Leung Chi C, Lam Tai H, Ho Kin S, Yew Wing W, Tam Cheuk M, Chan Wai M, Law Wing S, Chan Chi K, Chang Kwok C, Au Ka F
Department of Health, Hong Kong.
Arch Intern Med. 2010 Feb 8;170(3):287-92. doi: 10.1001/archinternmed.2009.506.
Increasing evidence has incriminated active smoking as a causal factor for tuberculosis (TB). However, the effect of secondhand tobacco smoke exposure on TB has not been similarly elucidated.
A cohort of 15 486 female never-smokers aged 65 to 74 years and living with their surviving husband were enrolled at 18 Elderly Health Centers in Hong Kong from 2000 to 2003 and followed up prospectively through linkage with the territory-wide TB notification registry and death registry for TB and death until December 31, 2008, using an identity card number as a unique identifier. The relationship between passive smoking and the development of TB was assessed with adjustment for other baseline characteristics.
Passive exposure to secondhand tobacco smoke in the household was independently associated with obstructive lung disease (odds [OR], 1.43; 95% confidence interval [CI], 1.16-1.77) and diabetes mellitus (OR, 1.13; 95% CI, 1.02-1.26) at baseline and with the development of both active TB (hazard ratio [HR], 1.49; 95% CI, 1.01-2.19) and culture-confirmed TB (HR, 1.70; 95% CI, 1.04-2.80) on prospective follow-up after potentially confounding background variables were controlled for. Passive smoking accounted for 13.7% of active TB and for 18.5% of culture-positive TB in this cohort.
Similar to active smoking, passive exposure to secondhand tobacco smoke in the household also predisposes to the development of TB. Increased emphasis should therefore be put on tobacco control in national TB programs.
越来越多的证据表明主动吸烟是结核病（TB）的一个致病因素。然而，二手烟草烟雾暴露对结核病的影响尚未得到类似的阐明。
2000年至2003年期间，在香港的18家老年健康中心招募了15486名年龄在65至74岁之间、与在世丈夫共同生活的从未吸烟的女性，并以前瞻性方式通过与全港结核病通报登记处和死亡登记处相联系，以身份证号码作为唯一标识符，追踪结核病发病情况和死亡情况直至2008年12月31日。在对其他基线特征进行调整后，评估被动吸烟与结核病发病之间的关系。
在家中被动接触二手烟草烟雾在基线时独立与阻塞性肺病（比值比[OR]，1.43；95%置信区间[CI]，1.16 - 1.77）和糖尿病（OR，1.13；95% CI，1.02 - 1.26）相关，并且在控制了潜在混杂背景变量后的前瞻性随访中与活动性结核病（风险比[HR]，1.49；95% CI，1.01 - 2.19）和培养确诊的结核病（HR，1.70；95% CI，1.04 - 2.80）的发生相关。在该队列中，被动吸烟占活动性结核病的13.7%，占培养阳性结核病的18.5%。
与主动吸烟类似，在家中被动接触二手烟草烟雾也易导致结核病的发生。因此，在国家结核病防治规划中应更加重视烟草控制。
