肺结核治疗后肺活量25%至75%之间用力呼气流量降低的临床意义：一项横断面研究
Clinical significance of low forced expiratory flow between 25% and 75% of vital capacity following treated pulmonary tuberculosis: a cross-sectional study.
作者信息
Pefura-Yone Eric Walter, Kengne Andre Pascal, Tagne-Kamdem Pierre Eugene, Afane-Ze Emmanuel
机构信息
Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine and Subspecialties, University of Yaounde I, Yaounde, Cameroon Pneumology Service, Yaounde Jamot Hospital, Yaounde, Cameroon.
South African Medical Research Council and University of Cape Town, Cape Town, South Africa.
出版信息
BMJ Open. 2014 Jul 23;4(7):e005361. doi: 10.1136/bmjopen-2014-005361.
OBJECTIVES
The aim of this study was to assess the prevalence and determinants of post-tuberculosis chronic respiratory signs, as well as the clinical impact of a low forced expiratory flow between 25% and 75% (FEF25-75%) in a group of individuals previously treated successfully for pulmonary tuberculosis.
DESIGN
This was a cross-sectional study involving individuals in their post-tuberculosis treatment period. They all underwent a spirometry following the 2005 criteria of the American Thoracic Society/European Respiratory Society. Distal airflow obstruction (DAO) was defined by an FEF25-75% <65% and a ratio forced expiratory volume during the first second (FEV1)/forced vital capacity (FVC) ≥ 0.70. Logistic regression models were used to investigate the determinants of persisting respiratory symptoms following antituberculous treatment.
SETTING
This study was carried out in the tuberculosis diagnosis and treatment centre at Yaounde Jamot Hospital, which serves as a referral centre for tuberculosis and respiratory diseases for the capital city of Cameroon (Yaounde) and surrounding areas.
PARTICIPANTS
All consecutive patients in their post-tuberculosis treatment period were consecutively enrolled between November 2012 and April 2013.
RESULTS
Of the 177 patients included, 101 (57.1%) were men, whose median age (25th-75th centiles) was 32 (24-45.5) years. At least one chronic respiratory sign was present in 110 (62.1%) participants and DAO was found in 67 (62.9%). Independent determinants of persisting respiratory signs were the duration of symptoms prior to tuberculosis diagnosis higher than 12 weeks (adjusted OR 2.91; 95% CI 1.12 to 7.60, p=0.029) and presence of DAO (2.22; 1.13 to 4.38, p=0.021).
CONCLUSIONS
FEF25-75%<65% is useful for the assessment and diagnosis of post-tuberculous DAO. Mass education targeting early diagnosis of pulmonary tuberculosis can potentially reduce the prevalence of post-tuberculosis respiratory signs and distal airflow obstruction.
目的
本研究旨在评估肺结核后慢性呼吸道症状的患病率及决定因素，以及一组既往成功治疗过肺结核的个体中25%至75%用力呼气流量（FEF25 - 75%）降低的临床影响。
设计
这是一项涉及肺结核治疗后个体的横断面研究。他们均按照美国胸科学会/欧洲呼吸学会2005年标准接受了肺功能测定。远端气流阻塞（DAO）定义为FEF25 - 75%<65%且第一秒用力呼气量（FEV1）/用力肺活量（FVC）比值≥0.70。采用逻辑回归模型研究抗结核治疗后持续呼吸道症状的决定因素。
背景
本研究在雅温得贾莫特医院的结核病诊断与治疗中心开展，该中心是喀麦隆首都雅温得及周边地区结核病和呼吸道疾病的转诊中心。
参与者
所有处于肺结核治疗后阶段的连续患者于2012年11月至2013年4月期间连续入组。
结果
纳入的177例患者中，101例（57.1%）为男性，其年龄中位数（第25 - 75百分位数）为32（24 - 45.5）岁。110例（62.1%）参与者存在至少一种慢性呼吸道症状，67例（62.9%）发现有DAO。持续呼吸道症状的独立决定因素为肺结核诊断前症状持续时间超过12周（校正OR 2.91；95%CI 1.12至7.60，p = 0.029）以及存在DAO（2.22；1.13至4.38，p = 0.021）。
结论
FEF25 - 75%<65%有助于肺结核后DAO的评估和诊断。针对肺结核早期诊断的大众教育可能会降低肺结核后呼吸道症状和远端气流阻塞的患病率。
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