Yakar Halil Ibrahim, Gunen Hakan, Pehlivan Erkan, Aydogan Selma
Department of Pulmonology, Faculty of Medicine, Istanbul Medeniyet University.
Department of Pulmonology, Sureyyapasa Training and Research Center for Chest Disease and Thoracic Surgery, Istanbul.
Int J Chron Obstruct Pulmon Dis. 2017 Jan 17;12:323-329. doi: 10.2147/COPD.S116086. eCollection 2017.
Influence of tuberculosis (TB) on the natural course of COPD has not been well known. This study was designed to investigate the effects of history of TB on the long-term course of COPD.
Patients hospitalized with COPD exacerbation were consecutively included (n=598). Cases were classified into two categories: those with TB history and those without. Clinical, demographic, and radiological features were meticulously recorded, and patients were followed up for hospitalizations due to exacerbation and for overall mortality.
A total of 93 patients (15%) had a history of TB. On average, patients with past TB history were 4 years younger than the rest of the patients (=0.002). Our study revealed that patients with past TB were diagnosed with COPD 4 years earlier and died 5 years earlier as compared to the patients without TB. In addition, in the past TB group, rate of hospital admissions per year was higher compared to the group that lacked TB history (2.46±0.26 vs 1.56±0.88; =0.001). Past TB group had higher arterial carbon dioxide tension (PaCO) and lower forced expiratory volume in 1 second (FEV; =0.008 and =0.069, respectively). Median survival was 24 months for patients who had past TB and 36 months for those who had not. Kaplan-Meier analysis revealed that although 3-year survival rate was lower in patients with past TB, it was not statistically significant (=0.08). Cox regression analysis showed that while factors such as age, PaCO, hematocrit, body mass index (BMI) and Charlson index affected mortality rates in COPD patients (<0.05), prior history of TB did not.
Our results showed that a history of TB caused more hospitalizations, reduced respiratory functions and increased PaCO. It was found that, despite similarity of the overall mortality, COPD diagnosis and death occurred 5 years earlier in patients with past TB. We conclude that history of TB has an important role in the natural course of COPD.
肺结核（TB）对慢性阻塞性肺疾病（COPD）自然病程的影响尚不明确。本研究旨在调查结核病史对COPD长期病程的影响。
连续纳入因COPD急性加重住院的患者（n = 598）。病例分为两类：有结核病史者和无结核病史者。详细记录临床、人口统计学和放射学特征，并对患者因急性加重住院情况及总死亡率进行随访。
共有93例患者（15%）有结核病史。既往有结核病史的患者平均比其他患者年轻4岁（P = 0.002）。我们的研究表明，与无结核病史的患者相比，既往有结核病史的患者COPD诊断早4年，死亡早5年。此外，在既往有结核病史的组中，每年的住院率高于无结核病史的组（2.46±0.26对1.56±0.88；P = 0.001）。既往有结核病史的组动脉血二氧化碳分压（PaCO₂）较高，第1秒用力呼气容积（FEV₁）较低（分别为P = 0.008和P = 0.069）。既往有结核病史患者的中位生存期为24个月，无结核病史患者为36个月。Kaplan-Meier分析显示，尽管既往有结核病史患者的3年生存率较低，但差异无统计学意义（P = 0.08）。Cox回归分析表明，年龄、PaCO₂、血细胞比容、体重指数（BMI）和Charlson指数等因素影响COPD患者的死亡率（P < 0.05），而既往结核病史则无此影响。
我们的结果表明，结核病史导致更多的住院、呼吸功能下降和PaCO₂升高。结果发现，尽管总死亡率相似，但既往有结核病史的患者COPD诊断和死亡时间早5年。我们得出结论：结核病史在COPD自然病程中起重要作用。
