Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
BMC Med. 2011 Jul 1;9:81. doi: 10.1186/1741-7015-9-81.
Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus may experience poor outcomes.We performed a systematic review and meta-analysis to quantitatively summarize evidence for the impact of diabetes on tuberculosis outcomes.
We searched PubMed, EMBASE and the World Health Organization Regional Indexes from 1 January 1980 to 31 December 2010 and references of relevant articles for reports of observational studies that included people with diabetes treated for tuberculosis. We reviewed the full text of 742 papers and included 33 studies of which 9 reported culture conversion at two to three months, 12 reported the combined outcome of failure and death, 23 reported death, 4 reported death adjusted for age and other potential confounding factors, 5 reported relapse, and 4 reported drug resistant recurrent tuberculosis.
Diabetes is associated with an increased risk of failure and death during tuberculosis treatment. Patients with diabetes have a risk ratio (RR) for the combined outcome of failure and death of 1.69 (95% CI, 1.36 to 2.12). The RR of death during tuberculosis treatment among the 23 unadjusted studies is 1.89 (95% CI, 1.52 to 2.36), and this increased to an effect estimate of 4.95 (95% CI, 2.69 to 9.10) among the 4 studies that adjusted for age and other potential confounding factors. Diabetes is also associated with an increased risk of relapse (RR, 3.89; 95% CI, 2.43 to 6.23). We did not find evidence for an increased risk of tuberculosis recurrence with drug resistant strains among people with diabetes. The studies assessing sputum culture conversion after two to three months of tuberculosis therapy were heterogeneous with relative risks that ranged from 0.79 to 3.25.
Diabetes increases the risk of failure and death combined, death, and relapse among patients with tuberculosis. This study highlights a need for increased attention to treatment of tuberculosis in people with diabetes, which may include testing for suspected diabetes, improved glucose control, and increased clinical and therapeutic monitoring.
多项结核病治疗研究表明，糖尿病患者可能出现较差的治疗结局。我们进行了系统评价和荟萃分析，以定量总结糖尿病对结核病结局影响的证据。
我们检索了 1980 年 1 月 1 日至 2010 年 12 月 31 日期间的 PubMed、EMBASE 和世界卫生组织区域索引以及相关文章的参考文献，以获取包含糖尿病结核病治疗患者的观察性研究报告。我们查阅了 742 篇论文的全文，纳入了 33 项研究，其中 9 项报告了 2-3 个月时的培养转阴情况，12 项报告了失败和死亡的联合结局，23 项报告了死亡情况，4 项报告了校正年龄和其他潜在混杂因素后的死亡情况，5 项报告了复发情况，4 项报告了耐多药复发性肺结核情况。
糖尿病与结核病治疗期间的失败和死亡风险增加相关。糖尿病患者的失败和死亡联合结局风险比（RR）为 1.69（95%CI，1.36-2.12）。23 项未校正研究中结核病治疗期间的死亡 RR 为 1.89（95%CI，1.52-2.36），而在 4 项校正年龄和其他潜在混杂因素的研究中，该 RR 增至 4.95（95%CI，2.69-9.10）。糖尿病还与复发风险增加相关（RR，3.89；95%CI，2.43-6.23）。我们没有发现糖尿病患者中耐多药菌株导致结核病复发风险增加的证据。评估结核病治疗 2-3 个月后痰培养转阴的研究存在异质性，相对危险度范围为 0.79-3.25。
糖尿病增加了结核病患者的失败和死亡联合结局、死亡和复发风险。本研究强调了需要加强对糖尿病患者结核病治疗的关注，这可能包括检测疑似糖尿病、改善血糖控制和增加临床及治疗监测。
