China is one of the countries with the heaviest burden of tuberculosis. Chinese scholars have been actively paying attention to and exploring new concepts, new technologies and new drugs for tuberculosis prevention and control. Some new achievements in recent years have not only It has made the diagnosis more rapid and accurate, and the treatment effect of tuberculosis has also been significantly improved.
By Health News in the 1950s
Anti-TB poster,
Now in the collection of the Tuberculosis History Museum.
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Multiple technologies significantly improve diagnosis rates
“How to diagnose” used to be a huge problem faced by tuberculosis prevention and control, and people’s exploration of tuberculosis diagnostic technology has never stopped.
Different from other infectious diseases such as AIDS and hepatitis, the specific antigens and antibodies of Mycobacterium tuberculosis have not yet been found, so tuberculosis cannot be diagnosed by “one tube of blood”. The traditional TB sputum smear detection has low sensitivity and is easy to miss diagnosis, and the TB culture and drug resistance test takes 2 to 3 months.
Nowadays, molecular biotechnology can provide a clinical basis for diagnosis through extremely small molecular-level clues in TB patients, greatly improving the accuracy and sensitivity of diagnosis. Molecular biotechnology not only shortens the diagnosis time to about two hours, but can also judge the drug resistance of anti-tuberculosis drugs. However, the cost of new detection technologies is about a few hundred yuan each time, which limits their application in grassroots and remote areas, and many patients in my country are still unable to benefit from them.
The normal or abnormal tissue cells in the human body, as well as volatile metabolites produced by viruses and microorganisms that infect the body, will enter the alveoli through the pulmonary circulation, and together with the metabolites in the lungs, will be excreted through the respiratory tract . This constitutes a major source of endogenous volatile organic compounds (VOCs) in human exhaled air. The tuberculosis breath detection system developed by Chinese scholars is a tuberculosis detection platform based on VOC detection and analysis technology in exhaled breath. It has outstanding advantages such as simple operation, safety and non-invasiveness, high accuracy, high throughput and low cost. rapid screening and efficacy follow-up testing. With in-depth research, this detection system is also expected to be used in the diagnosis of lung cancer, esophageal cancer, breast cancer, and new coronary pneumonia.
The combination of artificial intelligence technology and imaging examination is also a promising initial screening method for tuberculosis. Nowadays, imaging examinations such as X-ray and CT are extremely common in clinical applications. With the help of artificial intelligence technology, radiologists can screen pulmonary tuberculosis patients, which can significantly improve the detection efficiency. In 2017, Chinese scholars organized a “human-machine battle” for pulmonary tuberculosis imaging diagnosis, in which senior imaging experts from many hospitals competed against the artificial intelligence system. In terms of detection time, the judgment time of the machine group of 2 to 3 seconds is better than that of the expert group of 2 to 3 minutes, but the judgment accuracy of the artificial intelligence group is 75%, which is lower than the expert group’s 85%. In the next step, it is necessary to quickly integrate the imaging resources of patients across the country to provide “teaching materials” for the artificial intelligence system. When it grows to the point where it can accurately identify common abnormal images such as lung cancer, tuberculosis, and pneumonia, it can be extended to general hospitals to improve doctors’ performance. Screening capacity for tuberculosis. Because general hospitals are where most tuberculosis patients are first diagnosed.
Stopping MDR-TB promises
The global resurgence of tuberculosis in the 1980s, coupled with the serious challenges of multidrug-resistant tuberculosis, led to renewed enthusiasm for the development of new drugs to fight tuberculosis.
In 2012, the U.S. Food and Drug Administration granted accelerated approval to bedaquiline for the treatment of MDR-TB in adults. Subsequently, new anti-tuberculosis drugs such as Delamani and Putomani have also come out one after another.
So, are these new drugs equally effective and safe for our patients? In 2017, the “New Anti-TB Drug Introduction and Protection Mechanism Project” (NDIP) was officially launched, which covered more than 1,500 MDR-TB patients in 98 hospitals across the country. The final application effect showed that during the treatment period of the bedaquiline-containing regimen, the sputum culture negative conversion rate of MDR-TB patients in my country was 85.3%, and the median time to negative conversion was 4 weeks. With the help of this project, we built the first large-scale clinical-sample-data cohort of MDR-TB patients, and found that 90.6% of the MDR-TB patients in my country had a low level of resistance to bedaquiline. The program achieves ideal curative effect.
New drugs represented by bedaquiline have a very different mechanism of action from traditional anti-tuberculosis drugs. These drugs have high antibacterial activity against sensitive strains, multidrug-resistant strains and dormant bacteria. This not only makes them more effective in treating MDR-TB, but also significantly shortens the treatment cycle for MDR-TB.
According to estimates by the World Health Organization, in 2017, there were 460,000 new cases of MDR-TB globally. The treatment course of patients was about 20 months or longer, and the treatment success rate was only 54%. rate of 16%. In 2016, the World Health Organization updated the guidelines for the treatment of MDR-TB and introduced a short-course chemotherapy regimen for MDR-TB. It is recommended that the course of treatment be shortened to 9 to 12 months. Treatment compliance and lower treatment costs.
In order to promote the implementation of these new treatment concepts and plans, the Tuberculosis Branch of the Chinese Medical Association has successively formulated the “Chinese Expert Consensus on Short-course Treatment of MDR-TB” and “China’s Multidrug Resistance and Rifampicin” Expert consensus on the treatment of drug-resistant tuberculosis, etc., to provide reference for tuberculosis control workers in my country.
Fill in the prevention and control shortcomings and take precautions
Although advances in medical technology have given us the hope of defeating tuberculosis, there are still pressing issues before us.
First is the burden. In 2020, a total of 1.5 million people died of TB globally, ranking 13th among all causes of death. There are about 840,000 new cases in my country every year, and the number of patients ranks second in the world. The burden of tuberculosis on society and families cannot be ignored.
The second is the weak base. People often say that tuberculosis is a “disease of poverty”. After all, the incidence of tuberculosis is relatively higher in economically underdeveloped areas, and many patients who were not rich in life have become more embarrassed by tuberculosis. How to promote advanced diagnosis and treatment concepts and standardized diagnosis and treatment technology to the grassroots as soon as possible, so that grassroots patients can obtain better treatment effects with lower treatment costs, this is a huge systematic project, which requires careful planning and deployment to guide limited resources. Go to the grassroots level.
The last is the talent shortage. In my country, it is not realistic to defeat TB in the short term. In the future, countless medical workers will need to make unremitting efforts to fight TB. Excellent talent pool is crucial for tuberculosis prevention and control, but the high infection risk and relatively difficult working environment make tuberculosis prevention and control specialists less attractive to young doctors. Therefore, how to increase the number of employees and improve the level of employees is also a problem that must be solved at the moment.
Feelings and beliefs are indispensable
In 2017, on the occasion of the 80th anniversary of the establishment of the Tuberculosis Branch of the Chinese Medical Association, the author came up with the idea of creating a tuberculosis history museum.
During the long and arduous process of data collection, the strong support of many experts such as Li Dengrui and Wu Meiying made me deeply feel the feelings of tuberculosis prevention and control people, and saw everyone’s attitude towards tuberculosis. “Hate” and “Love”. Hate, tuberculosis is endless and endangers the people; love, defeating tuberculosis has become our lifelong pursuit and belief.
The material in the online museum spans 256 years. The long history and rich materials make us firmly believe that to end tuberculosis, we need medical staff to work tirelessly on the front line, scientific researchers to study silently in the laboratory, and the public to cheer and boost morale. It is hoped that the TB History Museum will allow the lighthouse of history to illuminate the future path, and allow colleagues in the field of TB prevention and control to join forces with more friends to jointly contribute to the end of TB.
In order to help the high-quality development of the health industry, the “Medical Vision” column will focus on advanced concepts and excellent practices in various fields of medicine, build a high-end medical think tank, capture innovative highlights, and condense development ideas. Improve governance capabilities.
Author: Deputy Director, Clinical Center for Tuberculosis Prevention and Control, Chinese Center for Disease Control and Prevention,
Li Liang, Vice President of Beijing Chest Hospital Affiliated to Capital Medical University
Planning: Fang Tong
Editor: Zheng Ying[