Yen Y-F, Yen M-Y, Lin Y-S, Lin Y-P, Shih H-C, Li L-H, Chou P, Deng C-Y
Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.
Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.
Int J Tuberc Lung Dis. 2014 Apr;18(4):492-8. doi: 10.5588/ijtld.13.0694.
To investigate whether tobacco smoking increases the risk of tuberculosis (TB) recurrence and identify factors associated with TB recurrence among adults who had successfully completed anti-tuberculosis treatment in Taipei, Taiwan.
Recurrence was defined as a new clinical or microbiological diagnosis of TB requiring the start of a new course of treatment in a patient who had satisfactorily completed treatment for a previous TB episode. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) for recurrence.
We followed 5567 adults for recurrence after successful anti-tuberculosis treatment. The mean age was 58.5 years; 62.9% were male. Overall, 84 (1.5%) had a recurrence of TB during follow-up. The incidence of TB recurrence was 4.9 episodes/1000 person-years of follow-up. Cox proportional hazards regression showed that after controlling for other variables, the risk of TB recurrence among subjects who smoked >10 cigarettes a day was double that of never/former smokers. Other independent risk factors significantly associated with TB recurrence were homelessness (aHR 3.75, 95%CI 1.17-12.07), presence of comorbidities (aHR 2.66, 95%CI 1.22-5.79) and a positive acid-fast bacilli smear (aHR 2.27, 95%CI 1.47-3.49).
Smoking >10 cigarettes a day was significantly associated with TB recurrence. To reduce the risk of recurrence, we recommend including effective measures of smoking cessation in TB control programmes, as recommended by the World Health Organization Stop TB Strategy.
探讨吸烟是否会增加结核病（TB）复发风险，并确定台湾台北地区成功完成抗结核治疗的成年人中与TB复发相关的因素。
复发定义为在先前TB发作治疗已圆满完成的患者中，需要开始新疗程治疗的新的TB临床或微生物学诊断。采用Cox比例风险模型计算复发的调整风险比（aHRs）。
我们对5567名成年人进行了成功抗结核治疗后的复发随访。平均年龄为58.5岁；62.9%为男性。总体而言，84人（1.5%）在随访期间出现TB复发。TB复发发生率为4.9例/1000人年随访。Cox比例风险回归显示，在控制其他变量后，每天吸烟超过10支的受试者TB复发风险是从不吸烟者/既往吸烟者的两倍。与TB复发显著相关的其他独立危险因素包括无家可归（aHR 3.75，95%CI 1.17-12.07）、合并症的存在（aHR 2.66，95%CI 1.22-5.79）和抗酸杆菌涂片阳性（aHR 2.27，95%CI 1.47-3.49）。
每天吸烟超过10支与TB复发显著相关。为降低复发风险，我们建议按照世界卫生组织终止结核病战略的建议，在结核病控制项目中纳入有效的戒烟措施。
