Jiménez-Corona M-E, García-García L, DeRiemer K, Ferreyra-Reyes L, Bobadilla-del-Valle M, Cano-Arellano B, Canizales-Quintero S, Martínez-Gamboa A, Small P M, Sifuentes-Osornio J, Ponce-de-León A
Instituto Nacional de Salud Pública (INSP), Cuernavaca Morelos, México.
Thorax. 2006 Apr;61(4):348-53. doi: 10.1136/thx.2005.049452. Epub 2006 Jan 31.
In most low income countries there are twice as many cases of tuberculosis (TB) reported among men than among women, a difference commonly attributed to biological and epidemiological characteristics as well as socioeconomic and cultural barriers in access to health care. The World Health Organization has encouraged gender specific comparisons in TB rates to determine whether women with TB are less likely than men with TB to be diagnosed, reported, and treated. A study was undertaken to identify gender based differences in patients with pulmonary TB and to use this information to improve TB control efforts.
Individuals with a cough for more than 2 weeks in southern Mexico were screened from March 1995 to April 2003. Clinical and mycobacteriological information (isolation, identification, drug susceptibility testing and IS6110 based genotyping, and spoligotyping) was collected from those with bacteriologically confirmed pulmonary TB. Patients were treated in accordance with official norms and followed to ascertain treatment outcome, retreatment, and vital status.
623 patients with pulmonary TB were enrolled. The male:female incidence rate ratio for overall, reactivated, and recently transmitted disease was 1.58 (95% CI 1.34 to 1.86), 1.64 (95% CI 1.36 to 1.98), and 1.41 (95% CI 1.01 to 1.96), respectively. Men were more likely than women to default from treatment (adjusted OR 3.30, 95% CI 1.46 to 7.43), to be retreated (hazard ratio (HR) 3.15, 95% CI 1.38 to 7.22), and to die from TB (HR 2.23, 95% CI 1.25 to 3.99).
Higher rates of transmitted and reactivated disease and poorer treatment outcomes among men are indicators of gender differentials in the diagnosis and treatment of pulmonary TB, and suggest specific strategies in endemic settings.
在大多数低收入国家，报告的男性结核病病例数是女性的两倍，这种差异通常归因于生物学和流行病学特征以及获得医疗保健方面的社会经济和文化障碍。世界卫生组织鼓励对结核病发病率进行针对性别的比较，以确定女性结核病患者与男性结核病患者相比，被诊断、报告和治疗的可能性是否更低。开展了一项研究，以确定肺结核患者中基于性别的差异，并利用这些信息改进结核病控制工作。
1995年3月至2003年4月，对墨西哥南部咳嗽超过2周的个体进行筛查。从痰菌确诊的肺结核患者中收集临床和分枝杆菌学信息（分离、鉴定、药敏试验以及基于IS6110的基因分型和间隔寡核苷酸分型）。患者按照官方规范接受治疗，并随访以确定治疗结果、再治疗情况和生命状态。
共纳入623例肺结核患者。总体、复发和近期传播疾病的男性与女性发病率之比分别为1.58（95%可信区间1.34至1.86）、1.64（95%可信区间1.36至1.98）和1.41（95%可信区间1.01至1.96）。男性比女性更易中断治疗（校正比值比3.30, 95%可信区间1.46至7.43）、接受再治疗（风险比3.15, 95%可信区间1.38至7.22）以及死于结核病（风险比2.23, 95%可信区间1.25至3.99）。
男性中较高的传播和复发疾病率以及较差的治疗结果表明，在肺结核诊断和治疗中存在性别差异，并提示在地方病流行地区应采取特定策略。
