中国山东治疗过的糖尿病合并结核病患者的耐药情况。

Drug resistance of previously treated tuberculosis patients with diabetes mellitus in Shandong, China.

机构信息

Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China.

出版信息

Respir Med. 2020 Mar;163:105897. doi: 10.1016/j.rmed.2020.105897. Epub 2020 Feb 7.

DOI:10.1016/j.rmed.2020.105897

PMID:32056837

Abstract

BACKGROUND

Although the association between diabetes mellitus (DM) and tuberculosis (TB) has been well-documented for centuries, evidence of the link between diabetes and drug resistance among previously treated TB patients remains limited and inconsistent.

METHODS

An observational study was performed that involved 1791 retreated TB-no DM patients (refers to TB cases without diabetes) and 93 retreated TB-DM patients (refers to TB cases with diabetes) in Shandong, China from 2004 to 2017. Baseline data including demographic and clinical characteristics, drug susceptibility test (DST) results, and diabetes status were collected. Categorical baseline characteristics were compared by Fisher's exact or Pearson Chi-square test. Univariable analysis and multivariable logistic models were used to estimate the association between diabetes and different drug resistance profiles.

RESULTS

Retreated TB-DM patients have a higher rate of drug resistance than TB-no DM patients (34.41% vs 25.00%, P < 0.01). Diabetes co-morbidity was significantly associated with any drug-resistant tuberculosis (DR-TB, odds ratio (OR):1.56, 95% confidence interval (CI): 1.01-2.43), multidrug resistant tuberculosis (MDR-TB, OR: 2.48, 95%CI:1.39-4.41; adjusted OR (aOR):2.94, 95%CI:1.57-5.48), isoniazid-related resistance (OR:1.71, 95%CI:1.04-2.81), rifampin-related resistance (OR:2.56, 0.54, 95%CI: 1.54-4.26; aOR:2.69, 95%CI:1.524-4.74), isoniazid + rifampin resistance (OR: 3.55, 95%CI:1.33-9.44; aOR:4.13, 95%CI:1.46-11.66), any resistance to isoniazid + streptomycin (OR:2.34, 95%CI:1.41-3.89; aOR:2.22, 95%CI:1.26-3.94), and any resistance to rifampin + isoniazid (OR:2.48, 95%CI:1.39-4.41; aOR:2.94, 95%CI: 1.57-5.48), compared with pan susceptible TB cases, P < 0.05.

CONCLUSIONS

The risk of acquired drug resistance increased significantly among retreated TB-DM patients compared with retreated TB-no DM patients, underlining the necessity of more interventions during the clinical management of TB-DM cases.

摘要

背景

尽管糖尿病（DM）和结核病（TB）之间的关联已被充分证实了几个世纪，但先前治疗过的 TB 患者中糖尿病与药物耐药之间的关联证据仍然有限且不一致。

方法

本研究开展了一项观察性研究，纳入了 2004 年至 2017 年间在中国山东的 1791 例无糖尿病的复治 TB 患者（无糖尿病的 TB 病例）和 93 例有糖尿病的复治 TB 患者（有糖尿病的 TB 病例）。收集了包括人口统计学和临床特征、药物敏感性试验（DST）结果和糖尿病状态在内的基线数据。采用 Fisher 确切检验或 Pearson Chi-square 检验比较分类基线特征。采用单变量分析和多变量逻辑模型来评估糖尿病与不同耐药谱之间的关联。

结果

与无糖尿病的 TB 患者（34.41% vs. 25.00%，P<0.01）相比，有糖尿病的复治 TB 患者的耐药率更高。糖尿病合并症与任何耐药性肺结核（DR-TB，比值比（OR）：1.56，95%置信区间（CI）：1.01-2.43）、耐多药结核病（MDR-TB，OR：2.48，95%CI：1.39-4.41；调整后的 OR（aOR）：2.94，95%CI：1.57-5.48）、异烟肼相关耐药（OR：1.71，95%CI：1.04-2.81）、利福平相关耐药（OR：2.56，0.54，95%CI：1.54-4.26；aOR：2.69，95%CI：1.524-4.74）、异烟肼+利福平耐药（OR：3.55，95%CI：1.33-9.44；aOR：4.13，95%CI：1.46-11.66）、任何异烟肼+链霉素耐药（OR：2.34，95%CI：1.41-3.89；aOR：2.22，95%CI：1.26-3.94）和任何利福平+异烟肼耐药（OR：2.48，95%CI：1.39-4.41；aOR：2.94，95%CI：1.57-5.48）显著相关，P<0.05。