Lawson Lovett, Muc Magdalena, Oladimeji Olanrewaju, Iweha Chijioke, Opoola Blessing, Abdurhaman Saddiq T, Bimba John S, Cuevas Luis E
Department of Community Medicine and Primary Healthcare, Bingham University, Karu, Nasarawa State, Nigeria; Zankli Medical Centre, Abuja, Nigeria.
Liverpool School of Tropical Medicine, Liverpool, UK.
Int J Infect Dis. 2017 Aug;61:121-125. doi: 10.1016/j.ijid.2017.06.014. Epub 2017 Jun 23.
Type 2 diabetes mellitus (DM) and HIV increase the risk of tuberculosis (TB). The frequency of DM among patients with TB with and without HIV is poorly documented in many low- and middle-income countries.
This was a cross-sectional hospital-based study performed in Abuja, Nigeria. Adults with presumptive TB were screened consecutively. Sputum culture was used for TB screening and blood was used for HIV screening, as well as fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) assessment for the diagnosis of DM. HbA1c was measured using the D-10 Haemoglobin Testing System and a point-of-care test (A1C Now+ system) for comparison. Patients were classified as having DM or pre-diabetes using the D-10 reference test.
Four hundred and ten individuals had TB culture, FPG, and HbA1c results. Participants had a mean (±standard deviation) age of 37.8±12.6 years and 217 (54.8%) were male. One hundred and thirteen (27.6%) patients were culture-positive, 62 (15.1%) had DM, and 46 (11.2%) had pre-diabetes. One hundred and eighty-four (53.3%) participants were HIV-positive and 95 (51.6%) were on antiretroviral therapy (ART). Patients with pre-diabetes and DM were more likely to have TB (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.01-3.74, and OR 2.39, 95% CI 1.35-4.24, respectively). After adjustment for HIV, age, and sex, only DM was statistically associated with TB (adjusted OR (AOR) 3.10, 95% CI 1.62-5.94). HIV-negative patients with DM had a higher risk of TB (AOR 4.32, 95% CI 1.57-11.92) than HIV-positive patients with DM (AOR 3.31, 95% CI 1.29-8.54), but the difference was not statistically significant. A1C Now+ HbA1c measurements correlated poorly with the D-10 HbA1c reference test.
A high proportion of patients in Abuja have markers of DM and pre-diabetes at the time of TB diagnosis.
2型糖尿病（DM）和人类免疫缺陷病毒（HIV）会增加患结核病（TB）的风险。在许多低收入和中等收入国家，合并或未合并HIV的结核病患者中DM的发病率鲜有文献记载。
这是一项在尼日利亚阿布贾进行的基于医院的横断面研究。对疑似患有结核病的成年人进行连续筛查。痰培养用于结核病筛查，血液用于HIV筛查，同时检测空腹血糖（FPG）和糖化血红蛋白（HbA1c）以诊断DM。使用D-10血红蛋白检测系统测量HbA1c，并使用即时检验（A1C Now+系统）进行比较。根据D-10参考检测将患者分类为患有DM或糖尿病前期。
410名个体有结核病培养、FPG和HbA1c检测结果。参与者的平均（±标准差）年龄为37.8±12.6岁，217名（54.8%）为男性。113名（27.6%）患者培养结果呈阳性，62名（15.1%）患有DM，46名（11.2%）患有糖尿病前期。184名（53.3%）参与者HIV检测呈阳性，95名（51.6%）正在接受抗逆转录病毒治疗（ART）。患有糖尿病前期和DM的患者更易患结核病（优势比（OR）分别为1.94，95%置信区间（CI）0.01 - 3.74，以及OR 2.39，95%CI 1.35 - 4.24）。在对HIV、年龄和性别进行校正后，仅DM与结核病存在统计学关联（校正OR（AOR）3.10，95%CI 1.62 - 5.94）。HIV阴性的DM患者患结核病的风险（AOR 4.32，95%CI 1.57 - 11.92）高于HIV阳性的DM患者（AOR 3.31，95%CI 1.29 - 8.54），但差异无统计学意义。A1C Now+ HbA1c测量值与D-10 HbA1c参考检测的相关性较差。
在阿布贾，很大一部分患者在结核病诊断时已有DM和糖尿病前期的标志物。
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