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成年患者社区样本中成功治疗结核病后肺动脉高压的患病率。

The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients.

作者信息

Louw Elizabeth, Baines Nicola, Maarman Gerald, Osman Muhammad, Sigwadhi Lovemore, Irusen Elvis, Koegelenberg Coenraad, Doubell Anton, Nathan Steven, Channick Richard, Allwood Brian

机构信息

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.

出版信息

Pulm Circ. 2023 Jan 1;13(1):e12184. doi: 10.1002/pul2.12184. eCollection 2023 Jan.

Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3a3e/9852678/c8045b3aa3ea/PUL2-13-e12184-g001.jpg

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