the observation group patients were higher than those in the control group patients (76.7% (23/30) and 66.7% (20/30), respectively)(χ²=5.192, P=0.023; χ ²=4.812, P=0.028). The airway inner diameter ((7.65±1.78) mm) in the observation group patients was significantly larger than that before treatment ((5.22±1.56) mm), and the difference was statistically significant (t=5.632, P<0.001). The airway inner diameter ((6.37±1.69) mm) in the control group patients was larger than that before treatment ((5.50±1.46) mm), but the difference was not statistically significant (t=0.539, P=0.592). There were no serious complications in the observation group patients. Conclusion: Cryointerventional therapy with electronic bronchoscope can improve the treatment outcomes of the patients with bronchial tuberculosis, improve airway stenosis of the pateints and shorten their disease courses. It is a treatment method with high effectiveness and safety.

Clinical effect of short-term regimen containing levofloxacin in the treatment of newly diagnosed bacteria-positive pulmonary tuberculosis

CHEN Zhuang-hao, LIN Jian-xiong, ZENG Li-xiang

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  19-21.  doi:10.19983/j.issn.2096-8493.20210145

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Objective: To analyze the clinical effect of short-term regimen containing levofloxacin (Lfx) in the treatment of newly diagnosed bacteria-positive pulmonary tuberculosis. Methods: A prospective study was conducted in 132 newly diagnosed bacteria-positive pulmonary tuberculosis patients in Shantou Tuberculosis Prevention and Treatment Institution from January 2017 to December 2019. The patients were consecutively numbered and randomly divided into observation group (n=68) and control group (n=64). The control group was treated with routine 2H-R-Z-E/4H-R scheme (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol), and the observation group was treated with 4.5Lfx-H-R-E-Z scheme. The cure rate, sputum negative conversion rate, focus absorption, incidence of adverse drug reactions and recurrence rate were compared between the two groups. Results: The cure rate of the observation group was 100.0% (68/68), which was significantly higher than that of the control group (90.6% (58/64))(Fisher’s exact probability method, P=0.011). The negative conversion rates of sputum bacteria in the observation group and the control group at the end of 2 months (8 weeks) of treatment were 97.1% (66/68) and 96.9% (62/64), respectively, with no significant difference (Fisher’s exact probability method, P>0.05). The total effective rate of lesion absorption was 100.0% (68/68) in the observation group and 90.6% (58/64) in the control group, with no significant difference (χ²=3.552, P=0.470). The incidence of adverse drug reactions in the observation group and the control group were 20.6% (14/68) and 18.8% (12/64), respectively, with no significant difference (χ²=0.070, P=0.791). After 2 years of follow-up, the recurrence rate was 2.9% (2/68) in the observation group and 3.1% (2/64) in the control group, with no significant difference (Fisher’s exact probability method, P=1.000). Conclusion: The short-term regimen containing Lfx is effective and safe in the treatment of newly diagnosed bacteria-positive pulmonary tuberculosis.

Analysis of willingness and effect of tuberculosis assistant APP and electronic kit in pulmonary tuberculosis patients

LI Yong, LU Li-ping, LI Jin, ZOU Jin-yan

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  22-26.  doi:10.19983/j.issn.2096-8493.20210110

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Objective: To analyze the willingness and effect of tuberculosis assistant APP and electronic kit in pulmonary tuberculosis patients. Methods: A total of 297 active pulmonary tuberculosis patients registered in Songjiang District, Shanghai from May 1 to October 31, 2019 were collected and screened according to the registration order and inclusion criteria. Based on the principle of informed consent, 269 patients who met the inclusion criteria were selected. After independent choose of tuberculosis assistant APP or electronic kit voluntarily, the cases were divided into tuberculosis assistant APP group (n=72) and electronic kit group (n=76). These 148 patients were prospectively studied until the end of the course of treatment. The willingness of patients with different gender, age and household registration to choose the tuberculosis assistant APP or the electronic kit, and the overall medication rate of the tuberculosis assistant APP group and the electronic kit group were analyzed. Results: Among the 269 patients, 72 chose the tuberculosis assistant APP, with a usage rate of 26.8%. The usage rate of household registration patients in this city was 13.6% (11/81), and the usage rate of floating population patients was 32.4% (61/188), and the difference was statistically significant (χ²=10.28, P<0.01). The usage rate of patients aged 18-44 years was 35.4% (67/189), the usage rate of patients aged 45-59 years was 8.8% (3/34), and the usage rate of patients aged ≥60 years was 4.3% (2/46), the difference was statistically significant (χ²=24.65, P<0.01). Of the 269 patients, 76 chose the electronic kit, with a usage rate of 28.3%. The usage rate of household registration patients in this city was 51.9% (42/81), and the usage rate of floating population patients was 18.1% (34/188), the difference was statistically significant (χ²=31.84, P<0.01). The selection rate of patients aged 18-44 years was 19.6% (37/189), the usage rate of patients aged 45-59 years was 38.2% (13/34), and the usage rate of patients aged ≥60 years was 56.5% (26/46), the difference was statistically significant (χ²=26.83, P<0.01). There were 197 patients unwilling to use the tuberculosis assistant APP, mainly because they thought it was troublesome to punch in every day, which accounting for 44.7% (88/197); 193 patients were unwilling to use electronic kit, the main reason was that they thought using pill boxes was not as convenient as taking medicine directly, which accounting for 29.0% (56/193). The overall medication rate of the tuberculosis assistant APP group was 95.2% (19478/20461), which was significantly higher than that of the electronic kit group (93.3%, 20183/21631) (χ²=69.01, P<0.01). The overall regular medication rate of tuberculosis assistant APP group was 93.1% (67/72), and that of electronic kit group was 90.8% (69/76). Conclusion: Pulmonary tuberculosis patients have a certain willingness to use the tuberculosis assistant APP and the electronic kit. The use of the tuberculosis assistant APP and the electronic kit to supervise the medication management of pulmonary tuberculosis patients has a good effect on the medication rate and treatment compliance.

Drug-resistant tuberculosis among patients in Ji’nan from 2016 to 2020

CAI Jun-li, JING Rui, ZHANG Wen-qian, WU Hong-yan, LIU Xiao-hua

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  27-32.  doi:10.19983/j.issn.2096-8493.20210138

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Objective: To analyze the drug resistance situation of pulmonary tuberculosis patients in Ji’nan, in order to provide basis for the prevention and control of drug-resistant pulmonary tuberculosis. Methods: The drug resistance results of 1104 patients with sputum culture positive pulmonary tuberculosis in Ji’nan from 2016 to 2020 were analyzed by retrospective research method. The factors affecting drug resistance of pulmonary tuberculosis patients were analyzed by univariate and multivariate logistic regression model. Results: From 2016 to 2020, the total drug resistance rate of pulmonary tuberculosis patients in Ji’nan was 24.82% (274/1104), of which the drug resistance rate of newly treated patients was 21.47% (204/950), and the drug resistance rate of retreated patients was 45.45% (70/154); The single drug resistance rate was 10.14% (112/1104), the multidrug-resistance rate was 7.70% (85/1104), the pre-extensively drug-resistant tuberculosis rate was 1.54% (17/1104), and the other drug resistance rate was 5.43% (60/1104). From 2016 to 2020, the total drug resistance rate of tuberculosis patients (the drug resistance rate was 50.00% (46/92) in 2016, and 50.00% (32/64) in 2017, 24.44% (33/135) in 2018, 16.16% (58/359) in 2019, and 23.13% (105/454) in 2020) showed a downward trend, and the difference was statistically significant (χ_trend²=38.100, P<0.001). Multivariate logistic regression analysis showed that the drug resistance rate of pulmonary tuberculosis patients aged 21-40 was higher (OR=4.394, 95%CI: 1.325-14.570); The drug resistance rate of retreated pulmonary tuberculosis patients was higher (OR=3.276, 95%CI: 2.264-4.740). Conclusion: The epidemic situation of drug-resistant pulmonary tuberculosis in Ji’nan is serious. We should focus on patients aged 21-40 and retreated pulmonary tuberculosis patients.

Convalescent plasma therapy for two cases of rapid progressing severe COVID-19 and literature review

WU Di, LIN Fen, CHEN Xiao-hong, LIN You-fei, HUANG Ming-xiang, CHEN Li-zhou

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  33-43.  doi:10.19983/j.issn.2096-8493.20210159

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Objective: To explore the efficacy and safety of convalescent plasma in treatment of severe COVID-19. Methods: Clinical data, diagnosis and treatment, and follow-up of two cases of rapid progressing severe COVID-19 treated with convalescent plasma were retrospectively analyzed with review of literatures. These two patients were treated in Fuzhou Pulmonary Hospital of Fujian Province from March to April, 2020. Literatures were searched with “convalescent plasma” and “SARS-CoV-2” or “COVID-19” as the retrieval terms in PubMed database, and searched with the retrieval words of “convalescent plasma” and “COVID-19” or “new coronavirus pneumonia” in CNKI and Wanfang medical network database with the retrieval time of November 2021. Literatures of incomplete reviews and incomplete data were excluded, and well-documented literatures of restorative plasma therapy for severe and severe COVID-19 were included. The clinical data, efficacy, outcome and adverse reactions were collected, and the literature was reviewed. Results: Case 1 was 65 years old, female, with chief complaint of “cough and fever for 8 days”; Case 2 was 57 years old, male, with chief complaint of “cough, expectoration and fever for 5 days”. Both of them were diagnosed as severe COVID-19. Chest CT scan showed the progress of lung lesions in the short term. Symptoms were improved in the short term after being treated with convalescent plasma, nucleic acid turned negative, and chest CT scan showed that the lung lesions were more absorbed than before. Cases from 4 Chinese literatures and 13 English articles selected, plus 2 new coronavirus pneumonia patients in this study, were totally 6623 treated with convalescent plasma (4121 were male and 2502 were female). They aged from 18 to 99 years old, and 1595 of them died, the all-cause mortality was 24.08%. Adverse reactions were found in 1160 cases, the incidence was 17.51%; the intubation rate was 13.05% (864/6623). In the control group (without convalescent plasma treatment, n=7213), 1676 cases died, and the all-cause mortality was 23.24%; 1176 cases had adverse reactions, the incidence was 16.30%; and the intubation rate was 14.35% (1035/7213). There was no significant difference in all-cause mortality (χ²=1.372, P=0.241) and incidence of adverse reactions (χ²=3.607, P=0.058) between the two groups. However, the intubation rate was significantly lower than that in the control group, and the difference was statistically significant (χ²=4.955,P=0.026). Conclusion: Convalescent plasma is safe for COVID-19, especially for with severe or severe ones. The significance of convalescent plasma in improving the total mortality of COVID-19 patients is still controversial, but using high titer convalescent plasmas soon as possible may reduce the rate of endotracheal intubation.

Review Articles

Advances in candidiasis in chronic obstructive pulmonary disease

LI He-rui, LUO Li-juan, ZENG Zi-hang, CHEN Yan

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  44-49.  doi:10.19983/j.issn.2096-8493.20210162

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Candida species, one of the most common opportunistic pathogens, is the leading cause of invasive fungal diseases. Risk factors, such as ageing, comorbidity, dystrophia, immunocompromised, mechanical ventilation, using of broad-spectrum antibiotics or glucocorticoids and candida colonization, contribute to candidiasis in chronic obstructive pulmonary disease (COPD) patients, which is commonly in respiratory tract, also involves oropharyngeal or digestive tract infection. We reviewed and summarized the literatures of risk factors of candidiasis in COPD patients, aimed to deepen the understanding of the disease and further guide clinical diagnosis and treatment.

Research progress of eosinophilic chronic obstructive pulmonary disease

ZENG Zi-hang, CHEN Yan, LONG Ying-jiao

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  50-54.  doi:10.19983/j.issn.2096-8493.20210164

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Chronic obstructive pulmonary disease (COPD) is a common chronic airway inflammatory disease with complex pathogenesis, and cellular or molecular mechanisms remain unknown. Airway inflammation is one of the treatable features, however, current diagnostic methods can not reflect the heterogeneity of airway inflammation in such patients, and the treatment limitations are obvious. In recent years, in large number of clinical trials, it has been a shown that the level of blood eosinophils is closely related to COPD response, deterioration risk, mortality and length of stay in the hospital of COPD, but the mechanism is not very clear. Therefore, the author reviewed the formation process, diagnosis, traditional glucocorticoids and new target therapy of eosinophilic COPD, to provide reference for eosinophils as a new potential biomarker and treatable feature of COPD.

Prevention and treatment of obesity-related pulmonary diseases and potential value of brown adipocytes

HUA Jian-lan, ZHANG Jing

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  55-59.  doi:10.19983/j.issn.2096-8493.20210163

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As a worldwide chronic metabolic disease with increasing prevalence, obesity has a significant impact on health. It increases the morbidity and mortality of many chronic diseases, including pulmonary diseases such as asthma and pulmonary hypertension. By reviewing the mechanism of regulating metabolism via inducing the browning of white adipocytes and promoting the function of brown and beige adipocytes, the authors hope to provide a new intervention strategy against obesity and obesity-related diseases.

Research progress of animal models of emphysema

LUO Li-juan, CHEN Yan

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  60-64.  doi:10.19983/j.issn.2096-8493.20210157

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Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with high morbidity and mortality. Emphysema is one of the main pathological manifestations of COPD whose development was related to protease-antiprotease imbalance, oxidative stress, cell inflammation, cell apoptosis and so on. However, the pathogenesis and mechanism of progression of emphysema have not been fully clarified. The establishment of disease animal model provides an effective and practical experimental platform for further understanding its physiological and pathological mechanism. This article reviews the established animal models of emphysema, methods and related progresses based on previous researches.

Progress in clinical research on comorbidity of pulmonary tuberculosis and diabetes mellitus

DONG Hang, DU Ying-rong

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  65-69.  doi:10.19983/j.issn.2096-8493.20210121

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Diabetes is a common clinical medical diseases, while tuberculosis is an important infectious disease that endangers people’s lives and health in developing countries. The prevalence of tuberculosis in diabetic patients is higher than the general population. Diabetes comorbidity with tuberculosis (DM-PTB) is a serious threat to human health and is prone to form a “vicious circle”, posing “dual challenges” to the public health prevention and control for both of the diseases. Therefore, we reviewed the prevalence, possible pathogenesis, epidemiological trends, clinical features, screening and diagnosis, anti-tuberculosis and anti-diabetic clinical treatment strategies and preventive management measures of DM-PTB, to provide scientific reference and feasible suggestion for the clinical diagnosis and treatment, disease control and prevention of it.

Application and prospect of immunological detection technology for active pulmonary tuberculosis

LIU Hui-min, TIAN Yao, BEI Cheng-li, FU Man-jiao

Journal of Tuberculosis and Lung Disease. 2022, 3(1):  70-74.  doi:10.19983/j.issn.2096-8493.20210112

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Tuberculosis is an infectious disease that seriously endangers human health. Active pulmonary tuberculosis is diagnosed by etiological detection in clinic, however, it is difficult to identify the active pulmonary tuberculosis with negative etiology. With the development of immunological detection technology, more and more new detection methods to determine the activity of pulmonary tuberculosis are proposed. This paper reviews the application of immunological detection techniques in active pulmonary tuberculosis from cellular immunity, cytokine detection and humoral immunity.