Risk factors for pulmonary mycobacterial disease in South African gold miners - A case-control study
Risk factors for pulmonary mycobacterial disease in South African gold miners - A case-control study
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DOI：
10.1164/ajrccm.159.1.9803048
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发表时间：
1999-01-01
影响因子：
24.7
通讯作者：
De Cock, KM
中科院分区：
文献类型：
--
作者：
Corbett, EL;Churchyard, GJ;De Cock, KM
肺分枝杆菌病在矿工中很常见。在一项回顾性病例对照研究中，金矿矿工非结核性肺分枝杆菌（NTM）疾病和结核病（TB）的危险因素被确定，该研究包括1993年至1996年间诊断的206名NTM患者和381名已知人类免疫缺陷病毒（HIV）状态的结核病患者。选取180例经hiv检测的创伤/外科住院患者作为对照。HIV感染（NTM患者的比值比为3.6，结核病患者的比值比为4.5）和较高程度的矽肺（NTM患者的比值比为5.0，结核病患者的比值比为4.9）在NTM和结核病患者中比在对照组中更为常见。在研究期间，对照组和两个病例组的艾滋病毒感染率均有所上升。NTM患者的总体HIV患病率为13.1%，结核病患者为14.2%，对照患者为5.6%。既往结核病（OR 9.6）、病前局灶性放射学瘢痕（OR 7.4）和诊断时工作多尘（OR 2.4）是NTM疾病的其他重要危险因素。这些发现表明，矿工NTM病的历史高发主要归因于吸入二氧化硅粉尘引起的慢性胸部疾病和既往结核病。艾滋病毒感染最近已成为矿工分枝杆菌病的另一个危险因素，随着艾滋病毒流行的进展，可能变得越来越重要。
Pulmonary mycobacterial disease is common in miners. Risk factors for nontuberculous pulmonary mycobacterial (NTM) disease and tuberculosis (TB) in gold miners were identified in a retrospective case-control study that included 206 NTM patients and 381 TB patients of known human immunodeficiency virus (HIV) status diagnosed between 1993 and 1996. A total of 180 HIV-tested trauma/surgical inpatients were selected as control patients. Both HIV infection (odds ratio [OR] 3.6 for NTM and 4.5 for TB patients) and higher grades of silicosis (OR 5.0 for NTM and 4.9 for TB patients) were significantly more common in NTM and TB patients than in control patients. HIV prevalence rose in the control and both case groups during the study period. The overall HIV prevalence was 13.1% in NTM patients, 14.2% in TB patients, and 5.6% in control patients. Previous TB (OR 9.6), premorbid focal radiological scarring (OR 7.4) and a dusty job at diagnosis (OR 2.4) were additional significant risk factors for NTM disease. These findings suggest that the historically high incidence of NTM disease in miners is largely attributable to chronic chest disease from silica dust inhalation and prior TB. HIV infection has recently become an additional risk factor for mycobacterial disease in miners and is likely to become increasingly important as the HIV epidemic progresses.