Shen Te-Chun, Lin Cheng-Li, Wei Chang-Ching, Liao Wei-Chih, Chen Wei-Chun, Chen Chia-Hung, Tu Chih-Yen, Hsia Te-Chun, Shih Chuen-Ming, Hsu Wu-Huei, Li Chia-Hsiang, Sung Fung-Chang
Division of Pulmonary and Critical Care Medicine (T-CS, W-CL, W-CC, C-HC, C-YT, T-CH, C-MS, W-HH, C-HL), Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung; Division of Pulmonary and Critical Care Medicine (T-CS), Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou; Institute of Clinical Medical Science (T-CS, F-CS), College of Medicine, China Medical University; Management Office for Health Data (C-LL, F-CS), China Medical University Hospital, Taichung; Division of Nephrology (C-CW), Department of Pediatrics, China Medical University Hospital and China Medical University, Taichung, Taiwan.
Medicine (Baltimore). 2014 Oct;93(16):e96. doi: 10.1097/MD.0000000000000096.
The studies on the risk of tuberculosis (TB) in patients with type 1 diabetes mellitus (T1DM) alone are limited. We examined this relationship using a population-based retrospective cohort study. From claims data of the National Health Insurance system of Taiwan, we identified 5195 patients with T1DM newly diagnosed from 2002 to 2011 and 20,780 randomly selected controls without T1DM, frequency matched by age, sex, and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the risk of TB. The overall incidence of TB was 4.07-fold higher in the T1DM cohort than in the control cohort (1.18 vs 0.29 per 1000 person-years, P < 0.001). Compared with the controls, the Cox model estimated adjusted hazard ratios (HRs) of TB in patients with T1DM were greater in men than in women (4.62 vs 3.59) and in adults than in children (4.06 vs 3.37), but not significant. The adjusted HR was much greater for those with comorbidities than those without comorbidities (14.6 vs 1.62, P < 0.001). Compared with the controls, the patients with T1DM were also more likely to develop TB with multiple emergency room visits (adjusted HR: 116.1, 95% confidence interval [CI] = 43.8-307.4) or hospitalizations (adjusted HR: 86.5, 95% CI = 33.7-222.4). Patients with T1DM are at elevated risks of developing TB with much higher HRs for those with comorbidities, within the first year of diagnosis, and with frequent emergency cares or hospitalizations.
仅针对1型糖尿病（T1DM）患者的结核病（TB）风险研究有限。我们通过一项基于人群的回顾性队列研究来探究这种关系。从台湾国民健康保险系统的理赔数据中，我们识别出2002年至2011年新诊断出的5195例T1DM患者以及20780例随机选取的无T1DM的对照者，这些对照者按年龄、性别和诊断年份进行频率匹配。两个队列均随访至2011年底以评估结核病风险。T1DM队列中结核病的总体发病率比对照队列高4.07倍（每1000人年分别为1.18和0.29，P<0.001）。与对照者相比，Cox模型估计T1DM患者结核病的调整后风险比（HR）在男性中高于女性（4.62对3.59），在成年人中高于儿童（4.06对3.37），但差异无统计学意义。有合并症者的调整后HR比无合并症者大得多（14.6对1.62，P<0.001）。与对照者相比，T1DM患者也更有可能因多次急诊就诊（调整后HR：116.1，95%置信区间[CI]=43.8 - 307.4）或住院（调整后HR：86.5，95%CI = 33.7 - 222.4）而患结核病。T1DM患者患结核病的风险升高，对于有合并症者、在诊断后的第一年内以及频繁接受急诊治疗或住院的患者，其HR要高得多。
