Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases
Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases
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DOI：
10.1371/journal.pone.0142607
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发表时间：
2015-11-11
期刊：
影响因子：
3.7
通讯作者：
Nakano, Yasutaka
中科院分区：
文献类型：
--
作者：
Kanda, Rie;Nagao, Taishi;Nakano, Yasutaka
背景在肺结核(TB)患者中，缩短痰培养转换时间是可取的，以减少分枝杆菌传播的可能性。据报道，治疗2个月后持续阳性的痰培养与空洞的存在和胸部X光检查的疾病程度、菌落计数高、糖尿病和吸烟有关。然而，人们对影响痰培养转化时间的因素知之甚少。本研究旨在探讨影响成人肺结核患者整个治疗过程中痰培养转阴时间的因素。方法应用2000年10月至2002年10月在日本大阪平仓市平方医院接受治疗的活动性肺结核患者的病历数据库进行研究。采用COX比例风险分析方法，对影响痰培养转阴时间的因素进行多因素分析。痰培养转阴时间中位数为39天，最长为116天。COX比例风险分析显示，涂片分级高(HR，0.40；95%CI，0.23~0.71)和吸烟史(HR，0.48；95%CI，0.25~0.94)与痰培养转阴延迟有关。结论涂片分级高，吸烟可延长肺结核患者痰培养转阴时间。要有效控制结核病，除了要及早发现和及时抗结核治疗外，还应采取措施降低吸烟率。
BackgroundIn patients with pulmonary tuberculosis (TB), shortening the time to sputum culture conversion is desirable to reduce the likelihood of mycobacterial transmission. A persistent positive sputum culture after 2 months of treatment is reported to be associated with the presence of cavitation and the extent of disease on chest X-ray, high colony count, diabetes mellitus, and smoking. However, little is known about factors affecting the time to sputum culture conversion. This study was conducted to evaluate factors affecting the time to sputum culture conversion throughout the course of treatment in adults with pulmonary TB.MethodsThis study was performed using a database of the medical records of patients with active pulmonary TB who were treated at Hirakata Kohsai Hospital in Hirakata City, Osaka, Japan, from October 2000 to October 2002. Cox proportional-hazards analysis was used to evaluate factors affecting the time to sputum culture conversion after adjusting for potential confounders.ResultsThe data of 86 patients with pulmonary TB were analyzed. The median time to sputum culture conversion was 39 days, and the maximum time was 116 days. The Cox proportional-hazards analysis showed that a higher smear grading (HR, 0.40; 95% CI, 0.23-0.71) and a history of ever smoking (HR, 0.48; 95% CI, 0.25-0.94) were associated with delayed sputum culture conversion.ConclusionHigh smear grading and smoking prolonged the time to sputum culture conversion in adults with pulmonary TB. To effectively control TB, measures to decrease the cigarette smoking rate should be implemented, in addition to early detection and timely anti-TB treatment.