Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana.
West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana.
PLoS One. 2019 Feb 7;14(2):e0211822. doi: 10.1371/journal.pone.0211822. eCollection 2019.
Diabetes Mellitus (DM) is a known risk factor for tuberculosis (TB) but little is known on TB-Diabetes Mellitus (TBDM) co-morbidity in Sub-Saharan Africa.
Consecutive TB cases registered at a tertiary facility in Ghana were recruited from September 2012 to April 2016 and screened for DM using random blood glucose and glycated hemoglobin (HbA1c) level. TB patients were tested for other clinical parameters including HIV co-infection and TB lesion location. Mycobacterial isolates obtained from collected sputum samples were characterized by standard methods. Associations between TBDM patients' epidemiological as well as microbiological variables were assessed.
The prevalence of DM at time of diagnosis among 2990 enrolled TB cases was 9.4% (282/2990). TBDM cases were significantly associated with weight loss, poor appetite, night sweat and fatigue (p<0.001) and were more likely (p<0.001) to have lower lung cavitation 85.8% (242/282) compared to TB Non-Diabetic (TBNDM) patients 3.3% (90/2708). We observed 22.3% (63/282) treatment failures among TBDM patients compared to 3.8% (102/2708) among TBNDM patients (p<0.001). We found no significant difference in the TBDM burden attributed by M. tuberculosis sensu stricto (Mtbss) and Mycobacterium africanum (Maf) and (Mtbss; 176/1836, 9.6% and Maf; 53/468, 11.3%, p = 0.2612). We found that diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mtbss (odds ratio (OR) = 1.52; 95% confidence interval (CI): 0.92-2.42, p = 0.072).
Our findings confirms the importance of screening for diabetes during TB diagnosis and highlights the association between genetic diversity and diabetes. in Ghana.
糖尿病（DM）是结核病（TB）的已知危险因素，但在撒哈拉以南非洲，关于 TB-糖尿病（TBDM）合并症的了解甚少。
2012 年 9 月至 2016 年 4 月，在加纳的一家三级医疗机构连续招募了登记的结核病例，并使用随机血糖和糖化血红蛋白（HbA1c）水平筛查 DM。TB 患者还测试了其他临床参数，包括 HIV 合并感染和 TB 病变部位。从收集的痰样本中获得的分枝杆菌分离株采用标准方法进行特征描述。评估了 TBDM 患者的流行病学和微生物学变量之间的关联。
在 2990 名纳入的 TB 病例中，诊断时 DM 的患病率为 9.4%（282/2990）。TBDM 病例与体重减轻、食欲不振、夜间出汗和疲劳显著相关（p<0.001），并且与 TB 非糖尿病（TBNDM）患者（2708 例中的 3.3%，90 例）相比，更有可能（p<0.001）出现更低的肺部空洞化 85.8%（282 例中的 242 例）。与 TBNDM 患者（2708 例中的 3.8%，102 例）相比，我们观察到 TBDM 患者中（282 例中的 63 例）治疗失败的比例为 22.3%（p<0.001）。我们发现，由结核分枝杆菌严格型（Mtbss）和非洲分枝杆菌（Maf）引起的 TBDM 负担没有显著差异（Mtbss：176/1836，9.6%和 Maf：53/468，11.3%，p=0.2612）。我们发现，与 Mtbss 相比，糖尿病患者更有可能患有由 M. africanum 谱系 6 引起的结核病（优势比（OR）=1.52；95%置信区间（CI）：0.92-2.42，p=0.072）。
我们的研究结果证实了在 TB 诊断期间筛查糖尿病的重要性，并强调了遗传多样性与糖尿病之间的关联。在加纳。
