Respiratory Department, Xiangya Hospital, Central South University, Changsha, China.
Tongji University, Shanghai, China.
J Chin Med Assoc. 2019 Dec;82(12):915-921. doi: 10.1097/JCMA.0000000000000205.
Multiple studies of tuberculosis (TB) treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-TB treatment effects in patients afflicted with both TB and DM.
Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-TB treatment effects (sputum conversion rate [SCR] and TB focus absorption) in diabetic patients receiving treatment for TB. We used RevMan 5.3 software to analyze the data.
We included 12 studies, of which five reported SCR at 2 months, seven reported the conversion at 3 months, and seven reported TB focus absorption. According to the five studies which reported 2 months-SCR, patients with diabetes and TB had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the 2 months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, additional seven studies reporting 3 months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the 12 studies demonstrated that there were differences in TB focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79).
HbA1c control levels influence the SCR at 3 months and the TB focus absorption at the end of the anti-TB intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.
多项结核病 (TB) 治疗研究表明，糖尿病患者可能会出现不良结局。我们进行了一项荟萃分析，以总结 HbA1c 控制水平与同时患有结核病和糖尿病的患者抗结核治疗效果之间关系的证据。
检索中英文数据库。中文数据库包括中国知网、万方、中国生物医学文献服务系统和维普。英文检索PubMed、Ovid MEDLINE、Embase、Cochrane 图书馆和 Web of Science。纳入的研究仅限于 HbA1c 水平与接受抗结核治疗的糖尿病患者抗结核治疗效果（痰转阴率[SCR]和结核病灶吸收）之间关系的研究。采用 RevMan 5.3 软件进行数据分析。
我们纳入了 12 项研究，其中 5 项报告了 2 个月时的 SCR，7 项报告了 3 个月时的转化率，7 项报告了结核病灶吸收。根据 5 项报告 2 个月 SCR 的研究，糖尿病合并结核病患者的 2 个月 SCR 的优势比（OR）为 2.14（95%CI：0.84-5.43），控制组（HbA1c<7.0）与未控制组（HbA1c≥7.0）之间的差异有统计学意义。然而，另外 7 项报告 3 个月 SCR 的研究表明，控制良好的糖尿病患者的 SCR 高于未控制的患者（OR 3.39，95%CI：2.12-5.43）。此外，12 项研究中的 7 项表明，控制组和未控制组在结核病灶吸收方面存在差异（OR 2.69，95%CI：1.91-3.79）。
HbA1c 控制水平影响抗结核强化治疗阶段 3 个月时的 SCR 和结束时的结核病灶吸收。本研究强调了需要更加关注同时患有结核病和糖尿病的患者的 HbA1c 或血糖控制。
