Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.
National Lung Hospital, Ba Dinh, Hanoi, Vietnam.
Int J Infect Dis. 2018 Sep;74:31-37. doi: 10.1016/j.ijid.2018.06.013. Epub 2018 Jun 23.
Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated individual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable.
We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random sampling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB.
We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6; 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5; 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9; 95% CI 1.1-3.1).
Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations.
在高患病率环境中完成结核病（TB）治疗的患者面临疾病复发的风险。鉴于其与耐药性和预后不良相关，这对公共卫生具有重要意义。先前的研究表明，吸烟、饮酒、HIV、治疗依从性差和耐药性疾病等个体因素是疾病复发的危险因素。然而，人们对这些因素如何共同作用导致疾病复发知之甚少。此外，也许与指数疾病相关的因素意味着资源匮乏的高负担地区可能更容易发生可预防的复发性疾病。
我们在越南 70 个随机选定的区诊所进行的一项连续入组成年人治疗涂阳肺结核队列研究中进行了一项病例对照研究。病例是通过对母体队列研究进行随访确定的复发性结核病患者。对照是通过随机抽样从队列中选择的。通过访谈获得人口统计学、临床和与疾病相关的特征信息。从诊所登记册中提取治疗信息。采用逐步选择的逻辑回归方法，建立 TB 复发的优势比的完全调整模型。
我们于 2010 年 10 月至 2013 年 7 月间招募了 10964 名患者。中位随访时间为 988 天。随访结束时，共确定了 505 例（4.7%）复发患者为病例，随机选择了 630 名其他患者作为对照。复发的预测因素包括耐多药结核病（MDR-TB）（调整后的比值比 79.6；95%CI：25.1-252.0）、自我报告的既往结核病治疗史（aOR=2.5；95%CI：1.7-3.5）和不完全依从性（aOR=1.9；95%CI 1.1-3.1）。
越南 TB 患者的指数疾病治疗史是疾病复发的主要决定因素。需要进一步研究以确定可降低复发性疾病风险并提高高危人群早期检测的干预措施。
