中国不同经济地区糖尿病合并肺结核患者的维生素 D 状况及相关因素。
Vitamin D status of tuberculosis patients with diabetes mellitus in different economic areas and associated factors in China.
机构信息
Beijing Hospital, National Center of Gerontology, Beijing, China.
Jilin Provincial Academy of Tuberculosis Control and Prevention, Changchun, China.
出版信息
PLoS One. 2018 Nov 1;13(11):e0206372. doi: 10.1371/journal.pone.0206372. eCollection 2018.
BACKGROUND
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.
OBJECTIVES
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
背景
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。
目的
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。
方法
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。
结果
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。
结论
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。
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