Pulmonary impairment after tuberculosis in Georgia: Enhancing clinical research capacity to address the intersection of non-communicablediseases and tuberculosis

项目摘要 结核病与包括慢性肺结核在内的非传染性疾病的交叉 损伤，已成为一个关键的临床和公共卫生障碍。非传染性疾病迅速增加 疾病流行威胁着包括格鲁吉亚在内的低收入和中等收入国家的结核病控制， 治疗结核病仍然是一个巨大的负担。然而，到目前为止，结核病可能增加 慢性非传染性疾病的风险尚未得到充分探讨。我们将确定 多药耐药（MDR）结核病、吸烟和肺部炎症生物标志物导致患病率增加 在格鲁吉亚，肺结核后肺功能受损。这项研究将促进对双 传染性和非传染性疾病的负担，并建设个人和机构的研究能力 在格鲁吉亚。 本研究的长期目标是阐明结核病患者与结核病病原因素之间的关系 患有结核病后慢性肺功能损害的患者，并加强未来确定治疗方法的研究能力 减少结核病治疗后患慢性非传染性疾病风险的预防战略 建成该提案的具体目标是：（1）确定负担，预测因素和轨迹 肺结核治疗后肺功能损害;（2）探讨肺部炎症生物标志物之间的关系 肺损害的严重程度的肺结核治疗完成时的肺破坏;和（3）建立 增加格鲁吉亚的研究基础设施和能力，重点是结核病和慢性 肺损伤本项目的目的将通过在研究中心招募一组患者（n=130）来实现。 结核病治疗完成时间和前瞻性随访1年。在这两个时间点，本研究将 对接受药物敏感结核病治疗的患者进行肺功能测定、脉搏血氧测定和生活质量评估 （n=65）和MDR TB治疗患者（n=65）。分析将包括多种建模策略， 评估患者和宿主因素与慢性肺损伤风险之间的关系。 这项拟议的研究将有助于描述结核病导致慢性肺损伤的程度 并将确定哪些现有的临床呼吸康复干预措施可用于改善生活质量 在结核病患者的整个生命周期中。此外，R21将利用现任和前任的干部， Fogarty支持的学员，并在结核病和慢性病领域提供宝贵的指导培训经验 肺部疾病。拟议工作的一个长期目标是为前瞻性研究做准备， 从结核病诊断时、结核病治疗期间和结核病治疗后几年开始的队列。

PROJECT SUMMARY The intersection of tuberculosis (TB) disease with non-communicable disease, including chronic pulmonary impairment, has emerged as a critical clinical and public health obstacle. Rapidly expanding non-communicable disease epidemics threaten TB control in low- and middle-income countries, including Georgia, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of chronic non-communicable disease has not been well explored. We will determine the extent to which multidrug-resistant (MDR) TB, smoking, and biomarkers of lung inflammation contribute to increased prevalence of pulmonary impairment post-TB in the country of Georgia. This research will advance understanding of dual burdens of communicable and non-communicable diseases and build individual and institutional research capacity in Georgia. The long-term objective of this research is to elucidate the relationship between TB patient and TB pathogen factors with post-TB chronic pulmonary impairment, and strengthen research capacity for future work to identify treatment and prevention strategies that reduce the risk of chronic non-communicable diseases after TB treatment completion. The specific aims of this proposal are to: (1) determine the burden, predictors, and trajectory of pulmonary impairment post-TB treatment; (2) explore the relationship between biomarkers of lung inflammation and lung destruction at time of TB treatment completion with severity of pulmonary impairment; and (3) build increased research infrastructure and capacity for Georgia that is focused on the intersection of TB and chronic pulmonary impairment. The aims of this project will be achieved by enrolling a cohort of patients (n=130) at the time of TB treatment completion and following them prospectively for one year. At both time points this study will measure spirometry, pulse oximetry, and quality of life among patients who were treated for drug susceptible TB (n=65) and among patients treated for MDR TB (n=65). The analysis will include multiple modeling strategies to assess the relationship between patient and host factors and the risk of chronic pulmonary impairment. The proposed study will help to characterize the extent to which TB contributes to chronic pulmonary impairment and will identify which existing clinical respiratory rehabilitation interventions may be used to improve quality of life throughout the lifespan among patients with TB. In addition, this R21 will leverage a cadre of current and former Fogarty-supported trainees and provide invaluable mentored training experiences in the areas of TB and chronic pulmonary diseases. A long term goal of the proposed work is to prepare for prospective studies that follow patient cohorts beginning at the time of TB diagnosis, during TB treatment, and several years after TB treatment.