Background Post-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults. Methods Adult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George’s Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling. Results Between February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work. Conclusions PTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.

中文翻译：

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与马拉维肺结核后肺损伤相关的患者结局：一项前瞻性队列研究

背景 结核病后肺损伤 (PTLD) 是肺结核 (pTB) 的公认后果。然而，人们对其患病率、模式和相关结果知之甚少，尤其是在撒哈拉以南非洲和艾滋病毒阳性的成年人中。方法 在马拉维布兰太尔，首次 pTB 发作的成年（≥15 岁）幸存者在结核病治疗完成时完成了圣乔治呼吸问卷、6 分钟步行试验、肺活量测定和高分辨率 CT (HRCT) 胸部成像。前瞻性收集了 1 年内的症状、肺活量测定、寻求健康、结核病再治疗和死亡率数据。通过多变量回归模型确定了持续症状、肺功能下降和呼吸相关健康寻求的危险因素。结果 2016 年 2 月至 2017 年 4 月期间，招募了 405 名参与者。中位年龄为 35 岁（IQR：28 至 41)，77.3% (313/405) 有微生物学证实的 pTB，60.3% (244/403) 为 HIV 阳性。在 pTB 治疗完成时，60.7% (246/405) 报告有呼吸道症状，34.2% (125/365) 有肺活量测定异常，44.2% (170/385) 有≥1 个肺叶的支气管扩张，9.4% (36/385) 有≥1 个肺叶HRCT 成像上的肺叶被破坏。1 年时，30.7% (113/368) 报告呼吸道症状，19.3% (59/305) 和 14.1% (43/305) 的患者 FEV1 或 FVC 下降≥100 mL，16.3% (62/380) ) 报告了≥1 次急性呼吸事件，12.2% (45/368) 的症状影响了他们的工作能力。结论 PTLD 是 pTB 常见且未被充分认识的后果，它使患者丧失能力，并与 pTB 治疗完成后的不良后果相关。迫切需要加大预防 PTLD 的力度和管理既定疾病的指南。必须评估可改善患者预后的低成本临床干预措施。