Department of Health Sciences, University of York, York, England.
Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England.
Chest. 2024 Jan;165(1):22-47. doi: 10.1016/j.chest.2023.08.021. Epub 2023 Aug 29.
Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically.
Is tobacco use associated with risk of poor treatment outcomes among people with TB?
The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively.
Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it.
Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes.
PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
吸烟与结核病治疗结局不佳之间存在关联，这一点已有充分的文献记载。然而，对于结核病复发或再发以及治疗期间的死亡率等重要结局，以及与无烟烟草（ST）的关联，目前尚无系统的证据总结。
吸烟与结核病患者治疗结局不佳之间是否存在关联？
于 2021 年 11 月 22 日在 MEDLINE、Embase 和 Cumulative Index of Nursing and Allied Health Literature 数据库中进行了检索。纳入报告吸烟与至少一种结核病治疗结局之间关联的流行病学研究。独立进行双次筛选、提取和质量评估。对于两个主要的综述结局（结核病复发或再发和治疗期间的死亡率）进行了随机效应荟萃分析，并使用亚组探索了异质性。其他结局则进行了叙述性综合。
我们的检索共确定了 1249 条记录，其中 28 条被纳入荟萃分析。基于 15 项研究，发现与从不吸烟相比，曾经吸烟（风险比[RR]，1.78；95%CI，1.31-2.43；I²=85%）、当前吸烟（RR，1.95；95%CI，1.59-2.40；I²=72%）和曾经吸烟（RR，1.84；95%CI，1.21-2.80；I²=4%）的结核病复发或再发风险更高。异质性源于研究质量、设计和参与者特征的差异。确定了 38 项关于死亡率的研究，其中 13 项报告了治疗期间的死亡率。与从不吸烟相比，曾经吸烟（RR，1.55；95%CI，1.32-1.81；I²=0%）和当前吸烟（RR，1.51；95%CI，1.09-2.10；I²=87%）显著增加了结核病患者治疗期间死亡的可能性；异质性主要通过研究设计的差异来解释。荟萃分析中的几乎所有研究在质量评估中均获得高分或中等分数。叙述性综合表明，吸烟是结核病治疗结局不良的危险因素，这与之前的文献记载一致。关于无烟烟草的证据有限，但已确定的研究表明，与不使用无烟烟草相比，使用无烟烟草会增加不良结局的风险。
吸烟显著增加了结核病患者结核病复发或再发以及治疗期间的死亡率风险，这突出表明需要解决吸烟问题以改善结核病结局。
PROSPERO；编号：CRD42017060821；网址：https://www.crd.york.ac.uk/prospero/。
