乌干达耐多药结核病治愈后的阻塞性肺病与生活质量：一项横断面研究
Obstructive lung disease and quality of life after cure of multi-drug-resistant tuberculosis in Uganda: a cross-sectional study.
作者信息
Nuwagira Edwin, Stadelman Anna, Baluku Joseph Baruch, Rhein Joshua, Byakika-Kibwika Pauline, Mayanja Harriet, Kunisaki Ken M
机构信息
1Department of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
2Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA.
出版信息
Trop Med Health. 2020 May 19;48:34. doi: 10.1186/s41182-020-00221-y. eCollection 2020.
BACKGROUND
Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthy treatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature about pulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This study sought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients who were treated for pulmonary MDR TB.
METHODS
Participants who completed 18 months of pulmonary MDR TB treatment and considered cured were eligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC). COPD was defined as FEV/FVC < 0.7; health-related QoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George's Respiratory Questionnaire (SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, and other characteristics of the cohort.
RESULTS
A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR), 29-45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8 (IQR, 3.1-14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0-61.5) and 52.9 (IQR, 47.8-57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical or mental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP) while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictor of COPD.
CONCLUSION
Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mental and physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs in patients with a low socioeconomic position (SEP) after MDR TB treatment.
背景
肺部耐多药结核病（MDR-TB）会改变肺部结构，治疗疗程漫长，服药负担重，存在药物不良反应、出行限制以及污名化问题。关于接受MDR-TB治疗患者的肺功能和健康相关生活质量（QoL）的文献有限。本研究旨在确定接受肺部MDR-TB治疗患者的慢性阻塞性肺疾病（COPD）患病率及生活质量。
方法
完成18个月肺部MDR-TB治疗且被认为已治愈的参与者有资格纳入一项横断面研究进行评估。我们进行了支气管扩张剂后肺量测定，以测量第1秒用力呼气量（FEV）和用力肺活量（FVC）。COPD定义为FEV/FVC < 0.7；使用HIV医学结果调查（MOS-HIV）和圣乔治呼吸问卷（SGRQ）评估健康相关生活质量。采用线性和逻辑回归模型评估与COPD、健康相关生活质量及队列其他特征的关联。
结果
共纳入95名参与者。队列的中位年龄为39岁（四分位间距（IQR），29 - 45岁），55名（58%）为HIV阳性。COPD患病率为23%（22/95）。SGRQ中位得分为正常水平，为7.8（IQR，3.1 - 14.8）。在0至100分的量表上（100分代表极佳的身心健康），心理健康和身体健康总结中位得分分别显著受损，为58.6（IQR，52.
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