Objective We investigated and analyzed past and ongoing welfare programs related to health equity, and the relevant policies, documents, and interventions measures for improving China’s migrant worker population’s accessibility and utilization of tuberculosis (TB) control services in TB control programs. Then we evaluated their impactin order to provide evidence and suggestions for the further TB prevention and treatment. Methods We retrieved published documents about TB prevention and treatment of the migrant worker population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB, and VIP electronically. Simultaneously, a series of interviews was conducted with patients who used the programs. Results Totally, 58 documents were retrieved. Of these documents 13 passed eligibility criteria: eight have been published, five have not been published, and only one of them is RCT with B degree for quality of evidence. Secondary document research has suggested that the intervention measures that have been adopted concerning TB in China, including health promotion, providing incentive, patient tracking and supervision management. Although tuberculosis cure rates have improved, the scene interviews show that the majority of TB and suspected cases of patients don’t have enough knowledge on TB prevention and free treatment policies. It is often difficult to track the migrant population. TB detection and treatment still need to be enhanced. Conclusions There it is lack of high-quality documents about good intervention design, so it is difficult to make a objective and fair evaluation to the effects of intervention on the migrant population. In the future, we should carry out large-scale, multicenter, high-quality RCTs specifically for TB controlin the migrant population in order to provide evidencefor making a scientific and feasible intervention project.
ObjectiveTo systematically review the diagnostic value of T-SPOT.TB and QuantiFERON-TB (QFT-GIT/QFT-Plus) in active tuberculosis (ATB). MethodsThe PubMed, Web of Science, Cochrane Library, EMbase, CNKI, WanFang Data, and CBM databases were electronically searched to collect diagnostic accuracy studies comparing QFT-GIT/QFT-Plus and T-SPOT.TB for diagnosing ATB from inception to February 8, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 20 studies were included. The results of meta-analysis showed that the pooled sensitivity of T-SPOT.TB and QFT-GIT were 0.89 (95%CI 0.85 to 0.92) and 0.84 (95%CI 0.79 to 0.89), the pooled specificity were 0.85 (95%CI 0.68 to 0.93) and 0.86 (95%CI 0.72 to 0.94), the area under the curve (AUC) of summary receiver operating characteristic (SROC) were 0.93 (95%CI 0.84 to 0.97) and 0.90 (95%CI 0.56 to 0.99), respectively. The pooled sensitivity of T-SPOT.TB and QFT-Plus were 0.93 (95%CI 0.81 to 0.97) and 0.93 (95%CI 0.89 to 0.96), specificity were 0.99 (95%CI 0.39 to 1.00) and 0.94 (95%CI 0.67 to 0.99), the AUC of SROC were 0.99 (95%CI 0.67 to 1.00) and 0.98 (95%CI 0.65 to 1.00), respectively. ConclusionBoth T-SPOT.TB and QFT have high diagnostic accuracy for ATB, and the diagnostic sensitivity of T-SPOT.TB is better than QFT-GIT. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
The application of precision medicine in the field of tuberculosis is still in its infancy. The precision medicine of tuberculosis cannot be separated from the rapid and accurate diagnosis, the effective anti-tuberculosis drugs, and the comprehensive application of new cutting-edge technologies. In recent years, the precision medicine of tuberculosis has focused on drug-resistant tuberculosis, host-directed therapy and nano-targeted therapy, which has achieved certain results, providing an important mean for the treatment of tuberculosis, especially for the drug-resistant tuberculosis. In the future, the development of new drugs and the application of emerging technologies are the focus of precision medicine of tuberculosis. It is necessary to gradually carry out relevant clinical trial research and objectively evaluate its application value and prospects.
ObjectivesTo systematically review the disease burden and epidemiological characteristics of tuberculosis in the Chinese population, and to provide reference for health resources allocation and health policy making.MethodsDatabases such as PubMed, EMbase, CNKI, VIP and WanFang Data were searched for studies investigating disease burden of tuberculosis in Chinese population from inception to August 1st, 2017. Two researchers independently screened literature, exacted data and assessed methodological quality of included studies. Statistical analysis was performed on data of tuberculosis associated population, mortality and disease burden.ResultsA total of 40 studies were included. The results of qualitative analysis showed that, since 1990, the prevalence of tuberculosis and its disease burden in China decreased year by year. However, the disease burden per patient and the total economic burden in China showed an increasing trend, and the economical disease burden increased 1.6 times from 1993 to 2003. The disease burden of men was higher than that of women, and it was higher in the countryside than in the city. In 2004, the ratio of YLL per thousand people in rural and urban areas was 2.18, and the ratio was 1.29 in 2014. Additionally, the disease burden decreased gradually in western, central and eastern regions. In 2014, compared with 2004, YLL decreased by 1.11, while the central and eastern regions were 0.48 and 0.25, respectively. The gap between the gender, the urban and rural areas and the regions was not as significant as in previous.ConclusionsThe disease burden of tuberculosis in China is seriously high and the tuberculosis prevention and control work should take into consideration the epidemiological characteristics of tuberculosis and the trends of the disease burden. It is necessary to rationally and effectively implement health intervention programs and allocate health resources based on different health demands in different regions and age groups to reduce the morbidity and mortality, and to pay more attention to drug-resistant tuberculosis. Besides, the emphasis of prevention should be placed on reducing disease burden in the elderly and strengthening prevention in the young population.
Objective To evaluate the diagnosis value of purified protein derivative (PPD) antibody tests in childhood tuberculosis. Methods We reviewed 126 cases of hospitalization children tested body fluid PPD antibody by Enzyme-Linked Immunosorbent Assay (ELISA). Twenty-two them were diagnosed with tuberculosis. We determined the sensitivity, specificity, diagnostic likelihood ratio, positive prognostic value, negative prognostic value, post-test probability, respectively. Results The following accuracy statistics for the PPD body liquid antibody tests in this study: sensitivity, 45.45%; specificity, 91.35%; diagnostic likelihood ratio positive, 5.25; diagnostic likelihood ratio negative, 0.597; positive predictive value, 52.63%; negative predictive value, 88.79% and post-test probability, 48.09% in 15% of prevalence. Conclusion This study shows that body fluid PPD tests have limited value for diagnosis of tuberculosis in pediatric tuberculosis. Clinic physicians should be wary of the positive results of body fluid PPD antibody tests. The value of diagnosis is related to prevalence of tuberculosis in the specific hospital.
ObjectiveThe diagnostic efficacy of long non-coding RNA (lncRNA) for tuberculosis was evaluated by systematic review. MethodsData from PubMed, Web of Science, Cochrane Library, Embase, CMJFD, CNKI and WanFang Data were searched. Literatures on the diagnostic value of lncRNA in tuberculosis from the database establishment to August 20, 2024 were selected, and the quality of literatures was assessed using QUADAS-2 tool. Meta-Disc 1.0 software tested the threshold heterogeneity of the included studies. Stata 18.0 software calculated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and other effect sizes, and performed subgroup analysis and meta regression to explore the source of heterogeneity. Deeks funnel plot evaluates publication bias. Results A total of 28 case-control studies were included in 14 literatures. The meta-results showed that the combined sensitivity was 0.88 (95%CI 0.81 to 0.93), the specificity was 0.90 (95%CI 0.84 to 0.94), and the PLR was 9.05 (95%CI 5.16 to 15.87). The NLR and DOR were 0.13 (95%CI 0.08 to 0.22) and 67.96 (95%CI 27.27 to 169.39), and the AUC were 0.95 (95%CI 0.93 to 0.97). Subgroup analysis showed that lncRNA was more effective in the diagnosis of tuberculosis when PMBC samples, lncRNA expression was down-regulation, the study sample size was ≤100, there was cut-off value, GAPDH was used as the internal reference, and RNA extraction kit was used. meta regression indicated that lncRNA expression level and sample size were the main sources of heterogeneity. Conclusion LncRNA has high accuracy in the diagnosis of tuberculosis, and is expected to become a new biomarker to assist the diagnosis of tuberculosis.
Objective To explore the factors influencing 2-month sputum smear conversion (2m-SSC) in patients with systemic lupus erythematosus (SLE) and tuberculosis, and to establish a prediction model for 2m-SSC. Methods The initial and follow-up medical records of inpatients with SLE and sputum smear-positive tuberculosis in West China Hospital of Sichuan University from December 2013 to September 2019 were retrospectively reviewed. Single factor analyses and multivariable Firth’s logistic regression were used to determine the influencing factors of 2m-SSC, and a prediction model for 2m-SSC was established. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated to evaluate the performance of the model. Results A total of 91 patients with SLE and sputum smear-positive tuberculosis were ultimately included, with 8 cases in the non-conversion group and 83 in the conversion group. There were statistically significant differences in white blood cell count, total bilirubin, indirect bilirubin (IBIL), triglyceride, and rheumatoid factor (RF) between the two groups (P<0.05). Serum RF [odds ratio (OR)=2.271, 95% confidence interval (CI) (1.312, 4.350), P=0.003], IBIL [OR=2.363, 95%CI (1.206, 5.045), P=0.013], and glucose [OR=2.058, 95%CI (1.016, 4.280), P=0.045] were identified as risk factors unfavorable to 2m-SSC outcomes. The constructed model (including three variables: RF, IBIL, and glucose) had a good ability in predicting 2m-SSC [AUC=0.893, 95%CI (0.744, 1.000)], with a sensitivity of 87.5% and a specificity of 84.3%. Conclusion This study established a prediction model for 2m-SSC in patients with SLE and tuberculosis, and found the value of serum RF, IBIL, and glucose in predicting 2m-SSC, providing certain guidance for clinicians in treatment decisions.
目的:比较4种选药方案治疗复治后耐多药结核病的治疗疗效。方法:回顾性分析152例复治后耐多药结核病例,按治疗方案分为4组。Ⅰ组采用标准化疗方案HSRZE;Ⅱ组根据过去的治疗史组成个体化方案;Ⅲ组根据药敏试验组成个体化方案;Ⅳ组采用力克肺疾、左氧氟沙星、卷曲霉素、阿奇霉素、阿莫西林克拉维酸方案。结果:4组病灶吸收有效率分别为20.00%、47.37%、52.38%、81.48%;4组12个月疾菌阴转率分别为22.22%、57.89%、50.00%、81.48%。结论:对于所有复治肺结核患者均采用统一的标准复治方案有效率低,由力克肺疾、左氧氟沙星、卷曲霉素、阿奇霉素、阿莫西林克拉维酸联合组成的化疗方案是治疗复治后耐多药结核病的有效方案。
ObjectiveTo discuss clinical characteristics and nursing countermeasure of pregnant/delivery women with tuberculosis. MethodsFrom January 2012 to December 2013, 52 cases of pregnant women complicated with tuberculosis were included. We offered specific nursing according to the psychological counseling, reasonable administration, diet nursing, fever and prevention of hospital infection on the base of their clinical features, and then analyzed the effect. ResultsIn 52 patients who had undergone the tuberculosis and obsterrics and gynecology treatment, 4 puerperal patients died of severe pneumonia and multiple organ failure; in 48 gestational patients with tuberculosis, 23 early-middle term patients accept termination of pregnancy, and in 25 middle-late term patients, 3 had full-term natural labor, 4 underwent full-term cesarean section, 5 had premature labor, and 13 continued the pregnacy. Sixteen neonatus (including 4 given at the other hospitals) had normal results of physical examination without any deformity, in whom 5 had low body weight (body weight less than 2500 g), with negative results of tuberculin test and the result of 3-moth follow-up was normal. Three months after the anti-tuberculosis treatment, the lesion was obviously absorbed in 25 patients and in 23 patients within half of a year. No patients had hospital infection. ConclusionNursing care of pregnant patients with tuberculosis should strengthen the guidance on the patients health education, improve their compliance and self-protection knowledge. Also should strengthen the basic level medical personnel training and improve the ability of early diagnosis of tuberculosis and early treatment to reduce maternal mortality.
目的:探讨临床一线抗结核药物引起肝损害状况及预后,以提高对结核化疗致药物性肝炎的认识。方法:采用回顾性对比分析短程间歇化疗方案(2H3R3Z3E3/4H3R3)与短程每日化疗方案(2HRES/7HRE)之间抗结核治疗后对肝功能损害的发生率。结果:1144例中,发生药物性肝损害157例,其中间歇化疗方案发生药物性肝损害118例,占75.2%,每日化疗方案发生药物性肝损害39例,占24.8%。同时还发现体质状况差、病情重、老年人及有慢性酗酒者结核药物性肝损害发生率高。结论:药物性肝炎是影响结核病化疗的重要因素。短程间歇化疗方案治疗应因人而异,不宜广泛用于老年人、体质状况差、病情重、有慢性酗酒者的结核病患者。