Cioboata Ramona, Vlasceanu Silviu Gabriel, Mitroi Denisa Maria, Zlatian Ovidiu Mircea, Balteanu Mara Amalia, Andrei Gabriela Marina, Biciusca Viorel, Olteanu Mihai
Department of Pneumology, University of Medicine and Pharmacy, 200349 Craiova, Romania.
Department of Pneumology, Victor Babes University Hospital, 200515 Craiova, Romania.
J Clin Med. 2025 Aug 24;14(17):5980. doi: 10.3390/jcm14175980.
Pulmonary tuberculosis (TB) is increasingly recognized as a risk factor for chronic obstructive pulmonary disease (COPD), but its impact on COPD onset and severity remains poorly characterized, particularly in low- and middle-income countries. This multicenter study aimed to assess the impact of prior pulmonary TB on COPD onset, severity, the timing of the first severe exacerbation, and progression among Romanian patients with and without a history of pulmonary TB. : This retrospective multicenter study included adults hospitalized for their first severe COPD exacerbation at two tertiary care centers in Romania between April 2020 and April 2025. Patients were grouped based on smoking status and prior TB history. Propensity score matching was used to control for confounding factors. Clinical characteristics, spirometry, and radiological TB patterns were analyzed comparatively between patients with prior TB and TB-naïve patients. : Among 403 COPD patients, those with prior TB had significantly earlier COPD onset (mean age 48.67 ± 6.42 vs. 65.61 ± 5.14 years in smokers, < 0.001) and shorter intervals to their first severe COPD exacerbation compared to patients without prior TB (6.35 ± 4.71 vs. 15.14 ± 6.93 years in smokers, < 0.001). COPD prevalence was higher among TB survivors compared to those without TB history, especially in smokers (OR = 5.73; 95% CI, 3.30-9.94, < 0.001), versus non-smokers (OR =2.23; 95% CI, 1.37-3.64, = 0.001). Radiological severity of TB lesions significantly influenced COPD prevalence among smokers (OR = 10.79, < 0.001). Prior pulmonary TB substantially accelerates COPD onset, exacerbation timing, and disease severity, particularly in smokers. This multicenter comparative study demonstrates that prior pulmonary TB significantly accelerates COPD onset, exacerbation timing, and disease severity, especially among smokers. Recognizing TB history as a significant COPD risk factor underscores the importance of targeted COPD screening and tailored management in populations with high TB prevalence.
肺结核（TB）日益被视为慢性阻塞性肺疾病（COPD）的一个风险因素，但其对COPD发病和严重程度的影响仍未得到充分描述，尤其是在低收入和中等收入国家。这项多中心研究旨在评估既往肺结核对罗马尼亚有和没有肺结核病史的患者中COPD发病、严重程度、首次严重加重的时间以及疾病进展的影响。：这项回顾性多中心研究纳入了2020年4月至2025年4月期间在罗马尼亚两个三级医疗中心因首次严重COPD加重而住院的成年人。患者根据吸烟状况和既往结核病史进行分组。倾向得分匹配用于控制混杂因素。对有既往结核病史的患者和未感染结核的患者的临床特征、肺功能检查和放射学结核模式进行了比较分析。：在403例COPD患者中，有既往结核病史的患者COPD发病明显更早（吸烟者中平均年龄为48.67±6.42岁，而无既往结核病史的患者为65.61±5.14岁，<0.001），与无既往结核病史的患者相比，首次严重COPD加重的间隔时间更短（吸烟者中为6.35±4.71年，而无既往结核病史的患者为15.14±6.93年，<0.001）。与无结核病史的患者相比，结核幸存者中COPD患病率更高，尤其是在吸烟者中（OR = 5.73；95%CI，3.30 - 9.94，<0.001），非吸烟者中（OR = 2.23；95%CI，1.37 - 3.64，= 0.001）。结核病变的放射学严重程度显著影响吸烟者中的COPD患病率（OR = 10.79，<0.001）。既往肺结核显著加速COPD发病、加重时间和疾病严重程度，尤其是在吸烟者中。这项多中心比较研究表明，既往肺结核显著加速COPD发病、加重时间和疾病严重程度，尤其是在吸烟者中。将结核病史视为COPD的一个重要风险因素凸显了在结核高流行人群中进行有针对性的COPD筛查和个性化管理的重要性。
