Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
Departamento de Neumología, Hospital Universitario de Gran Canaria «Dr. Negrín», Las Palmas, Canarias, España.
Arch Bronconeumol. 2017 May;53(5):245-250. doi: 10.1016/j.arbres.2016.10.021. Epub 2017 Jan 11.
Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City.
Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9-21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8-54.2), but not for a worse outcome.
Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.
糖尿病（DM）是墨西哥非常常见的疾病，是结核病（TB）的已知危险因素。然而，尚不清楚 DM 会在多大程度上导致耐多药（MDR-TB）和广泛耐药（XDR-TB）患者对抗 TB 药物产生不良反应（AE）和/或导致更差的结局。本研究的主要目的是描述耐多药/广泛耐药肺结核患者的 TB 治疗结局、DM 的影响以及不良事件的发生率，该研究对象为在墨西哥城国家结核病转诊中心接受治疗的患者。
2010 年至 2015 年间共纳入 90 例患者：73 例为 MDR-TB（81.1%），11 例为预 XDR-TB（12.2%），6 例为 XDR-TB（6.7%），其中 49 例（54.4%）患有糖尿病，3 例合并人类免疫缺陷病毒（HIV）感染（3.3%）。在 98%的患者中，通过培养和药敏试验诊断，而在单个病例中，通过分子检测做出诊断。DM 的存在与严重药物相关 AE 的风险增加相关，例如肾毒性（优势比 [OR]=6.5；95%置信区间 [95%CI]：1.9-21.8）和甲状腺功能减退症（OR=8.8；95%CI：1.8-54.2），但与不良结局无关。
我们的数据表明，DM 不会影响二线 TB 治疗结局，但 DM 患者发生耐多药 TB 治疗严重 AE（如肾毒性和甲状腺功能减退症）的风险更高。
