Beijing Hospital, National Center of Gerontology, Beijing, China.
Jilin Provincial Academy of Tuberculosis Control and Prevention, Changchun, China.
PLoS One. 2018 Nov 1;13(11):e0206372. doi: 10.1371/journal.pone.0206372. eCollection 2018.
Vitamin D could be a mediator in the association between tuberculosis (TB) and diabetes mellitus (DM). A large scale multi-center study confirmed that TB patients with DM had significantly lower serum vitamin D level compared with those without DM and reported that DM was a strong independent risk factor for vitamin D deficiency.
This study was undertaken to determine amongst patients with both TB and DM living in different economically defined areas in China: i) their baseline characteristics, ii) their vitamin D status and iii) whether certain baseline characteristics were associated with vitamin D deficiency.
In DM-TB patients consecutively attending seven clinics or hospitals, we measured 25 hydroxycholecalciferol at the time of registration using electrochemiluminescence in a COBASE 601 Roche analyser by chemiluminescence immunoassay. Data analysis was performed using chi square test and multivariate logistic regression.
There were 178 DM-TB patients that included 50 from economically well-developed areas, 103 from better-off areas and 25 from a poverty area. Median vitamin D levels in well-developed, better-off and poverty areas were 11.5ng/ml, 12.2ng/ml and 11.5ng/ml respectively. Amongst all patients, 149 (84%) had vitamin D deficiency-91 (51%) with vitamin D deficiency (10-19.9 ng/ml) and 58 (33%) with severe deficiency (< 10 ng/ml). There was a significantly higher proportion with vitamin D deficiency in the poverty area. The adjusted odds of vitamin D deficiency (25-(OH)D3 <20 ng/ml) were significantly higher in those with longer history of DM (P = 0.038) and with HbA1c≥10% (P = 0.003).
Over 80% of TB patients with DM in China were vitamin D deficient, with risk factors being residence in a poverty area, a long duration of DM and uncontrolled DM. TB programme managers and clinicians need to pay more attention to the vitamin D status of their patients.
维生素 D 可能是结核病（TB）和糖尿病（DM）之间关联的中介。一项大规模多中心研究证实，与无 DM 的 TB 患者相比，DM 患者的血清维生素 D 水平明显更低，并报告 DM 是维生素 D 缺乏的强独立危险因素。
本研究旨在确定在中国不同经济定义地区居住的同时患有 TB 和 DM 的患者中：i）他们的基线特征，ii）他们的维生素 D 状况，以及 iii）某些基线特征是否与维生素 D 缺乏有关。
在连续就诊于七家诊所或医院的 DM-TB 患者中，我们使用 Roche 公司的 COBASE 601 电化学发光分析仪，通过化学发光免疫分析法，在登记时测量 25 羟胆钙化醇。使用卡方检验和多变量逻辑回归进行数据分析。
共有 178 例 DM-TB 患者，其中 50 例来自经济发达地区，103 例来自较富裕地区，25 例来自贫困地区。发达地区、较富裕地区和贫困地区的中位维生素 D 水平分别为 11.5ng/ml、12.2ng/ml 和 11.5ng/ml。在所有患者中，149 例（84%）存在维生素 D 缺乏症-91 例（51%）存在维生素 D 缺乏症（10-19.9ng/ml），58 例（33%）存在严重缺乏症（<10ng/ml）。贫困地区维生素 D 缺乏症的比例明显更高。患有较长时间 DM（P=0.038）和 HbA1c≥10%（P=0.003）的患者，维生素 D 缺乏症（25-（OH）D3<20ng/ml）的调整后比值比明显更高。
中国超过 80%的同时患有 TB 和 DM 的患者维生素 D 缺乏，其危险因素是居住在贫困地区、DM 病程较长和 DM 控制不佳。TB 规划管理者和临床医生需要更加关注患者的维生素 D 状况。
