Shen Lingyu, Zhang Yu, Xin Henan, Cao Xuefang, Du Jiang, Di Yuanzhi, Huang Juanjuan, He Yijun, Feng Boxuan, Li Zihan, Liang Jianguo, Wang Wei, Peng Ying, Hao Xiaogang, Fang Chunfu, Xu Bingjun, Wang Xiaomeng, Chen Bin, Wang Zhen, Wang Fei, Zhu Ping, Gao Lei
NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
ERJ Open Res. 2025 Jul 21;11(4). doi: 10.1183/23120541.01231-2024. eCollection 2025 Jul.
Individuals with inactive pulmonary tuberculosis (PTB) lesions were found to be high-risk populations for active PTB development. This retrospective study evaluated the association between different types of inactive PTB lesions and the development of active PTB aiming to provide epidemiological evidence for developing precise intervention strategies.
Based on a population-based PTB active-case-finding project conducted on the elderly, 154 028 subjects who had participated in the 2020 baseline survey were included in the current analysis.
During the 2-year follow-up, 462 cases developed microbiologically confirmed active PTB with an overall incidence rate of 0.19 per 100 person-years. Among the study population, 15 037 (9.76%) showed chest radiography (CXR) abnormalities suggestive of inactive PTB, which was found to be independently associated with an increased risk of active PTB with an adjusted hazard ratio (aHR) of 6.00 (95% confidence interval (CI) 4.85-7.43) compared with normal CXR. Such a relationship was consistently observed for inactive lesions, including fibrosis, calcification, pleural thickening and nodule lesions with aHRs ranging from 2.94 to 6.55. Inactive PTB lesions alone or a history of anti-tuberculosis (TB) treatment alone were independently associated with the risk of active PTB with aHRs of 6.96 (95% CI 5.59-8.67) and 7.67 (95% CI 4.26-13.78), respectively. A combined effect between inactive PTB lesions and with history of anti-TB treatment was found with an aHR of 10.50 (95% CI 5.93-18.52).
Overall, individuals with inactive PTB lesions, regardless of lesion type and history of anti-TB treatment, are at increased risk of developing active PTB and deserve interventions for TB control.
发现患有非活动性肺结核（PTB）病灶的个体是活动性PTB发病的高危人群。本回顾性研究评估了不同类型的非活动性PTB病灶与活动性PTB发病之间的关联，旨在为制定精准干预策略提供流行病学证据。
基于一项针对老年人开展的基于人群的PTB主动病例发现项目，本分析纳入了154028名参与2020年基线调查的受试者。
在2年随访期间，462例发生了微生物学确诊的活动性PTB，总发病率为每100人年0.19例。在研究人群中，15037例（9.76%）胸部X线摄影（CXR）显示有提示非活动性PTB的异常，与正常CXR相比，发现其与活动性PTB风险增加独立相关，调整后风险比（aHR）为6.00（95%置信区间（CI）4.85-7.43）。对于包括纤维化、钙化、胸膜增厚和结节性病变在内的非活动性病灶，均一致观察到这种关系，aHR范围为2.94至6.55。单独的非活动性PTB病灶或单独的抗结核（TB）治疗史均与活动性PTB风险独立相关，aHR分别为6.96（95%CI 5.59-8.67）和7.67（95%CI 4.26-13.78）。发现非活动性PTB病灶与抗结核治疗史之间存在联合效应，aHR为10.50（95%CI 5.93-18.52）。
总体而言，患有非活动性PTB病灶的个体，无论病灶类型和抗结核治疗史如何，发生活动性PTB的风险均增加，值得进行结核病控制干预。
