Dobler Claudia Caroline, Flack Jeffrey Ronald, Marks Guy Barrington
Department of Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
BMJ Open. 2012 Feb 13;2(1):e000666. doi: 10.1136/bmjopen-2011-000666. Print 2012.
Previous studies that have found an increased risk for tuberculosis (TB) in people with diabetes mellitus (DM) have been conducted in segments of the population and have not adjusted for important potential confounders. We sought to determine the RR for TB in the presence of DM in a national population with data on confounding factors in order to inform the decision-making process about latent tuberculosis infection (LTBI) screening in people with diabetes.
Whole population historical cohort study.
All Australian States and Territories with a mean TB incidence of 5.8/100 000.
Cases of TB in people with DM were identified by record linkage using the National Diabetes Services Scheme Database and TB notification databases for the years 2001-2006.
Primary outcome was notified cases of TB. Secondary outcome was notified cases of culture-confirmed TB. RR of TB was estimated with adjustment for age, sex, TB incidence in country of birth and indigenous status.
There were 6276 cases of active TB among 19 855 283 people living in Australia between 2001 and 2006. There were 271 (188 culture positive) cases of TB among 802 087 members of the DM cohort and 130 cases of TB among 273 023 people using insulin. The crude RR of TB was 1.78 (95% CI 1.17 to 2.73) in all people with DM and 2.16 (95% CI 1.19 to 3.93) in people with DM using insulin. The adjusted RRs were 1.48 (95% CI 1.04 to 2.10) and 2.27 (95% CI 1.41 to 3.66), respectively.
The presence of DM alone does not justify screening for LTBI. However, when combined with other risk factors for TB, the presence of DM may be sufficient to justify screening and treatment for LTBI.
既往研究发现糖尿病（DM）患者患结核病（TB）的风险增加，但这些研究是在部分人群中进行的，且未对重要的潜在混杂因素进行校正。我们试图在一个有混杂因素数据的全国性人群中确定糖尿病患者患结核病的相对危险度（RR），以便为糖尿病患者潜伏性结核感染（LTBI）筛查的决策过程提供信息。
全人群历史性队列研究。
所有澳大利亚州和领地，结核病平均发病率为5.8/10万。
2001年至2006年期间，通过使用国家糖尿病服务计划数据库和结核病通报数据库进行记录链接，确定糖尿病患者中的结核病病例。
主要结局是通报的结核病病例。次要结局是通报的培养确诊结核病病例。在对年龄、性别、出生国结核病发病率和原住民身份进行校正后，估计结核病的RR。
2001年至2006年期间，澳大利亚19855283名居民中有6276例活动性结核病病例。糖尿病队列的802087名成员中有271例（188例培养阳性）结核病病例，使用胰岛素的273023人中有130例结核病病例。所有糖尿病患者结核病的粗RR为1.78（95%CI 1.17至2.73），使用胰岛素的糖尿病患者为2.16（95%CI 1.19至3.93）。校正后的RR分别为1.48（95%CI 1.04至2.10）和2.27（95%CI 1.41至3.66）。
仅患有糖尿病并不足以证明需要进行LTBI筛查。然而，当与其他结核病危险因素相结合时，糖尿病的存在可能足以证明进行LTBI筛查和治疗是合理的。
