Shu Chin-Chung, Wu Huey-Dong, Yu Ming-Chih, Wang Jann-Tay, Lee Chih-Hsin, Wang Hao-Chien, Wang Jann-Yuan, Lee Li-Na, Yu Chong-Jen, Yang Pan-Chyr
From Department of Traumatology (CCS), Department of Internal Medicine (HDW, JTW, HCW, JYW, CJY, PCY), and Department of Laboratory Medicine (LNL), National Taiwan University Hospital, Taipei; Department of Internal Medicine (MCY), Taipei Medical University-Wan Fang Hospital, Taipei; Department of Internal Medicine (CHL), Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei; and the TAMI group, Taiwan.
Medicine (Baltimore). 2010 Jan;89(1):53-61. doi: 10.1097/MD.0b013e3181cafcd3.
The use of high-dose inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) has recently been shown to increase the incidence of pneumonia. However, to our knowledge, the impact of high-dose ICS on pulmonary tuberculosis (TB) has never been investigated. To study that impact, we conducted a retrospective study including patients aged more than 40 years old with irreversible airflow limitation between August 2000 and July 2008 in a medical center in Taiwan. Of the 36,684 patients who underwent pulmonary function testing, we included 554 patients. Among them, patients using high-dose ICS (equivalent to >500 microg/d of fluticasone) were more likely to have more severe COPD and receive oral corticosteroids than those using medium-dose, low-dose, or no ICS. Sixteen (3%) patients developed active pulmonary TB within a follow-up of 25,544 person-months. Multivariate Cox regression analysis revealed that the use of high-dose ICS, the use of 10 mg or more of prednisolone per day, and prior pulmonary TB were independent risk factors for the development of active pulmonary TB. Chest radiography and sputum smear/culture for Mycobacterium tuberculosis should be performed before initiating high-dose ICS and regularly thereafter.
近期研究表明，慢性阻塞性肺疾病（COPD）患者使用高剂量吸入性糖皮质激素（ICS）会增加肺炎发病率。然而，据我们所知，高剂量ICS对肺结核（TB）的影响尚未得到研究。为研究这一影响，我们进行了一项回顾性研究，纳入了2000年8月至2008年7月间台湾某医疗中心年龄超过40岁且存在不可逆气流受限的患者。在36684例接受肺功能测试的患者中，我们纳入了554例。其中，与使用中剂量、低剂量或未使用ICS的患者相比，使用高剂量ICS（相当于氟替卡松>500μg/d）的患者更易患有更严重的COPD且接受口服糖皮质激素治疗。在25544人月的随访期内，16例（3%）患者发生了活动性肺结核。多因素Cox回归分析显示，使用高剂量ICS、每日使用10mg或更多泼尼松龙以及既往有肺结核病史是发生活动性肺结核的独立危险因素。在开始使用高剂量ICS之前以及之后应定期进行胸部X线检查和痰涂片/结核分枝杆菌培养。
