Current Issue

2023 Vol.8 No.6 Published:31 December 2023

Original Articles

Establishment of the ultra-sensitive detection method for HIV integrase by rolling circle amplification combined with DNA nanosensor Chen Fuming, Wang Jing, Li Furong 2023, 8 (6):  1-8.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.001 Abstract ( 191)    PDF (1506KB) ( 148 )    Objective A novel isothermal amplification assay (REIAD) for human immunodeficiency virus (HIV) integrase (IN) was developed using RCA and DNA nanosensors. Method Purified recombinant HIV IN or packaged HIV particles were extracted, and the LTR terminal sequence of att site and double-stranded DNA ring identified by IN were designed with the activity of HIV IN as the target, and then combined with DNA nanosensor detection technology. The LTR sequence was fixed on the surface of the slide and catalyzed to insert the end of the double-stranded DNA ring to produce a DNA ring with incision for interface RCA amplification and fluorescent labeling probe detection, and the HIV integrase isothermal amplification assay (REIAD) was established. The sensitivity of the detection method was evaluated and the detection limit was determined by detecting the gradient dilution of HIV IN and packaging HIV particles. The specificity of the assay was evaluated by detecting the effects of gradient dilution mouse leukemia virus (MLV) and HIV IN inhibitor raltegravir. By adding HEK293 whole cell extract and 10% fetal bovine serum cell culture medium to gradient diluted HIV IN, the feasibility of detecting plasma samples from patients was evaluated. Result The detection of graded diluted HIV IN and packaged HIV particles was completed by REIAD method at 37℃, integration for 50 minutes, and rolling ring amplification for 30 minutes. The minimum detection limits of recombinant HIV IN and packaged HIV particles were up to 15 fmol and 2 TU/μl, and there was no cross-reaction with MLV. It has good specificity. Conclusion The REIAD detection method established in this study has high sensitivity, good specificity, simple operation and low platform requirements, and is expected to provide a new detection method for the early detection of HIV virus.

Sequence analysis of pol gene of HIV-1 strain in Dongguan He Songmei, Liang Jinhu, Zhong Qingyang, Cao Huanhuan, Yin Juzhen, Wang Fuxiang 2023, 8 (6):  9-13.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.002 Abstract ( 92)    PDF (2416KB) ( 110 )    Objective To investigate the epidemiological characteristics of human immunodeficiency virus type 1 (HIV-1) and the subtypes distribution among HIV-1-infected individuals in Dongguan. Method From January 2019 to January 2021, 284 HIV-1 infected patients who had received antiviral treatment in Dongguan were selected, and was collected their epidemiological information. The viral RNA of HIV-1 was extracted from plasma. The pol gene was amplified by nested polymerase chain reaction. and gene sequence analysis was performed using biological software such as LaserGene, HIV BLAST, and MEGA 6.0. Result A total of 284 samples were collected in this study and finally successfully obtained 269 HIV-1 pol gene sequences. Among the 269 samples, 86.2% (232/269) were male, 61.3% (165/269) were younger than 40 years old, 52.4% (141/269) were unmarried, and 49.4% (133/269) were heterosexual and 47.2% (127/269) were homosexual. Of the 269 pol gene sequences, eight genetic subtypes were identified: 131 (48.7%) CRF07_BC, 59 (21.9%) CRF01_AE, 38 (14.1%) CRF55_01B, 19 (7.1%) subtype B, 12 (4.5%) CRF08_BC, and 10 (3.7%) other subtypes. Among 133 patients with heterosexual transmission, the predominant subtypes were 59 (44.4%) CRF07_BC, 32 (24.1%) CRF01_AE, and 15 (11.3%) CRF55_01B, and among 127 patients with homosexual transmission, the predominant subtypes were 65 (51.2%) CRF07_BC, 26 (20.5%) CRF01_AE, and 23 (18.1%) CRF55_01B. Differences in gender and marital status composition among individuals infected with different subtypes were statistically significant (P<0.05), while no statistically significant differences were observed in age and mode of infection composition. Conclusion The distribution of HIV-1 subtypes in Dongguan is complex and diverse, with CRF07_BC, CRF01_AE, and CRF55_01B being predominant. Furthermore, significant differences exist among HIV-infected individuals of different genders and marital statuses.

Construction of multidrug-resistant pulmonary tuberculosis patient prediction model based on different CT imaging characteristics Xu Duoyao, Yang Han, Quan Shenwen, Luo Weijun, Zhong Cheng, Guo Lin, Zheng Qiuting 2023, 8 (6):  14-21.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.003 Abstract ( 118)    PDF (2088KB) ( 168 )    Objective Different clinical prediction models were constructed to provide an imaging basis for the diagnosis of multidrug-resistant pulmonary tuberculosis (MDR-PTB) by characterizing the lung imaging of MDR-PTB patients. Method Data on imaging characteristics of 110 MDR-PTB patients and 154 drug sensitive pulmonary tuberculosis drug-sensitive pulmonary tuberculosis (DS-PTB) patients admitted to the outpatient department of Shenzhen Center for Chronic Disease Control from January 2018 to December 2020, were retrospectively collected, in order to compare and analyze the differences in the lung imaging characteristics and cavity characteristics between MDR-PTB group and DS-PTB group. Different prediction models were constructed by logistic regression method and then further validated. We analyzed the baseline data, CT imaging characteristics between DS-PTB and MDR-PTB groups. The age, patient type, bud sign OR lobule-centered nodule, calcification, and involvement of the lung field were used to construct model1, the minimum internal diameter of lung cavities was used to construct model2, and the minimum internal diameter and bud sign OR lobule-centered nodule were used to construct model3. Result The incidence rate of pulmonary cavities was higher in the MDR-PTB group (64.5%), and both the number of thin-walled and thick-walled pulmonary cavities were higher than that of the DS-PTB group [(0.8±2.4) vs (0.1±0.3), (1.8±3.1) vs (0.3±0.7)], and the number of lobular segments affected by cavities was higher in the MDR-PTB group than that of the DS-PTB group [(1.0±1.1) vs (0.3±0.5)], with a predominance of the right upper and lower lobes, the antero-posterior and posterior apical segments of the left upper lobe, and the left lower lobe. All differences above were statistically different. In MDR-PTB group, tree bud sign or lobule-centered nodule and bronchiectasis were more likely to occur, and these signs were more likely to involve more lung segments and lung fields, with statistical significance. When factors of age, patient type, tree bud sign or lobule-centered nodule, calcification, and involvement of the lung fields were included in the prediction model, the model achieved a higher diagnostic performance with an area under the curve of 0.829 (95%CI 0.779-0.879). We selected cases with lung cavities of the DS-PTB and MDR-PTB groups and performed propensity matching and one-factor logistic regression analysis for them. The results showed that there were significant differences in the maximum outer diameter, the maximum inner diameter, the minimum inner diameter, the maximum wall thickness and the minimum wall thickness of lung cavities between the two groups. However, only one factor of minimum inner diameter of lung cavities was significantly different in the multivariate logistic regression analysis. The OR was 0.34(95%CI 0.17-0.68, P=0.002). Conclusion In this study, the three constructed models can provide a better performance on MDR-PTB diagnosis, especially when there is insufficient evidence of TB etiology and drug resistance test, providing a certain diagnostic basis.

Establishment and evaluation of a clinical diagnostic score model for AIDS complicated with active pulmonary tuberculosis Mo Shenglin, Huang Yun, Huang Xiaohong, Qin Jinyu, Chen Tao, Hu Jiaguang, Meng Dali, Zhang Peng, Jiang Zhongsheng, Kong Jinliang 2023, 8 (6):  22-26.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.004 Abstract ( 64)    PDF (811KB) ( 104 )    Objective To establish a scoring model for the clinical diagnosis of active pulmonary tuberculosis in patients with AIDS using common clinical indicators and to evaluate the predictive performance of the model. Method A total of 229 patients admitted to the Department of Infectious Diseases, Liuzhou People's Hospital, from October 1, 2014, to September 30, 2021, were included in the study. Among them, there were 104 cases of AIDS combined with active pulmonary tuberculosis and 125 cases of AIDS combined with other non-tuberculous pulmonary diseases. Univariate analysis and binary logistic regression analysis were used to select variables favorable for diagnosing active pulmonary tuberculosis in AIDS patients. A clinical scoring model for the diagnosis of active pulmonary tuberculosis in AIDS was established, and the predictive ability of the model was assessed. Result In this clinical diagnostic scoring model, six variables were analyzed: cough and sputum symptoms (7 points), CD4+T lymphocyte count (12 points), upper lobe lung lesions (6 points), multi-segment lung lesions (7 points), lung lesions with mediastinal lymphadenopathy (7 points), and unilateral pleural effusion (6 points). When the score was greater than 24 points, the area under the curve for clinical diagnosis of active pulmonary tuberculosis in AIDS patients was 0.911 (95%CI 0.864-0.958) (P<0.05). The sensitivity and specificity were 82.2% and 92.0%, respectively. The positive predictive value and negative predictive value were 89.6% and 86.9%, respectively. The results obtained from the validation group achieved an accuracy of 88.2% (60/68). Conclusion The clinical diagnostic scoring model for active pulmonary tuberculosis in AIDS patients established in this study is simple to use in clinical practice and has good predictive and pre-judgment efficacy for evaluating whether HIV-infected individuals with a CD4+T lymphocyte count ≤200/μl are combined with active pulmonary tuberculosis.

Clinical effect of uniportal thoracoscopic decortication for stage Ⅲ tuberculous empyema Wang Haijiang, Zheng Shuo, Wang Yanfeng, Huang Pilai, Shi Qinlang, Ning Xinzhong, Fu Qiang, Xia Zhaohua, Tao Xiaoting, Qiao Kun 2023, 8 (6):  27-30.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.005 Abstract ( 122)    PDF (877KB) ( 111 )    Objective To explore the safety and feasibility of uniportal thoracoscopic decortication in the treatment of stage Ⅲ tuberculous empyema. Method From June 2020 to June 2022, 52 patients including 38 males and 14 females with stage Ⅲ tuberculous empyema who underwent uniportal thoracoscopic decortication were retrospectively analyzed in Department of Thoracic Surgery, The Third People's Hospital of Shenzhen. The mean age was (36.96±14.24) years (range:21 to 72 years). general After general anesthesia, a 4-5cm incision was made in the center of the pus cavity. In the case of severe intercostal stenosis, a section of rib was removed. And the outer parietal pleural space was separated. With the help of incision protector the thickened visceral parietal pleural fibreboard was removed free under a single hole. Follow‐up was performed in the outpatient clinic monthly. When there is no air leakage in the thoracic drainage tube, the color of the drainage fluid is pale, and the drainage volume is less than 100ml/d, the chest tube was removed. If chest imaging showed good lung dilation, the drainage volume of the trench drainage tube was <50ml/d, the trench drainage tube was removed, and the anti-tuberculosis treatment plan was formulated according to the bacteriological examination results. The postoperative follow-up was 12 months. The postoperative imagings were performed at 6 and 12 months.and compared with preoperative chest CT. Result Among the 52 cases, 27 cases had excellent recovery, 21 cases had good recovery and 4 cases general recovery. The excellent and good rate of postoperative cure was 92.3%,No patients had recurrence. Among the 52 patients, 51 cases underwent uniportal thoracoscopic decortications, and 1 case changed to thoracotomy. The operative time was (268± 110)min （range: 110 to 430）min; and median blood loss was (126±68)ml(range: 50 to 300 ml). All patients were discharged with 2 chest tubes, and the median duration drainage was(5±2.5) days (range: 3 to 16 days), and (9.0±2.8) days (range: 7 to 21 days) separately. The postoperative hospital stay was (5.0±2.5) days (range:3 to 7 days). There were no major complications except 1 case of prolonged lung leakage with the thoracic tube was removed 16 days after surgery, 2 cases of incision infection and 1 case encapsulated pleural effusion. Conclusion Uniportal thoracoscopic decortication is safe, feasible and effective for patients with stage Ⅲ tuberculous empyema.

Evaluation of the degree of thoracic collapse in stage Ⅲ tuberculous empyema and analysis of the factors related to improvement of thoracic collapse after surgery Chen Shiming, Li Gang, Jia Shuang, Gong Sheng, Song Yijie, Wu Banggui, Li Xiao, Zhong Ming, Jiang Liangshuang, Yao Xiaojun 2023, 8 (6):  31-36.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.006 Abstract ( 69)    PDF (921KB) ( 117 )    Objective To find an Objective evaluation method for the degree of thoracic collapse of stage Ⅲ tuberculous empyema, and to analyze the related factors affecting the improvement of thoracic collapse after stage Ⅲ tuberculous empyema. Method Retrospective analysis was performed on stage Ⅲ patients with tuberculous empyema who received surgical treatment in Chengdu Public Health Clinical Center from February 2018 to August 2021. Chest CT examination was performed 12 months after surgery, and the half circumference of the inner margin of the bone of the affected side and the healthy side was measured through the plane of the carina and xiphoid process, and the "thoracic collapse index" was calculated. The study population was divided into the group with significant improvement of thoracic collapse and the group without significant improvement, and the factors affecting the significant improvement of thoracic collapse were analyzed. Result A total of 62 patients were included in the study, including 46 males and 16 females, with an average age of (27.58±12.55) years. The thoracic collapse index in the carina and xiphoid plane after each follow-up period was significantly lower than that before surgery (P<0.05), and the overall trend was gradually decreasing. The thoracic collapse recovery was the best and the thoracic collapse index was the lowest 12 months after surgery. In the follow-up period of 12 months after surgery, the study population was divided into two groups: significantly improved thoracic collapse group and no significantly improved thoracic collapse group according to whether the "improvement percentage of thoracic collapse" was ≥4% or not. Multivariate logistic regression analysis showed that the disease course < 6 months (P=0.048), BMI <18.5kg/m2 (P=0.043) and preoperative pleural thickness <1cm (P=0.027) were the risk factors for significant improvement of thoracic collapse after carinal plane surgery. BMI<18.5kg/m2 (P=0.042) was a protective factor that significantly improved thoracic collapse after xiphoid plane surgery. Conclusion In this study, the index "thoracic collapse index" was successfully defined to quantitatively evaluate the degree of thoracic collapse in stage Ⅲ tuberculous empyema, and the related factors affecting the improvement of postoperative thoracic collapse were preliminarily found.

Efficacy observation of the two-drug regimen DTG+3TC in treatment-naive human immunodeficiency virus infection/acquired Immure deficiency syndrome patients Lan Shuanglai, Lan Ke, Zhang Yong, Dou Yangyun 2023, 8 (6):  37-41.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.007 Abstract ( 75)    PDF (751KB) ( 108 )    Objective To investigate the clinical efficacy of a simplified regimen of dolutegr-avir(DTG)+lamivudine(3TC) in first-treatment human immunodeficiency virus infection/acquired immure deficiency syndrome patients. Method Historical control subgroups were selected, and primary HIV/AIDS patients who received antiretroviral therapy（ART）at the Chest Hospital of Guangxi Zhuang Autonomous Region between January 2019 and September 2022 were selected. According to the enrolment criteria, 47 cases in the observation group were treated with DTG+3TC regimen, and 49 cases in the control group were treated with tenofovir (TDF) + lamivudine (3TC) + efavirenz (EFV) regimen, and the HIV suppression rate and immunological status of the two groups were compared with each other after 36 weeks of treatment under observation. Result In the baseline characteristics of the two groups, the difference in age distribution and baseline HIV RNA load capacity were statistically significant, with no significant difference in residual baseline index; at 12 week of treatment, the observation group and control group were 56.6% and 30.6%, respectively(P=0.011); at 24 weeks of treatment, the viral suppression rates of the two groups were 63.6% and 79.6%, respectively (P=0.139); at 36 weeks treatment, the viral suppression rates of the two groups were 85.1% and 81.6%,respectively(P=0.786), and the median CD4+T lymphocyte counts and CD4+/CD8+T lymphocyte ratios were significantly higher than those at baseline, and there was no significant difference in the magnitude of the increase between the two groups(P>0.05). Conclusion The viral suppression effect of the simplified two-drug regimen of DTG+3TC in the treatment of first-treatment HIV/AIDS patients was not different from that of the triple-drug regimen of TDF+3TC+EFV, and even the early viral suppression rate was better than that of the triple-drug regimen of TDF+3TC+EFV, and at the same time it could effectively improve immune function.

The effect of interferon-λ3 level and interleukin-28B polymorphisms on prognosis of hepatitis B virus acute (subacute)-on- chronic liver failure Zhang Dongqing, Lin Shenglong, Ma Huaxi, Wang Xiangmei, Liao Ziyuan, Wu Wenjun, Chen Mengyun, Wang Jianyu, Gao Haibing 2023, 8 (6):  42-46.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.008 Abstract ( 87)    PDF (824KB) ( 104 )    Objective To investigate the effect of the interferon-λ3（IFN-λ3） and IL-28B polymorphisms in peripheral blood on the prognosis of hepatitis B acute (subacute)-on- chronic liver failure and try to establish an early, sensitive and specific prognosis model of hepatitis B acute (subacute)-on- chronic liver failure combined with other influencing factors. Method Retrospective cohort study of 97 patients diagnosed with chronic and subacute (subacute) liver failure and viral hepatitis B in Mengchao Hepatobiliary Hospital of Fujian Medical University from October 2019 to March 2020. All the enrolled patients were followed up for half a year, and the end point of follow-up was death. The level of IFN-λ3 and polymorphism of IL-28B rs12979860 were detected. Clinical indicators such as cholesterol, cholinesterase, albumin, total serum bilirubin (TBil), international normalized ratio (INR), plasma thromboplastin antecedent (PTA), and serum creatinine (cr) were collected at baseline treatment, and MELD values at baseline treatment were calculated. Univariate and multiple regression analyses were performed for the above indicators to establish a prognosis assessment model of hepatitis B acute (subacute)-on- chronic liver failure. Result After six months of follow-up, 15 cases died and 82 cases survived, with a mortality rate of 15.5%. Age, total bilirubin, direct bilirubin, indirect bilirubin, cholesterol, prothrombin time, PTA, INR, fibrinogen, IFN-λ3 level and MELD score were statistically different between the two groups (P<0.05). The above indexes were included in logistic regression analysis, and the model was established by stepwise regression method. The results showed that PTA and IFN-λ3 level were independent risk factors for survival. PTA and IFN-λ3 levels were lower in the death group than in the survival group. A new prognostic model equation was established: Y=0.144+0.054×age +0.005×TBil(µmol/L) -0.07×PTA(%) -0.002×IFN-λ3 (pg/ml). ROC curve comparison: The diagnostic value of the newly established model, MELD score, and IFN-λ3 were compared respectively. The results showed that the area under ROC curve of the new predictive model was larger than the MELD score and IFN-λ3 level. IL-28Brs12979860 polymorphism sequencing: Only one died patient was CT genotype, and the rest were CC genotype, so genotype frequency was not statistically different between the two groups. Conclusion The level of IFN-λ3 can be used as an indicator of prognosis in patients with hepatitis B acute (subacute)-on- chronic liver failure. The new model of IFN-λ3 combined with PTA, total bilirubin level and age can predict the prognosis of patients with liver failure better.

The value of shear wave elastography in the study of gallbladder disease and spleen size in hepatitis B patients with different alanine amino transferase levels Guo Guoqiang, Zhang Jiahui, Xu Qin, Yuan Wei, Wu Xinyin, Guan Xiaoyun, Zhang Jing 2023, 8 (6):  47-51.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.009 Abstract ( 65)    PDF (1282KB) ( 92 )    Objective To study the relationship between the elasticity of hepatitis B patients with different alanine transaminase (ALT), gallbladder disease and spleen size by shear wave elastography (SWE). Method Select hepatitis B patients with elevated liver elasticity who visited Shenzhen Second People's Hospital from December 2018 to December 2022, the patients were divided into normal group (N group) 107 cases, high but not more than twice the normal value group (Ha group) 34 cases and more than twice the normal value group (Hb group) 25 cases according to the ALT level. Analyze the impact of liver elasticity values on the incidence of gallbladder disease and spleen size in each group, and analyze the correlation between liver elasticity values and spleen thickness. Result ①There was no statistically significant difference in gender composition ratio, gallbladder disease incidence, and spleen size among the N, Ha, and Hb groups (P>0.05), but there was a statistically significant difference in age distribution (P=0.010). ②The liver elasticity value and age of positive patients with gallbladder disease in group N were significantly higher than those of negative patients (P<0.001, P=0.005), and after adjusting for age, liver elasticity value was a risk factor for gallbladder disease (OR=1.167, P=0.040); The elasticity values of liver in group N with splenomegaly were significantly higher than those with the spleen is not swollen (P=0.006) and the elasticity value was a risk factor for splenomegaly (OR=1.221, P=0.004). ③The liver elasticity value of Hb group with splenomegaly was significantly higher than that of the spleen is not swollen (P=0.021). The liver elasticity value is a risk factor for splenomegaly (OR=1.327, P=0.026), and the liver elasticity value is moderately correlated with splenic thickness (r=0.580, P=0.002). ④A ROC curve was drawn based on the liver elasticity value and gallbladder disease incidence in group N, with an area under the curve of 0.704. The optimal intervention treatment threshold was 7.350, and the corresponding sensitivity and specificity were 68.0% and 66.7%. ⑤The ROC curve of the subjects was drawn based on the liver elasticity value and splenomegaly incidence of the N and Hb groups. The area under the curve was 0.660 and 0.773, respectively. The optimal intervention treatment thresholds were 7.450 and 12.500, with corresponding sensitivity of 61.5% and 72.7%, and specificity of 67.6% and 92.9%, respectively. Conclusion In hepatitis B patients with normal ALT level, gallbladder disease and spleen size are related to liver elasticity; In patients with hepatitis B whose ALT level is twice the normal value, the liver elasticity value is moderately related to the thickness and diameter of the spleen. Early treatment of such patients may help reduce the incidence rate of biliary and splenic diseases.

Expression of serum MCP-1, INF-γ and IL-18 in patients with pulmonary tuberculosis and its value in the diagnosis and treatment evaluation of the disease Chen Jie, Ye Haiming, Zhang Jufang 2023, 8 (6):  52-57.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.010 Abstract ( 66)    PDF (1598KB) ( 105 )    Objective To analyze the expression of serum monocyte chemoattractant protein-1 (MCP-1), interferon-γ (INF-γ) and interleukin-18 (IL-18) in patients with pulmonary tuberculosis, and to explore their clinical value in the diagnosis and treatment of pulmonary tuberculosis. Method From January 2019 to June 2021, 85 patients with active pulmonary tuberculosis who were treated in Futian District Chronic Disease Prevention in Shenzhen were selected, and they were divided into mild group (51 cases) and severe group (34 cases). Serum INF-γ, IL-18 and MCP-1 levels of patients with different clinical characteristics were compared. And the serum INF-γ, IL-18 and MCP-1 levels before and after treatment between the mild and severe groups- were compared; The serum INF-γ, IL-18 and MCP-1 levels of patients with different absorption levels of lesions in the mild and severe groups. The correlation between serum INF-γ, IL-18, MCP-1 levels and acute physiology and chronic health evaluation (APACHE) Ⅱscore in patients with active pulmonary tuberculosis was analyzed. 85 patients of the active group received drug treatment. The serum INF-γ, IL-18 and MCP-1 levels in 2 months for treatment were compared with those before treatment, and the ratio values of their concentrations were obtained. The receiver operating characteristic curve (ROC curve) was drawn to analyze the efficiency of the ratio value of serum INF-γ, IL-18 and MCP-1 in evaluating the therapeutic effect of pulmonary tuberculosis. Result The levels of serum INF-γ, IL-18 and MCP-1 of patients with ≥ 2 lung fields, cavities, and severe pulmonary tuberculosis were higher than those of patients with one lung field, no cavities, and mild tuberculosis (P<0.001); The number of voids, sputum examination outcome and clinical symptom scores were significantly reduced in both mild and severe groups, with a statistically significant difference between before treatment in this group (P<0.001). The levels of Serum INF-γ,IL-18 and MCP-1 of patients after treatment in mild and severe groups were significantly reduced (P<0.001); The levels of serum INF-γ,IL-18 and MCP-1 of significantly absorb, absorb, and not absorb patient of mild and severe groups gradually increased (P<0.001);Pearson correlation analysis showed that the serum levels of INF-γ, IL-18 and MCP-1 of the active group were positively correlated with APACHEⅡ score (r=0.428, 0.505 and 0.581, P<0.001). The ROC curve showed that the area under the curve (AUC) of the ratio value of serum INF-γ, IL-18 and MCP-1 in evaluating the treatment effect of pulmonary tuberculosis was 0.808, and the sensitivity and specificity were 85.4% and 72.9%, respectively. Conclusion The serum levels of INF-γ, IL-18 and MCP-1 can reflect the severity of pulmonary tuberculosis and the effect of anti-tuberculosis treatment.

Analysis of the prevalence and drug resistance of non tuberculosis mycobacterium in Tangshan from 2016 to 2021 Liu Haitao, Tian Jie, Han Yunyan, Zhao Junpeng 2023, 8 (6):  58-62.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.011 Abstract ( 78)    PDF (937KB) ( 121 )    Objective To analyze the prevalence and drug resistance of non tuberculosis mycobacterium(NTM) in Tangshan area, and to provide a basis for the prevention and treatment of NTM disease. Method Through a retrospective study, the NTM isolation rate and drug sensitivity test results of Tangshan area from January 2016 to December 2021 were collected. The trend of NTM isolation rate and corresponding bacterial composition ratio were analyzed by trend testing. The difference in NTM drug resistance rate was compared through χ2 test. Result A total of NTM 390 strains were isolated from sputum samples of 2487 suspected tuberculosis patients, and the separation rate was 15.68%. The isolation rates of NTM each year were 13.89%, 14.12%, 14.36%, 17.44%, 15.69%, and 18.37%, respectively. The top three dominant strains in NTM were Mycobacterium intracellularis (62.31%), Mycobacterium kansas (18.72%), and Mycobacterium abscessus (9.49%). The order of resistance rate of single anti NTM drugs was imipenem and cilastatin(IC) (80.3%)> doxycycline(DOX) (55.49%)> minocycline(MNO) (43.35%)>sulfamethazole(SMZ) (28.32%)> cefoxitin(FOX) (24.86%)> tobramycin(TOB) (17.92%)> ethambutol(EMB) (14.45%)> rifampin(RFP) (10.98%)> azithromycin(AZM) (9.83%)> gatifloxacin(GAT) (8.67%)> rifabutin(RFb) (8.09%)> linezolid(LZD) (7.51%)> clarithromycin(CLA) (4.62%)= amikacin(AMK) (4.62%)> moxifloxacin(MXF) (1.73%). The trend test results showed a statistically significant increase in the resistance rate to IC、DOX(χ2=23.204,4.349, P<0.05). Conclusion Mycobacterium intracellularis, Mycobacterium Kansas, and Mycobacterium abscessus were the dominant NTM strains in Tangshan area. The resistance rates of some anti-NTM drugs are on the rise, and attention should be paid to the diagnosis and rational use of NTM infection in clinical diagnosis and treatment.

Application and evaluation of γ-interferon releasing test in tuberculosis screening in general practice outpatients Liu Changwei, Ma Lingdi, Wei Zhenhua, Jiang Shuping, Li Bin, Wang Yan, Huang Mincong 2023, 8 (6):  63-68.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.012 Abstract ( 78)    PDF (883KB) ( 119 )    Objective Through the clinical application of γ interferon release Assay(IGRA) in primary outpatient tuberculosis screening, the application effect and influencing factors can be evaluated to provide reference opinions for correct and reasonable clinical use. Method 3073 suspected newly diagnosed pulmonary tuberculosis patients who were treated at the Longhua District Chronic Disease Prevention and Control Center in Shenzhen from January 2021 to December 2022 were selected, and sputum samples were collected using acid-fast stain（AFS), BACTEC-MGIT 960 liquid culture method, and other methods crossing-primer amplification (CPA) technology was used to detect Mycobacterium tuberculosis (MTB) in sputum samples before treatment. Peripheral blood samples were collected for IGRA, and positive MGIT 960 liquid culture was used as the reference standard for tuberculosis infection. Clinical diagnosis was used as the diagnostic criterion to evaluate the detection efficiency of IGRA and other methods for tuberculosis infection. Result There is a significant statistical difference in the positive detection rate of IGRA among patients of different ages, with the highest positive detection rate in the 30-40 year old group and the lowest in the 0-10 year old group, with males being higher than females (P<0.01). Among several methods, the overall diagnostic accuracy of culture and CPA were 77.62% and 66.88%, respectively, which were significantly better than IGRA. The sensitivity and specificity of IGRA were 72.89% and 40.96%, respectively, with an overall diagnostic accuracy of only 59.04%. IGRA combined with culture or CPA can significantly improve detection sensitivity (86.89% and 84.22%), but there is no significant improvement in overall diagnostic efficiency (67.39% vs 77.62%, 65.86% vs 66.88%). The clinical diagnostic accuracy of IGRA for confirmed tuberculosis patients was 72.89%, with a false negative rate of 27.11%. The clinical diagnostic accuracy with non tuberculosis patients was 40.96% (136/332), with a false positive rate of 59.34%. The positive and negative predictive values for tuberculosis diagnosis were significantly lower than those of culture. There was no significant difference in the detection rate of IGRA for bacterial negative tuberculosis and bacterial positive tuberculosis (χ2=0.147, P=0.7014). Conclusion Although IGRA has good sensitivity, there are certain false positive and false negative rates in practical applications. Compared to pathogen detection, it has advantages in early screening of target disease or close contacts. However, its effectiveness in eliminating tuberculosis is insufficient, and it can be combined with other methods to improve its detection efficiency.

Case Report

A case report of a combination of Rifampicin and Edoxaban in the treatment of TB complicated by deep vein thrombosis Luo Tingru, Sun Nannan 2023, 8 (6):  69-72.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.013 Abstract ( 93)    PDF (1059KB) ( 103 )    Tuberculosis (TB) is a major infectious disease that seriously jeopardizes human health, and TB patients are at high risk of venous thromboembolism (VTE). Anticoagulant drugs are an important measure for treating VTE. However, Rifampicin, as an important drug in anti-tuberculosis treatment, has drug-drug interactions with a larger number of anticoagulant drugs, so it is important to explore the option of anticoagulant regimen when Rifampicin is used in TB patients. In this paper, a 69-year-old female TB patient was reported, who was admitted to the hospital with ultrasound suggesting thrombosis of the posterior tibial veins and intermuscular veins of both lower limbs, and was treated with Warfarin for anticoagulation, which resulted in an extremely unstable international normalized ratio. Then, Warfarin was discontinued and replaced with Edoxaban, and a review after 3 months of treatment suggested that VTE of the lower limbs disappeared, and the lung lesions were obviously absorbed and improved. In this case, the treatment results and DDI data showed that the use of Edoxaban is safer and more effective for patients who need to take a combination of Rifampicin and anticoagulant drugs, which ensures the completeness of the anti-tuberculosis regimen and the effectiveness of anticoagulation therapy, and also enables a better early therapeutic effect in TB patients.

Consensus and Reports

2023 WHO Tuberculosis Report: key data analysis for China and the global world Lu Chunrong, Tan Weiguo, Lu Puxuan, Wang Haopeng 2023, 8 (6):  73-78.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.014 Abstract ( 486)    PDF (1660KB) ( 380 )    An estimated 10.6 million people fell ill with tuberculosis worldwide in 2022, and there were 748 000 total cases in China(accounts for 7.1% of global cases). China ranks the third out of 30 high tuberculosis burden countries. The estimated tuberculosis deaths of Worldwide were 1.3 million, and China were 30 000. Globally, an estimated 410 000 people developed multidrug-resistant or rifampicin resistant TB (MDR/RR-TB) in 2022,these figures in China were 30 000. Globally, the cumulative reduction in the TB incidence rate from 2015 to 2022 was 8.7%, the net reduction of deaths was 19%, and 49% of TB patients and their households face total costs that are catastrophic, far from the 2025 milestones of WHO End TB Strategy. The cumulative number of people treated between 2018 and 2022 was 34 million, 15.5 million people were treated with TB preventive treatment. The global target set at the 2018 UN high-level meeting on TB has not been achieved. The global TB services were recovering in 2022. Globally in 2022, 7.5 million people were newly diagnosed with TB and officially notified as a TB case, with the services were recovering. This is the highest number since WHO began global TB monitoring in 1995. However, there was still a global gap about 3.1 million cases between the incident cases and the notified cases. The TB incidence rate is estimated to have increased by 3.9% between 2020 and 2022. The global termination of TB strategy should be achieved early and achieve ending the global TB epidemic requires that the new and reaffirmed commitments made at the second UN high-level meeting on TB in September 2023 are urgently translated into action. With the global data to set the standard, China still faces the grim reality of the high burden of TB and MDR/RR-TB. It advise to take the multisectoral action, accelerate the achievement of universal health coverage, improve the capacity of health systems, and strengthen scientific and technological innovation.

Review

Research status and prospect of artificial intelligence technology in imaging diagnosis of pediatric pulmonary tuberculosis Luo Fan, Zhang Na, Li Chenxi 2023, 8 (6):  79-83.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.015 Abstract ( 97)    PDF (803KB) ( 172 )    Tuberculosis remains one of the most prevalent infectious diseases globally, and pediatric tuberculosis continues to be an important issue for the public health of children and adolescents in our country. Due to the lack of specificity in the clinical diagnosis of pediatric tuberculosis, early screening and diagnosis pose certain challenges. Chest imaging diagnosis is considered a practical approach to tuberculosis diagnosis and has high utility in controlling pediatric pulmonary tuberculosis. In recent years, artificial intelligence (AI) technology has rapidly developed and achieved remarkable results in the medical field, particularly in big data processing, reducing manpower costs, and improving clinical efficiency. The integration of AI and medical imaging has gradually been applied to tuberculosis screening and diagnosis, leading to various AI algorithms, software, and diagnostic systems aimed at tuberculosis screening and diagnosis using imaging examinations. Previous studies have mainly focused on adult tuberculosis, with insufficient reports and attention given to pediatric pulmonary tuberculosis. This article primarily summarizes the research and application status of AI technology in the imaging diagnosis of tuberculosis and pediatric pulmonary tuberculosis in recent years and provides an overview of its limitations and future prospects in the field of pediatric pulmonary tuberculosis. It is hoped that future AI development research will pay more attention to children's cases.

The progress of human papilloma virus vaccination to prevent infection and related cancers Zhang Ying, Zeng Yanming, Lu Yanqiu, Chen Yaokai 2023, 8 (6):  84-88.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.016 Abstract ( 78)    PDF (860KB) ( 137 )    Persistent infection with human papilloma virus (HPV) is a major cause of HPV-related cancers such as cervical, vaginal and vulvar cancers, as well as anal, penile and oropharyngeal cancers.HPV vaccination can prevent the occurrence of HPV infection and related cancers, and is a primary prevention measure for the prevention and control of HPV infection-related diseases HPV vaccine is the world's first vaccine for cancer prevention, since the clinical application, the incidence of HPV infection and its associated cervical cancer has decreased, the vaccine has shown good protective efficacy and safety, but also accumulated some research data on oral, vulvar and vagina, penis and anal HPV infection and related cancers. With the increase in the scope of vaccination and the expansion of indications, the safety of HPV vaccines has also received more and more attention. This article reviews the research progress on the protective effect and safety of HPV vaccine according to the latest literature, and provides data reference for HPV vaccine vaccination.

Education Fields

Updated interpretation of the Guidelines for the Prevention and Treatment of Hepatitis C (2022 Edition) Chang Yukun, Zhang Zhidan 2023, 8 (6):  89-92.  DOI: 10.19871/j.cnki.xfcrbzz.2023.06.017 Abstract ( 125)    PDF (745KB) ( 137 )    Hepatitis C, caused by the hepatitis C virus (HCV), continues to be a global epidemic, posing a significant threat to public health and individual well-being. To accelerate the achievement of the World Health Organization's strategic goal of eliminating the public health impact of hepatitis C by 2030, the Chinese Society of Hepatology and the Chinese Society of Infectious Diseases, based on the increasing accessibility of direct-acting antiviral agents (DAAs) and the constantly evolving evidence from evidence-based medicine both domestically and internationally, have organized relevant experts to develop the Guidelines for the Prevention and Treatment of Hepatitis C (2022 Edition). Compared to the 2019 edition, this update of the hepatitis C guidelines further refines the recommended practices in various aspects, including screening, diagnosis, pre-treatment assessment, treatment regimen selection, and treatment endpoints. This signifies that the screening and clinical management of hepatitis C have entered an era of efficiency and simplification. This article focuses on interpreting the updated sections of the guidelines, summarizing and organizing the recommended practices, enhancing understanding, and improving practicality. It aims to provide basis and reference for the prevention and treatment of viral hepatitis C.