Johns Hopkins University School of Medicine, Baltimore, United States of America.
Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.
PLoS One. 2019 May 23;14(5):e0217289. doi: 10.1371/journal.pone.0217289. eCollection 2019.
Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear.
We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVC<LLN among participants with obstruction. Restrictive spirometry pattern was defined as FVC<LLN among participants without obstruction. Multivariable logistic and linear regression was used to identify risk-factors for obstruction, restriction and low lung function despite successful treatment.
Of the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2-9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23-39) years and 18.1 (16.0-20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04-1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51-9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14-14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02).
We found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.
成功治疗的结核病患者的肺部功能缺陷的负担、表型和危险因素尚不清楚。
我们在印度对新诊断的、药物敏感的成年（≥18 岁）肺结核患者在成功治疗后的 12 个月内进行支气管扩张剂后肺量计检查。气流阻塞定义为支气管扩张剂前的 FEV1/FVC<全球肺倡议混合种族参考值的第 5 百分位数（正常值下限[LLN]）。支气管扩张剂后 FEV1/FVC<LLN 的患者被定义为慢性阻塞性肺疾病（COPD）。支气管扩张剂后 FEV1/FVC≥LLN 且无气流阻塞的患者被定义为存在限制性通气障碍。使用多变量逻辑回归和线性回归来确定尽管成功治疗但仍存在阻塞、限制和低肺功能的危险因素。
在纳入分析的 172 名参与者中，82 名（48%）为女性，22 名（13%）患有糖尿病，34 名（20%）有吸烟史，中位（IQR）暴露量为 3.5（0.2-9.9）包年。登记时的中位（IQR）年龄和体重指数（BMI）分别为 32（23-39）岁和 18.1（16.0-20.5）kg/m2。42 名（24%）参与者存在气流阻塞；其中 9 名（21%）对短效支气管扩张剂有反应，25 名（56%）患有 COPD；与治疗前疾病持续时间有关（优势比[OR]每增加 30 天为 1.32，95%置信区间[CI]为 1.04-1.68，p=0.02）。89 名（52%）参与者存在限制性通气障碍，与女性（优势比[OR]=3.73，95%CI 1.51-9.17，p=0.004）和糖尿病（OR=4.06，95%CI 1.14-14.42，p=0.03）有关。治疗开始时 HbA1c 越高，发生限制性通气障碍的可能性越大（OR 每单位 HbA1c 增加 1.29，95%CI 1.04 至 1.60，p=0.02）。
我们发现成功治疗的结核病患者肺部功能缺陷和 COPD 的负担很高。在印度，无论传统的 COPD 危险因素（如年龄较大和吸烟）如何，在治疗后都应筛查慢性肺部疾病，并与呼吸健康诊所联系，将其纳入所有结核病患者的常规管理计划中。
