Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Sichuan, China.
Int J Infect Dis. 2020 Aug;97:69-77. doi: 10.1016/j.ijid.2020.05.080. Epub 2020 May 29.
This study aimed to explore the relationship between glycosylated hemoglobin (HbA1c) and the risk of anti-tuberculosis (TB) drug resistance for TB-type 2 diabetes mellitus (T2DM) patients.
From March 2014 to June 2019, medical records from multiple centers were searched. Logistic regression analyses were performed. A predictive model for multidrug-resistance (MDR) was developed and validated. Calibration and discrimination of the model were assessed.
Inconsistent results were found in the systemic review. A multicenter chart review with 657 records was thus conducted. The HbA1c <7% group and HbA1c ≥7% group had 390 and 267 patients, respectively. The HbA1c<7% group had a lower risk of developing rifampicin resistance, isoniazid resistance and MDR, with odd ratios (ORs) of 1.904 (p=0.001), 2.896 (p<0.001) and 3.228 (p<0.001), respectively. The between-group differences in the risk of anti-TB drug resistance were analyzed based on data from three provinces in China. After adding HbA1c grading, the predictive model for MDR (https://mengyuan.shinyapps.io/Shinyapp/) showed excellent capacity with an AUC of 75.4% in the training set (Sichuan and Gansu) and 73.9% in the internal validation set (Henan). The performances in calibration, prediction probabilities and net clinical benefit were significantly improved by HbA1c grading.
HbA1c grading was an independent risk factor for isoniazid resistance and MDR in TB-T2DM patients.
本研究旨在探讨糖化血红蛋白（HbA1c）与结核病（TB）-2 型糖尿病（T2DM）患者耐抗结核药物（TB）风险之间的关系。
本研究检索了 2014 年 3 月至 2019 年 6 月期间多个中心的病历记录，进行了逻辑回归分析，建立并验证了多药耐药（MDR）的预测模型，并评估了模型的校准和区分能力。
系统评价结果不一致，因此进行了一项包含 657 例病历的多中心图表回顾。HbA1c<7%组和 HbA1c≥7%组分别有 390 例和 267 例患者。HbA1c<7%组发生利福平耐药、异烟肼耐药和 MDR 的风险较低，比值比（OR）分别为 1.904（p=0.001）、2.896（p<0.001）和 3.228（p<0.001）。根据中国三个省份的数据，分析了两组之间抗 TB 药物耐药风险的差异。加入 HbA1c 分级后，MDR 预测模型（https://mengyuan.shinyapps.io/Shinyapp/）在训练集（四川和甘肃）的 AUC 为 75.4%，内部验证集（河南）的 AUC 为 73.9%，具有良好的能力。HbA1c 分级显著改善了校准、预测概率和净临床获益的性能。
HbA1c 分级是 TB-T2DM 患者异烟肼耐药和 MDR 的独立危险因素。
