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Objective:To analyze the clinical characteristics of pulmonary tuberculosis (PTB) in patients with prediabetes mellitus (PreDM) and improve the understanding and diagnosis of pulmonary tuberculosis complicated by prediabetes mellitus (PreDM-PTB).Methods:The clinical data of 109 inpatients with PTB who underwent glycated hemoglobin A1c (HbA1c) examination admitted to Beijing Chest Hospital, Capital Medical University from January 2015 to January 2016 were retrospectively analyzed. These patients were divided into the PreDM-PTB group ( n = 45) and the non-PreDM-PTB group (N-PreDMPTB group, n = 64) according to HbA1c test results. Patient demographic data, clinical features, imaging data, bacteriological results, and other laboratory results were collected from all patients. Results:The mean age and body mass index (BMI) were higher in the PreDM-PTB group than the N-PreDMPTB group. The proportion of patients having a smoking history was higher in the PreDM-PTB group than the N-PreDMPTB group (46.7% vs. 25.0%). The proportions of patients who had a cough (88.9%), fever (55.6%), anorexia (17.8%), chest tightness (31.1%), shortness of breath (28.9%), weight loss (40.0%), and pleural effusion (22.2%) were higher in the PreDM-PTB group than the N-PreDMPTB group. Patients with PreDM-PTB were more prone to develop anemia (55.6%), hypoproteinemia (55.6%), and increased low-density lipoprotein (26.7%) compared with patients with N-PreDMPTB. The levels of D-Dimer (93.2%), C-reactive protein (86.7%), and erythrocyte sedimentation rate (79.1%) were increased in the PreDM-PTB group compared with the N-PreDMPTB group. Sputum smear results showed that the positivity of mycobacterium tuberculosis was higher in the PreDM-PTB group (74.4%) compared with the N-PreDMPTB group. There was no significant difference in drug resistance between the two groups ( P > 0.05). The positivity of blood tuberculosis antibody and blood T-cell spot test for tuberculosis infection were 60.9% and 84.6% respectively in the PreDM-PTB group and they were 50.9% and 95.2% respectively in the N-PreDMPTB group. There were no significant differences in these two indices between the two groups ( P = 0.321, 0.066). Conclusion:Patients with Pre-DMPTB have different clinical manifestations and auxiliary examination characteristics compared with patients with N-PreDMPTB patients, which should be paid more attention to by clinicians. Early intervention should be actively adopted to prevent diabetes development from pre-DM.
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BACKGROUND@#Differential diagnosis of active tuberculosis (ATB) and latent tuberculosis infection (LTBI) has been a challenge for clinicians in high TB burden countries. The purpose of this study was to improve the accuracy of differential diagnosis of ATB and LTBI by using fluorescent immunospot (FluoroSpot) assay to detect specific Th1 cell immune responses. The novel mycobacterium tuberculosis (MTB) latency-associated antigens Rv1733c and synthetic long peptides derived from Rv1733c (Rv1733c SLP) were used based on virulence factors early secreting antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10).@*METHODS@#Fifty-seven ATB cases, including 20 pathogen-confirmed ATB and 37 clinically diagnosed ATB, and 36 LTBI cases, were enrolled between January and December 2017. FluoroSpot assay was used to detect the interferon γ (IFN-γ) and interleukin 2 (IL-2) secreted by the specific T cells after being stimulated with MTB virulence factors ESAT-6 and CFP-10, MTB latency-associated antigens Rv1733c and Rv1733c SLP. The receiver operating characteristic (ROC) curve was used to define the best cutoff value of latency-associated antigens in the use of differentiating ATB and LTBI. The sensitivity, specificity, predictive value, and likelihood ratio of ESAT-6 and CFP-10-FluoroSpot combined with latency-associated antigen in the differential diagnosis of ATB and LTBI were also calculated.@*RESULTS@#Following the stimulation with Rv1733c and Rv1733c SLP, the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP had the largest area under the ROC curve, which was 0.766. With a cutoff value of 1 (spot-forming cells [SFCs]/2.5 × 105 peripheral blood mononuclear cells) for frequency, the sensitivity and specificity of distinguishing ATB from LTBI were 72.2% and 73.7%, respectively. ESAT-6 and CFP-10-FluoroSpot detected the frequency and proportion of single IFN-γ-secreting T cells; the sensitivity and specificity of distinguishing ATB from LTBI were 82.5% and 66.7%, respectively. Combined with the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP on the basis of ESAT-6 and CFP-10-FluoroSpot, the sensitivity and specificity increased to 84.2% and 83.3%, respectively.@*CONCLUSION@#Rv1733c SLP, combined with ESAT-6 and CFP-10, might be used as a candidate antigen for T cell-based tuberculosis diagnostic tests to differentiate ATB from LTBI.
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Humans , Antigens, Bacterial , Diagnosis, Differential , Latent Tuberculosis/diagnosis , Leukocytes, Mononuclear , Mycobacterium tuberculosis , Tuberculosis/diagnosisABSTRACT
Objective To explore the clinical characteristics of elderly patients with tuberculous meningitis (TBM) and analyze the causes of misdiagnosis.Methods The clinical data of patients aged 60 years and over with TBM in Beijing Chest Hospital Affiliated to Capital Medical University from January 2011 to January 2017 were retrospectively analyzed.The clinical characteristics of the elderly patients with TBM were analyzed and compared between misdiagnosis and non-misdiagnosis groups.Results Among 60 elderly patients with TBM,32 cases (53.3%) were misdiagnosed before hospitalization.Among 32 misdiagnosed cases,11 (34.4%) were misdiagnosed as pulmonary infection,6 (18.8%) as infectious diseases with unspecified site,4(12.5%) as upper respiratory tract infections and 3 (9.4%) as cerebral vascular diseases,and so on.The onset time of TBM,fever prevalence and CSF glucose levels were 42.5 (20.3,60.0) d,96.9% (31 cases),1.5(1.1,2.3)mmol/L in misdiagnosis group respectively,and 15.0 (10.0,20.0) d,75.0%(21 cases),2.3(1.4,3.2)mmol/L in non-misdiagnosis group respectively,which was statistically significantly different between the two groups (all P 0.05).Conclusions Elderly patients with TBM have atypical clinical manifestations,many comorbidities,and less specific imaging,and especially,the cerebrospinal fluid pathogen sensitivity is low,which may result in higher misdiagnosis rate.
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Objective To investigate the immune protection of heparin-hinding hemagglutinin ad-hesin(HBHA) and to estimate its potential diagnostic value. Methods Native HBHA were used to stimu-late peripheral blood mononuelear cells (PBMCs) from different infected-cases including PPD negative healthy control, PPD positive latent tuberculosis(LTB) infection, pulmonary tuberculosis, and the IFN-γ/in the supernatant of culture was detected. Meanwhile, HBHA specific IgG antibody in the sera was detected by ELISA. Results The middle level of HBHA specific IFN-γ of the three groups were 49.5 pg/ml, 781.9 pg/ml and 341.8 pg/ml, respectively. IFN-γ of latent tuberculosis group was much higher than that of the control, and slightly higher than that of the patients with pulmonary tuberculosis. And the absorbency of the IgG antibody to HBHA in the three groups was 0.212±0.066, 0.224 ± 0.076 and 0.285±0.078. lgG an-tibody in the patients with pulmonary tuberculosis is higher than that of the healthy, including the control and the latent tuberculosis infection. Conclusion HBHA has good immunogenieity, and it can stimulate the LTB to release high level IFN-γ, suggests that the LTB doesn't develop active tuberculosis may rely on its protection. HBHA specific. IFN-γ release may identify 1,333 from the healthy. Anti-HBHA antibody plays an auxiliary role in the diagnosis of pulmonary tuberculosis.
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OBJECTIVE:To study and evaluate the efficacy and safety of homemade sterilized powder for injection of rifampicin(weifunin) in the treatment of pulmonary tuberculosis(PT) and to compared with same import preparation . METHODS:Divide the 121 of bacteriological positive PT patients in the proportion of 1 to 1 with computer automatically into the trial group and the control group used with homemade rifampicin (weifuxin) and import rifampicin(nifu)respectively,the others regimens was same in 2 groups,to evaluate the sputum culture negative conversion rates,X-ray results and adverse drug event etc.after treatment 1 and 2 months . RESULTS: 116 cases were finished ,at the end of 2 month the sputum smear negative conversion rates were 86.21 % and 91.38% (X2=0.780,P=0.377), the sputum culture negative conversion rates were 91.38% and 93.10%(X2=0.120,P=0.729)in the trial group and the control group respectively .The X-ray remarkable effective rates of 2 groups were 82.76% amd 70.69%(X2=2.365,P=0.124)respectively, and the effective rates of the 2 groups were both be 96.55% .The adverse drug event rates were 8.20% and 11.67% respectively, there was on sighificant difference in each indexes .CONCLUSIONS:2 preparation were similar in efficacy ,safety and tolerance.