Table of Content

20 December 2022, Volume 3 Issue 6

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Special Topic

Key issues of diagnosis and treatment of acquired immunodeficiency syndrome complicated with tuberculosis

Huang Wei, Shen Yinzhong

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  431-436.  doi:10.19983/j.issn.2096-8493.20220156

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Tuberculosis is a common opportunistic infection and an important factor in disease progression in patients with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), and is also one of the main causes of death in HIV infection/AIDS patients. With the deepening of understanding of the two diseases and the accumulation of relevant clinical research evidence, people pay more and more attention to some problems in the diagnosis and treatment of AIDS combined with tuberculosis.In combination with the consensus of domestic experts on AIDS complicated with tuberculosis in 2022 and clinical practice, the author reviewed several key issues such as the screening direction of this special group, the application of new diagnostic techniques, the efficacy of short-term anti-tuberculosis regimen, the selection and timing of antiviral drugs, the interaction between integrase inhibitors and rifamycin, and the identification and treatment of tuberculosis related immune reconstitution inflammatory response syndrome.

Original Articles

Epidemiological characteristics of MTB/HIV co-infection in Yunnan Province from 2010 to 2020

Yang Rui, Xu Lin, Li Ling

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  437-442.  doi:10.19983/j.issn.2096-8493.20220133

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Objective: To analyze the epidemic pattern of MTB/HIV co-infection in Yunnan Province, and to provide scientific basis for the prevention and control of MTB/HIV co-infection. Methods: The data of screening and diagnosis of MTB/HIV co-infection cases from 2010 to 2020 were obtained from the Tuberculosis management information system and MTB/HIV co-infection prevention and management annual report. Descriptive statistics and trend test were used to analyze the epidemiological characteristics of MTB/HIV co-infection over time. Results: From 2010 to 2020, the proportion of HIV/AIDS patients receiving TB testing increased from 25.01% to 91.26%, the detection positive rate decreased from 4.03% to 0.42%, and the proportion of TB patients receiving HIV antibody testing increased from 24.04% to 98.33%, the detection positive rate decreased from 0.72% to 0.30%. The ratio of male to female was about 4.2∶1 (4000∶960) among all tested positive MTB/HIV co-infection patients. The proportion of farmers, patients aged over 45 years old, patients without patient delay (the interval between onset of suspicious symptoms of tuberculosis and visit to medical institutions <14 days), and etiologically positive patients among all registered MTB/HIV co-infection patients increased from 49.50% (198/400), 18.00% (72/400), 30.75% (123/400), 16.75% (67/400) in 2010 to 84.13% (477/567), 40.04% (227/567), 37.63% (213/566), 47.62% (270/567) in 2020, which all showed an increasing trend year by year (Z_trend values were -14.617, 11.833, -5.628, -10.118 respectively, P<0.001). Conclusion: The implementation of MTB/HIV co-infection screening strategy in Yunnan Province has achieved remarkable results. However, it is still necessary to continue to improve the quality of all aspects of screening, take more effective prevention and control measures, and detect patients as much as possible, so as to control the epidemic of MTB/HIV co-infection to a greater extent.

Analysis on the current status and trend of MTB/HIV co-infection screening in Zhejiang Province from 2015 to 2021

Luo Dan, Chen Songhua, Zhang Yu, Wang Wei, Wu Qian, Wu Yonghao, Liu Kui, Chen Bin

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  443-448.  doi:10.19983/j.issn.2096-8493.20220132

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Objective: To analyze the screening of MTB/HIV co-infection in Zhejiang Province from 2015 to 2021, so as to provide scientific basis for formulating and adjusting corresponding prevention and control policies. Methods: The relevant data of MTB/HIV co-infection in Zhejiang Province from 2015 to 2021 were collected from the Annual Report of Prevention and Management of MTB/HIV co-infection in Zhejiang Province. Excel 2010 software was used to organize and calculate the data. JoinPoint software was used to identify the inflection points of double infection detection rate and positive rate. ArcGIS 10.8 software was used to draw the spatial distribution map and visualize the results. R software was used to compare the differences between groups. Results: A total of 773 patients with double infection were found in Zhejiang Province from 2015 to 2021,771 patients (99.74%, 771/773) were over 15 years old, 90.94% (703/773) of the patients received tuberculosis treatment. Jinhua and Wenzhou were the areas with high incidence of double infection in Zhejiang Province, numbers of patients were 149 and 146, respectively. The detection rate of HIV screening in tuberculosis patients increased in the past seven years (APC=4.9, P<0.05), while the positive detection rate in HIV/AIDS patients showed a trend of decrease (APC=-15.5, P<0.05). Conclusion: The MTB/HIV co-infection screening in Zhejiang Province from 2015 to 2021 has a certain effect on the early detection and treatment of patients with co-infection. The screening rate of tuberculosis among HIV/AIDS patients should be improved, Jinhua and Wenzhou should strengthen the prevention and control of co-infection epidemic situation according to local conditions.

Analysis of feasibility and effectiveness of the implementation of strengthened tuberculosis management model in Liangshan Yi Autonomous Prefecture, Sichuan Province

Li Jing, He Jinge, Li Ting, Li Yunkui, Gao Wenfeng

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  449-454.  doi:10.19983/j.issn.2096-8493.20220152

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Objective: To evaluate the feasibility and effectiveness of strengthened tuberculosis management model for local tuberculosis management on the basis of AIDS “1+M+N” bottom-up model in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture), Sichuan Province. Methods: A total of 688 HIV/AIDS patients who were managed in Muer Township, Jiudu Township and Temuli Township of Butuo County, Liangshan Prefecture (two townships and one town) from January to December 2019 with informed consent were selected as the study subjects. All the subjects were screened for suspicious symptoms of tuberculosis, chest X-ray and tuberculin skin test at the same time. The treatment plan for confirmed rifampicin and isoniazid sensitive pulmonary tuberculosis was 2H-R-Z-E/4H-R (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol); HIV/AIDS patients confirmed to have been infected with latent tuberculosis infection (LTBI) and meet the conditions for preventive anti-tuberculosis treatment were treated with preventive anti-tuberculosis treatment, and isoniazid alone was used for 6 months. Face to face interviews were conducted in the subjects and medical staff. Patients were followed up using the strengthened tuberculosis management model. The epidemiological characteristics of active pulmonary tuberculosis patients, the outcome of anti-tuberculosis treatment and the outcome of preventive anti-tuberculosis treatment for LTBI patients were analyzed. Results: Among the 688 subjects, 115 were active pulmonary tuberculosis patients (16.7%) of which 91 (79.1%) got the treatment, and 86 (94.5%) were successfully treated. Preventive anti-tuberculosis treatment applicable to 565 cases, of which 453 (80.2%) were in the drug group and 112 (19.8%) were in the control group. In the drug group, 413 cases (91.2%) completed the treatment. After two years of follow-up, the incidence rate of the drug group was 0.7% (3/453), and that of the control group was 1.8% (2/112), there was no statistically significant difference (χ²=1.292, P=0.256). The protection rate of preventive anti-tuberculosis treatment was 62.9% (1.1%/1.8%). The results of face-to-face interviews showed that due to the influence of local traditional customs and habits, residents in ethnic minority areas had different levels of cooperation in tuberculosis prevention and control. Patients with symptoms always cooperate, while those without symptoms did not; the effect of anti-tuberculosis treatment on HIV/AIDS patients complicated with tuberculosis and LTBI patients receiving preventive anti-tuberculosis treatment was better; some respondents were more sensitive to personal information and had resistance to investigators in the region. Conclusion: The tuberculosis management mode based on the “1+M+N” network bottom work mode of AIDS in Liangshan Prefecture should be strengthened on the responsibilities of “county-township-village” medical institutions, the scope of grass-roots tuberculosis managers should be broadened, to improve the efficiency of patient management and the success rate of anti-tuberculosis treatment for local patients with MTB/HIV co-infection, as well as to improve the coverage and completion rate of preventive anti-tuberculosis treatment for HIV/AIDS patients.

Analysis of treatment adverse outcomes for rifampicin sensitive pulmonary tuberculosis patients with random effects logistic model in Gansu Province from 2018 to 2020

Guo Qiang, Li Ruiping, Ma Yubao, Zhang Lan, Yang Shumin

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  455-462.  doi:10.19983/j.issn.2096-8493.20220111

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Objective: To understand the related influencing factors of treatment adverse outcomes for rifampicin sensitive pulmonary tuberculosis patients in Gansu Province. To provide scientific basis for effectively,in order to improve the rate of successful treatment for rifampicin sensitive pulmonary tuberculosis patients. Methods: A total of 20398 rifampicin sensitive pulmonary tuberculosis patients registered for treatment management in Gansu Province from 2018 to 2020 were collected, and a random effects logistic model was constructed to explore the relevant factors affecting the treatment adverse outcomes of rifampicin sensitive pulmonary tuberculosis patients. Results: Among the 20398 rifampicin sensitive pulmonary tuberculosis patients, 1407 had adverse treatment outcomes, the rate of adverse outcomes was 6.90% (1407/20398). The random effects logistic model showed that patients with male OR (95%CI)=1.273 (1.133-1.430), age 25-45 years old OR (95%CI)=1.501 (1.295-1.740), 46-60 years old OR (95%CI)=1.623 (1.372-1.920), more than 60 years old OR (95%CI)=2.272 (1.752-2.948), occupation with retired/housekeeping/catering/unemployed/others OR (95%CI)=1.587 (1.089-2.312), occupation with farmers, herdsmen, fishermen/migrant workers/long-distance drivers OR (95%CI)=1.532 (1.098-2.138), comorbidities OR (95%CI)=1.366 (1.031-1.811), positive etiological diagnosis OR (95%CI)=2.590 (2.271-2.953), critically ill OR (95%CI)=1.271 (1.009-1.600), retreatment OR (95%CI)=2.795 (2.300-3.398) were more likely to fail in treatment. Conclusion: The relevant departments of tuberculosis prevention and control should strengthen the management of treatment tuberculosis patients aged 25 and over (especially those over 60), retired/housekeeping/catering/unemployed/farmers/herdsmen/fishermen/migrant workers/long-distance drivers, retreatment patients, patients with comorbidities, and patients with positive etiology, dynamically monitor patients review, supervise the drug-taking process, and pay attention to health education to reduce the incidence of adverse outcomes of rifampicin sensitive pulmonary tuberculosis patients.

Analysis of management and treatment effects of pulmonary tuberculosis patients in Nanshan District, Shenzhen City, 2011—2020

Huang Yao, Fan Yuzheng, Wang Xiangyu, Zhong Tao, Zhang Jie, Yang Nansen, Li Shengbin, Ye Xuetian, Liu Shengyuan

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  463-468.  doi:10.19983/j.issn.2096-8493.20220098

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Objective: To evaluate the management and treatment effects of pulmonary tuberculosis (PTB) patients registered for treatment in Nanshan District, Shenzhen City, from 2011 to 2020, and to provide a basis for optimizing prevention and control measures in the future. Methods: Information of registration, treatment management and outcomes of PTB patients in Nanshan District from 2011 to 2020 was collected from the Chinese Disease Prevention and Control Information System, and statistical analysis of management and treatment indicators was performed using the descriptive analysis method. Results: From 2011 to 2020, a total of 5386 PTB cases were registered and managed in Nanshan District, with an average annual registration rate of 40.26/100000 (5386/13379013) which were statistically significantly differentiated among years ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=31.160, P<0.001); the registration rates for local and migrated populations were 12.80/100000 (994/7767261) and 78.26/100000 (4392/5611752) respectively, the latter was significantly higher than the former (χ²=25.623, P=0.002).The pathogenetically positive rate among all cases was 53.89% (2785/5168) during the 10-year period, while the rate was significantly higher in 2016-2020 (58.08%,1646/2834) than in 2011-2015 (48.80%,1139/2334) with a statistically significant difference (χ²=44.359,P<0.001). 85.04% (1194/1404) of smear-positive cases registered in 2011-2020 got sputum negative conversion after being treated for 2 months, while retreated smear-positive cases got a lower 2-months conversion rate (76.00%, 95/125) than new smear-positive patients (85.93%, 1099/1279)(χ²=8.821, P=0.003); the average treatment success rate was 91.66% (4780/5215) over the 10 years which was higher in local population (94.90%, 911/960) than in migrated population (90.93%, 3869/4255), with a statistically significant difference (χ²=16.127,P<0.001). Conclusion: The PTB registration rate in Nanshan District from 2011 to 2020 showed an overall decreasing trend, a significant increase in the pathogenetically positive rate, a treatment success rate of more than 90%, and a significant positive PTB management and control effect.

Investigation on catastrophic cost of pulmonary tuberculosis in three counties, Yunnan Province

Liu Liangli, Zhao Yujie, Yang Yunbin, Chen Jin’ou, Xu Lin

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  469-476.  doi:10.19983/j.issn.2096-8493.20220154

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Objective: To investigate the catastrophic costs of pulmonary tuberculosis (PTB) and the influencing factors, in order to provide reference for formulating and improving social security measures for PTB patients in Yunnan Province. Methods: A retrospective investigation was conducted in 233 PTB patients who completed the course of treatment from Mojiang, Lancang and Simao County, Yunnan Province by the way of face-to-face questionnaire and hospital information system query since 2017. The catastrophic costs of PTB patients (account for over 20% of annual income) influencing factors were investigated. Results: A total of 233 patients were included in this survey. The total cost (M(Q₁,Q₃)) was RMB 7820 (5269, 12754) yuan with the total self paid cost of 4623 (3251, 7637) yuan, which accounted for 60.81% of the total cost. The direct medical cost was RMB 2705 (1727, 4559) yuan, which accounted for 62.89% of the total self paid cost. The indirect medical cost was 1760 (822, 3192) yuan, which accounted for 37.11% of the total self paid cost. Overall, the proportion of patients with catastrophic cost was 69.53% (162/233). The results of binary logistic regression analysis showed that patients with high annual family income (≥RMB 4000 yuan) had low risk of catastrophic expenditure (OR=0.062, 95%CI: 0.025-0.156), and the risk of catastrophic expenditure was high in patients with more than once hospitalization experiences or multi-hospital experiences (OR=37.610, 95%CI: 7.615-185.742; OR=4.196, 95%CI: 1.457-12.079). Conclusion: The situation of PTB patients experienced catastrophic cost is severe in Yunnan Province, thus, it is necessary to strengthen the formulation and improvement of social security measures for patients with low annual family income per capita, more than once hospitalization experiences or multi-hospital experiences.

Analysis of epidemiological characteristics and treatment outcomes of etiological negative pulmonary tuberculosis patients in Tongzhou District of Beijing, 2016—2020

Yang Chao, Wang Jing, Tang Guilin, Gao Hanqing

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  477-482.  doi:10.19983/j.issn.2096-8493.20220149

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Objective: To understand the epidemiological characteristics and treatment outcomes of etiological negative pulmonary tuberculosis (TB) patients in Tongzhou District of Beijing, so as to provide reference for formulating prevention and control strategies. Methods: The data of pulmonary TB (excluding drug-resistant pulmonary TB) patients registered in Tongzhou District from 2016 to 2020 was collected from the Chinese TB Management Information System.The medical record data of etiological negative patients was extracted according to periodic statistics tables generated by the system. Descriptive statistics was used to analyze the data. Results: From 2016 to 2020, a total of 3136 cases of pulmonary TB patients were registered in Tongzhou District of Beijing, among which 1344 cases were etiological negative, accounting for 42.9%. The incidence of etiological negative pulmonary TB showed a downward trend, decreasing from 21.6/100000 (309/1.428 million) in 2016 to 8.2/100000 (150/1.840 million) in 2020 ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=95.828,P=0.000).The male-female ratio of patients was 1.9∶1. The main age group was 15-44 years (67.4% (906/1344)). The main occupation were housekeepers/unemployed people (44.8% (602/1344)), staffs with fixed job (12.8% (172/1344)) and peasants (9.7% (131/1344)). The main source of patients was patients referred from general hospitals (71.3% (958/1344)). The non-local residents accounted for 61.6% (828/828), and most patients came from Hebei Province (25.7% (213/828)) and Heilongjiang Province (11.0% (91/1344)). All patients received full-course supervision and management. The overall treatment completion rate was 93.2% (1252/1344, over 90% for every year of the 5 years). Thirty-four cases (2.5%) defaulted,15 cases (1.1%) died, and 1 case (0.1%) developed multidrug-resistant TB. Conclusion: The epidemic of etiological negative pulmonary TB in Tongzhou District has declined from 2016 to 2020, people aged 15-44 years and peasants are high risk populations. It is of great importance to take comprehensive strategies for TB prevention and control.

Investigation and analysis of tuberculosis awareness among students in 9 schools in Tianjin City in 2021

Zhang Xiaomeng, Yu Yanming, Pang Xuewen, Wan Ying, Jia Jingwen, Xu Ran, Zhang Fan

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  483-489.  doi:10.19983/j.issn.2096-8493.20220153

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Objective: To understand the tuberculosis awareness level of college students in Tianjin City, and to provide basic data for the subsequent improvement of the input-output ratio of tuberculosis health education in schools. Methods: Nine high-epidemic schools in 2020 were selected from the two educational campuses of Xiqing District and Haijiaoyuan District in Tianjin City, and an electronic questionnaire survey was conducted among the students from September to October 2021. The questionnaire included 32 tuberculosis cognition questions from four dimensions, namely disease cognition, diagnosis and treatment cognition, prevention and control cognition and preventive treatment cognition. Each correct answer was awarded 1 point, and the maximum cognitive score of each person was 32 points. Demographic characteristics and answers of respondents were collected. Descriptive method was used to analyze students’ knowledge of tuberculosis, and generalized linear model was used to analyze factors affecting students’ cognitive level of tuberculosis. Results: A total of 27974 valid questionnaires were retrieved this time. The awareness rate of core knowledge of tuberculosis in schools was 87.20% (243941/279740), and the awareness rate of knowledge cognition was 68.62% (614241/895168). The average scores of tuberculosis disease, diagnosis and treatment, prevention and control and preventive treatment were 6 (5,8), 5 (4,6), 8 (7,10) and 2 (2,3) respectively. The awareness rates of the four dimensions were 67.95% (171063/251766), 72.14% (141271/195818), 76.18% (234412/307714) and 48.26% (67495/139870), respectively. Among them, the awareness rates of sub-items such as the awareness of onset of tuberculosis, BCG vaccine and prophylactic medication were 44.18% (37073/83922), 38.46% (21519/55948) and 33.13% (18537/55948), respectively. Multivariable analysis showed, the average score of female was 23 (20,28) points, higher than that of male (21 (18,25) points;β=1.97, 95%CI: 1.84-2.09). Those with bachelor’s degree or above averagely scored 23 (20,27) points, higher than those with technical secondary school degree (20 (16,28)) and junior college degree (20 (17,23);β=2.13, 95%CI: 1.84-2.42). The highest average score was 23 (20,28) for students who participated in three tuberculosis awareness promotion activities, that is, the number of previous participation in tuberculosis awareness promotion activities was related to students’ cognitive level (β=0.44, 95%CI: 0.40-0.49). Conclusion: The awareness rate of core knowledge of tuberculosis among college students in Tianjin City is acceptable. It is necessary to carry out targeted and planned school tuberculosis health education activities in schools according to different gender and educational backgrounds in the aspects of tuberculosis knowledge and preventive medication.

Investigation on cognition of chronic obstructive pulmonary disease related fatigue among respiratory and critical care nurses in tertiary hospitals

Lu Yu, Wang Xiaodong, Jiang Qiuling, Xu Yulin

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  490-495.  doi:10.19983/j.issn.2096-8493.20220120

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Objective: To investigate the cognition of respiratory and critical care nurses on chronic obstructive pulmonary disease (COPD) related fatigue in the tertiary hospitals, and to provide reference for promoting the fatigue management of COPD patients. Methods: Using the convenience sampling method, from July to September, 2021, a cross-sectional survey was conducted among 673 respiratory and critical care nurses in four tertiary hospitals in He’nan Province based on a self-designed questionnaire. Of the 582 collected questionnairese, 568 were valid, with the effective recovery rate of 84.4%. The survey included the cognition of respiratory and critical care nurses on COPD related fatigue, the current situation of clinical intervention and suggestions on training methods of related knowledge. Results: The score of the 568 respondents on the cognition of fatigue-related knowledge of COPD patients was 38.65±4.54, including 14.83±4.22 on the understanding dimension and 23.83±1.30 on the influence dimension of fatigue. Of total investigated nurses, 65.3% (371/568) had never (or occasionally) paid attention to the fatigue of COPD patients, only 7.6% (43/568) paid attention to the fatigue regularly, and 92.1% (523/568) had never (or occasionally) taken intervention measures for the fatigue. As to the choice of training methods for fatigue-related knowledge of COPD patients, most of the nurses choose operation demonstration (351, 61.8%) and case analysis (316, 55.6%), while few of them choose concentrated lectures (193, 34.0%) and self-study (114, 20.1%). Conclusion: Respiratory and critical care nurses in the tertiary hospitals have a high degree of understanding about the influence dimension of COPD relative fatigue, but they have poor basic knowledge. The hospital should carry out systematic training on COPD related fatigue, and timely update the concept and nursing measures.

Clinical analysis of continuous drainage in lumbar cistern for severe tuberculous meningitis

Meng Yizhe, Han Weixin, Li Junxia, Zhao Liming, Chen Yanqiang, He Hongyan

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  496-500.  doi:10.19983/j.issn.2096-8493.20220041

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Objective: To investigate the clinical effectiveness and safety of continuous lumbar cistern drainage with intrathecal injection on severe tubercular meningitis patients. Methods: A retrospective analysis was performed on data of 42 patients with severe tubercular meningitis admitted to Hebei Chest Hospital from August 1,2018 to October 1, 2021. The patients were divided into control group (n=21) and treatment group (n=21) according to whether continuous drainage of lumbar cistern was given. Control group was given routine anti-tuberculosis treatment and intrathecal injection. For treatment group, continuous lumbar cistern drainage was added, 14 days as one session of treatment. The two groups were compared before and after treatment in terms of recovery time of intracranial pressure, disturbance of consciousness, fever, headache, CSF ADA, CSF protein, and CSF neutrophils. Comparison was also done for mortality rate of control group and treatment group. Results: The average recovery time of fever in the treatment group was (6.24±4.07)d, significantly shorter than the control group ((11.65±3.02)d,t=-4.403, P<0.01). In the treatment group, the time of headache disappearance was 4.5 (0.5,8.5) d, the time of consciousness disorder recovery was 3 (0,7) d, the time of CSF ADA decreased to normal was 10 (0,21) d, the time of CSF protein decreased to normal was 35 (0,99) d, and the time of CSF neutrophil disappearance was 33 (0,85) d, which were all significantly better than the control group (10.5 (1.5,19.5) d, 29 (23,35) d, 18 (9,27) d, 94 (0,197) d and 100 (8,192) d), the differences were all statistically significant (Z=33.500, 169.000, 94.000, 338.500, 349.000, P values all <0.05). The recovery time of intracranial pressure was 21 (0,52) d in the treatment group and 27 (19,35) d in the control group, but difference between the two groups was not statistically significant (Z=241.500, P=0.597). The mortality of both groups was 4.7% (1/21). Conclusion: Continuous lumbar cistern drainage combined with intrathecal injection can shorten the fever time, promote consciousness recovery, shorten the recovery time of CSF ADA and protein, accelerate disappearance of CSF neutrophils, improve clinical symptoms and shorten the length of hospital stay of patients with severe tubercular meningitis.

The diagnostic value of different thresholds for T cell spot test with peritoneal effusion tuberculosis in tuberculous peritonitis

Shi Haiping, Wu Qianhong

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  501-505.  doi:10.19983/j.issn.2096-8493.20220138

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Objective: To investigate the diagnostic value of T cell spot test (T-SPOT. TB) with different thresholds in tuberculosis peritonitis. Methods: From January 2016 to December 2020, 48 patients with abdominal effusion diagnosed in Shaanxi Provincial Hospital of Tuberculosis Prevention and treatment were selected as the research objects. All patients underwent intraperitoneocentesis and peritoneal tissue biopsy under ultrasound guidance. At the same time, peripheral blood T-SPOT.TB, abdominal fluid effusion T-SPOT.TB, peritoneal fluid effusion Mycobacterium tuberculosis smear, peritoneal fluid effusion BACTEC MGIT 960 fluid culture (MGIT 960 liquid culture), peritoneal fluid molecular biology examination, peritoneal histopathological examination and molecular biology examination were performed. Final clinical composite criteria were used as a reference. The sensitivity, specificity, compliance rate and consistency of peripheral blood T-SPOT.TB and abdominal effusion T-SPOT.TB (setting 6 SFC/10⁶ and 30 SFC/10⁶, respectively) were evaluated in tuberculous peritonitis. Results: Of the 48 patients, 31 were definitely diagnosed as tuberculous peritonitis, 3 were confirmed by positive antiacid staining of abdominal effusion, 11 were confirmed by positive MGIT 960 liquid culture medium, 13 were confirmed by positive molecular biological tests of peritoneal effusion or peritoneal tissue, 2 were confirmed as granuloma of peritoneal tissue with caseous necrosis, 2 were confirmed as granulomatous inflammation of peritoneal tissue after effective anti-tuberculosis therapy for 2 months. 17 were definitely diagnosed as non-tuberculous peritonitis, with 13 malignant ascites, 2 bacterial ascites, 1 lupus erythematosus, 1 lymphoma lymphoma. Four were diagnosed by pathology ascites, athological diagnosis, 11 by peritoneal histopathology, and 2 by bacterial culture of ascites. Clinical composite standard was used as the reference standard. We choose 6 SFC/10⁶ for peripheral blood T-SPOT.TB, and 30 SFC/10⁶ for peritoneal effusion T-SPOT.TB as positive thresholds, respectively. The sensitivity of the three assays tested in tuberculous peritonitis were 83.9% (95%CI:65.5%-93.9%), 87.1% (95%CI:69.2%-95.8%) and 83.9% (95%CI:65.5%-93.9%), and the specificity were 76.5% (95%CI:48.8%-92.2%), 82.4% (95%CI:55.8%-95.3%) and 94.1% (95%CI:69.2%-99.7%), with the conformance rate of 81.2% (95%CI:68.7%-92.1%), 85.4% (95%CI:66.8%-97.2%) and 87.5%(95%CI:72.1%-98.4%), and the Kappa values of 0.596, 0.685 and 0.778, respectively. Conclusion: With the clinical composite standard as the reference standard, setting different positive T-SPOT.TB threshold values in abdominal effusion might change the diagnostic efficacy of tuberculosis peritonitis, and raising the positive threshold from 6 SFC/10⁶ to 30 SFC/10⁶ might enhance its diagnostic efficacy.

Application of accelerated rehabilitation management model in perioperative period of patients with abdominal tuberculosis

Huo Xuee, Wu Qianhong, Zhang Yanli, Huang Jing, Cai Yamei, Jian Jingjing

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  506-510.  doi:10.19983/j.issn.2096-8493.20220129

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Objective: To explore the application value of enhanced recovery after surgery (ERAS) model in perioperative period of patients with abdominal tuberculosis. Methods: A retrospective analysis was made on 107 patients with abdominal tuberculosis who were admitted to the Tuberculosis Surgery Department of Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 2015 to December 2020. Among them, 49 patients with abdominal tuberculosis admitted from January 2015 to June 2018 received routine perioperative care as the control group; from July 2018 to December 2020, 58 patients undergoing abdominal tuberculosis surgery were integrated into the ERAS management mode on the basis of routine nursing measures as the ERAS group. The differences between the two groups at the time of admission, and postoperative ambulation time, postoperative 72 hours pain score, average hospitalization days, the time of exhaust, defecation, gastric tube removal, drainage tube removal, complications, postoperative body mass index, satisfaction rate were compared. Results: In the postoperative ERAS group, postoperative ambulation time, postoperative 72 h pain score, average hospitalization days ((21.93±0.75) h, (3.17±1.17) points, (34.38±3.20) d) were lower than the control group ((24.51±4.67) h, (3.86±1.79) points, (35.90±4.17) d), the differences were statistically significant (t=4.152, P<0.001; t=2.373, P=0.019; t=2.131, P=0.035). The time of exhaust, defecation, gastric tube removal, drainage tube removal, and complications in the ERAS group ((2.12±0.73) d,(4.00±0.73) d,(5.29±1.08) d,(12.84±3.54) d,10.34% (6/58)) were lower than those in the control group ((2.57±0.58) d, (4.55±0.58) d, (7.02±1.79) d, (14.65±3.94) d, 28.57%(14/49)).The difference was statistically significant (t=0.440, P=0.001; t=0.440, P<0.001; t=5.056, P<0.001;t=2.502, P=0.014; χ²=5.805, P=0.016). The body mass index and satisfaction rate of ERAS group were (20.30±1.12) points and 96.55% (56/58), respectively, which were higher than those of the control group ((18.76±1.38) points and 85.71% (42/49)), the difference was statistically significant (t=0.546, P<0.001; χ²=4.049, P=0.044). Conclusion: The application of ERAS management mode in the perioperative period of patients with abdominal tuberculosis can promote the recovery of patients, reduce postoperative pain, shorten hospitalization time, reduce complications and improve patient satisfaction.

Review Articles

Research progress in current situation of Mycobacterium tuberculosis infection and preventive treatment in HIV/AIDS population

Cao Xuefang, He Yongpeng, Gao Lei

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  511-516.  doi:10.19983/j.issn.2096-8493.20220155

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The co-infection of Mycobacterium tuberculosis (MTB) and the occurrence of tuberculosis (TB) seriously affect the quality of life among patients with human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS). It is of great practical significance to strengthen the control of MTB infection and preventive treatment of TB among MTB/HIV co-infected people for the prevention and control of the above two major infectious diseases. The current situation of MTB infection in HIV/AIDS population and research progress in TB preventive treatment were reviewed, to explore the key content and ideas of TB prevention and control in HIV/AIDS population in China.

Current status and prospect of screening and treatment of latent multidrug-resistant tuberculosis infection

Chen Qiuqi, Wu Chaoling, Zhang Peize, Deng Guofang

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  517-520.  doi:10.19983/j.issn.2096-8493.20220148

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Close contacts with multidrug-resistant tuberculosis (MDR-TB) patients have a high risk of MDR-TB infection. Some of them are prone to develop latent MDR-TB infections so that they will become a key population for tuberculosis management and control. At present, the screening and treatment of latent MDR-TB infection are challenging and still unclear. Therefore, we reviewed the epidemic and the evidence of screening, management or prevention in close contact with MDR-TB.

Research progress in pathological mechanism and treatment of cough variant asthma

Lou Nannan, Guo Jing, Ma Xiang, Gai Zhongtao

Journal of Tuberculosis and Lung Disease. 2022, 3(6):  521-525.  doi:10.19983/j.issn.2096-8493.20220135

Abstract ( 440 )   HTML ( 14 )   PDF (788KB) ( 561 )   Save

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Cough variant asthma (CVA) is a special type of asthma and is the most common cause of chronic cough in Chinese adults and children. Early diagnosis and treatment can prevent CVA from developing into typical asthma. With further research, we have new findings on the pathological mechanism and treatment of CVA. Therefore, we reviewed the progress of CVA in recent years for clinical reference.