二肽基肽酶IV抑制剂与2型糖尿病患者发生分枝杆菌肺部感染的风险

Dipeptidyl peptidase IV inhibitors and the risk of mycobacterial pulmonary infections in type 2 diabetes mellitus.

作者信息

Wang Cheng-Yi, Liao Kuang-Ming, Wang Ya-Hui, Chen Kuang-Hung, Chuang Shulin, Liu Chia-Jung, Shu Chin-Chung, Wang Hao-Chien

机构信息

Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.

Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan.

出版信息

J Infect Public Health. 2023 Nov;16(11):1709-1715. doi: 10.1016/j.jiph.2023.08.018. Epub 2023 Aug 26.

DOI:10.1016/j.jiph.2023.08.018

PMID:37729686

Abstract

BACKGROUND

Type 2 diabetes mellitus (DM) is a risk factor for mycobacterial pulmonary infections (MPI), including tuberculosis (TB) and nontuberculous mycobacterial lung disease (NTM-LD). Dipeptidyl peptidase IV inhibitor (DPP4i), a common DM medication, has an immune-modulation effect that raises concerns about developing MPI. However, there is scarce research on the topic.

METHODS

This retrospective study was conducted in a tertiary-referral center in Taiwan from 2009 to 2016. Patients with type 2 DM who were receiving any DM medication were enrolled. TB and NTM-LD were defined by microbiological criteria. We analyzed the risk of MPI in DPP4i users using Cox proportional hazard regression with adjusted inverse probability of treatment weighting.

RESULTS

A total of 9963 patients were included. Among them, 3931 were classified as DPP4i users, and 6032 patients were DPP4i nonusers. DPP4i users had no increase in incidences of MPI (604 vs. 768 per 100,000 person-years, p = 0.776), NTM-LD (174 vs. 255 per 100,000 person-years, p = 0.228), and TB (542 vs. 449 per 100,000 person-years, p = 0.663) relative to those of DPP4i nonusers. After adjustment, the adjusted hazard ratios for MPI (aHR: 1.07, 95% CI: 0.79-1.45), TB (aHR: 1.15, 95% CI: 0.81-1.64) and NTM-LD (aHR: 0.85, 95% CI: 0.49-1.47) were not significantly increased relative to those of nonusers. The subgroup analysis also showed that DPP4i use did not increase the risk of MPI in different DM severities and comorbidities.

CONCLUSIONS

According to our large cohort study, DPP4i use is safe for patients with type 2 DM and might not increase the risk of MPI.

摘要

背景

2型糖尿病（DM）是包括肺结核（TB）和非结核分枝杆菌肺病（NTM-LD）在内的分枝杆菌肺部感染（MPI）的一个危险因素。二肽基肽酶IV抑制剂（DPP4i）是一种常用的糖尿病药物，具有免疫调节作用，这引发了人们对发生MPI的担忧。然而，关于该主题的研究很少。

方法

这项回顾性研究于2009年至2016年在台湾的一家三级转诊中心进行。纳入正在接受任何糖尿病药物治疗的2型糖尿病患者。TB和NTM-LD根据微生物学标准定义。我们使用Cox比例风险回归和调整后的治疗权重逆概率分析了DPP4i使用者发生MPI的风险。

结果

共纳入9963例患者。其中，3931例被归类为DPP4i使用者，6032例患者为非DPP4i使用者。与非DPP4i使用者相比，DPP4i使用者的MPI发病率（每10万人年604例对768例，p = 0.776）、NTM-LD发病率（每10万人年174例对255例，p = 0.228）和TB发病率（每10万人年542例对449例，p = 0.663）均未增加。调整后，MPI（调整后风险比：1.07，95%置信区间：0.79-1.45）、TB（调整后风险比：1.15，95%置信区间：0.81-1.64）和NTM-LD（调整后风险比：0.85，95%置信区间：0.49-1.47）的调整后风险比相对于非使用者没有显著增加。亚组分析还表明，在不同的糖尿病严重程度和合并症中，使用DPP4i不会增加MPI的风险。