Leow M K S, Dalan R, Chee C B E, Earnest A, Chew D E K, Tan A W K, Kon W Y C, Jong M, Barkham T, Wang Y T
Senior Consultant, Department of Endocrinology, Tan Tock Seng Hospital.
Consultant, Department of Endocrinology, Tan Tock Seng Hospital.
Exp Clin Endocrinol Diabetes. 2014 Oct;122(9):528-32. doi: 10.1055/s-0034-1377044. Epub 2014 Jul 8.
Diabetes mellitus (DM) confers a higher risk for tuberculosis (TB). Yet, TB screening and chemoprophylaxis for latent TB infection (LTBI) in DM remains controversial. We conducted a cross-sectional study to elucidate LTBI prevalence and longitudinal follow-up to ascertain LTBI to active TB progression rate in DM.
220 DM patients without previous TB from the outpatient diabetes clinic of the hospital were enrolled. T-Spot TB, tuberculin-skin-test (TST) and chest radiography (CXR) were performed. LTBI was defined by negative CXR with reactive T-Spot TB. Progression to active TB was confirmed by cross-checking against the TB registry.
The prevalence of LTBI was 28.2% (62/220) by reactive T-Spot. None progressed to active TB from 2007-2013. Multivariate analysis revealed that any co-morbidity (p=0.016) was positively associated while metformin (p=0.008) was negatively associated with LTBI.
Over a quarter of DM patients harbor LTBI. While the lack of demonstrable progression to active TB within the follow-up time frame up to this point does not unequivocally support a routine TB screening policy or anti-TB chemoprophylaxis for LTBI in a diabetic population for now, this preliminary evidence needs re-evaluation with longer follow-up of this enrolled cohort over the next decade.
糖尿病（DM）患者患结核病（TB）的风险更高。然而，糖尿病患者潜伏性结核感染（LTBI）的结核病筛查和化学预防仍存在争议。我们进行了一项横断面研究，以阐明LTBI的患病率，并进行纵向随访，以确定糖尿病患者从LTBI进展为活动性结核病的发生率。
招募了来自医院门诊糖尿病诊所的220例既往无结核病的糖尿病患者。进行了结核感染T细胞检测（T-Spot TB）、结核菌素皮肤试验（TST）和胸部X线摄影（CXR）。LTBI的定义为CXR阴性且T-Spot TB反应性阳性。通过与结核病登记处交叉核对确认进展为活动性结核病。
通过反应性T-Spot检测，LTBI的患病率为28.2%（62/220）。2007年至2013年期间，无患者进展为活动性结核病。多变量分析显示，任何合并症（p=0.016）与LTBI呈正相关，而二甲双胍（p=0.008）与LTBI呈负相关。
超过四分之一的糖尿病患者患有LTBI。虽然在目前的随访时间范围内缺乏向活动性结核病进展的明显证据，目前并不明确支持对糖尿病患者进行常规结核病筛查政策或对LTBI进行抗结核化学预防，但这一初步证据需要在未来十年对该队列进行更长时间的随访后重新评估。
