气流阻塞和慢性阻塞性肺疾病在肺结核中很常见，即使胸部 X 射线检查没有发现后遗症。

Airflow obstruction and chronic obstructive pulmonary disease are common in pulmonary tuberculosis even without sequelae findings on chest X-ray.

机构信息

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea.

出版信息

Infect Dis (Lond). 2023 Aug;55(8):533-542. doi: 10.1080/23744235.2023.2217904. Epub 2023 May 26.

DOI:10.1080/23744235.2023.2217904

PMID:37243367

Abstract

PURPOSE

Pulmonary tuberculosis (TB) is a well-known risk factor for airflow obstruction and chronic obstructive pulmonary disease (COPD). The prognosis of TB without sequelae on chest X-ray (CXR) remains uncertain.

METHODS

We used the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES) data and 2007-2012 KNHANES-matched Health Insurance Review and Assessment Service cohort data. Airflow obstruction was assessed using a pulmonary function test. COPD was defined using diagnostic codes and the use of COPD medication for 3-year. We classified subjects into three groups based on TB history and sequelae on CXR.

RESULTS

In 4911 subjects, the CXR(-) (no TB sequelae on CXR) post-TB group ( = 134) showed similar characteristics and normal lung function compared to that of the control group ( = 4,405), while the CXR(+) (TB sequelae on CXR) post-TB group ( = 372) showed different characteristics and reduced lung function. The prevalence of airflow obstruction was 9.3%, 13.4%, and 26.6% in control, CXR(-) post-TB, and CXR(+) post-TB groups, respectively. COPD was more common in the post-TB with CXR(+) (6.5%) or without CXR (-) (4.5%) groups, than in the control group (1.8%). Compared to the CXR(-) post-TB group, the control group showed a lower risk for airflow obstruction (OR, 0.774; = .008). The CXR(+) post-TB group showed a higher risk for airflow obstruction (OR, 1.456; = .011). The Control group also showed a lower risk for the development of COPD than the CXR(-) post-TB group (OR, 0.496; = .011).

CONCLUSIONS

We need to educate TB patients that airway obstruction and COPD can easily develop, even if TB sequelae are not observed on CXR.

摘要

目的

肺结核（TB）是气流阻塞和慢性阻塞性肺疾病（COPD）的已知危险因素。胸部 X 线（CXR）无后遗症的肺结核的预后仍不确定。

方法

我们使用了 2008-2009 年韩国国家健康和营养检查调查（KNHANES）数据和 2007-2012 年 KNHANES 匹配的健康保险审查和评估服务队列数据。气流阻塞通过肺功能测试进行评估。COPD 使用诊断代码和 COPD 药物使用 3 年来定义。我们根据 TB 病史和 CXR 后遗症将受试者分为三组。

结果

在 4911 名受试者中，CXR（-）（CXR 无 TB 后遗症）肺结核后组（ = 134）与对照组（ = 4405）相比具有相似的特征和正常的肺功能，而 CXR（+）（CXR 有 TB 后遗症）肺结核后组（ = 372）则表现出不同的特征和降低的肺功能。在对照组、CXR（-）肺结核后组和 CXR（+）肺结核后组中，气流阻塞的患病率分别为 9.3%、13.4%和 26.6%。CXR（+）肺结核后组（6.5%）或无 CXR（-）肺结核后组（4.5%）的 COPD 比对照组（1.8%）更为常见。与 CXR（-）肺结核后组相比，对照组气流阻塞的风险较低（OR，0.774； = .008）。CXR（+）肺结核后组发生气流阻塞的风险更高（OR，1.456； = .011）。与 CXR（-）肺结核后组相比，对照组发生 COPD 的风险也较低（OR，0.496； = .011）。