Department of Chest Medicine, Taipei Veterans General Hospital, Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, China.
Clin Microbiol Infect. 2012 Sep;18(9):E331-7. doi: 10.1111/j.1469-0691.2012.03931.x. Epub 2012 Jun 27.
Gender disparities in tuberculosis (TB) cases are reported worldwide, and socio-cultural factors have been proposed as possible causes. To date, gender differences in treatment outcomes of TB patients remain controversial. In this prospective observational study, newly diagnosed, culture-proven TB patients from six hospitals in Taiwan were enrolled for analysis. Gender differences in demographic characteristics and treatment outcomes, including sputum conversion and on-treatment mortality, were analysed accordingly. From January 2007 through to December 2009, a total of 1059 patients were enrolled, including 819 (77.3%) males and 240 (22.7%) females. The ratio of male gender was around 50 ~ 60% in TB patients below 35 years and >80% for those older than 65 years. When compared with the female patients, the male patients were older, more likely to have the habit of smoking, chronic obstructive pulmonary disorder, malignancy and liver cirrhosis, and more likely to present with haemoptysis, body weight loss and pleural effusion. Regarding treatment outcomes, male gender is associated with a lower 2-month sputum culture conversion rate (78.8% vs. 89.3%, p 0.002) and higher on-treatment mortality (21.1% vs. 12.1%, p 0.002). Kaplan-Meier survival analysis demonstrated significantly higher mortality in the men (p 0.005). In multivariate analysis, male gender was an independent risk factor for 2-month sputum culture un-conversion (OR, 1.96; 95% CI, 1.12-3.41). Our findings suggest that male gender is associated with older age, more co-morbidities and worse treatment outcomes. Gender-specific strategies, including active case finding in elderly women and smoking cessation in male patients, are warranted to optimize TB management.
全球范围内都有报道称结核病（TB）病例存在性别差异，社会文化因素被认为是可能的原因。迄今为止，TB 患者的治疗结果的性别差异仍存在争议。在这项前瞻性观察研究中，我们对来自台湾六家医院的新诊断、培养阳性的 TB 患者进行了分析。分析了性别差异对人口统计学特征和治疗结果的影响，包括痰培养转化和治疗期间死亡率。2007 年 1 月至 2009 年 12 月，共纳入 1059 例患者，其中男性 819 例（77.3%），女性 240 例（22.7%）。35 岁以下的 TB 患者中男性比例约为 50%~60%，而 65 岁以上的患者中男性比例则超过 80%。与女性患者相比，男性患者年龄更大，更有可能有吸烟、慢性阻塞性肺疾病、恶性肿瘤和肝硬化等病史，更有可能出现咯血、体重减轻和胸腔积液。在治疗结果方面，男性患者的 2 个月痰培养转阴率较低（78.8% vs. 89.3%，p 0.002），治疗期间死亡率较高（21.1% vs. 12.1%，p 0.002）。Kaplan-Meier 生存分析显示男性死亡率显著更高（p 0.005）。多因素分析显示，男性是 2 个月痰培养未转阴的独立危险因素（OR，1.96；95%CI，1.12-3.41）。我们的研究结果表明，男性与年龄较大、合并症较多和治疗结果较差有关。需要针对不同性别制定具体策略，包括在老年女性中积极发现病例和在男性患者中戒烟，以优化结核病管理。
