Xin Henan, Du Jiang, Cao Xuefang, Duan Weitao, He Aiwei, Liang Jun, Zhu Limei, Feng Boxuan, He Yijun, Shen Lingyu, Huang Juanjuan, Liu Zisen, Liu Fang, Yang Shumin, Xu Zuhui, Chen Cheng, Zhang Bin, Yan Jiaoxia, Liang Yanchun, Liu Rong, Zhu Tao, Li Hongzhi, Shen Fei, Guo Tonglei, Di Yuanzhi, Li Zihan, Liang Jianguo, Zhao Yaqi, Bai Liqiong, Lu Wei, Jin Qi, 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 & Peking Union Medical College, Beijing, PR China.
Lancet Reg Health West Pac. 2025 Aug 12;61:101659. doi: 10.1016/j.lanwpc.2025.101659. eCollection 2025 Aug.
In China, there is limited research on the role of recent and long-term infection of in relation to the incidence of pulmonary tuberculosis (PTB), as well as the impact of tuberculosis infection (TBI) on other diseases. A population-based, multicenter prospective study (LATENTTB-NSTM) was implemented since 2013 to assess the prevalence of TBI and to track the development of active disease in rural China. This cohort study provides an opportunity to address these gaps in knowledge.
In October 2023, all 21,832 participants from rural China who initially participated in the baseline survey of the LATENTTB-NSTM study were invited to take part in the 10-year follow-up survey. The data on the incident PTB and other health concerns including type 2 diabetes mellitus (T2DM), cancers, cardiovascular and cerebrovascular diseases were acquired from medical record or self-reported. The proportion of baseline TBI and newly acquired infection to the incident PTB and the association of baseline TBI status with the incidence of other diseases were analyzed.
Overall, 21,211 study participants with a sum of 170,152 person-years were included in final analysis. During the 10-year period, a total of 181 incident PTB patients were identified, including 134 patients developed from TBI defined at baseline and 47 patients developed from newly acquired infection during follow-up. The proportion of newly acquired infection during follow-up was statistically pronounced in incident PTB cases diagnosed in the latter 5 years as compared to in the first 5 years of the follow-up period (38·30% (18/47) vs. 21·64% (29/134), p = 0·031). The proportion of baseline TBI was statistically higher in incident PTB cases aged ≥60 years than in those aged <60 years (85·19% (69/81) vs. 65·00% (65/100), p = 0·002). In addition, baseline TBI status was found to be significantly associated with increased risk of incident T2DM, cancers and chronic bronchitis with adjusted hazard ratio of 1·22 (95% confidence interval (CI): 1·04-1·42), 1·81 (95% CI: 1·20-2·72), and 2·94 (95% CI: 1·06-8·15), respectively. The risk of incident T2DM slightly increased along with the increasing intensity of the immune response in TBI testing at baseline.
As compared to recent infection, TBI remains the dominating contributor of incident PTB in rural China. Alongside efforts to systematically manage infectious cases and close contacts, preventive treatment targeting individuals under high risk of developing active diseases from TBI is crucial for achieving rapid declining of PTB incidence. Moreover, the possible influence of TBI on the other health conditions further underscores the importance of TBI management from a new perspective.
The CAMS Innovation Fund for Medical Sciences and the National Natural Science Foundation of China.
在中国，关于近期和长期感染与肺结核（PTB）发病率的关系，以及结核感染（TBI）对其他疾病的影响的研究有限。自2013年起开展了一项基于人群的多中心前瞻性研究（LATENTTB-NSTM），以评估中国农村地区TBI的患病率，并追踪活动性疾病的发展情况。这项队列研究为填补这些知识空白提供了契机。
2023年10月，邀请了最初参加LATENTTB-NSTM研究基线调查的来自中国农村的所有21832名参与者参加10年随访调查。从病历或自我报告中获取新发PTB及其他健康问题的数据，包括2型糖尿病（T2DM）、癌症、心脑血管疾病。分析基线TBI和新获得感染在新发PTB中的比例，以及基线TBI状态与其他疾病发病率的关联。
总体而言，最终分析纳入了21211名研究参与者，总计170152人年。在10年期间，共确定了181例新发PTB患者，其中134例由基线时定义的TBI发展而来，47例由随访期间新获得的感染发展而来。与随访期的前5年相比，随访期后5年诊断的新发PTB病例中，随访期间新获得感染的比例在统计学上更为显著（38.30%（18/47）对21.64%（共29/134），p = 0.031）。≥60岁的新发PTB病例中基线TBI的比例在统计学上高于<60岁的病例（85.19%（69/81）对65.00%（65/共100），p = 0.002）。此外，发现基线TBI状态与新发T2DM、癌症和慢性支气管炎风险增加显著相关，调整后的风险比分别为1.22（95%置信区间（CI）：1.04 - 1.42）、1.81（95% CI：1.20 - 2.72）和2.94（95% CI：1.从新的角度进一步强调了TBI管理的重要性。
中国医学科学院医学创新基金和国家自然科学基金。 06 - 8.15）。基线时TBI检测中免疫反应强度增加，新发T2DM的风险略有增加。
与近期感染相比，TBI仍是中国农村地区新发PTB的主要促成因素。除了系统管理感染病例和密切接触者的努力外，针对有从TBI发展为活动性疾病高风险个体的预防性治疗对于实现PTB发病率的快速下降至关重要。此外，TBI对其他健康状况的可能影响从新的角度进一步强调了TBI管理的重要性。
中国医学科学院医学创新基金和国家自然科学基金。
