Abstract: Objective　To explore clinical characteristics and the related factors of multidrug-resistant tuberculosis and rifampicin-resistant tuberculosis (MDR/RR-TB) patients with decreased peripheral blood CD4+T lymphocytes, providing a basis for the prevention and treatment of multidrug-resistant tuberculosis. Methods　A retrospective analysis was conducted on 311 MDR/RR-TB patients hospitalized at Chengdu Public Health Clinical Center from January 2018 to December 2020. according to whether accompanied by peripheral blood CD4+T lymphocyte reduction, patients were divided into two groups, the decreased group (n=115) with CD4+T lymphocytes count <414 cell/μL and the normal group (n=196) with CD4+T lymphocytes count ≥ 414 cell/μL. Clinic data, including demographics, types of tuberculosis, complications, clinical symptoms, chest imaging, and treatment outcomes were collected. The binary logistic regression equation was used to analyze the risk factors of MDR/RR-TB with peripheral blood CD4+T lymphocyte reduction. Results　In total, 311 cases with MDR/RR-TB were enrolled, with a male-to-female ratio of 1.68∶1. The median age [M(P25, P75)] was 32 (24, 45) years. The median CD4+T lymphocyte count was 492.0 (328.0, 661.0) cells/μL, and 115 patients had CD4+T lymphocyte counts <414 cells/μL. Compared with the normal group, the proportion of older patients, male, baseline anemia, baseline leukopenia, baseline hypoalbuminemia, combined with other chronic respiratory diseases, hematogenous disseminated pulmonary tuberculosis, tuberculous pleurisy, and tuberculous meningitis were higher (P<0.05), while the success rate of treatment was lower in the decreased group (P=0.024). Being male (OR=2.045, 95%CI : 1.147-3.648), older age (OR=1.032, 95%CI : 1.012-1.052), baseline anemia (OR=2.246, 5%CI : 1.457-3.426), and baseline leukopenia (OR=2.398, 95%CI : 1.387-4.148) were risk factors for decreased CD4+T lymphocyte count in MDR/RR-TB patients. Conclusions　MDR/RR-TB patients with decreased CD4+T lymphocytes are more likely to suffer from severe tuberculosis (hematogenic disseminated tuberculosis, tuberculous meningitis) and tuberculous pleurisy, meanwhile the success rate of treatment was lower. Male, elder age, baseline anemia, and baseline leukopenia are associated with decreased CD4+T lymphocyte count in MDR/RR-TB patients, and the immune status of these patients needs to be paid attention to in clinical work.

Changes in structure of oral solid dosage forms (OSDF) elementally determine the drug release and its therapeutic effects. In this research, synchrotron radiation X-ray micro-computed tomography was utilized to visualize the 3D structure of enteric coated pellets recovered from the gastrointestinal tract of rats. The structures of pellets in solid state and in vitro compendium media were measured. Pellets in vivo underwent morphological and structural changes which differed significantly from those in vitro compendium media. Thus, optimizations of the dissolution media were performed to mimic the appropriate in vivo conditions by introducing pepsin and glass microspheres in media. The sphericity, pellet volume, pore volume and porosity of the in vivo esomeprazole magnesium pellets in stomach for 2 h were recorded 0.47, 1.55 × 10⁸ μm³, 0.44 × 10⁸ μm³ and 27.6%, respectively. After adding pepsin and glass microspheres, the above parameters in vitro reached to 0.44, 1.64 × 10⁸ μm³, 0.38 × 10⁸ μm³ and 23.0%, respectively. Omeprazole magnesium pellets behaved similarly. The structural features of pellets between in vitro media and in vivo condition were bridged successfully in terms of 3D structures to ensure better design, characterization and quality control of advanced OSDF.