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.

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(P<0.05), while there was no correlation among peripheral blood CD4+T cells, ALB and PA (P>0.05). 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.

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.

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.

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.

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.

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

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.

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.

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). 3.Incidence of liver injury in group B was lower than group D (20.69% 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).5. Incidence of liver injury in group A was higher than group E (34.38% vs. 17.48%,P< 0.05)and there was no difference between group B and group E (20.69% vs. 17.48%,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.