Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study
Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study
复制标题
DOI：
10.5588/ijtld.18.0313
复制
发表时间：
2019-02-01
影响因子：
4
通讯作者：
Metcalfe, J.
中科院分区：
文献类型：
--
作者：
Chin, A. T.;Rylance, J.;Metcalfe, J.
目的：研究在人类免疫缺陷病毒(HIV)流行环境下，复发性结核病(TB)幸存者中慢性肺部疾病(CLD)的患病率和严重程度及其与经验性抗结核治疗(由于缺乏细菌学确认)的相关性。方法：对津巴布韦哈拉雷再治疗结核病幸存者进行前瞻性队列研究。结果：在175名再次治疗的结核病幸存者中，65%的患者HIV阳性，21%的患者接受过经验性治疗，14%的患者在随访时发现了多参数CLD(95%可信区间9.0-19.7)，在治疗完成后的第一年，年龄调整死亡人数增加了6倍。经验性治疗的结核病(相对危险度[RR]3.4，95%可信区间1.4-8.3)与慢性阻塞性肺疾病有关，以往剂量依赖的抗结核治疗疗程数(三个疗程与一个疗程，相对危险度6.2，95%可信区间1.7-22.1)与CLD有关。在再治疗的结核病幸存者中，33%(95%可信区间26.0~40.1)有持续的呼吸道症状(慢性阻塞性肺疾病评估试验评分=10)，26%(95%可信区间19.8~33.0)运动能力明显不足(中位数穿梭步行距离550米，Q1~Q3 440~730m)，83%(95%可信区间75.7~89.7)胸片残留X线异常，12%(95%可信区间6.6~16.1%)肺活量测定中重度梗阻；13%(95%可信区间7.6-17.5%)为严重抑郁。结论：尽管治疗成功，但复治结核病幸存者仍有相当大的发病率和死亡率风险。
OBJECTIVE: To examine the prevalence and magnitude of chronic lung disease (CLD) and its association with empiric anti-tuberculosis treatment (due to lack of bacteriologic confirmation) among recurrent tuberculosis (TB) survivors in a human immunodeficiency virus (HIV) prevalent setting.METHODS: Prospective cohort study of retreatment TB survivors in Harare, Zimbabwe. At median follow-up of 2 years post-treatment initiation, we characterized mortality, respiratory impairment, and mental health.RESULTS: Among 175 retreatment TB survivors, 65% of whom were HIV-positive and 21% had been empirically treated, multiparameter CLD was noted at follow-up among 14% of patients (95% CI 9.0-19.7), with a six-fold increase in age-adjusted death in the first year following treatment completion. Empirically treated TB (relative risk [RR] 3.4, 95% CI 1.4-8.3) was associated with CLD, as was the number of previous anti-tuberculosis treatment courses in dose-dependent fashion (three vs. one, RR 6.2, 95% CI 1.7-22.1). Among retreatment TB survivors, 33% (95% CI 26.0-40.1) had persistent respiratory symptoms (Chronic Obstructive Pulmonary Disease Assessment Test score >= 10); 26% (95% CI 19.8-33.0) significant deficits in exercise capacity (median incremental shuttle walk test distance, 550 m; Q1-Q3 440-730 m); 83% (95% CI 75.7-89.7) residual radiographic abnormalities on chest X-ray; 12% (95% CI 6.6-16.1%) moderate-to-severe obstruction on spirometry; and 13% (95% CI 7.6-17.5%) major depression.CONCLUSIONS: Despite successful treatment, retreatment TB survivors retain a substantial risk of morbidity and mortality.