Center for Clinical Epidemiology, Lady Davis Research Institute, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
Am J Respir Crit Care Med. 2011 Mar 1;183(5):675-8. doi: 10.1164/rccm.201007-1099OC. Epub 2010 Oct 1.
Treatment with substantial doses of oral corticosteroids (OCS) for prolonged periods increases the risk of tuberculosis (TB). However, little is known about the effect of inhaled corticosteroids (ICS) in this respect.
We quantified the independent contribution of ICS to the risk of TB in a population of patients with airway diseases.
A population-based cohort design with a nested case-control analysis was used. A cohort of patients with airways disease was formed using the Quebec databases. TB cases were identified and age-matched control subjects were selected from all subjects who entered the cohort in the same month as the cases. TB incidence among the cohort was compared with the general population of Quebec using the standardized incidence ratio.
The cohort consisted of 427,648 subjects. There were 564 cases of TB identified between 1990 and 2005. The standardized incidence ratio was 3.9 (95% confidence interval [CI], 2.6-5.4). Any and current users of ICS are at an increased risk of TB (rate ratio [RR], 1.27; 95% CI, 1.05-1.53; and RR, 1.33; 95% CI, 1.04-1.71, respectively). Among users of OCS, no significant relationship could be demonstrated. Among subjects without OCS exposure, adjusted RRs were significant for any ICS use (RR, 1.26; 95% CI, 1.02-1.56) and current use (RR, 1.48; 95% CI, 1.11-1.97) and at the current high dose exposure level (RR, 1.97; 95% CI, 1.18-3.3).
Exposure to ICS is not associated with risk of TB in the presence of OCS but is associated with increased TB risk in nonusers of OCS.
长期大剂量口服皮质类固醇（OCS）治疗会增加结核（TB）的风险。然而，吸入皮质类固醇（ICS）在这方面的影响知之甚少。
我们通过对气道疾病患者的人群研究，量化了 ICS 对 TB 风险的独立贡献。
采用基于人群的队列设计，并进行嵌套病例对照分析。使用魁北克数据库建立气道疾病患者队列。确定 TB 病例，并从与病例同月进入队列的所有患者中选择年龄匹配的对照。使用标准化发病比比较队列中的 TB 发病率与魁北克的一般人群。
队列包括 427648 名患者。1990 年至 2005 年间共发现 564 例 TB。标准化发病比为 3.9（95%置信区间[CI]，2.6-5.4）。任何时候和当前使用 ICS 的患者发生 TB 的风险均增加（RR，1.27；95%CI，1.05-1.53；和 RR，1.33；95%CI，1.04-1.71）。在 OCS 使用者中，未发现显著的相关性。在没有 OCS 暴露的患者中，任何 ICS 使用（RR，1.26；95%CI，1.02-1.56）和当前使用（RR，1.48；95%CI，1.11-1.97）以及当前高剂量暴露水平（RR，1.97；95%CI，1.18-3.3）的调整 RR 均有统计学意义。
在存在 OCS 的情况下，ICS 暴露与 TB 风险无关，但与 OCS 未使用者的 TB 风险增加有关。
