Africa Health Research Institute, KwaZulu-Natal, South Africa.
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2023 Mar 16;18(3):e0282371. doi: 10.1371/journal.pone.0282371. eCollection 2023.
Tuberculosis (TB) may predispose individuals to the development of diabetes. Such a relationship could have an outsized impact in high-prevalence TB settings. However, few studies have explored this relationship in populations heavily burdened by diabetes and TB.
We analyzed data from a community-based population cohort that enrolled adults in rural South Africa. Individuals were considered to have prior TB if they self-reported a history of TB treatment. We fitted sex-specific logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between dysglycemia (HBA1c ≥6.5%) and prior TB. Propensity score-matched cohorts accounted for the differential age distributions between comparator groups. We examined the interactions between sex, prior TB, and HIV status.
In the analytic cohort (n = 17,593), the prevalence of prior TB was 13.8% among men and 10.7% among women. Dysglycemia was found in 9.1% of the population, and HIV prevalence was 34.0%. We found no difference in dysglycemia prevalence by prior TB (men OR 0.96, 95% CI 0.60-1.56: women OR 1.05, 95% CI 0.79-1.39). However, there was a qualitative interaction by HIV serostatus, such that among men without HIV, those with a history of TB had a greater prevalence of dysglycemia than those without prior TB (10.1% vs. 4.6%, p = 0.0077). An inverse relationship was observed among men living with HIV (prior TB 3.3% vs. no TB 7.3%, p = 0.0073).
Treated TB disease was not associated with dysglycemia in an HIV-endemic, rural South African population. However, we found a significant interaction between prior TB and HIV status among men, suggesting distinct pathophysiological mechanisms between the two infections that may impact glucose metabolism. Longitudinal studies are needed to better establish a causal effect and underlying mechanisms related to resolved TB, HIV, and diabetes.
结核病（TB）可能使个体易患糖尿病。在结核病高发地区，这种关系可能会产生巨大影响。然而，很少有研究在深受糖尿病和结核病负担影响的人群中探讨这种关系。
我们分析了一项基于社区的人群队列研究的数据，该研究招募了南非农村地区的成年人。如果个体自述有结核病治疗史，则认为其患有既往结核病。我们使用性别特异性逻辑回归模型，调整了潜在的临床和人口统计学混杂因素，以估计血糖异常（HBA1c≥6.5%）与既往结核病之间的关系。倾向评分匹配队列考虑了对照组之间不同的年龄分布。我们检查了性别、既往结核病和 HIV 状态之间的相互作用。
在分析队列中（n=17593），男性既往结核病的患病率为 13.8%，女性为 10.7%。人群中血糖异常的患病率为 9.1%，HIV 患病率为 34.0%。我们没有发现既往结核病与血糖异常患病率之间的差异（男性 OR 0.96，95%CI 0.60-1.56；女性 OR 1.05，95%CI 0.79-1.39）。然而，HIV 血清学状态存在定性交互作用，即对于没有 HIV 的男性，既往有结核病史者的血糖异常患病率高于没有既往结核病者（10.1%比 4.6%，p=0.0077）。在感染 HIV 的男性中则观察到相反的关系（既往结核病 3.3%比无结核病 7.3%，p=0.0073）。
在 HIV 流行的南非农村人群中，治疗过的结核病与血糖异常无关。然而，我们发现既往结核病与 HIV 状态之间存在显著的交互作用，这表明两种感染之间存在不同的病理生理机制，可能影响葡萄糖代谢。需要进行纵向研究，以更好地确定与已治愈的结核病、HIV 和糖尿病相关的因果效应和潜在机制。
