Leung Chi C, Yew Wing W, Mok Thomas Y W, Lau Kam S, Wong Chi F, Chau Chi H, Chan Chi K, Chang Kwok C, Tam Greta, Tam Cheuk M
Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
Respirology. 2017 Aug;22(6):1225-1232. doi: 10.1111/resp.13017. Epub 2017 Feb 28.
With the colliding global epidemics of diabetes mellitus (DM) and tuberculosis (TB), we studied the effects of DM on the presentation of TB and its response to treatment.
Consecutive TB patients from 2006 to 2010 in a territory-wide treatment programme offering 9-month extended treatment for TB patients with DM were examined and followed up prospectively to assess their treatment response. Successful treatment completers were tracked through the TB registry and death registry for relapse, death or till 31 December 2014, whichever was the earliest.
DM was independently associated with more chest symptoms (adjusted OR (AOR): 1.13) and systemic symptoms (AOR: 1.30) but less with other site-specific symptoms (AOR: 0.58) at TB presentation. There was more frequent pulmonary involvement (AOR: 1.69), with more extensive lung lesion (AOR: 1.25), lung cavity (AOR: 2.00) and positive sputum smear (AOR: 1.83) and culture (AOR: 1.38), but no difference in the proportion of retreatment cases or isoniazid and/or rifampicin resistance. After treatment initiation, there was higher overall incidence (AOR: 1.38) of adverse effects (mainly gastrointestinal symptoms, renal impairment and peripheral neuropathy but less fever and skin hypersensitivity reactions), more smear non-conversion (AOR: 1.59) and culture non-conversion (AOR: 1.40) at 2 months, and lower combined cure/treatment completion rate at 12 months (AOR: 0.79), but no difference in the relapse rate after having successfully completed treatment.
DM adversely affected the clinical presentation and treatment response of TB, but there was no difference in the drug resistance and relapse rates.
鉴于全球糖尿病（DM）与结核病（TB）疫情相互交织，我们研究了糖尿病对结核病表现及其治疗反应的影响。
对2006年至2010年在一项为糖尿病合并结核病患者提供9个月延长治疗的全地区治疗项目中的连续结核病患者进行检查，并进行前瞻性随访，以评估其治疗反应。通过结核病登记册和死亡登记册对成功完成治疗的患者进行追踪，以了解其复发、死亡情况或直至2014年12月31日（以最早者为准）。
糖尿病在结核病发病时独立与更多的胸部症状（调整后比值比（AOR）：1.13）和全身症状（AOR：1.30）相关，但与其他特定部位症状（AOR：0.58）相关性较低。肺部受累更为频繁（AOR：1.69），肺部病变更广泛（AOR：1.25）、有空洞（AOR：2.00），痰涂片阳性（AOR：1.83）和培养阳性率（AOR：1.38）更高，但复治病例比例或异烟肼和/或利福平耐药率无差异。开始治疗后，不良反应的总体发生率较高（AOR：1.38）（主要为胃肠道症状、肾功能损害和周围神经病变，但发热和皮肤过敏反应较少），2个月时痰涂片转阴率（AOR：1.59）和培养转阴率（AOR：1.40）较低，12个月时联合治愈/治疗完成率较低（AOR：0.79），但成功完成治疗后的复发率无差异。
糖尿病对结核病的临床表现和治疗反应有不利影响，但耐药率和复发率无差异。
