Gedfew Mihretie
College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
J Clin Tuberc Other Mycobact Dis. 2021 Oct 16;25:100280. doi: 10.1016/j.jctube.2021.100280. eCollection 2021 Dec.
Extrapulmonary tuberculosis is an emerging public health problem among diabetic patients. Diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Therefore, this study aimed to investigate the incidence and predictors of extra pulmonary tuberculosis among diabetic patients at Debre Markos referral hospital, Northwest Ethiopia.
This institutionally-based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos compressive specialized hospital between January 2016 to December 2020. All eligible diabetic patients who full filled the inclusion criteria were included in the study. Data were entered using Epi-data Version 3.1 and analyzed using STATA Version 14. The survival time of diabetic patients was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables was compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients.
Among a cohort of 433 diabetic patients at Debre Markos compressive specialized hospital, 17(3.9%) developed extra pulmonary tuberculosis during the follow-up time. The total time allotted to follow up the study participants was 1101.5 person-years (PY). The overall extra pulmonary tuberculosis incidence rate was 1.5 per 100 PY with 95% CI. Using the multivariable Cox-regression analysis, age (AIR 4.8 (95% CI (1.2-20.7), 0.03), diabetic medication (AIR 1.4 (95% CI(1.24-16), 0.03), having past history of PTB before diabetic follow up initiation (AID 1.5(95% CI (3.2-6.9),0.01) and having history of alcohol (AIR (95%CI (4(1.2-13),0.02) were significantly increased the risk of extra pulmonary tuberculosis while BMI (18.5-25) AIR(95% CI (0.22 (0.06-0.76), 0.02) was associated with a rate reduction for the incidence of extra pulmonary tuberculosis.
In this study, we found a high rate of extra pulmonary tuberculosis among diabetic patients. Factors significantly linked with increased risk of extra pulmonary tuberculosis included: age, using insulin as hypoglycemic medication, having past history of PTB before diabetic follow up initiation and alcoholic history while BMI was associated with a rate reduction of EPTB. Early screening and treatment for extra pulmonary tuberculosis is highly recommended at diabetes mellitus follow up for patients with the above risk factors.
肺外结核是糖尿病患者中一个新出现的公共卫生问题。糖尿病会导致免疫抑制，越来越被认为是结核病的一个独立危险因素，且二者常并存并相互影响。因此，本研究旨在调查埃塞俄比亚西北部德布雷马科斯转诊医院糖尿病患者肺外结核的发病率及预测因素。
本基于机构的回顾性队列研究在德布雷马科斯综合专科医院的433例糖尿病患者中进行，研究时间为2016年1月至2020年12月。所有符合纳入标准的合格糖尿病患者均纳入研究。数据使用Epi-data 3.1版本录入，并用STATA 14版本进行分析。使用Kaplan-Meier生存曲线估计糖尿病患者的生存时间，并用对数秩检验比较不同分类变量之间的生存时间。采用双变量和多变量Cox比例风险回归模型来确定糖尿病患者中结核病的独立预测因素。
在德布雷马科斯综合专科医院的433例糖尿病患者队列中，17例（3.9%）在随访期间发生了肺外结核。分配给研究参与者的总随访时间为1101.5人年（PY）。肺外结核的总体发病率为每100 PY 1.5例，95%置信区间。采用多变量Cox回归分析，年龄（风险比4.8（95%置信区间（1.2 - 20.7），P = 0.03）、糖尿病用药（风险比1.4（95%置信区间（1.24 - 16），P = 0.03）、在糖尿病随访开始前有肺结核病史（风险比1.5（95%置信区间（3.2 - 6.9），P = 0.01）以及有饮酒史（风险比（95%置信区间（4（1.2 - 13），P = 0.02）显著增加了肺外结核的风险，而体重指数（18.5 - 25）（风险比（95%置信区间（0.22（0.06 - 0.76），P = 0.02）与肺外结核发病率降低相关。
在本研究中，我们发现糖尿病患者中肺外结核的发生率较高。与肺外结核风险增加显著相关的因素包括：年龄、使用胰岛素作为降糖药物、在糖尿病随访开始前有肺结核病史以及饮酒史，而体重指数与肺外结核发病率降低相关。强烈建议对有上述危险因素的糖尿病患者在随访时进行肺外结核的早期筛查和治疗。
