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Objective To study the level of clinical diagnosis of pulmonary tuberculosis and implementa-tion of tuberculosis prevention and control policy. Methods Frequencies and percentages of pulmonary tuberculosis, other lung diseases and health among 3315 cases with pulmonary tuberculosis suspicious symptoms ,transferred by non-tuberculosis control institutions during 2010-2015,were calculated and analyzed. Results Among the 3315 suspected cases of pulmonary tuberculosis ,cases of pulmonary tuberculosis ,tuberculosis ,other lung diseases and healthy group were 2068,598 and 649 based on final diagnosis and their percentages were 62.38%,18.04% and 19.58% respectively. As to groups of elder than fifteen years ,the proportion of patients with pulmonary tubercu-losis accounts for 72.62%,61.00%and 48.58% of the total of young group(15~44 years old ),middle age group (45 ~ 64 years old)and elderly group(≥ 65 years old )respectively. Conclusions Compared with pulmonary tuberculosis suspicious symptomscases from tuberculosis control institution during the same period ,the proportion of tuberculosis patients from transferred groups is roughly the same.It indicate high levels of tuberculosis diagnosis and implementation to tuberculosis control policy.
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Objective To explore the impact of hypocholesterolemia on pneumonia in pulmonary tubercu-losis.Methods Data of 600 patients who were diagnosed with pulmonary tuberculosis in Guangzhou chest hospital were collected.Of these patients,300 were combined with pneumonia(experimental group)and the other subjects were pulmonary tuberculosis only(control group). Parameters including age,gender,sputum tubercle bacilli state,alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(Scr),blood urea ni-trogen(BUN),hemameba(WBC),c-reactive protein(CRP),procalcitonin(PCT),serum albumin(ALB),hemo-globin(HB),total of blood lymphocytes(TLC),and plasma total cholesterol(TC)between the 2 groups were com-pared. The correlation between hypocholesterolemia and the severity of pneumonia estimated with CURB-65 score was analyzed. Results hypoproteinemia,low lymphocyte and(all P < 0.05)were identified as risk factors for pneumonia with univariate logistic regression(all P<0.05).Moreover,hypocholesterolemia was confirmed as inde-pendent risk factor in mulitvariate logistic model(P < 0.05). The TC concentration was negatively correlated with CURB-65 score and significantly different among low-risk(CURB-65 score of 0-1),moderate(CURB-65 score of 2)and high risk(CURB-65 score of 3-5)pneumonia groups(all P < 0.05). Conclusions Hypocholesterolemia was an independent risk factor for pneumonia in pulmonary tuberculosis patients. The decreased level of TC was parallel with the severity of pneumonia.
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Objective To explore the relapse rate of the patients with primary smear-positive pulmonary tu-berculosis and pyrazinamide-resistance. Methods Retrospective analysis was made on the relapse for 150 patients with primary smear-positive pulmonary tuberculosis , who had been diagnosed and completed treatment in Guangzhou Chest Hospital from January 2012 to August 2013 , and had followed up two years. According to the re-sults of drug susceptibility test before treatment, they were divided into pyrazinamide-sensitive (114 cases) and pyrazinamide-resistant (36 cases) groups. Results (1)By the end of the treatment, the recovery rates in the sensi-tive group and resistant group were 98.25%and 88.89%respectively (P=0.044). The rate of the lesions absorption was 99.12%and 94.44%respectively (P=0.143). The rate of the cavity shrinking was 89.01% and 70.37% re-spectively (P = 0.039). The rate of the relapse was 3.57% and 6.25% respectively (P = 0.867) within 2 years fol-low-up in the sensitive group and the resistant group. Conclusions PZA has certain effects on the patients with primary smear-positive pulmonary tuberculosis. Those who are tolerant would have lower incidence for cavity shrink-ing. But the relapse rate for two-year follow-up showed there were not significant differences in two groups.
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Objective To analyze the different expressed protein of pleural effusion caused by tuberculosis and to identify proteins associated with tuberculous pleural effusion for building an economic , rapid, and accurate diagnostic method. Methods Two-dimensional gel electrophoresis technology was applied to separate protein in pleural effusion of 20 cases of tuberculous pleurisy ,19 cases of lung cancer patients and 6 cases of transudate. Analysis of isoelectric point, the range of molecular weight, matching rate and grey value of the protein was carried out by the PDQuest8.0 software.Then the electrophoregram was compared to get the distinct protein. Results There were 13 differential protein spots between tuberculous pleural effusion and the transudateand 9 protein spots were highly expressed for two folds, but 4 protein spots poorly expressed for 0.5 folds in pleural effusion caused by tuberculous pleurisy. There were 11 differential protein spots between tuberculous and malignant pleural effusion and 5 protein spots were highly expressed , but 4 protein spots poorly expressed in pleural effusion caused by tuberculous pleurisy , while 2 protein spots were expressed only in the pleural effusion caused by lung cancer. Conclusion Two-dimensional electrophoresis technology is available to acquire an electrophoretogram of pleural effusion caused by tuberculosis , lung cancer and transudate with well resolution and high repetition rate.In addition, there are different protein spots.
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Objective To study the correlation of PAZ with anti-tuberculosis treatment regimen and drug-induced liver injury in tuberculosis patients with HBV-DNA positive in order to provide an optimized treatment regimen. Methods from Jan 2013 to Dec 2014, 199 pulmonary tuberculosis with HBV-DNA positive patients and 103 pulmonary tuberculosis patients without HBV in our hospital were collected. They were assigned as follows:122 cases were anti tuberculosis treatment with antiviral therapy,64 cases were A(HRZE),58 cases were B (HRE). 77 cases were anti tuberculosis treatment but not antiviral therapy , 41 cases were C (HRZE), 36 cases were D(HRE) and 103 patients without HBV were E (HRZE, the contrast group). We had observed the liver injury for 2 months after the treatment. Results 1.Incidence of liver injury was 34.38% in group A , higher than the cases in group B(20.69%,P > 0.05). 2.Incidence of liver injury in group C was apparently higher than in group D (73.17% vs. 30.56%,P 0.05)4.Incidence of liver injury in group A was lower than group C (34.38% vs. 73.17%,P 0.05). Conclusion Although anti tuberculosis treatment combined with antiviral therapy can be partially reduce the incidence of liver injury and relieve the severity of liver injury in tuberculosis patients infected with HBV , but PZA toxicity to hepatocytes is a major risk factor for liver injury , and we need to change the treatment plan to reduce the occurrence of liver injury.
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Objective Age and sex of the population with suspected pulmonary tuberculosis (PTB) symptoms in Yuexiu District of Guangzhou were analyzed , to find out the prevalence and important risk factors responsible for tuberculosis in this district. Methods New PTB suspects domiciling in Guangzhou Yuexiu District during 2010-2015 were of interests. Data from Guangzhou Tuberculosis Control Project registration book and biobank of Guangzhou Tuberculosis Translational Medicine Center were applied to analyzed the frequency distribution of age and sex of the population. Results 6 154 cases of PTB suspects were included in this study. As to sex,ratio of male to female was 1.70 and there was no obvious fluctuation from 2010 to 2015. Frequency distribution among PTB suspects under 40 had no difference between male and female , but the ratio of male to female was nearly 1.70 for study objects aged above 40.As to age , there was a minor peak in the age group of 25~ while the greater peak was in the age group of 50~ after the age group of 35~. Conclusion In Yuexiu District of Guangzhou ,male were more likely to be the PTB suspects than female , and the peak age of prevalence was between 50 and 60.
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Objective To analyze the clinical efficacy of pre-extensive drug resistant tuberculosis (pre-XDR-TB), and to explore the feasibility of using the standard multidrug resistant tuberculosis (MDR-TB) therapeutic regimen to treat the patients with pre-MDR-TB. Methods A retrospective analysis was made for 126 cases of the MDR-TB patients who were received the treatment in Guangzhou chest hospital from 2009 to 2013. It was divided into MDR-TB group, pre-XDR-TB group and XDR-TB group according to the drug sensitive test (DST) of quinolone(levofloxacin, moxifloxacin) and aminoglycoside (amikacin). All patients were treated for 6-months with the standard therapeutic regimen including Am(Cm), Lfx(Mfx), Pto, PAS and PZA. Results (1) There were 126 cases of the MDR-TB patients in the study, 31 cases (24.6%) complicate with aminoglycosides-resistance, 69 cases (54.7%) complicate with quinolone-resistance. (2) The negative rate of MDR-TB group, pre-XDR-TB group and XDR-TB group was 82.0%, 55.8% and 29.2% respectively (χ2 = 20.110, P < 0.001). (3)The negative rate of pre-XDR-TB group significantly lower than MDR-TB group (χ2 = 8.146, P = 0.004). The negative rate of pre-XDR-TB group higher than XDR-TB group (χ2= 4.661, P = 0.031). Conclusions The situation of quinolone and aminoglycoside resistance was high in the patients with MDR-TB. We should carry out the detection of quinolone and aminoglycoside resistance in clinical treatment. The clinical efficacy for the patients with pre-XDR-TB was significantly poorer than the patients with MDR-TB using the standard MDR-TB therapeutic regiment treated.
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Objective To study the feasibility of in vitro release of γ-interferon tests (IGRA) in screening of tuberculosis for children with close TB contacts. Methods 185 children with close TB contacts were detected by IGRA at the pediatric clinic in our hospital. Results In IGRA-positive group, the rate of strong positive PPD (PDD≥15 mm) was 50.9%, which was higher than 9.1% in IGRA-negative group (X2 =37.263, P < 0.00). The morbidity rate for children with close TB contacts was 30.2% in IGRA-positive group, and it was significantly higher than 3.0% in IGRA-negative group (X2 = 28.928, P < 0.00). The sensitivity was 80% and the specificity was 77.6% for IGRA screening in children who had close contacts with TB patients. The sensitivity would be 95.0%, as the test was combined with PPD test. Conclusions IGRA screening in children with close TB contacts can increase the detection rate of tuberculosis and reduce imaging screening.
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Objective To investigate the effects of different liver protective drugs on preventing liver injury induced by anti-tuberculosis drugs. Methods Retrospective analysis was made on 355 patients with primary pulmonary tuberculosis during intensified time. The patients received silibinon and bicyclol to prevent liver injury. 82 patients with TB were treated as control group during the same time. Results The number of patients with liver injury in silibinon group and bicyclol group were 16 cases (14.7%) and 55 cases (22.4%) respectively. The number of control group with liver injury was 9 cases (11.0%) (χ2 = 3.627,P > 0.05). The liver injuries within 4 weeks were mainly counted in. There is no difference between intervention and control groups(χ2 = 0.414,P > 0.05). There is no difference between three groups in liver injury degree (U = 0.288,P> 0.05). Conclusion Without high risk factors, anti-inflammatory and enzyme reduction drugs have no significant protective effects on liver injury caused by anti-tuberculosis drugs.
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Objective To explore the epidemic situation of nontuberculous Mycobacteria in both Yuexiu and Zhuhai districts. Methods Mycobacterium tuberculosis culture and strain identification were conducted in suspected smear-positive tuberculosis patients who had visited our clinics at Yuexiu and Haizhu districts in Guangzhou during the period of 2010 to 2012. Results 2 014 sputum samples were identified as NTM and MTC, 1 630 samples were MTC (80.9%), and 384 samples were NTM (19.1%). The isolated rate for NTM from 2010 to 2012 was 17.6%, 17.1% and 21.2%, respectively. 79 strains of 384 NTM were identified; the rapid-growing mycobacterium was 50.6%, and the slow-growing mycobacterium was 49.4%. Conclusions The sputum-isolated rate of NTM for the suspected tuberculosis patients was 19.1% in Yuexiu and Haizhu districts in Guangzhou. For the smear-positive pulmonary tuberculosis patients who respond to treatment poorly , we should pay attention to NTM lung disease.
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Objective To establish a diagnostic scoring system for diabetic patients with smear-negative pulmonary tuberculosis , and then to improve the rapidity and accuracy of clinical diagnosis and save medical expenses. Methods A case-control study was applied. 150 diabetic patients with smear-positive pulmonary tuberculosis who on initial treatment were assigned to a study group; 150 patients with lung infection were recruited as a study group. The data on general status, symptoms, chest X-ray manifestation, and laboratory examinations was collected. Univariate logistic regression analysis was used to gain significant indexes for multiple logistic regression analysis. β-coefficients derived from the independent predictors in our logistic regression model was applied to develop a scoring system. Results Toxic symptoms of tuberculosis, cough, upper lung, cavity, multiple lung field , and PPD positive entered into the final multipie logistic regression model , and the scoring system was accordingly established. The patient with a score of more than 11 had higher probability of TB , while those with a score of smaller than 11 were not likely to have TB. Conclusion The scoring system can be used as a predictive tool in diagnosis of diabetes mellitus complicated by smear-negative pulmonary tuberculosis , helping diagnose active tuberculosis rapidly.
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Objective To explore the impact of peripheral blood CD4 + T cells on nutritional status of patients with non-tuberculosis mycobacteria (NTM) lung disease. Methods A retrospective analysis was performed including 78 patients with NTM lung disease from January 2008 to December 2012 in Guangzhou Chest Hospital, who were divided into cellular immunocompromised group with 43 cases and control group including 35 cases and then the impact of malnutrition on cellular immune function decline was explored. Results Peripheral blood CD4+T cells were positively correlated with CD3+T cells, CD8+T cells, CD4+/CD8+T cell ratio in all of the included patients(P0.05). Compared with those in control group, TLC count was obviously lower while there were more patients with bronchiectasis in cellular immunocompromised group, which indicated statistical significance (P < 0.05). Conclusions Most of NTM patients are associated with malnutrition and NTM patients of cellular immunocompromised are associated with bronchiectasis easily and obvious reducing of TLC, but CD4+T cells and serum proteins levels are not necessarily correlated. The severity of NTM is commonly caused by such factors as basic pathologic change, cellular immunization, nutrition and infection.
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Objective To assess the efficacy of using four kinds of proteins / peptides to distinguish the tuberculosis patients from healthy people. Methods A, B, C and D were used to represent four proteins /peptides with 1 060, 1 944, 2 081 and 3 954 of mass to charge ratio (m / z) in serum, respectively. Levels A, B, C and D in serum of 57 patients with tuberculosis and 30 healthy people were determined by using the surface-enhanced laser desorption-ionization time of flight mass spectrometry (SELDI-TOF-MS). Then the differences of levels of f A, B, C and D were anlyzed between tuberculosis patients and healthy people. The efficacy of distinguishing tuberculosis patient from healthy people were evaluated by using diagnostic test evaluation method. Results (1) The levels of A, B, C and D were 1 ± 11, 1 597 ± 3 102, 460 ± 765 and 1 208 ± 1 003 in tuberculosis patients, while they were 123 ± 201, 47 ± 98, 36 ± 93 and 397 ± 355 in healthy people. (2) The area under the receiver operator characteristic (ROC) curve was 0.644, 0.848, 0.735 and 0.810 respectively. The serum levels of A, B, C and D could be used to distinguish tuberculosis patient from healthy people and the cut-off values of A, B, C and D were ≤166, ≥318, ≥48 and ≥728, respectively. Conclusions B, C and D have better performances to distinguish tuberculosis patients from healthy people , which may be regarded as new promising candidate markers for diagnosis of tuberculosis.
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Objective To find humoral protein markers to develop new experimental diagnostic methods for tuberculous pleurisy. Methods Proteomes of 7 d and 14 d culture filtrate of Mycobacterium tuberculosis growing in Middlebrook 7H9, serum and pleural effusion from five patients with tuberculous pleurisy were detected by surface-enhanced laser desorptionionization time-of-flight massspectrometry (SELDI-TOF-MS). And the data were analyzed with descriptive statistics method to observed the protein components all owned by three kinds of proteome. Results From protein species, proteins of all culture filtrate were far more than that of pleural effusion and serum while proteins of pleural effusion in four cases were more than that of serum. The kinds of common proteins between culture filtrate and pleural effusion, between culture filtrate and serum, between serum and pleural effusion, among culture filtrate and pleural effusion and serum were different. But the protein of relative molecular mass of 2 660 depending on the ratio of mass to charge existed in all samples of culture filtrate, pleural effusion and serum. Conclusion The protein of relative molecular mass of 2 660 possess the latent quality as a specific humoral protein marker for tuberculous pleurisy. But it is essential that must be further confirmed among large samples.
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<p><b>OBJECTIVE</b>To compare the clinical characteristics of rifampin-dependent (R-dependent Mycobacterium tuberculosis) and rifampin-resistant (R-resistant Mycobacterium tuberculosis) patients with pulmonary tuberculosis.</p><p><b>METHODS</b>The clinical data including the demographic data, age groups, course of disease, history of chemotherapy with anti-TB drugs, and results of drug susceptibility test were collected from 61 cases of R-dependent pulmonary tuberculosis and 148 cases of R-resistant pulmonary tuberculosis treated between October, 2008 and January, 2012.</p><p><b>RESULTS</b>Most of the R-dependent and R-resistant patients were between 30 and 44 years of age. The R-dependent patients included 12 receiving the first treatment patients and 49 with previous treatments, and the R-resistant patients included 11 without and 137 with previous treatments. The multi-drug resistant rate was 80.3% in R-dependent group, as compared to 92.6% in R-resistant group.</p><p><b>CONCLUSION</b>Most of the patients infected with R-dependent Mycobacterium tuberculosis are young or middle-aged, often having serious disease conditions. Detecting rifampin dependence is important for patients with initial treatment failure. Multi-drug resistance therapy guideline should be applied to patients infected with R-dependent Mycobacterium tuberculosis to improve the cure rate.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Antitubercular Agents , Pharmacology , Therapeutic Uses , Mycobacterium tuberculosis , Rifampin , Pharmacology , Therapeutic Uses , Tuberculosis, Multidrug-Resistant , Drug Therapy , Microbiology , Tuberculosis, Pulmonary , Drug Therapy , MicrobiologyABSTRACT
Objective To study the mutation of DNA fragment of rpoB gene in different degrees of rifampin-resistance in Mycobacterium tuberculosis.Methods DNA fragment of rpoB gene in Mycobacterium tuberculosis was sequenced,including 32 low-level (R50) rifampin-resistant strains (50?g/mL rifampin-resistant),22 high-level (R250) rifampin-resistant strains (250?g/mL rifampin-resistant),10 (R0)rifampin-sensative strains and 1 H 37 Rv strain.Results No mutation was detected in 10 rifampin-sensative strains and 1 H 37 Rv strain;25(78.1%)rifampin-resistant strains had mutations in R50 and 21(95.5%)rifampin-resistant strains had mutations in R250(P=0.170).The mutatione points were distributed disorderly in R50.The 531-Ser mutation(57.1%)and joint mutation(23.8%)were more in R250 than those in R50.Conclusion The frequency of mutation in the rpoB gene of rifampin-resistant strain is higher.The mutation points are distributed disorderly in R50.The 531-Ser mutation(57.1%)and joint mutation(23.8%)are major mutative characteristics in R250.
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Objective:To explore the influence of disease severity and effectiveness of antituberculosis treatment on helper T-cells in peripheral blood from patients with pulmonary tuberculosis.Methods:Th1 cells and Th2 cells of peripheral blood of 62 pulmonary TB patients and 30 controls were marked by intracellular cytokine(INF-? and IL-4 representative of Th1 and Th2 subsets respectively) and counted by Flow Cytometry.The levels of Th1 and Th2 cell count from patients with different disease severities radiologically before antituberculosis therapy were compared and their correlation with effectiveness of different antituberculosis treatment radiologically was analyzed either.Results:The baseline levels of Th1 cell count and Th2 cell count in pulmonary tuberculosis group before antituberculosis therapy were significantly lower than those in the control group(P0.05,t test).The levels of Th1 cell count in the stable group were still significantly lower than those in the control group(P