吸烟与结核病成功治疗后患者死亡关系前瞻性队列研究

Association of smoking with mortality among tuberculosis patients after successful treatment:a prospective cohort study

目的了解吸烟与结核病成功治疗后患者死亡的关系,为结核病的预防控制提供参考依据。方法采用前瞻性队列研究方法,于2010年3—8月连续纳入江西省兴国县和宁都县结核病防治所登记的634例新确诊且成功治疗的结核病患者进行基线问卷调查及后续跟踪随访,应用多因素Cox比例风险回归模型分析吸烟与结核病成功治疗后患者死亡的关系。结果截至2018年11月30日,634例新确诊且成功治疗的结核病患者中有59例患者死亡,结核病成功治疗后患者死亡率为9.31%;多因素Cox比例风险回归分析结果显示,男性患者的结核病成功治疗后死亡风险为女性患者的2.474倍(HR=2.474,95%CI=1.166~5.247),结核类型为阳性患者的结核病成功治疗后死亡风险为阴性和肺外患者的2.204倍(HR=2.204,95%CI=1.316~3.689),吸烟≥30年患者的结核病成功治疗后死亡风险为不吸烟患者的1.829倍(HR=1.829,95%CI=1.020~3.279)。结论吸烟可增加结核病成功治疗后患者的死亡风险。

Objective To assess the relationship between smoking and mortality among tuberculosis(TB)patients after successful treatment for providing evidences to TB control and prevention.Methods During March-August 2010,we consecutively recruited 634 first diagnosed TB patients with successful treatment registered in two counties of Jiangxi province;a baseline questionnaire interview and a 7-year follow-up survey were conducted among all the patients.Cox proportional risk regression model was adopted to evaluate the correlation of smoking with mortality among the patients.Results Totally 59 deaths were observed among the patients by the end of follow up till August 30,2018,with a mortality rate of 9.31%.The results of Cox regression analysis revealed following risk factors of mortality among the patients:being male(versus female:hazard risk[HR]=2.474,95% confidence interval[95%CI]:1.166-5.247),sputum smear positive(versus negative:HR=2.204,95%CI:1.316-3.689),and with a smoking history of more than 30 years(versus nonsmoking:HR=1.829,95%CI:1.020-3.279).Conclusion Smoking could increase mortality risk among tuberculosis patients after successful treatment.