Thorax：吸入型糖皮质激素增加肺结核的发病风险

吸入型糖皮质激素（ICS）的使用可降低肺部免疫力。在ICS使用者中肺结核（TB）的发病风险越来越受关注。对于各种呼吸系统疾病患者中，ICS的使用是否与肺结核发病风险之间存在关联。针对这种情况，来自韩国汉城国立大学医学院呼吸内科的LeeChang-Hoon博士等人进行了一项研究，研究结果发表于2013年6月8日的《胸部》（Thorax）杂志上。作者发现长期大剂量使用ICS的患者可能会增加肺结核的发生风险。

该研究为基于韩国国家数据库的巢式病例对照研究。在2007年1月1日和2010年12月31日之间，使用吸入型呼吸道药物的新成年患者中有853439符合入组标准。开始吸入药物后确诊为肺结核的患者被纳入案例。对于每个案例，最多选择五个相匹配的个体分别从年龄，性别，诊断为哮喘或慢性阻塞性肺疾病（COPD）和吸入器使用的起始日期进行对照。在队列研究中，将4139例确诊为患有肺结核的患者与20583例对照组予以配对。

研究结果表明，ICS的使用与肺结核的诊断增加有关（AOR）（校正OR1.20，95％CI为1.08至1.34），且这种联系呈剂量依赖性（趋势检验P<0.001）。亚组分析显示，在非口服皮质类固醇（OCS）患者中使用ICS会增加发生肺结核的风险，但在OCS使用者中不存在这种相关性。

该研究发现，在中等肺结核负担的国家，使用ICS可能会增加患肺结核风险。临床医师应当意识到在长期大剂量使用ICS的患者中可能会增加肺结核的发病风险。

Use of inhaled corticosteroids and the risk of tuberculosis.
Background
Inhaled corticosteroid (ICS) use could decrease local immunity of the lung. Concerns have been raised regarding the risk of tuberculosis (TB) development among ICS users. The aim of this study was to elucidate the association between ICS use and development of TB among patients with various respiratory diseases in South Korea, an intermediate-TB-burden country.
Methods
A nested case-control study based on the Korean national claims database was performed. The eligible cohort consisted of 853 439 new adult users of inhaled respiratory medications between 1 January 2007 and 31 December 2010. Patients diagnosed as having TB after initiation of inhaled medication were included as cases. For each case individual, up to five control individuals matched for age, sex, diagnosis of asthma or chronic obstructive pulmonary disease (COPD) and initiation date of inhaler use were selected.
Results
From the cohort population, we matched 4139 individuals diagnosed as having TB with 20 583 controls. ICS use was associated with increased rate of TB diagnosis (adjusted OR (aOR), 1.20; 95% CI 1.08 to 1.34). The association was dose dependent (p for trend <0.001). A subgroup analysis revealed that ICS use increased the risk of TB development among non-users of oral corticosteroid (OCS) but not among OCS users.
Conclusions
ICS use increases the risk of TB in an intermediate-TB-burden country. Clinicians should be aware of the possibility of TB development among patients who are long-term high-dose ICS users.