Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa.
Division of Public Health Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa.
Diabetes Res Clin Pract. 2018 Apr;138:16-25. doi: 10.1016/j.diabres.2018.01.018. Epub 2018 Jan 31.
Studies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in sub-Saharan Africa are limited. We assessed the prevalence of active TB among DM patients at a primary care clinic, and identified risk factors for prevalent TB.
A cross-sectional study was conducted in adult DM patients attending a clinic in Khayelitsha, Cape Town. Participants were screened for active TB (symptom screening and microbiological diagnosis) and HIV.
Among 440 DM patients screened, the active TB prevalence was 3.0% (95% CI 1.72-5.03). Of the 13 prevalent TB cases, 53.9% (n = 7; 95% CI 27.20-78.50) had no TB symptoms, and 61.5% (n = 8; 95% CI 33.30-83.70) were HIV-1 co-infected. There were no significant differences in either fasting plasma glucose or HbA levels between TB and non-TB participants. On multivariate analysis, HIV-1 infection (OR 11.3, 95% CI 3.26-39.42) and hemoptysis (OR 31.4, 95% CI 3.62-273.35) were strongly associated with prevalent active TB, with no differences in this association by age or gender.
The prevalence of active TB among DM patients was 4-fold higher than the national prevalence; suggesting the need for active TB screening, particularly if hemoptysis is reported. Our results highlight the importance of HIV screening in this older population group. The high prevalence of sub-clinical TB among those diagnosed with TB highlights the need for further research to determine how best to screen for active TB in high-risk TB/HIV population groups and settings.
在撒哈拉以南非洲地区，针对糖尿病（DM）和结核病（TB）之间关联的研究有限。我们评估了初级保健诊所中 DM 患者中活动性 TB 的患病率，并确定了 TB 流行的危险因素。
在开普敦的 Khayelitsha 进行了一项横断面研究，纳入在诊所就诊的成年 DM 患者。参与者接受了活动性 TB（症状筛查和微生物学诊断）和 HIV 的筛查。
在筛查的 440 名 DM 患者中，活动性 TB 的患病率为 3.0%（95%CI 1.72-5.03）。在 13 例流行的 TB 病例中，53.9%（n=7；95%CI 27.20-78.50）没有 TB 症状，61.5%（n=8；95%CI 33.30-83.70）合并 HIV-1 感染。TB 组和非 TB 组的空腹血浆葡萄糖或 HbA1c 水平无显著差异。多变量分析显示，HIV-1 感染（OR 11.3，95%CI 3.26-39.42）和咯血（OR 31.4，95%CI 3.62-273.35）与流行的活动性 TB 密切相关，年龄或性别对此无影响。
DM 患者中活动性 TB 的患病率是全国患病率的 4 倍；这表明需要进行活动性 TB 筛查，尤其是如果出现咯血。我们的结果强调了在这一年龄组人群中进行 HIV 筛查的重要性。在诊断为 TB 的患者中，亚临床 TB 的高患病率突出表明，需要进一步研究如何在高风险 TB/HIV 人群和环境中最好地筛查活动性 TB。
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