Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, Analysis Group, Los Angeles, California, USA.
Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1269-1276. doi: 10.5588/ijtld.18.0011.
Studies of US populations have produced conflicting findings about the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment outcomes.
To investigate the association between DM and all-cause mortality among patients on anti-tuberculosis treatment in California, USA.
Using TB surveillance data, we conducted a retrospective analysis of California patients with culture-confirmed TB who started anti-tuberculosis treatment during 2010-2014. We used Cox proportional hazards models to estimate the association of DM with all-cause mortality and conducted a sensitivity analysis to estimate the attenuating effect of unmeasured confounding by body mass index.
Among 8461 patients with TB, 2124 (25.1%) had DM and 713 (8.4%) died during anti-tuberculosis treatment. A higher proportion of TB-DM patients died (13.1% vs. 6.8% TB-no DM). After adjusting for confounders, DM was associated with mortality (adjusted hazards ratio [aHR] 1.35, 95%CI 1.15-1.57). There was effect modification by human immunodeficiency virus (HIV) status, with HIV-positive patients having an aHR of 5.33 (95%CI 1.76-16.12).
TB patients with DM had a greater hazard of death during anti-tuberculosis treatment than those without DM. Further investigation into the impact of HIV on the relation of DM to death is necessary.
针对糖尿病（DM）对结核病（TB）治疗结果影响的研究，美国人群的研究结果存在矛盾。
研究美国加利福尼亚州抗结核治疗患者中 DM 与全因死亡率之间的关系。
我们利用结核病监测数据，对 2010-2014 年期间开始抗结核治疗的、经培养确诊为结核病且有完整数据的加利福尼亚州患者进行了回顾性分析。我们使用 Cox 比例风险模型来估计 DM 与全因死亡率之间的关联，并进行敏感性分析来估计体重指数引起的未测量混杂的衰减作用。
在 8461 例结核病患者中，2124 例（25.1%）患有 DM，713 例（8.4%）在抗结核治疗期间死亡。TB-DM 患者的死亡率更高（13.1% vs. TB-无 DM 患者的 6.8%）。在调整混杂因素后，DM 与死亡率相关（校正后的危险比 [aHR] 1.35，95%CI 1.15-1.57）。人类免疫缺陷病毒（HIV）状态存在效应修饰，HIV 阳性患者的 aHR 为 5.33（95%CI 1.76-16.12）。
与无 DM 的 TB 患者相比，DM 的抗结核治疗患者的死亡风险更高。需要进一步研究 HIV 对 DM 与死亡之间关系的影响。
