Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
PLoS One. 2014 Apr 15;9(4):e94890. doi: 10.1371/journal.pone.0094890. eCollection 2014.
Diabetes mellitus (DM) is a risk factor for active tuberculosis (TB) but little is known about the effect of DM on culture conversion among patients with multidrug-resistant (MDR)-TB. The primary aim was to estimate the association between DM and rate of TB sputum culture conversion. A secondary objective was to estimate the association between DM and the risk of poor treatment outcomes among patients with MDR-TB.
A cohort of all adult patients starting MDR-TB treatment in the country of Georgia between 2009-2011 was followed during second-line TB therapy. Cox proportional models were used to estimate the adjusted hazard rate of sputum culture conversion. Log-binomial regression models were used to estimate the cumulative risk of poor TB treatment outcome.
Among 1,366 patients with sputum culture conversion information, 966 (70.7%) had culture conversion and the median time to conversion was 68 days (interquartile range 50-120). The rate of conversion was similar among patients with MDR-TB and DM (adjusted hazard ratio [aHR] 0.95, 95%CI 0.71-1.28) compared to patients with MDR-TB only. The rate of culture conversion was significantly less in patients that currently smoked (aHR 0.82, 95%CI 0.71-0.95), had low body mass index (aHR 0.71, 95%CI 0.59-0.84), second-line resistance (aHR 0.56, 95%CI 0.43-0.73), lung cavities (aHR 0.70, 95%CI 0.59-0.83) and with disseminated TB (aHR 0.75, 95%CI 0.62-0.90). The cumulative risk of poor treatment outcome was also similar among TB patients with and without DM (adjusted risk ratio [aRR] 1.03, 95%CI 0.93-1.14).
In adjusted analyses, DM did not impact culture conversion rates in a clinically meaningful way but smoking did.
糖尿病（DM）是活动性结核病（TB）的一个危险因素，但对于 DM 对耐多药（MDR）-TB 患者培养转换的影响知之甚少。主要目的是估计 DM 与 TB 痰培养转换率之间的关联。次要目标是估计 DM 与 MDR-TB 患者不良治疗结局风险之间的关联。
对 2009-2011 年间在格鲁吉亚国家开始 MDR-TB 治疗的所有成年患者进行了队列研究，在二线 TB 治疗期间进行了随访。使用 Cox 比例模型估计痰培养转换的调整危险率。使用对数二项式回归模型估计不良 TB 治疗结局的累积风险。
在有痰培养转换信息的 1366 名患者中，966 名（70.7%）有培养转换，转换的中位时间为 68 天（四分位距 50-120）。与仅患有 MDR-TB 的患者相比，MDR-TB 和 DM 患者的转换率相似（调整后的危险比[aHR]0.95，95%CI 0.71-1.28）。目前吸烟（aHR 0.82，95%CI 0.71-0.95）、低体重指数（aHR 0.71，95%CI 0.59-0.84）、二线耐药（aHR 0.56，95%CI 0.43-0.73）、肺空洞（aHR 0.70，95%CI 0.59-0.83）和播散性 TB（aHR 0.75，95%CI 0.62-0.90）的患者培养转换率显著降低。DM 对 TB 患者的不良治疗结局风险的累积影响与无 DM 的患者也相似（调整风险比[aRR]1.03，95%CI 0.93-1.14）。
在调整分析中，DM 对 TB 培养转换率的影响在临床上没有意义，但吸烟有影响。
