中国农村地区结核病感染与活动性结核病及合并症发展的关系：一项基于人群、多中心、前瞻性研究的10年随访结果

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-08-01 DOI:10.1016/j.lanwpc.2025.101659

Henan Xin , Jiang Du , Xuefang Cao , Weitao Duan , Aiwei He , Jun Liang , Limei Zhu , Boxuan Feng , Yijun He , Lingyu Shen , Juanjuan Huang , Zisen Liu , Fang Liu , Shumin Yang , Zuhui Xu , Cheng Chen , Bin Zhang , Jiaoxia Yan , Yanchun Liang , Rong Liu , Lei Gao

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引用次数: 0

摘要

在中国，近期和长期感染结核分枝杆菌与肺结核（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年以来实施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TBI的患病率并跟踪活动性疾病的发展。这项队列研究为解决这些知识差距提供了机会。方法于2023年10月，邀请所有最初参加LATENTTB-NSTM研究基线调查的中国农村21832名参与者参加为期10年的随访调查。关于肺结核和其他健康问题，包括2型糖尿病（T2DM）、癌症、心脑血管疾病的数据是从医疗记录或自我报告中获得的。分析基线TBI和新获得性感染占PTB发病率的比例，以及基线TBI状况与其他疾病发病率的关系。总体而言，最终分析纳入了21,211名研究参与者，总计170,152人年。在10年期间，共确定了181例PTB患者，其中134例为基线时定义的TBI， 47例为随访期间新获得性感染。随访后5年诊断的肺结核病例中新获得性感染的比例与随访前5年相比有统计学意义（38.30%（18/47）比21.64% (29/134),p = 0.031）。≥60岁PTB患者发生基线TBI的比例高于≥60岁PTB患者(85.19% （69/81)vs. 65.00% (65/100), p = 0.002）。此外，发现基线TBI状态与T2DM、癌症和慢性支气管炎发生风险增加显著相关，校正风险比分别为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: 1.06 - 8.15）。在基线TBI测试中，随着免疫反应强度的增加，发生T2DM的风险略有增加。与近期感染相比，TBI仍然是中国农村PTB发病的主要原因。除了努力系统地管理感染病例和密切接触者外，针对因TBI而发展为活动性疾病的高风险个体进行预防性治疗对于实现结核病发病率的快速下降至关重要。此外，创伤性脑损伤对其他健康状况的可能影响进一步强调了从新的角度管理创伤性脑损伤的重要性。资助CAMS医学创新基金和国家自然科学基金。

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Association of tuberculosis infection with the development of active tuberculosis and comorbidities in rural China: a 10-year follow-up results of a population-based, multicentre, prospective study

Background

In China, there is limited research on the role of recent and long-term infection of Mycobacterium tuberculosis 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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

The CAMS Innovation Fund for Medical Sciences and the National Natural Science Foundation of China.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.