Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China.
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
BMJ Open. 2022 Jul 28;12(7):e059149. doi: 10.1136/bmjopen-2021-059149.
To investigate the independent and collective impact of alcohol drinking and tobacco smoking on the drug-resistance of newly diagnosed tuberculosis (TB).
This was a retrospective cohort study.
Shandong, China.
Patients with newly diagnosed TB from 1 January 2004 to 31 December 2020 were collected. Exclusive criteria: retreated cases; extrapulmonary tuberculosis; without information on drug susceptibility testing results, smoking or drinking habits; bacteriological identification as .
Patients were classified into four groups including smokers only (G), drinker only (G), smoker +drinker (G), non-smoker +non-drinker group (G). We described the drug-resistant profiles, clinical factors and calculated the ORs of different drug-resistance among G, G, G, compared with G through univariate and multivariate logistics regression models.
Of the 7996 TB cases enrolled, the proportions of G, G, G and G were 8.25%, 3.89%, 16.46% and 71.40%, respectively. The rates of drug-resistant (DR)-TB, mono-resistant TB, multidrug resistant (MDR)-TB, polydrug resistant TB in G G, G and G were 19.24%/16.4%/17.33%/19.08%, 11.52%/8.68%/10.94%/11.63%, 3.03%/2.57%/2.96%/3.66% and 4.70%/4.82%/3.34%/ 4.08%, respectively. G had a higher risk of MDR1: isoniazid +rifampin (adjusted OR (aOR)=1.91, 95% CI: 1.036 to 3.532), but had a lower risk of DR-TB (aOR=0.84, 95% CI: 0.71 to 0.99), rifampin-related resistance (aOR=0.68, 95% CI: 0.49 to 0.93), streptomycin-related resistance (aOR=0.82, 95% CI: 0.68 to 0.99), ethambutol-related resistance (aOR=0.57, 95% CI: 0.34 to 0.95), MDR3: isoniazid +rifampin+streptomycin (aOR=0.41, 95% CI: 0.19 to 0.85), any isoniazid +streptomycin resistance (aOR=0.85, 95% CI: 0.71 to 1.00). However, there were no significant differences between G and G, G and G in all drug-resistant subtypes. Those patients with cavity had a higher risk of DR-TB among G (OR=1.35, 95% CI: 1.01 to 1.81).
Although we did not found an independent impact of alcohol drinking or tobacco smoking on TB drug-resistance, respectively, these two habits had a combined effect on TB drug-resistance.
探讨新诊断结核病（TB）患者中饮酒和吸烟对耐药性的独立和联合影响。
这是一项回顾性队列研究。
中国山东。
收集了 2004 年 1 月 1 日至 2020 年 12 月 31 日新诊断的 TB 患者。排除标准：复治病例；肺外结核；无药敏试验结果、吸烟或饮酒习惯信息；细菌学鉴定为非结核分枝杆菌。
患者分为 4 组：仅吸烟者（G）、仅饮酒者（G）、吸烟者+饮酒者（G）、非吸烟者+非饮酒者组（G）。我们描述了不同组的耐药谱、临床因素，并通过单因素和多因素逻辑回归模型比较了 G、G、G 和 G 之间不同耐药性的 OR。
在纳入的 7996 例 TB 病例中，G、G、G 和 G 的比例分别为 8.25%、3.89%、16.46%和 71.40%。G、G、G 和 G 的耐多药结核病（DR-TB）、单耐药结核病、耐多药结核病（MDR-TB）、多药耐药结核病的发生率分别为 19.24%/16.4%/17.33%/19.08%、11.52%/8.68%/10.94%/11.63%、3.03%/2.57%/2.96%/3.66%和 4.70%/4.82%/3.34%/4.08%。G 发生 MDR1：异烟肼+利福平（调整后的 OR（aOR）=1.91，95%CI：1.036 至 3.532）的风险更高，但发生 DR-TB（aOR=0.84，95%CI：0.71 至 0.99）、利福平相关耐药（aOR=0.68，95%CI：0.49 至 0.93）、链霉素相关耐药（aOR=0.82，95%CI：0.68 至 0.99）、乙胺丁醇相关耐药（aOR=0.57，95%CI：0.34 至 0.95）、MDR3：异烟肼+利福平+链霉素（aOR=0.41，95%CI：0.19 至 0.85）、任何异烟肼+链霉素耐药（aOR=0.85，95%CI：0.71 至 1.00）的风险较低。然而，G 和 G、G 和 G 之间在所有耐药亚群中均无显著差异。G 中存在空洞的患者发生 DR-TB 的风险更高（OR=1.35，95%CI：1.01 至 1.81）。
虽然我们没有发现饮酒或吸烟对结核病耐药性的独立影响，但这两种习惯对结核病耐药性有联合作用。
