苏丹患者中肺结核与2型糖尿病之间的关联。

Association between pulmonary tuberculosis and Type 2 diabetes in Sudanese patients.

作者信息

Ahmed Mona, Omer Ibtihal, Osman Sannaa M A, Ahmed-Abakur Eltayib H

机构信息

Department of Molecular Biology, National Ribat University Teaching Hospital, Khartoum, Sudan.

Department of Microbiology, Alzaiem Alazhari University, Khartoum, Sudan.

出版信息

Int J Mycobacteriol. 2017 Jan-Mar;6(1):97-101. doi: 10.4103/ijmy.ijmy_13_17.

DOI:10.4103/ijmy.ijmy_13_17

PMID:28317813

Abstract

INTRODUCTION

Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues, and the association between DM and TB may be the next challenge for global TB control worldwide, type 2 DM (T2DM) responsible for 90% of DM cases. Persons with diabetes have a significantly increased risk of active TB, which is two to three times higher than in persons without diabetes. The aim of this study was to determine the association between pulmonary tuberculosis (PTB) and T2DM among Sudanese patients and also to determine the association between hemoglobin A1c (HbA1c) percentage in diabetic patients and development of PTB and effect of duration of T2DM in developing PTB.

MATERIALS AND METHODS

A total of 120 sputum samples were collected from patients during 6 months in Ribat University Hospital, Khartoum, Sudan. Sixty of them were known type 2 diabetic patients categorized as study group and sixty were nondiabetic patients categorized as control group. Ziehl-Neelsen smear preparation and DNA were extracted from sputum for detection of Mycobacterium tuberculosis by polymerase chain reaction (PCR).

RESULTS

Among the 120 sputum specimens, 72 (60%) were males and 48 (40%) were females. Fourteen (19.4%) males and 6 (12.5%) females had PTB, the difference was not statistically significant according to gender P = 0.229. According to treatment modalities, diabetic patients were treated with injectable insulin (36.7%), PCR positive was 4(33.3%) P value (0.853), oral hypoglycemic drugs (51.7%) PCR positive 7 (58.3%) P value (0.849) and dietary control (11.7%) PCR positive (1 (8.3%) P value (1.000) Were insignificant differences. The frequency of HbA1c of 58 patients with diabetes was 24 (41.4%) who had controlled DM (HbA1c level ≤ 6.5%) and 34 (58.6%) had uncontrolled DM. Of the 60 patients with diabetes, 12 had PTB with uncontrolled DM, with significant difference (P=0.000). The mean duration of diabetes mellitus was (6.92 years ± Std 6.801) and the frequency of diabetes mellitus in first 10 years was 47 (78.3%), in (11-20) years was 10 (16.7%) and in (21-30) years was 3 (5%), the PCR positive PTB showed 10(21.3%) for the first 10 years, (11-20) years was 2 (20%) and zero (0.0%) for (21-30) years, P-value (0.480) insignificant different.

CONCLUSIONS

In summary, we found consistent evidence for an increased risk of TB among patients with uncontrolled DM (high-level HbA1c).

摘要

引言

结核病（TB）和糖尿病（DM）都是重要的健康问题，DM与TB之间的关联可能是全球结核病控制面临的下一个挑战，2型糖尿病（T2DM）占糖尿病病例的90%。糖尿病患者患活动性结核病的风险显著增加，比非糖尿病患者高出两到三倍。本研究的目的是确定苏丹患者中肺结核（PTB）与T2DM之间的关联，以及糖尿病患者血红蛋白A1c（HbA1c）百分比与PTB发生之间的关联，以及T2DM病程对PTB发生的影响。

材料与方法

在苏丹喀土穆的里巴特大学医院6个月期间，共收集了120份患者的痰液样本。其中60例为已知的2型糖尿病患者，分为研究组，60例为非糖尿病患者，分为对照组。制备齐-尼氏涂片并从痰液中提取DNA，通过聚合酶链反应（PCR）检测结核分枝杆菌。

结果

在120份痰液标本中，72例（60%）为男性，48例（4）为女性。14例（19.4%）男性和6例（12.5%）女性患有PTB，根据性别差异无统计学意义，P = 0.229。根据治疗方式，糖尿病患者接受注射胰岛素治疗（36.7%），PCR阳性为4例（33.3%），P值（0.853），口服降糖药（51.7%），PCR阳性7例（58.3%），P值（0.849），饮食控制（11.7%），PCR阳性（1例（8.3%），P值（1.000）差异无统计学意义。58例糖尿病患者的HbA1c频率为24例（41.4%）血糖得到控制（HbA1c水平≤6.5%），34例（58.6%）血糖未得到控制。在60例糖尿病患者中，12例患有未控制血糖的PTB，差异有统计学意义（P = 0.000）。糖尿病的平均病程为（6.92年±标准差6.801），前10年糖尿病的频率为47例（78.3%），（1,1-20）年为10例（16.7%），（21-30）年为3例（5%），PCR阳性的PTB在前10年为10例（21.3%），（11-20）年为2例（20%），（21-30）年为零（0.0%），P值（0.480）差异无统计学意义。