既往肺结核与 COPD 发病的相关性：一项前瞻性队列研究。
Associations of prior pulmonary tuberculosis with the incident COPD: a prospective cohort study.
机构信息
Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Huazhong University of Science and Technology, Wuhan, China.
Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
出版信息
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241239455. doi: 10.1177/17534666241239455.
BACKGROUND
Prior pulmonary tuberculosis (PTB) might be associated with the development of chronic obstructive pulmonary disease (COPD). However, the impact of prior PTB on the risk of incident COPD has not been studied in a large prospective cohort study of the European population.
OBJECTIVES
This study aimed to investigate the association of prior PTB with the risk of COPD.
DESIGN
Prospective cohort study.
METHODS
A multivariable Cox proportional model was used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) for the association of prior PTB with COPD. Subgroup analyses were further conducted among individuals stratified by age, sex, body mass index, smoking status, drinking status, physical activity, and polygenic risk score (PRS).
RESULTS
The study involved a total of 216,130 participants, with a median follow-up period of 12.6 years and 2788 incident cases of COPD. Individuals with a prior history of PTB at baseline had an 87% higher risk of developing incident COPD compared to those without such history [adjusted hazard ratio (aHR) = 1.87; 95% confidence interval (CI): 1.26-2.77; = 0.002]. Subgroup analysis revealed that individuals having prior PTB history presented a higher risk of incident COPD among individuals who were aged from 50 to 59 years with aHR of 2.47 (1.02-5.95, = 0.044), older than 59 years with aHR of 1.81 (1.16-2.81, = 0.008), male with aHR of 2.37 (1.47-3.83, < 0.001), obesity with aHR of 3.35 (2.16-5.82, < 0.001), previous smoking with aHR of 2.27 (1.39-3.72, < 0.001), current drinking with aHR of 1.98 (1.47-3.83, < 0.001), low physical activity with aHR of 2.62 (1.30-5.26, = 0.007), and low PRS with aHR of 3.24 (1.61-6.53, < 0.001), as well as high PRS with aHR of 2.43 (1.15-5.14, = 0.019).
CONCLUSION
A history of PTB is an important independent risk factor for COPD. Clinical staff should be aware of this risk factor in patients with prior PTB, particularly in countries or regions with high burdens of PTB.
背景
既往肺结核（PTB）可能与慢性阻塞性肺疾病（COPD）的发生有关。然而，既往 PTB 对欧洲人群大型前瞻性队列研究中 COPD 发病风险的影响尚未研究。
目的
本研究旨在探讨既往 PTB 与 COPD 发病风险的关系。
设计
前瞻性队列研究。
方法
采用多变量 Cox 比例模型估计既往 PTB 与 COPD 发病风险的风险比（HR）和 95%置信区间（95%CI）。进一步对按年龄、性别、体重指数、吸烟状态、饮酒状态、体力活动和多基因风险评分（PRS）分层的个体进行亚组分析。
结果
该研究共纳入 216130 名参与者，中位随访时间为 12.6 年，有 2788 例 COPD 发病。与无既往 PTB 史的参与者相比，基线时存在既往 PTB 史的参与者发生 COPD 的风险增加了 87%[校正 HR（aHR）=1.87；95%CI：1.26-2.77；=0.002]。亚组分析显示，在年龄在 50-59 岁的个体中，有既往 PTB 史的个体发生 COPD 的风险更高，aHR 为 2.47（1.02-5.95，=0.044），年龄大于 59 岁的个体 aHR 为 1.81（1.16-2.81，=0.008），男性 aHR 为 2.37（1.47-3.83，<0.001），肥胖者 aHR 为 3.35（2.16-5.82，<0.001），既往吸烟者 aHR 为 2.27（1.39-3.72，<0.001），目前饮酒者 aHR 为 1.98（1.47-3.83，<0.001），体力活动较少者 aHR 为 2.62（1.30-5.26，=0.007），PRS 较低者 aHR 为 3.24（1.61-6.53，<0.001），PRS 较高者 aHR 为 2.43（1.15-5.14，=0.019）。
结论
PTB 史是 COPD 的一个重要独立危险因素。临床医生应在有既往 PTB 的患者中注意到这一风险因素，特别是在 PTB 负担较高的国家或地区。
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