PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam.
BMJ Open. 2023 Aug 23;13(8):e073266. doi: 10.1136/bmjopen-2023-073266.
We reported the incidence and associated factors of extrapulmonary tuberculosis (EPTB).
A retrospective cohort study.
Brunei Darussalam, an intermediate tuberculosis (TB)-burden country with stagnating annual TB rates.
All active TB cases identified in the country between January 2001 and December 2018 (18 years).
Annual proportions of EPTB (overall and specific) were calculated. Multiple logistic regression was done to investigate factors associated with developing EPTB, when compared with pulmonary TB (PTB). Χ trend test was used to determine any trends during the 18-year study period.
We identified 3916 TB cases, among which 743 (19.0%) were EPTB cases. Lymphatic (44.8%) and pleural (19.4%) EPTB were most common. The main modes of diagnosis were tissue biopsy (73.6%) and radiological assessment (18.3%). Treatment success and mortality rate were 79.7% and 7.0%, respectively. Associations with specific EPTB types varies with age-group and gender. Younger age-group (adjusted OR (aOR)≥1.94) and women (aOR: 2.45 (95% CI: 1.94 to 3.11)) had higher adjusted odds of developing lymphatic EPTB, but had lower adjusted odds of developing pleural EPTB (younger age-group (aOR≤0.54) and women (aOR: 0.41 (95% CI: 0.17 to 0.90)). When compared to foreign residents, locals had higher adjusted odds of skeletal (aOR: 4.44 (95% CI: 2.04 to 11.69)), gastrointestinal (aOR: 3.91 (95% CI: 1.84 to 9.66)) and other types of EPTB (aOR: 3.42 (95% CI: 1.53 to 9.14)). No significant trend differences were observed for overall and specific EPTB types.
Despite being generally non-infectious and less recognised than PTB, understanding EPTB epidemiology is important as it also contributes to the overall TB burden in a country. Examining EPTB cases by their specific anatomical site would provide more information on risk factors. Raising public awareness on the EPTB symptoms and that TB affects lungs and other parts of the body could promote early health seeking behaviour and early EPTB diagnosis.
报告肺外结核（EPTB）的发病率及相关因素。
回顾性队列研究。
文莱达鲁萨兰国，一个结核病负担中等、年结核病发病率停滞不前的国家。
2001 年 1 月至 2018 年 12 月期间在该国确诊的所有活动性结核病病例（18 岁）。
计算了 EPTB（总体和特定）的年比例。与肺结核（PTB）相比，采用多因素逻辑回归分析了与发生 EPTB 相关的因素。Χ趋势检验用于确定 18 年研究期间的任何趋势。
我们共发现 3916 例结核病病例，其中 743 例（19.0%）为 EPTB 病例。淋巴（44.8%）和胸膜（19.4%）EPTB 最为常见。主要诊断方式为组织活检（73.6%）和影像学评估（18.3%）。治疗成功率和死亡率分别为 79.7%和 7.0%。特定 EPTB 类型的相关性因年龄组和性别而异。年轻年龄组（调整比值比（aOR）≥1.94）和女性（aOR：2.45（95%CI：1.94 至 3.11））发生淋巴 EPTB 的调整后优势比更高，但发生胸膜 EPTB 的调整后优势比更低（年轻年龄组（aOR≤0.54）和女性（aOR：0.41（95%CI：0.17 至 0.90））。与外国居民相比，当地人发生骨骼（aOR：4.44（95%CI：2.04 至 11.69））、胃肠道（aOR：3.91（95%CI：1.84 至 9.66））和其他类型 EPTB（aOR：3.42（95%CI：1.53 至 9.14））的调整后优势比更高。总体和特定类型的 EPTB 未观察到显著的趋势差异。
尽管 EPTB 通常是非传染性的，且不如 PTB 那么受重视，但了解 EPTB 的流行病学情况很重要，因为它也会影响一个国家的整体结核病负担。按特定解剖部位检查 EPTB 病例可提供更多有关危险因素的信息。提高公众对 EPTB 症状的认识，即结核病会影响肺部和身体的其他部位，可以促进早期寻求健康的行为和早期 EPTB 诊断。
