Abstract
Heavy alcohol intake seems to increase risk of TB in males. New measures for alcohol abuse are neededhttp:///ow.ly/2esr304cdg4.
To the Editor:
全球约三分之一的人口有结核分枝杆菌感染,虽然90%的受感染的个体永远不会发展临床疾病[1,2]。
The association between alcohol consumption and tuberculosis (TB) is well known [3,4]。Individuals who consume alcohol are considered immune-compromised because they have a greater incidence and severity of infectious diseases than abstainers, and are also more susceptible to lung infections, such as TB and pneumonia [4]。In fact, alcohol users are a group at high risk for TB who should be addressed accordingly with targeted preventative interventions [5,6]。
In the present study, we tried to determine the threshold of alcohol consumption that increased the risk for active TB in men and women.
Cases and controls were recruited from primary healthcare units in the same geographical region. Pregnant or lactating women, and individuals infected with HIV or other immunosuppressive conditions were excluded. Cases were patients with active pulmonary TB (with or without pleural involvement), aged >18 years-old, and diagnosed with TB at outpatient centres in northern Portugal between August 2013 and September 2015. Controls were healthy individuals aged >18 years-old with no suspicion of active TB or history of TB in the participant's household within the previous 5 years.
Registered data included daily alcohol consumption over the previous year (including types of beverages and the quantity consumed), age, sex, area of residence, nationality and current occupation/employment status. The clinical data included co-morbidities (diabetes, chronic kidney disease, rheumatological diseases, solid and haematological cancers, lung disease, silicosis, heart and liver conditions and history of TB) and other risk factors for TB infection (drug abuse, imprisonment, homelessness or residence in a community shelter). This project was approved by Portugal's Northern Region Health Administration Ethics Committee, and all participants provided written informed consent.
We performed separate analyses of men and women in the present study given the fact that the impact of ethanol is different in the two sexes [7]。通过简单的逻辑回归研究了每种评估变量对Tb感染的粗效果,除了与非常低的Tb感染相关的变量。然后包括在多个二进制逻辑回归模型中的统计学意义的变量。最佳模型的选择是基于可能性比率测试,否则在Akaike信息标准(AIC)上。模型可辨别性是接收器操作特征曲线(AUC)下的区域。所有统计分析都与R软件(2.12.1版)进行。意义程度设定为0.05。
We enrolled 289 subjects in this study, 50.5% of whom were male. The mean±SD(range)年龄为51.6±16.9(19-87) years for men and 50.9±17.2 (19–85) years for women.
Among men, those with TB were significantly younger (mean±SD.年龄48.1±17.0岁versus56.8±15.7 years-old) and more likely to be unemployed (29%versus12%)。吸烟者明显更可能有TB(55%versus23%). Analysis of alcohol consumption indicated that those who consumed more than 38 g of ethanol per day had a greater risk of TB than those who did not drink at all. The multiple logistic model indicated that drinking more than 38 g of ethanol per day, young age and being unemployed were statistically significant risk factors for TB (AUC 0.715). According to the model estimates, any 1-year increase in age decreased the odds for TB by 3.8% (95% CI 0.938–0.988), unemployment increased the risk two-fold (95% CI 0.902–6.247) and daily consumption of more than 38 g of ethanol per day increased the risk for TB four-fold (95% CI 1.508–10.738).
与TB的女性也明显小于没有TB的女性(平均值±SD.age 40.8±15.6 yearsversus55.4±15.9 years). As with the males, the low prevalence of living in poor conditions precluded analysis of this variable. Smoking was also significantly associated with TB in women (32%versus11.%).
The multiple logistic model indicated that young age and smoking were statistically significant risk factors for TB, but there was no significant association between alcohol consumption and TB (table 1,AUC 0.753)。因此,对于年龄的任何1年增加,模型(表1)估计TB的赔率的减少5.1%(95%CI 0.947-6.724)。目前吸烟的效果非常接近统计学意义(P = 0.064),所以我们留在这个变量中,因为它提供了更好的合适。目前吸烟占TB的2.5倍(95%CI:0.925-0.974)。
Our results showed that men who were younger, drink more than 38 g of ethanol per day and were unemployed had an increased risk for TB, and that women who were younger and smokers had an increased risk for TB.
Previous studies showed there might be a dose-response relationship between the amount of alcohol consumption and risk for TB. However, few studies have focused on the threshold amount of alcohol that increases the risk for TB [8]。在本研究中,我们将男性分为非饮酒者,中等饮酒者(每天<38克乙醇)或重饮酒者(每天38克乙醇)。就标准饮料(1标准饮料= 10g乙醇)而言,38克乙醇相当于每天约4杯。以前的系统评价报告了类似的结果[8]。However, we found no significant association between alcohol consumption and TB in females. This may be due to the small percentage of women who consumed alcohol in our study population (21%). Nonetheless, because of biological differences between men and women, we would expect the threshold (g ethanol per day) for increasing the risk of TB would be lower in women than men.
Our analysis indicated that young age increased the risk for TB. This is in line with previous research that showed that TB mostly affects adults in their most productive years [9]。此外,现有文献还引用了许多社会因素,例如失业,因为TB的显着风险因素[10.]。这是我们的结果支持。
本研究的两个主要局限性是我们才能在上一年中测量饮酒,并且我们依赖于自我报告的酒精消费,这可能无法反映实际的饮酒模式。
In conclusion, the epidemiologic data and other evidence presented here indicate that heavy alcohol consumption in men is an independent risk factor for TB. Other variables significantly associated with TB were unemployment in men, current smoking in women, and young age in men and women.
有具体的干预措施可以常规地提供给弱势饮酒者等脆弱的TB患者[11.–14.]。
其他政策措施,例如增加对酒精饮料的税收和对酒精饮料的可用性更严格的控制,可以减少与繁重饮酒相关的问题。还应鼓励对重型饮酒者的预防性和治疗干预措施的研究。
Disclosures
Supplementary Material
O. FelgueirasERJ-01468-2016_Felgueiras
J. FranciscoERJ-01468-2016_Francisco
A.R. GaioERJ-01468-2016_GAIO.
O. OliveiraERJ-01468-2016_OLIVEIRA.
致谢
作者的贡献如下。构想与设计:R. Duarte和O. Oliveira;分析与解释:J. Francisco,O. Felgueiras,A.R.盖奥和罗德;起草了重要的知识分子内容的稿件:J. Francisco,O. Oliveira,A.R.盖奥和罗德。
Footnotes
Support statement: This work was supported by the Portuguese Foundation for Science and Technology (FCT; grant number PTDC/DTP-PIC/0747/2012). A. R. Gaio and O. Felgueiras were partially supported by CMUP (UID/MAT/00144/2013), which is funded by FCT with national (MEC) and European structural funds (FEDER), under the partnership agreement PT2020. Funding information for this article has been deposited with开放式资助服务员注册表.
Conflict of interest: Disclosures can be found alongside this article atwww.qdcxjkg.com
- 收到2016年6月30日。
- AcceptedAugust 30, 2016.
- 版权所有©2017