Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Int J Clin Pract. 2013 Nov;67(11):1199-209. doi: 10.1111/ijcp.12215. Epub 2013 Jun 10.
To assess the clinical and laboratory parameters, response to therapy and development of antituberculosis (TB) drug resistance in pulmonary TB (PTB) patients with diabetes mellitus (DM) and without DM.
Using a prospective design, 227 of 310 new cases of culture-positive PTB diagnosed at the Queen Savang Vadhana Memorial Hospital and the Chonburi Hospital between April 2010 and July 2012 that met the study criteria were selected. Data regarding clinical and laboratory parameters, drug susceptibility and treatment outcomes were compared between PTB patients with DM and those without DM. To control for age, the patients were stratified into two age groups (< 50 and ≥ 50 years) and their data were analysed.
Of the 227 patients, 37 (16.3%) had DM, of which 26 (70.3%) had been diagnosed with DM prior to PTB diagnosis and 11 (29.7%) had developed DM at PTB diagnosis. After controlling for age, no significant differences were found between the two groups regarding mycobacterium burden, sputum-culture conversion rate, evidence of multidrug-resistant tuberculosis, frequency of adverse drug events from anti-TB medications, treatment outcomes and relapse rate. The presenting symptoms of anorexia (p = 0.050) and haemoptysis (p = 0.036) were observed significantly more frequently in PTB patients with DM, while the presenting symptom of cough was observed significantly more frequently in PTB patients without DM (p = 0.047).
Plasma glucose levels should be monitored in all newly diagnosed PTB patients and a similar treatment regimen should be prescribed to PTB patients with DM and those without DM in high TB-burden countries.
评估患有糖尿病（DM）和无 DM 的肺结核（PTB）患者的临床和实验室参数、对治疗的反应以及发展为抗结核（TB）药物耐药的情况。
采用前瞻性设计，从 2010 年 4 月至 2012 年 7 月在 Queen Savang Vadhana Memorial 医院和 Chonburi 医院诊断为培养阳性的 310 例新发病例中，选择符合研究标准的 227 例。比较 DM 和非 DM 的 PTB 患者的临床和实验室参数、药物敏感性和治疗结果。为了控制年龄因素，将患者分为两个年龄组（<50 岁和≥50 岁）并进行数据分析。
在 227 例患者中，37 例（16.3%）患有 DM，其中 26 例（70.3%）在 PTB 诊断前已被诊断患有 DM，11 例（29.7%）在 PTB 诊断时新诊断为 DM。在控制年龄后，两组之间的分枝杆菌负担、痰培养转化率、耐多药结核证据、抗结核药物不良反应的发生频率、治疗结果和复发率均无显著差异。DM 组患者的临床表现为厌食（p=0.050）和咯血（p=0.036）更为常见，而非 DM 组患者的临床表现为咳嗽更为常见（p=0.047）。
在所有新诊断的 PTB 患者中应监测血糖水平，在高结核负担国家中，应向 DM 和非 DM 的 PTB 患者开具相似的治疗方案。
