Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich.
Int J Tuberc Lung Dis. 2023 Aug 1;27(11):850-857. doi: 10.5588/ijtld.23.0040.
Spirometry is considered relevant for the diagnosis and monitoring of post-TB lung disease. However, spirometry is rarely done in newly diagnosed TB patients. Newly diagnosed, microbiologically confirmed TB patients were recruited for the study. Spirometry was performed within 21 days of TB treatment initiation according to American Thoracic Society/European Respiratory Society guidelines. Spirometry analysis was done using Global Lung Initiative equations for standardisation. Of 1,430 eligible study participants, 24.7% (353/1,430) had no spirometry performed mainly due to contraindications and 23.0% (329/1,430) had invalid results; 52.3% (748/1,430) of participants had a valid result, 82.8% (619/748) of whom had abnormal spirometry. Of participants with abnormal spirometry, 70% (436/619) had low forced vital capacity (FVC), 6.1% (38/619) had a low ratio of forced expiratory volume in 1 sec (FEV) to FVC, and 19.1% (118/619) had low FVC, as well as low FEV/FVC ratio. Among those with abnormal spirometry, 26.3% (163/619) had severe lung impairment. In this population, a high proportion of not performed and invalid spirometry assessments was observed; this was addressed by removing tachycardia as a (relative) contraindication from the study guidance and retraining. The high proportion of patients with severe pulmonary impairment at the time of TB diagnosis suggests a huge morbidity burden and calls for further longitudinal studies on the relevance of spirometry in predicting chronic lung impairment after TB.
肺量测定术被认为与肺结核后肺部疾病的诊断和监测有关。然而，在新诊断的肺结核患者中很少进行肺量测定术。本研究招募了新诊断且经微生物学证实的肺结核患者。根据美国胸科学会/欧洲呼吸学会指南，在开始抗结核治疗后 21 天内进行肺量测定术。使用全球肺倡议方程对肺量测定分析进行标准化。在 1430 名符合条件的研究参与者中，24.7%（353/1430）未进行肺量测定，主要是由于禁忌症，23.0%（329/1430）的结果无效；52.3%（748/1430）的参与者有有效结果，其中 82.8%（619/748）的肺量测定异常。在肺量测定异常的参与者中，70%（436/619）的人肺活量低，6.1%（38/619）的人 1 秒用力呼气量与肺活量的比值低，19.1%（118/619）的人肺活量低，以及 1 秒用力呼气量与肺活量的比值低。在肺量测定异常的患者中，26.3%（163/619）的人有严重的肺损伤。在该人群中，未进行和无效的肺量测定评估比例很高；通过从研究指南中删除心动过速作为（相对）禁忌症并进行再培训，解决了这个问题。在肺结核诊断时，大量患者存在严重的肺部损伤，这表明发病率负担巨大，需要进一步进行关于肺量测定术在预测肺结核后慢性肺部损伤相关性的纵向研究。
