Smoking adversely affects treatment response, outcome and relapse in tuberculosis
Smoking adversely affects treatment response, outcome and relapse in tuberculosis
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DOI：
10.1183/09031936.00114214
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发表时间：
2015-03-01
影响因子：
24.3
通讯作者：
Tam, Cheuk M.
中科院分区：
文献类型：
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作者：
Leung, Chi C.;Yew, Wing W.;Tam, Cheuk M.
在一项全港性的治疗计划中，研究人员评估了吸烟对结核病预后的影响。研究人员对16345名在2001年至2003年期间在香港政府胸肺科诊所接受化疗的活动性结核病患者进行了为期两年的前瞻性随访，以了解治疗结果，并随后在全港范围内进行跟踪调查-在基线时，吸烟与更广泛的肺部疾病、肺空洞、痰涂片和培养阳性相关。在当前吸烟者和戒烟者中，痰涂片和培养在治疗2个月后保持阳性的可能性明显更大。这两类吸烟者在2年内实现治愈或完成治疗的可能性显著降低。总体而言，16.7%的不成功治疗结局可归因于吸烟，主要原因是当前吸烟者的违约和既往吸烟者的死亡。在成功完成治疗的患者中，从从不吸烟者到戒烟者和当前吸烟者的复发风险（风险比为1.00、1.33和1.63），总体人群归因风险为19.4%（目前吸烟者：12.2%;已戒烟者：吸烟对结核病的基线疾病严重程度、细菌学反应、治疗结果和复发有不利影响。戒烟可能会减少复发和二次传播。
The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme.16 345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012.Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%).Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission.