Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York.
Ann Am Thorac Soc. 2020 Jan;17(1):38-48. doi: 10.1513/AnnalsATS.201904-281OC.
Permanent lung function impairment after active tuberculosis infection is relatively common. It remains unclear which spirometric pattern is most prevalent after tuberculosis. Our objective was to elucidate the impact of active tuberculosis survival on lung health in the Strong Heart Study (SHS), a population of American Indians historically highly impacted by tuberculosis. As arsenic exposure has also been related to lung function in the SHS, we also assessed the joint effect between arsenic exposure and past active tuberculosis. The SHS is an ongoing population-based, prospective study of cardiovascular disease and its risk factors in American Indian adults. This study uses tuberculosis data and spirometry data from the Visit 2 examination (1993-1995). Prior active tuberculosis was ascertained by a review of medical records. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV), and FEV/FVC were measured by spirometry. An additional analysis was conducted to evaluate the potential association between active tuberculosis and arsenic exposure. A history of active tuberculosis was associated with reduced percent predicted FVC and FEV, an increased odds of airflow obstruction (odds ratio = 1.45, 95% confidence interval = 1.08-1.95), and spirometric restrictive pattern (odds ratio = 1.73, 95% confidence interval = 1.24-2.40). These associations persisted after adjustment for diabetes and other risk factors, including smoking. We also observed the presence of cough, phlegm, and exertional dyspnea after a history of active tuberculosis. In the additional analysis, increasing urinary arsenic concentrations were associated with decreasing lung function in those with a history of active tuberculosis, but a reduced odds of active tuberculosis was found with elevated arsenic. Our findings support existing knowledge that a history of active tuberculosis is a risk factor for long-term respiratory impairment. Arsenic exposure, although inversely associated with prior active tuberculosis, was associated with a further decrease in lung function among those with a prior active tuberculosis history. The possible interaction between arsenic and tuberculosis, as well as the reduced odds of tuberculosis associated with arsenic exposure, warrants further investigation, as many populations at risk of developing active tuberculosis are also exposed to arsenic-contaminated water.
活动性肺结核感染后永久性肺功能损害较为常见。目前尚不清楚肺结核后哪种肺活量模式最为常见。我们的目的是阐明在强心脏研究（SHS）中，活动性肺结核存活对肺健康的影响，该研究人群是历史上受肺结核影响较大的美洲印第安人。由于砷暴露也与 SHS 中的肺功能有关，我们还评估了砷暴露与过去活动性肺结核之间的联合效应。SHS 是一项正在进行的基于人群的前瞻性研究，研究对象为美国印第安成年人的心血管疾病及其危险因素。本研究利用了肺结核数据和 SHS 第 2 次访视（1993-1995 年）的肺活量测定数据。通过审查病历确定既往活动性肺结核。用力肺活量（FVC）、第 1 秒用力呼气量（FEV）和 FEV/FVC 通过肺活量测定法测量。进行了一项额外的分析，以评估活动性肺结核与砷暴露之间的潜在关联。活动性肺结核病史与预计 FVC 和 FEV 的百分比降低、气流阻塞的几率增加（比值比=1.45，95%置信区间=1.08-1.95）和肺活量测定限制性模式（比值比=1.73，95%置信区间=1.24-2.40）有关。在调整了糖尿病和其他危险因素（包括吸烟）后，这些关联仍然存在。我们还观察到在活动性肺结核病史后存在咳嗽、咳痰和运动时呼吸困难。在额外的分析中，尿液砷浓度升高与活动性肺结核病史者的肺功能下降有关，但砷浓度升高则与活动性肺结核的几率降低有关。我们的研究结果支持现有的知识，即活动性肺结核病史是长期呼吸损害的一个危险因素。尽管砷暴露与既往活动性肺结核呈负相关，但在既往有活动性肺结核病史的人群中，与砷暴露相关的肺功能进一步下降。砷与肺结核之间的相互作用以及砷暴露与肺结核几率降低的可能性值得进一步研究，因为许多有发生活动性肺结核风险的人群也暴露于含砷污染的水中。
