COPD and the Risk of Tuberculosis - A Population-Based Cohort Study
COPD and the Risk of Tuberculosis - A Population-Based Cohort Study
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DOI：
10.1371/journal.pone.0010138
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发表时间：
2010-04-13
期刊：
影响因子：
3.7
通讯作者：
Egesten, Arne
中科院分区：
文献类型：
--
作者：
Inghammar, Malin;Ekbom, Anders;Egesten, Arne
背景资料：慢性阻塞性肺疾病（COPD）和结核病（TB）主要影响肺部，是全球发病率和死亡率的主要原因。COPD和TB具有共同的风险因素，如吸烟、社会经济地位低下和宿主防御功能失调。COPD是一种常见的合并症，尤其是在老年结核病患者中，但与其他已知会增加结核病风险的疾病相比，COPD与结核病发病率和死亡率的具体关系和影响知之甚少。方法和发现：所有40岁以上的人，1987-2003年，在瑞典住院患者登记处（n = 115，867）中确定了从瑞典医院出院并诊断为COPD的患者。记录与1989-2007年瑞典结核病登记相关，使用考克斯回归估计COPD患者与从普通人群中随机选择的对照受试者（性别、出生年份和居住县匹配）相比活动性结核病的相对风险。这些分析按出生年份、性别和居住县进行分层，并根据移民身份、社会经济地位（SES）和以前已知的增加结核病风险的住院合并症进行调整。COPD患者发生活动性TB的风险比（HR）增加3倍（HR 3.0（95%置信区间2.4 - 4.0）），这主要取决于肺TB风险的增加。此外，logistic回归估计显示，与普通人群结核病对照受试者相比，发生活动性结核病的COPD患者在结核病诊断后第一年内因各种原因死亡的风险增加了两倍（OR 2.2，95%置信区间1.2 ~ 4.1）。这项基于人群的研究包括大量COPD患者，表明与普通人群相比，这些患者发生活动性结核病的风险增加。这些结果引起了人们的担忧，即COPD的全球负担增加将增加活动性结核病的发病率。在进一步的研究中需要解开潜在的促成因素。
Background: Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality.Methods and Findings: All individuals $40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987-2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989-2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1).Conclusions: This population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies.