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目的:了解在香港人群中吸烟与结核病的联系。方法:利用间接调整法比较1996年报告登记的851例结核病人样本与一般人群的吸烟率。并利用分层单因素分析和多元logisitc回归分析方法比较了曾吸烟者与不吸烟者的临床特征。结果:与人群对照相比,结核病人的吸烟率较高。在16-64岁组,吸烟与结核病之间的比值比(OR)在男性和女性分别为2.44和2.08(Mantel-Haenszel加权OR=2.40,P<0.001);在65岁以上组,则分别为 2.09和2.83(Mantel-Haenszel加权 OR=2.19,P<0.001)。男性、65岁以上、发病时仍在工作、经 常饮酒、吸毒以及无结核病接触史等与吸烟有关(P<0.05)。曾吸烟者的咳嗽比例高(OR=1.69)、容易憋气(OR=1.84)、上肺区受累多(OR=1.67)、易发空洞(OR=1.76)和粟粒性肺结核(OR=2.77)以及痰菌培养阳性的概率较大(OR=1.43),但发生孤立肺外结核病的机会要小(OR=0.31),即使控制了背景因素的混杂作用后也如此(P<0.05)。结论:吸烟与结核病有关。严重类型的肺结核多见于曾吸烟者。
Objective: To understand the link between smoking and tuberculosis in Hong Kong population. Methods: Indirect adjustment was used to compare the smoking rates of 851 TB patients and the general population registered in 1996. The clinical characteristics of both smokers and non-smokers were compared using stratified univariate analysis and multivariate logisitc regression analysis. Results: Tuberculosis patients had a higher rate of smoking compared with controls. In the 16-64 age group, the odds ratio between smoking and tuberculosis was 2.44 and 2.08 for men and women, respectively (Mantel-Haenszel weighted OR = 2.40, P <0.001). In the age group 65 and older, 2.09 and 2.83 (Mantel-Haenszel weighted OR = 2.19, P <0.001). Men, over 65 years of age, still working while the onset of illness, frequent alcohol consumption, drug abuse, and history of exposure to TB were associated with smoking (P <0.05). Smokers had a higher proportion of cough (OR = 1.69), easier breath holding (OR = 1.84), more involvement in the upper lung area (OR = 1.67), voids (OR = 1.76) and miliary tuberculosis (OR = 2.77) The probability of positive sputum cultures was greater (OR = 1.43), but the chance of isolating extrapulmonary TB was lower (OR = 0.31) even after controlling for the confounding of background factors (P <0.05). Conclusion: Smoking is related to tuberculosis. Severe types of tuberculosis are more common in smokers.