华东耐药监测中的一项调查研究：肺结核合并与未合并糖尿病患者的流行病学特征及其影响因素分析。
Epidemiological Characteristics and Their Influencing Factors Among Pulmonary Tuberculosis Patients With and Without Diabetes Mellitus: A Survey Study From Drug Resistance Surveillance in East China.
机构信息
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
Quzhou City Center Blood Station, Quzhou, China.
出版信息
Front Public Health. 2022 Jan 24;9:777000. doi: 10.3389/fpubh.2021.777000. eCollection 2021.
BACKGROUND
The burden of pulmonary tuberculosis (TB) and diabetes mellitus (DM) have become serious global concerns, while the comprehensive evaluations of DM status and drug resistance in TB patients are still lacking.
METHODS
All details of TB cases were collected from drug resistance monitoring sentinels in Zhejiang province. Fisher's exact test or Pearson chi-square test (χ) was used to compare the baseline characteristics among TB with different DM statuses. The logistic regression model was used to estimate the relationship between DM and different drug resistance spectra. Univariate analysis and multivariate logistic model were used to explore the possible risk factors of drug resistance in TB patients with DM and no DM.
RESULTS
936 TB cases with smear-positive in Zhejiang province were collected, in which 76 patients (8.12%) owned the co-morbidity of DM. TB-DM prevalence was higher in older, Han nationality, employed, accompanied by no health insurance and hepatitis B status. Among 860 cases of TB-no DM and 76 cases of TB-DM, drug resistance-TB accounted for 31.51% and 23.68% ( > 0.05), MR-TB accounted for 15.93% and 14.47% ( > 0.05), respectively. MDR-TB was 4.88% and 6.58% ( > 0.05). The incidence of poly-drug resistant tuberculosis (PDR-TB) in TB-no DM patients (10.70 vs. 2.63%, OR: 4.43; 95% CI, 1.07-18.36) was higher than that in the TB-DM group ( < 0.05). In univariate and multivariate analysis, none of the basic factors were statistically significant with drug resistance among TB-DM cases (all > 0.05). Retreatment was the risk factor of drug resistance among TB-no DM cases.
CONCLUSIONS
Our results showed that the drug resistance rate of the TB-DM group was not higher than that of the TB-no DM group. Patients with TB-no DM were at a higher risk for PDR-TB, but not for MDR-TB, MR-TB, and drug resistance-TB. Special attention should be paid to TB-no DM patients who have been previously treated. In the future, large-scale and well-designed prospective studies are needed to clarify the impact of DM on the drug-resistance among TB.
背景
肺结核（TB）和糖尿病（DM）的负担已成为全球严重关切的问题，而对 TB 患者的 DM 状况和耐药性的综合评估仍存在不足。
方法
从浙江省耐药监测哨点收集所有 TB 病例的详细信息。采用 Fisher 确切检验或 Pearson 卡方检验（χ）比较不同 DM 状态下 TB 患者的基线特征。采用 logistic 回归模型估计 DM 与不同耐药谱之间的关系。采用单因素分析和多因素 logistic 模型探讨 TB 合并 DM 患者和无 DM 患者耐药的可能危险因素。
结果
共收集浙江省 936 例涂阳 TB 病例，其中 76 例（8.12%）合并 DM。老年、汉族、有工作、未参加医疗保险和乙肝状态的 TB-DM 患病率较高。在 860 例 TB-无 DM 和 76 例 TB-DM 患者中，耐药性 TB 分别占 31.51%和 23.68%（>0.05），耐多药 TB 分别占 15.93%和 14.47%（>0.05），广泛耐药性 TB 分别占 4.88%和 6.58%（>0.05）。TB-无 DM 患者中多药耐药结核病（PDR-TB）的发生率（10.70%比 2.63%，OR：4.43；95%CI，1.07-18.36）高于 TB-DM 组（<0.05）。单因素和多因素分析均显示，TB-DM 患者中无基础因素与耐药性有统计学意义（均>0.05）。复治是 TB-无 DM 患者耐药的危险因素。
结论
我们的结果表明，TB-DM 组的耐药率并不高于 TB-无 DM 组。TB-无 DM 患者发生 PDR-TB 的风险更高，但发生 MDR-TB、MR-TB 和耐药性-TB 的风险并不更高。应特别关注既往治疗过的 TB-无 DM 患者。未来需要开展大规模、精心设计的前瞻性研究，以明确 DM 对 TB 耐药性的影响。
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