Anemia at the Initiation of Tuberculosis Therapy Is Associated with Delayed Sputum Conversion among Pulmonary Tuberculosis Patients in Dar-es-Salaam, Tanzania
Anemia at the Initiation of Tuberculosis Therapy Is Associated with Delayed Sputum Conversion among Pulmonary Tuberculosis Patients in Dar-es-Salaam, Tanzania
复制标题
DOI：
10.1371/journal.pone.0091229
复制
发表时间：
2014-03-18
期刊：
影响因子：
3.7
通讯作者：
Mugusi, Ferdinand
中科院分区：
文献类型：
--
作者：
Nagu, Tumaini J.;Spiegelman, Donna;Mugusi, Ferdinand
背景：肺结核和贫血在坦桑尼亚都很流行。关于结核病治疗后贫血与痰转化之间关系的文献有限且不一致。方法：从达累斯萨拉姆 54 家结核病诊所中的 14 家招募年龄≥15 岁、开始接受标准抗结核治疗的新诊断痰涂片阳性肺结核患者。患者根据推荐的短期直接观察治疗 (DOT) 策略接受药物治疗，并进行前瞻性随访直至治疗完成（六个月）。在开始结核病治疗之前，通过执行以下操作对患者进行评估；临床病史、体格检查、全血细胞计数、血清生化和痰镜检查。抗结核治疗两个月后，再次检查痰涂片是否存在抗酸杆菌。贫血定义为血红蛋白< 13 g/dl（男性）或< 12 g/dl（女性）。使用对数二项回归来评估两个月时贫血与痰转化之间的关联。结果：在该研究纳入的 1245 名患者中，在抗结核治疗两个月时，86% 患有贫血，7% 痰涂片阳性。两个月时，贫血患者痰涂片阳性的可能性是非贫血患者的三倍（RR = 3.05；95% CI 1.11-8.40）p = 0.03。痰涂片结果呈阳性的风险随着贫血的严重程度而增加（趋势 P < 0.01）。结论：基线贫血与结核病治疗两个月后持续痰涂片呈阳性的风险增加相关。未来的研究应评估结核病相关贫血的机制以及结核病患者贫血干预的作用。
Background: Pulmonary tuberculosis and anemia are both prevalent in Tanzania. There is limited and inconsistent literature on the association between anemia and sputum conversion following tuberculosis treatment.Methods: Newly diagnosed sputum smear positive pulmonary tuberculosis patients aged >= 15 years initiating on standard anti tuberculosis therapy were recruited from 14 of 54 tuberculosis clinics in Dar es Salaam. Patients were receiving medication according to the recommended short course Directly Observed Therapy (DOT) strategy and were followed up prospectively until completion of treatment (six months). Patients were evaluated before initiation of TB treatment by performing the following; clinical history, physical examination, complete blood counts, serum biochemistry and sputum microscopy. Sputum smears were re-examined at two months of anti-tuberculosis therapy for presence of acid fast bacilli. Anemia was defined as hemoglobin < 13 g/dl (males) or < 12 g/dl (females). Log-binomial regression was used to assess the association between anemia and sputum conversion at two months.Results: Of the 1245 patients included in the study, 86% were anemic and 7% were sputum smear positive at two months of anti-tuberculosis therapy. Anemic patients were three times more likely to have sputum positive smear as compared to non-anemic patients at two months (RR = 3.05; 95% CI 1.11-8.40) p = 0.03. The risk for sputum positive smear results increased with severity of anemia (P for trend < 0.01).Conclusion: Baseline anemia is associated with increased risk for persistent positive sputum smears at two months of tuberculosis treatment. Future studies should evaluate the mechanisms for TB-associated anemia as well as the role of intervention for anemia among TB patients.