马来西亚结核病患治疗成果受吸烟影响之多中心研究。
Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study.
机构信息
Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
出版信息
BMC Public Health. 2020 Jun 4;20(1):854. doi: 10.1186/s12889-020-08856-6.
BACKGROUND
Smoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes. The current study was conducted to determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients.
METHODS
A multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form.
RESULTS
Of all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smokers, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with extrapulmonary TB. Male gender (OR = 1.43, 95% CI 1.30-1.58), Chinese ethnicity (OR = 1.23, 95% CI 1.02-1.49), Sarawak indigenous ethnicity (OR = 0.74, 95% CI 0.58-0.95), urban residents (OR = 1.46, 95% CI 1.33-1.61), employed individuals (OR = 1.21, 95% CI 1.09-1.34), alcoholics (OR = 4.91, 95% CI 4.04-5.96), drug abusers (OR = 7.43, 95% CI 5.70-9.60) and presence of co-morbid condition (OR = 1.27, 95% CI 1.16-1.40) all showed significant association with smoking habits. This study found that 3236 (75.0%) patients were successfully treated in the smokers' group, while 4004 (79.7%) patients were non-smokers. The proportion of deaths (6.6%, n = 283), defaulters (6.6%, n = 284) and treatment interruptions (4.7%, n = 204) was higher in the smokers' group.
CONCLUSIONS
Smoking has a strong influence on TB and is a major barrier towards treatment success (OR = 0.76, 95% CI 0.69-0.84, p < 0.001). Therefore, the findings indicate that smoking cessations are an effective way to decrease treatment failure and drug resistance.
背景
吸烟在结核病（TB）感染的发展中起着关键作用，也是结核病治疗预后和结局不良的预测因素。本研究旨在确定吸烟的流行率，并评估吸烟对结核病患者治疗结果的影响。
方法
采用多中心回顾性研究设计，从马来西亚四个不同州（槟城、沙巴、砂拉越和雪兰莪）的结核病患者中收集数据。该研究纳入了 2006 年 1 月至 2009 年 3 月期间在选定医院住院的结核病患者的病历。不包括数据不完整的病历。使用经过验证的数据收集表收集患者的人口统计学和临床数据。
结果
在所有结核病患者（9337 人）中，吸烟者的比例为 4313 人（46.2%）。在吸烟者中，3584 人（83.1%）患有肺结核，729 人（16.9%）患有肺外结核病。男性（OR=1.43，95%CI 1.30-1.58）、华族（OR=1.23，95%CI 1.02-1.49）、砂拉越原住民（OR=0.74，95%CI 0.58-0.95）、城市居民（OR=1.46，95%CI 1.33-1.61）、就业人员（OR=1.21，95%CI 1.09-1.34）、酗酒者（OR=4.91，95%CI 4.04-5.96）、吸毒者（OR=7.43，95%CI 5.70-9.60）和合并症（OR=1.27，95%CI 1.16-1.40）均与吸烟习惯显著相关。本研究发现，吸烟者组中 3236 名（75.0%）患者成功治疗，而非吸烟者组中 4004 名（79.7%）患者成功治疗。吸烟者组中死亡（6.6%，n=283）、失访（6.6%，n=284）和治疗中断（4.7%，n=204）的比例较高。
结论
吸烟对结核病有很强的影响，是治疗成功的主要障碍（OR=0.76，95%CI 0.69-0.84，p<0.001）。因此，研究结果表明，戒烟是减少治疗失败和耐药性的有效方法。
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