Mahishale Vinay, Avuthu Sindhuri, Patil Bhagyashri, Lolly Mitchelle, Eti Ajith, Khan Sujeer
Department of Pulmonary Medicine, Karnataka Lingayat Education University`s J. N. Medical College, Belgaum Karnataka, India.
Iran J Med Sci. 2017 Mar;42(2):144-151.
There is growing evidence that diabetes mellitus (DM) is an important risk factor for tuberculosis (TB). A significant number of DM patients have poor glycemic control. This study was carried out to find the impact of poor glycemic control on newly diagnosed smear-positive pulmonary tuberculosis patients with type-2 diabetes mellitus in a tertiary care hospital.
In a hospital-based prospective study, newly diagnosed smear-positive pulmonary TB with DM patients were classified as poorly controlled diabetes (HBA≥7%) and optimal control diabetics (HbA1c<7%). Patients were started on anti-TB treatment and followed for 2 years for severity and treatment outcome. ANOVA was used for numerical variables in the univariable analysis. Logistic regression analysis was used for multivariable analysis of treatment outcome. The significance level was kept at a P≤0.05.
A total of 630 individuals who met the inclusion criteria were analyzed; of which 423 patients had poor glycemic control (PGC) and 207 patients had optimal glycemic control (OGC). The average HbA1c was 10±2.6 and 5±1.50 in the PGC and OGC groups, respectively. The mean symptom score was significantly higher in the PGC group compared with patients in the OGC group (4.55±0.80 vs. 2.70±0.82, P<0.001). PGC was associated with more extensive lung disease, lung cavitation, and positive sputum smear at the baseline. In PGC, sputum smears were significantly more likely to remain positive after 2 months of treatment. PGC patients had significantly higher rates of treatment failure (adj. OR 0.72, 95% CI 0.58-0.74, P<0.001) and relapse (adj. OR 2.83, 95% CI 2.60-2.92, P<0.001).
Poor glycemic control is associated with an increased risk of advanced and more severe TB disease in the form of lung cavitations, positive sputum smear, and slower smear conversion. It has a profound negative effect on treatment completion, cure, and relapse rates in patients with pulmonary tuberculosis.
越来越多的证据表明，糖尿病（DM）是结核病（TB）的一个重要危险因素。相当数量的糖尿病患者血糖控制不佳。本研究旨在探讨血糖控制不佳对一家三级医院新诊断的2型糖尿病涂片阳性肺结核患者的影响。
在一项基于医院的前瞻性研究中，新诊断的涂片阳性肺结核合并糖尿病患者被分为血糖控制不佳组（糖化血红蛋白≥7%）和血糖控制理想组（糖化血红蛋白<7%）。患者开始接受抗结核治疗，并随访2年，观察病情严重程度和治疗结果。单变量分析中，数值变量采用方差分析。治疗结果的多变量分析采用逻辑回归分析。显著性水平设定为P≤0.05。
共分析了630名符合纳入标准的个体；其中423例患者血糖控制不佳（PGC），207例患者血糖控制理想（OGC）。PGC组和OGC组的平均糖化血红蛋白分别为10±2.6和5±1.50。PGC组的平均症状评分显著高于OGC组患者（4.55±0.80对2.70±0.82，P<0.001）。PGC与基线时更广泛的肺部疾病、肺空洞形成和痰涂片阳性相关。在PGC组中，治疗2个月后痰涂片仍呈阳性的可能性显著更高。PGC患者的治疗失败率（校正比值比0.72，95%可信区间0.58 - 0.74，P<0.001）和复发率（校正比值比2.83，95%可信区间2.60 - 2.92，P<0.001）显著更高。
血糖控制不佳与以肺空洞、痰涂片阳性和涂片转阴缓慢为表现的晚期及更严重结核病风险增加相关。它对肺结核患者的治疗完成率、治愈率和复发率有深远的负面影响。
