Louw Elizabeth, Baines Nicola, Maarman Gerald, Osman Muhammad, Sigwadhi Lovemore, Irusen Elvis, Koegelenberg Coenraad, Doubell Anton, Nathan Steven, Channick Richard, Allwood Brian
Division of Pulmonology, Department of Medicine Stellenbosch University & Tygerberg Hospital Cape Town South Africa.
Division of Medical Physiology, Department of Biomedical Sciences, CARMA: Centre for Cardio-Metabolic Research in Africa, Faculty of Medicine & Health Sciences Stellenbosch University Stellenbosch South Africa.
Pulm Circ. 2023 Jan 1;13(1):e12184. doi: 10.1002/pul2.12184. eCollection 2023 Jan.
There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross-sectional, community-based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6-min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years ( 13.8 years) and a median of one TB episode (interquartile range: 1-2). Co-morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35-40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH-postTB 2.13-fold (confidence interval [CI]: 1.17-3.88; = 0.013). All of those found to have PH were smokers or ex-smokers yielding an unadjusted odds ratio for PH-postTB of 3.67 (95% CI: 0.77-17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co-morbidities demonstrated significant association with PH. PH after TB was a common finding in this community-based population. Further research is needed to confirm and determine the significance of these findings.
据估计，有1.55亿结核病幸存者。临床经验表明，肺结核后肺部疾病（PTLD）是3型肺动脉高压（PH）的一个重要病因。然而，在大多数指南中，结核病并未被列为PH的病因。在已成功完成结核病治疗、未寻求医疗保健的成年人中开展了一项基于社区的横断面研究。研究对象接受问卷调查、肺活量测定、6分钟步行距离测试（6MWD）和经胸超声心动图（TTE）检查。TTE检查时，将估计肺动脉收缩压峰值（PASP）≥40 mmHg定义为疑似PH。共纳入100名成年人（71名男性），平均年龄42岁（标准差13.8岁），结核病发作次数中位数为1次（四分位间距：1 - 2次）。合并症包括高血压（21%）、糖尿病（16%）、人类免疫缺陷病毒（10%）和哮喘/慢性阻塞性肺疾病（5%）。结核病后仅25%的人没有残留症状。9%的人被发现疑似患有PH，7%的人PASP值处于临界升高范围（PASP 35 - 40 mmHg）。发现PH与既往结核病发作次数之间存在关联，每增加一次结核病发作，结核病后发生PH的几率增加2.13倍（置信区间[CI]：1.17 - 3.88；P = 0.013）。所有被发现患有PH的人都是吸烟者或既往吸烟者，结核病后发生PH的未调整比值比为3.67（95% CI：0.77 - 17.46）。有PH和无PH者在肺活量测定或6MWD方面无统计学差异。症状和合并症与PH均无显著关联。结核病后PH在这个基于社区的人群中是一个常见发现。需要进一步研究来证实并确定这些发现的意义。
