TB and Chest Service, Dept of Health, Hong Kong, China.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
Eur Respir J. 2015 Mar;45(3):738-45. doi: 10.1183/09031936.00114214. Epub 2014 Oct 30.
The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme. 16,345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012. Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%). Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission.
在一项全港范围内的治疗计划中，评估了吸烟对结核病结局的影响。2001 年至 2003 年期间，香港政府胸科诊所对 16345 例连续接受化学疗法治疗活动性肺结核的患者进行了前瞻性随访，为期 2 年，以评估治疗结局，随后通过全港结核病通报登记处对复发情况进行追踪，直至 2012 年底。吸烟与更广泛的肺部疾病、肺空洞和基线时痰涂片和培养阳性有关。在现吸烟者和曾经吸烟者中，痰涂片和培养在治疗 2 个月后仍保持阳性的可能性明显更高。这两类吸烟者在 2 年内达到治愈或治疗完成的可能性明显更低。总的来说，16.7%的治疗失败结局归因于吸烟，其中主要原因是现吸烟者失访和曾经吸烟者死亡。在成功完成治疗的患者中，从不吸烟者到曾经吸烟者和现吸烟者的复发风险呈明显梯度（风险比分别为 1.00、1.33 和 1.63），总人群归因风险为 19.4%（现吸烟者：12.2%；曾经吸烟者：7.2%）。吸烟对结核病的基线疾病严重程度、细菌学反应、治疗结局和复发均有不利影响。戒烟可能会降低复发和二次传播的风险。
