印度尼西亚万隆糖尿病患者中的潜伏性结核感染和肺结核病

Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia.

作者信息

Koesoemadinata Raspati C, McAllister Susan M, Soetedjo Nanny N M, Febni Ratnaningsih Dwi, Ruslami Rovina, Kerry Sarah, Verrall Ayesha J, Apriani Lika, van Crevel Reinout, Alisjahbana Bachti, Hill Philip C

机构信息

TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.

Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand.

出版信息

Trans R Soc Trop Med Hyg. 2017 Feb 1;111(2):81-89. doi: 10.1093/trstmh/trx015.

DOI:10.1093/trstmh/trx015

PMID:28419376

Abstract

BACKGROUND

Screening and treatment of latent TB infection (LTBI) and TB disease could reduce diabetes mellitus (DM)-associated TB. We aimed to describe the prevalence of LTBI and pulmonary TB among patients with DM in a TB-endemic setting.

METHODS

Patients with DM attending a hospital and community centres in Bandung, Indonesia, underwent LTBI screening using interferon gamma release assay (IGRA). TB was investigated by sputum smear, culture and x-ray. TB contacts from a parallel study were age- and sex-matched to patients with DM to compare LTBI and TB disease prevalence.

RESULTS

Of 682 patients with DM screened, 651 (95.5%) were eligible. Among 'TB disease-free' patients, LTBI prevalence was 38.9% (206/530; 95% CI 34.7-43.2). Patients with DM were less likely to be IGRA positive than TB contacts (38.6%, 54/140; 95% CI 30.5-46.6 vs 68.6%, 96/140; 95% CI 60.9-72.3: p<0.001); but had a higher disease prevalence (4.9%, 8/164; 95% CI 1.6-8.2 vs 1.2%, 2/164; 95% CI -0.5 to 2.9: p=0.054). Patients with DM in crowded households had increased risk of LTBI (AOR 1.71; 95% CI 1.19-2.45).

CONCLUSIONS

LTBI prevalence in patients with DM was lower than in household contacts, but patients with DM were more likely to have TB disease. Further studies should explore possible benefits of LTBI screening and preventive therapy in patients with DM in TB-endemic settings.

摘要

背景

潜伏性结核感染（LTBI）和结核病的筛查与治疗可降低糖尿病（DM）相关结核病的发生。我们旨在描述结核病流行地区糖尿病患者中LTBI和肺结核的患病率。

方法

在印度尼西亚万隆的医院和社区中心就诊的糖尿病患者采用干扰素γ释放试验（IGRA）进行LTBI筛查。通过痰涂片、培养和X线检查来排查结核病。将一项平行研究中的结核接触者按年龄和性别与糖尿病患者进行匹配，以比较LTBI和结核病的患病率。

结果

在筛查的682例糖尿病患者中，651例（95.5%）符合条件。在“无结核病”患者中，LTBI患病率为38.9%（206/530；95%可信区间34.7 - 43.2）。糖尿病患者IGRA阳性的可能性低于结核接触者（38.6%，54/140；95%可信区间30.5 - 46.6 对比68.6%，96/140；95%可信区间60.9 - 72.3：p<0.001）；但疾病患病率更高（4.9%，8/164；95%可信区间1.6 - 8.2对比1.2%，2/164；95%可信区间 - 0.5至2.9：p = 0.054）。居住在拥挤家庭中的糖尿病患者LTBI风险增加（调整后比值比1.71；95%可信区间1.19 - 2.45）。