吸烟、酒精使用障碍与结核病治疗结局：双重共病负担不容忽视。
Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored.
机构信息
National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India.
Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
出版信息
PLoS One. 2019 Jul 31;14(7):e0220507. doi: 10.1371/journal.pone.0220507. eCollection 2019.
BACKGROUND
More than 20% of tuberculosis (TB) disease worldwide may be attributable to smoking and alcohol abuse. India is the second largest consumer of tobacco products, a major consumer of alcohol particularly among males, and has the highest burden of TB globally. The impact of increasing tobacco dose, relevance of alcohol misuse and past versus current or never smoking status on TB treatment outcomes remain inadequately defined.
METHODS
We conducted a multi-centric prospective cohort study of newly diagnosed adult pulmonary TB patients initiated on TB treatment and followed for a minimum of 6 months to assess the impact of smoking status with or without alcohol abuse on treatment outcomes. Smokers were defined as never smokers, past smokers or current smokers. Alcohol Use Disorder Identification Test (AUDIT) scores were used to assess alcohol misuse. The association between smoking status and treatment outcomes was assessed in univariate and multivariate random effects poisson regression models.
RESULTS
Of 455 enrolled, 129 (28%) had a history of smoking with 94 (20%) current smokers and 35 (8%) past smokers. Unfavourable treatment outcomes were significantly higher among past and current smokers as compared to never smokers. Specifically, the risk of treatment failure was significantly higher among past smokers (aIRR = 2.66, 95% CI: 1.41-4.90, p = 0.002), recurrent TB among current smokers (aIRR = 2.94, 95% CI: 1.30-6.67, p = 0.010) and death among both past (2.63, 95% CI: 1.11-6.24, p = 0.028) and current (aIRR = 2.59, 95% CI: 1.29-5.18, p = 0.007) smokers. Furthermore, the combined effect of alcohol misuse and smoking on unfavorable treatment outcomes was significantly higher among past smokers (aIRR: 4.67, 95% CI: 2.17-10.02, p<0.001) and current smokers (aIRR: 3.58, 95% CI: 1.89-6.76, p<0.001).
CONCLUSION
Past and current smoking along with alcohol misuse have combined effects on increasing the risk of unfavourable TB treatment outcomes. Innovative interventions that can readily address both co-morbidities are urgently needed.
背景
全球超过 20%的结核病（TB）可能与吸烟和酗酒有关。印度是世界上第二大烟草制品消费国，是酒精的主要消费国，特别是在男性中，并且是全球结核病负担最高的国家。吸烟量增加、酒精滥用的相关性以及过去、现在或从不吸烟状态对结核病治疗结果的影响仍未得到充分定义。
方法
我们对新诊断的成年肺结核患者进行了一项多中心前瞻性队列研究，这些患者开始接受结核病治疗，并至少随访 6 个月，以评估吸烟状况（无论是否有酒精滥用）对治疗结果的影响。吸烟者定义为从不吸烟者、过去吸烟者或现在吸烟者。使用酒精使用障碍识别测试（AUDIT）评分评估酒精滥用。在单变量和多变量随机效应泊松回归模型中评估吸烟状况与治疗结果之间的关系。
结果
在 455 名入组患者中，有 129 名（28%）有吸烟史，其中 94 名（20%）为现在吸烟者，35 名（8%）为过去吸烟者。与从不吸烟者相比，过去和现在吸烟者的不良治疗结局显著更高。具体而言，过去吸烟者的治疗失败风险显著更高（调整后的相对风险比[aIRR] = 2.66，95%置信区间：1.41-4.90，p = 0.002），现在吸烟者的复发性结核病风险更高（aIRR = 2.94，95%置信区间：1.30-6.67，p = 0.010），过去吸烟者的死亡风险更高（aIRR = 2.63，95%置信区间：1.11-6.24，p = 0.028），现在吸烟者的死亡风险更高（aIRR = 2.59，95%置信区间：1.29-5.18，p = 0.007）。此外，过去吸烟者（调整后的相对风险比[aIRR]：4.67，95%置信区间：2.17-10.02，p<0.001）和现在吸烟者（aIRR：3.58，95%置信区间：1.89-6.76，p<0.001）酒精滥用和吸烟对不良治疗结果的联合影响显著更高。迫切需要创新的干预措施，以解决这两种共病。
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