Department of Integrated Pulmonology, The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, P.R. China.
National Clinical Research Base of Traditional Chinese Medicine in Xinjiang, Urumqi, 830000, P.R. China.
Comb Chem High Throughput Screen. 2023;26(1):93-102. doi: 10.2174/1386207325666220406111435.
Pulmonary tuberculosis (PTB) is a significant risk factor for COPD, and Xinjiang, China, has a high incidence of pulmonary tuberculosis. The effects of tuberculosis history on airflow restriction, clinical symptoms, and acute episodes in COPD patients have not been reported in the local population. Besides, the exact relationship between lung function changes in people with a history of tuberculosis and COPD risk is not clear.
This study is based on the Xinjiang baseline survey data included in the Natural Population Cohort Study in Northwest China from June to December, 2018. Subjects' questionnaires, physical examination, and lung function tests were performed through a face-to-face field survey to analyze the impact of previous pulmonary tuberculosis on local COPD. Furthermore, we clarified the specific relationship between pulmonary function decline and the probability of developing COPD in people with a history of tuberculosis.
A total of 3249 subjects were eventually enrolled in this study, including 87 with a history of tuberculosis and 3162 non-TB. The prevalence of COPD in the prior TB group was significantly higher than that in the control group (p-value = 0.005). First, previous pulmonary tuberculosis is an essential contributor to airflow limitation in the general population and patients with COPD. In all subjects included, pulmonary function, FEV1% predicted (p-value < 0.001), and FEV1/FVC (%) (p-value < 0.001) were significantly lower in the prior TB group than in the control group. Compared to non-TB group, FEV1% prediction (p-value = 0.019) and FEV1/FVC (%) (p-value = 0.016) were found to be significantly reduced, and airflow restriction (p-value = 0.004) was more severe in prior TB group among COPD patients. Second, COPD patients in the prior TB group had more severe clinical symptoms. Compared with no history of tuberculosis, mMRC (p-value = 0.001) and CAT (p-value = 0.002) scores were higher in the group with a history of tuberculosis among COPD patients. Third, compared with the non-TB group, the number of acute exacerbations per year (p-values=0.008), the duration of each acute exacerbation (p-values=0.004), and hospitalization/ patient/year (p-values<0.001) were higher in the group with a history of tuberculosis among COPD patients. Finally, a dose-response relationship between FEV1/FVC (%) and the probability of developing COPD in people with previous pulmonary TB was observed; when FEV1/FVC (%) was < 80.8, the risk of COPD increased by 13.5% per unit decrease in lung function [0.865(0.805, 0.930)].
COPD patients with previous pulmonary tuberculosis have more severe airflow limitations and clinical symptoms and are at higher risk for acute exacerbations. Furthermore, lung function changes in people with a history of tuberculosis were associated with a dose-response relationship with the probability of developing COPD.
肺结核（PTB）是 COPD 的重要危险因素，而中国新疆的肺结核发病率较高。肺结核病史对 COPD 患者气流受限、临床症状和急性发作的影响在当地人群中尚未报道。此外，肺结核病史患者肺功能变化与 COPD 风险之间的确切关系尚不清楚。
本研究基于 2018 年 6 月至 12 月在中国西北地区自然人群队列研究中的新疆基线调查数据。通过面对面的现场调查对受试者进行问卷调查、体格检查和肺功能测试，以分析既往肺结核对当地 COPD 的影响。此外，我们还阐明了肺结核病史患者肺功能下降与发展为 COPD 概率之间的具体关系。
本研究共纳入 3249 名受试者，其中 87 名有肺结核病史，3162 名无结核病史。既往结核组 COPD 的患病率明显高于对照组（p 值=0.005）。首先，既往肺结核是普通人群和 COPD 患者气流受限的重要因素。在所有纳入的受试者中，既往结核组的肺功能、FEV1%预测值（p 值<0.001）和 FEV1/FVC（%）（p 值<0.001）明显低于对照组。与无结核病史组相比，既往结核组 COPD 患者的 FEV1%预测值（p 值=0.019）和 FEV1/FVC（%）（p 值=0.016）明显降低，气流受限（p 值=0.004）更为严重。其次，既往结核组 COPD 患者的临床症状更为严重。与无肺结核病史相比，既往肺结核组 COPD 患者的 mMRC（p 值=0.001）和 CAT（p 值=0.002）评分更高。第三，与无结核病史组相比，既往结核组 COPD 患者的急性加重次数/年（p 值=0.008）、每次急性加重持续时间（p 值=0.004）和住院/患者/年（p 值<0.001）更高。最后，观察到既往肺结核患者 FEV1/FVC（%）与发展为 COPD 的概率之间存在剂量-反应关系；当 FEV1/FVC（%）<80.8 时，肺功能每下降 1 个单位，发展为 COPD 的风险增加 13.5%[0.865（0.805，0.930）]。
患有既往肺结核的 COPD 患者气流受限和临床症状更严重，急性加重的风险更高。此外，肺结核病史患者的肺功能变化与发展为 COPD 的概率之间存在剂量-反应关系。
