评估直接烟草烟雾对感染及活动性结核病管理的影响。
Assessment of the influence of direct tobacco smoke on infection and active TB management.
作者信息
Altet Neus, Latorre Irene, Jiménez-Fuentes María Ángeles, Maldonado José, Molina Israel, González-Díaz Yoel, Milà Celia, García-García Esther, Muriel Beatriz, Villar-Hernández Raquel, Laabei Maisem, Gómez Andromeda-Celeste, Godoy Pere, de Souza-Galvão Maria Luiza, Solano Segismundo, Jiménez-Ruiz Carlos A, Domínguez Jose
机构信息
Unitat de Tuberculosi Vall d'Hebron-Drassanes, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Serveis Clínics, Unitat Clínica de Tractament Directament Observat de la Tuberculosi, Barcelona, Spain.
出版信息
PLoS One. 2017 Aug 24;12(8):e0182998. doi: 10.1371/journal.pone.0182998. eCollection 2017.
BACKGROUND
Smoking is a risk factor for tuberculosis (TB) infection and disease progression. Tobacco smoking increases susceptibility to TB in a variety of ways, one of which is due to a reduction of the IFN-γ response. Consequently, an impaired immune response could affect performance of IFN-γ Release Assays (IGRAs).
OBJECTIVE
In the present study, we assess the impact of direct tobacco smoking on radiological manifestations, sputum conversion and immune response to Mycobacterium tuberculosis, analyzing IFN-γ secretion by IGRAs.
METHODS
A total of 525 participants were studied: (i) 175 active pulmonary TB patients and (ii) 350 individuals coming from contact tracing studies, 41 of whom were secondary TB cases. Clinical, radiological and microbiological data were collected. T-SPOT.TB and QFN-G-IT were processed according manufacturer's instructions.
RESULTS
In smoking patients with active TB, QFN-G-IT (34.4%) and T-SPOT.TB (19.5%) had high frequencies of negative results. In addition, by means of an unconditional logistic regression, smoking was a main factor associated with IGRAs' false-negative results (aOR: 3.35; 95%CI:1.47-7.61; p<0.05). Smoking patients with active TB presented a high probability of having cavitary lesions (aOR: 1.88; 95%CI:1.02-3.46;p<0.05). Mean culture negativization (months) ± standard deviation (SD) was higher in smokers than in non-smokers (2.47±1.3 versus 1.69±1.4). Latent TB infection (LTBI) was favored in smoking contacts, being a risk factor associated with infection (aOR: 11.57; 95%CI:5.97-22.41; p<0.00005). The IFN-γ response was significantly higher in non-smokers than in smokers. Smoking quantity and IFN-γ response analyzed by IGRAs were dose-dependent related.
CONCLUSIONS
Smoking had a negative effect on radiological manifestations, delaying time of sputum conversion. Our data establish a link between tobacco smoking and TB due to a weakened IFN-γ response caused by direct tobacco smoke.
背景
吸烟是结核病（TB）感染和疾病进展的一个风险因素。吸烟通过多种方式增加对结核病的易感性，其中之一是由于干扰素-γ反应降低。因此，免疫反应受损可能会影响干扰素-γ释放试验（IGRAs）的性能。
目的
在本研究中，我们通过分析IGRAs检测的干扰素-γ分泌情况，评估直接吸烟对肺结核的影像学表现、痰菌转阴及对结核分枝杆菌免疫反应的影响。
方法
共研究了525名参与者：（i）175例活动性肺结核患者和（ii）350名来自接触者追踪研究的个体，其中41例为继发性结核病例。收集了临床、影像学和微生物学数据。T-SPOT.TB和QFN-G-IT按照制造商的说明进行检测。
结果
在活动性肺结核吸烟患者中，QFN-G-IT（34.4%）和T-SPOT.TB（19.5%）检测结果为阴性的频率较高。此外，通过无条件逻辑回归分析，吸烟是与IGRAs假阴性结果相关的主要因素（调整后比值比：3.35；95%置信区间：1.47-7.61；p<0.05）。活动性肺结核吸烟患者出现空洞性病变的可能性较高（调整后比值比：1.88；95%置信区间：1.02-3.46；p<0.05）。吸烟者痰培养转阴的平均时间（月）±标准差（SD）高于非吸烟者（2.47±1.3对1.69±1.4）。吸烟接触者中潜伏性结核感染（LTBI）更为常见，是与感染相关的一个风险因素（调整后比值比：11.57；95%置信区间：5.97-22.41；p<0.00005）。非吸烟者的干扰素-γ反应显著高于吸烟者。通过IGRAs分析的吸烟量与干扰素-γ反应呈剂量依赖性相关。
结论
吸烟对影像学表现有负面影响，延迟了痰菌转阴时间。我们的数据表明，由于直接吸烟导致干扰素-γ反应减弱，吸烟与结核病之间存在联系。
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