吸烟对涂阳肺结核患者治疗效果影响

Impact of smoking on treatment outcome among smear-positive pulmonary tuberculosis patients

目的探讨吸烟对涂阳肺结核患者治疗效果的影响。方法 2008——2011年选择我国8个省共49个实施单位确诊并完成治疗的2 038例涂阳肺结核患者进行分析,根据患者吸烟情况分为现在吸烟者、戒烟者及不吸烟者3组,采用χ~2检验比较3组患者在病灶吸收、空洞闭合、 2月末痰培养及治疗转归方面的差异。采用非条件logistic回归分析吸烟对肺结核治疗效果的影响。结果在2 038例涂阳肺结核患者中,从不吸烟者占46.5%,戒烟者占36.1%,现在吸烟者占17.4%;3组患者2月末痰菌未阴转率差异明显(χ~2=9.045,P=0.011);治疗转归差异明显(χ~2=17.130,P=0.008)。戒烟组患者2月末痰培养未阴转率(OR=1.376,95% CI=1.102～1.871)及治疗失败率(OR=1.183,95% CI=1.021～1.929)分别是现在吸烟组患者的1.376及1.183倍,而现在吸烟者患者2月末痰培养未阴转率(OR=1.657,95% CI=1.137～2.414)及治疗失败率(OR=1.325,95% CI=1.023～2.308)分别是从不吸烟组患者的1.657倍及1.325倍。结论吸烟影响了涂阳肺结核疗效,增加了2月末痰菌未阴转率、治疗失败及死亡的风险。

Objective To explore the impact of smoking upon therapeutic outcome among smear-positive pulmonary tuberculosis (TB) patients.Methods We recruited 2 038 smear-positive TB patients diagnosed and completing TB therapy from 2008 through 2011 in 49 TB dispensaries or medical institutions designated for medication of TB patients in 8 provinces across China;then we assigned the patients into three groups of current smoker, ex-smoker, and never smoker. Disparities in lesion resorption, cavity closure, sputum-culture negative conversion, and treatment outcome were compared among the three groups with Chi-square test. Unconditional logistic regression analysis was adopted to assess influences of smoking on therapeutic outcomes among the patients.Results Of all the patients, 17.4%, 36.1%, and 46.5% were current smoker, ex-smoker, and never smoker, respectively. There were significant differences in sputum-culture negative conversion by the end of 2-month medication (χ^2=9.045, P=0.011) and treatment outcome (χ^2=17.130, P=0.008) among the three groups. In comparison with the current smokers, the ex-smokers were more likely to have sputum-culture positive by the end of 2-month medication (odds ratio[OR]=1.376, 95% confidence interval[95% CI]:1.102-1.871) and treatment failure (OR=1.183, 95% CI:1.021-1.929);compared to never smokers, the current smokers were more likely to have sputum-culture positive by the end of 2-month medication (OR=1.657, 95% CI:1.137-2.414) and treatment failure (OR=1.325, 95% CI:1.023-2.308).Conclusion Smoking has adverse impact on outcome of TB treatment and could increase sputum-culture positive rate by the end of 2-month medication, treatment failure and death rate among smear-positive pulmonary tuberculosis patients.