Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK.
Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK.
BMC Infect Dis. 2018 Feb 27;18(1):94. doi: 10.1186/s12879-017-2933-4.
Tuberculosis (TB) recurrence represents a challenge to control programs. In low incidence countries, the prevailing risk factors leading to recurrence are poorly characterised.
We conducted a nested case-control study using the Leicester TB service TBIT database. Cases were identified from database notifications between 1994 and 2014. Controls had one episode and were matched to cases on a ratio of two to one by the date of notification. Multiple imputation was used to account for missing data. Multivariate conditional logistic regression analysis was employed to identify clinical, sociodemographic and TB specific risk factors for recurrence.
From a cohort of 4628 patients, 82 TB recurrences occurred (1.8%). Nineteen of 82 patients had paired isolates with MIRU-VNTR strain type profiles available, of which 84% were relapses and 16% reinfections. On multivariate analysis, smoking (OR 3.8; p = 0.04), grade 3/4 adverse drug reactions (OR 5.6; p = 0.02), ethnicity 'Indian subcontinent' (OR 8.5; p = <0.01), ethnicity 'other' (OR 31.2; p = 0.01) and receipt of immunosuppressants (OR 6.8; p = <0.01) were independent predictors of TB recurrence.
Within this UK setting, the rate of TB recurrence was low, predominantly due to relapse. The identification of an elevated recurrence risk amongst the ethnic group contributing most cases to the national TB burden presents an opportunity to improve individual and population health.
结核病（TB）复发是控制项目面临的挑战。在发病率较低的国家，导致复发的主要危险因素尚未得到很好的描述。
我们使用莱斯特结核病服务 TBIT 数据库进行了一项嵌套病例对照研究。病例是通过 1994 年至 2014 年数据库通知确定的。对照病例有一次发病，并按通知日期以 2:1 的比例与病例相匹配。采用多重插补法处理缺失数据。采用多变量条件逻辑回归分析确定复发的临床、社会人口学和结核病特定危险因素。
从 4628 例患者队列中，发生了 82 例 TB 复发（1.8%）。82 例患者中有 19 例配对分离株，可获得 MIRU-VNTR 菌株类型谱，其中 84%为复发，16%为再感染。多变量分析显示，吸烟（OR 3.8；p=0.04）、3/4 级药物不良反应（OR 5.6；p=0.02）、“印度次大陆”族裔（OR 8.5；p<0.01）、其他族裔（OR 31.2；p=0.01）和使用免疫抑制剂（OR 6.8；p<0.01）是结核病复发的独立预测因素。
在英国，结核病复发率较低，主要是因为复发。在导致国家结核病负担的主要族裔中，结核病复发风险升高，这为改善个人和人群健康提供了机会。
