Zhang Y M, Wang F, van Soolingen D, Anthony R M
People's Hospital of Jianyang City, Hospital Road 180#, Jianyang City, Chengdu, Sichuan Province, China.
Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Public Health Action. 2022 Jun 21;12(2):64-67. doi: 10.5588/pha.21.0070.
To compare the clinical characteristics and laboratory results of pulmonary TB (PTB) patients with and without diabetes mellitus (DM) and the relationship between haemoglobin A1C (HbA1c) concentration and mycobacterial load at county level area in Sichuan Province, China.
A retrospective study was performed from January 2018 to July 2019 inJianyang People's Hospital, Sichuan Province. Clinical characteristics and laboratory results of newly diagnosed TB patients were collected. Univariable and multivariable logistic regression analyses were performed. The Kruskal-Wallis test was used to compare HbA1c level and mycobacterial load.
The final sample included 415 patients with TB, of whom 45 were diagnosed with DM (10.8%). Uni-variable logistic regression showed that PTB patients with concomitant DM were more likely to present with haemoptysis, positive acid-fast bacilli (AFB) smear, cavity, higher erythrocyte sedimentation rate (ESR), higher serum C-reactive protein (CRP), lower serum albumin (ALB), or higher fasting blood glucose (FBG). Multivariate logistic regression analyses showed that AFB smear positivity (OR 15.81, 95% CI 3.09-80.95) and FBG (OR 1.88, 95% CI 1.53-2.31) were independent risk factors of DMPTB. The mycobacterial load was heaviest when the HbA1c was 7.9 mmol/L (95% CI 7.35-11.1) and declined along with HbA1c rising up. But it has not been significantly associated with HbA1c.
Patients with PTB over 45 years old, with haemoptysis, positive AFB, cavity, higher ESR, higher CRP, lower ALB or higher FBG are more likely to present with concomitant DM. Patients with PTB with these factors need to be targeted for DM screening. The mycobacterial load has not been significantly associated with HbA1c.
比较中国四川省某县级地区合并和未合并糖尿病（DM）的肺结核（PTB）患者的临床特征和实验室检查结果，以及糖化血红蛋白（HbA1c）浓度与分枝杆菌载量之间的关系。
2018年1月至2019年7月在四川省简阳市人民医院进行一项回顾性研究。收集新诊断结核病患者的临床特征和实验室检查结果。进行单变量和多变量逻辑回归分析。采用Kruskal-Wallis检验比较HbA1c水平和分枝杆菌载量。
最终样本包括415例结核病患者，其中45例被诊断为DM（10.8%）。单变量逻辑回归显示，合并DM的PTB患者更易出现咯血、抗酸杆菌（AFB）涂片阳性、空洞、红细胞沉降率（ESR）升高、血清C反应蛋白（CRP）升高、血清白蛋白（ALB）降低或空腹血糖（FBG）升高。多变量逻辑回归分析显示，AFB涂片阳性（比值比15.81，95%置信区间3.09-80.95）和FBG（比值比1.88，95%置信区间1.53-2.31）是糖尿病合并肺结核（DMPTB）的独立危险因素。当HbA1c为7.9 mmol/L（95%置信区间7.35-11.1）时分枝杆菌载量最高，并随HbA1c升高而下降。但它与HbA1c无显著相关性。
年龄超过45岁、有咯血、AFB阳性、空洞、ESR升高、CRP升高、ALB降低或FBG升高的PTB患者更易合并DM。有这些因素的PTB患者需要针对性地进行DM筛查。分枝杆菌载量与HbA1c无显著相关性。
