Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
J Epidemiol Community Health. 2009 Oct;63(10):799-804. doi: 10.1136/jech.2008.077560. Epub 2009 Jan 29.
Little is known about recurrent tuberculosis (TB) in developed countries. The objective of this study was to determine the probability of TB recurrence and the associated risk factors among cured patients in a city with moderate TB incidence.
A population-based retrospective longitudinal study was carried out in Barcelona, Spain. All patients with culture-confirmed TB and drug susceptibility testing were included between 1995 and 1997 and followed until December 2005. The authors defined recurrence as a new TB event after a patient was considered cured and had remained free of the disease for a minimum of 1 year. Kaplan-Meier and Cox regression were used in the statistical analysis. HRs with 95% CIs were calculated.
Among the 681 patients studied, the authors observed 29 recurrences (recurrence rate 0.53/100 person-years of follow-up). The mean incidence of TB in Barcelona from 1995 to 2005 was 36.25 cases per 100,000 inhabitants. The incidence of recurrence was 14.6 times higher in the cohort than the incidence of a first TB episode in the general population. The factors associated with recurrence at bivariate level were being male, being an immigrant, being an intravenous drug user (IDU), having human immunodeficiency virus, smoking, being an alcoholic, being in prison, and having both pulmonary and extrapulmonary TB. At multivariate level, only being an immigrant (HR 3.2, 95% CI 1.2 to 9), an IDU (HR 2.9, 95% CI 1.3 to 6.4) and male (HR 4.3, 95% CI 1.3 to 14.6) were associated.
Having TB in the past is a risk factor for developing TB. Social policies must be implemented in populations at risk of recurrence, especially in immigrants and IDUs.
在发达国家，复发性结核病（TB）的情况鲜为人知。本研究的目的是确定在结核病发病率中等的城市中，治愈患者中结核病复发的概率和相关的危险因素。
本研究是在西班牙巴塞罗那市进行的一项基于人群的回顾性纵向研究。所有经培养证实的结核病和药敏试验患者均于 1995 年至 1997 年期间入选，并随访至 2005 年 12 月。作者将复发定义为患者被认为治愈并在至少 1 年内无疾病后出现新的结核病事件。统计分析采用 Kaplan-Meier 和 Cox 回归。计算了 95%置信区间的 HR。
在 681 名研究对象中，作者观察到 29 例复发（复发率为 0.53/100 人年随访）。1995 年至 2005 年期间巴塞罗那的结核病平均发病率为每 10 万人 36.25 例。该队列的复发发病率比一般人群中首次结核病发作的发病率高 14.6 倍。在单变量水平上，与复发相关的因素包括男性、移民、静脉吸毒者（IDU）、人类免疫缺陷病毒、吸烟、酗酒、入狱以及肺部和肺外结核病。在多变量水平上，只有移民（HR 3.2，95%CI 1.2 至 9）、IDU（HR 2.9，95%CI 1.3 至 6.4）和男性（HR 4.3，95%CI 1.3 至 14.6）与复发相关。
过去患有结核病是发生结核病的危险因素。必须在有复发风险的人群中实施社会政策，特别是在移民和 IDU 中。
