Cigarette Smoking Increases the Risk of Latent Tuberculosis Infection: A Cross-Sectional Study in a TB-Endemic Area

抽菸增加潛伏結核感染風險－一個結核病盛行區的橫斷面研究

馮嘉毅(Jia-Yih Feng) ； 潘聖衛(Sheng-Wei Pan) ； 黃祥芬(Shiang-Fen Huang) ； 蘇維鈞(Wei-Juin Su)

《胸腔醫學》 32卷5期 (2017/10) Pp. 201-212

摘要

Introduction: An association between smoking and latent TB infection (LTBI) using the tuberculin skin test was noted in previous reports. The impact of smoking, including intensity and duration, on LTBI deserves further investigation with a more specific diagnostic tool: the interferon-γ release assay (IGRA). Methods: From 2011 to 2013, individuals at high risk for LTBI and progression from LTBI to active TB were enrolled. LTBI was diagnosed by the QuantiFERON-TB Gold In- Tube test. Patients were categorized as never-smokers, ex-smokers or current smokers. The associations between smoking and LTBI were analyzed accordingly. The impact of smoke exposure on interferon-γ responses was explored as well. Results: During the study period, we enrolled 1,037 patients in our analysis, including 167 ex-smokers, 152 current smokers, and 718 never-smokers. The proportions of LTBI among ex-smokers, current smokers, and never-smokers were 38.9%, 37.5%, and 23.4%, respectively; ever-smokers had a significantly higher incidence of LTBI than never-smokers (P＜0.001). In multivariate analysis, both current smokers (OR 1.85, 95% CI 1.19-2.86) and ex-smokers (OR 1.66, 95% CI 1.06-2.60) were significantly associated with an increased risk of LTBI. After adjusting for related clinical factors, a dose-response relationship was found between LTBI and smoking duration (P_(trend)＜0.001). The relationship between LTBI and smoking intensities was less consistent. Patients in the IGRA-positive population with higher smoking intensities had stronger interferon-γ responses. In the IGRA-negative population, the interferon-γ responses were comparable among patients with various smoke exposures. Conclusions: Smoking significantly increases the risk of LTBI in high-risk individuals, especially those with a longer duration of smoking.

關鍵字

interferon-γ release assays ； latent tuberculosis infection ； smoking

並列摘要

前言：過去使用結核菌素測驗的研究顯示抽菸會增加潛伏結核感染的風險。但是使用丙型干擾素測驗分析抽菸與潛伏結核感染相關性的研究相對有限。方法：自2011年至2013 年收集潛伏結核感染高風險族群病人，以丙型干擾素測驗的結果診斷潛伏結核感染，分析病人抽菸情形與合併潛伏結核感染的相關性。結果：在1,037位受試者中，有過去與現今抽菸史者的病人合併潛伏結核感染的比例顯著高於無抽菸者(38.9% vs. 37.5% vs. 23.4%, P＜0.001)。過去抽菸史(OR 1.66, 95% CI 1.06-2.60)與現今抽菸史(OR 1.85, 95% CI 1.19-2.86)都會顯著的增加潛伏結核感染的風險，而且會隨著抽菸時間的增加而上升(P_(trend)＜0.001)，但與每日抽菸量的相關性則較低。結論：抽菸會顯著增加潛伏結核感染的風險，而且與抽菸的時間有正向的劑量反應關係。

並列關鍵字

潛伏結核感染 ； 抽菸 ； 丙型干擾素測驗