Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Respirology. 2019 May;24(5):467-474. doi: 10.1111/resp.13482. Epub 2019 Feb 5.
Tuberculosis (TB) and sarcoidosis are both granulomatous diseases with potential interassociations. However, much uncertainty remains; thus, the present study aimed to clarify the association between these diseases.
We established two cohorts in this retrospective longitudinal cohort study using data obtained from the Taiwan National Health Insurance Database from 2000 to 2015. One cohort, which comprised 31 221 patients with TB and 62 442 age-, sex- and index year-matched controls, was used to analyse the risk of sarcoidosis; the other cohort comprised 2442 patients with sarcoidosis and 9688 controls and was used to assess the risk of TB. A Cox proportional hazards model adjusted for potential confounders was used in each cohort.
Patients with TB showed an 8.09-fold higher risk of developing sarcoidosis than non-TB subjects (95% CI = 3.66-17.90), whereas patients with sarcoidosis showed a 1.85-fold higher risk of developing TB than non-sarcoidosis subjects (95% CI = 1.36-2.50). The TB subtype analysis revealed the highest risk of developing sarcoidosis in patients with extrapulmonary TB, and the highest risk of developing extrapulmonary TB was observed in patients with sarcoidosis compared with non-sarcoidosis subjects. Patients with TB showed a higher risk of developing sarcoidosis throughout the follow-up period, but patients with sarcoidosis only showed a higher risk of developing TB within the first year.
TB is a risk factor for developing sarcoidosis. The results of this bidirectional cohort study also highlight the clinical difficulty of diagnosing sarcoidosis and TB.
结核病（TB）和结节病都是具有潜在相互关联的肉芽肿性疾病。然而，仍存在许多不确定性；因此，本研究旨在阐明这两种疾病之间的关联。
我们使用 2000 年至 2015 年从台湾全民健康保险数据库中获得的数据，在这项回顾性纵向队列研究中建立了两个队列。一个队列包括 31221 例 TB 患者和 62442 例年龄、性别和指数年匹配的对照者，用于分析结节病的风险；另一个队列包括 2442 例结节病患者和 9688 例对照者，用于评估 TB 的风险。每个队列均使用经潜在混杂因素调整的 Cox 比例风险模型进行分析。
与非 TB 患者相比，TB 患者发生结节病的风险高出 8.09 倍（95%CI=3.66-17.90），而结节病患者发生 TB 的风险高出 1.85 倍（95%CI=1.36-2.50）。TB 亚型分析显示，肺外 TB 患者发生结节病的风险最高，而与非结节病患者相比，结节病患者发生肺外 TB 的风险最高。TB 患者在整个随访期间发生结节病的风险较高，但结节病患者仅在第一年发生 TB 的风险较高。
TB 是发生结节病的一个危险因素。这项双向队列研究的结果还突出了诊断结节病和 TB 的临床困难。
