糖尿病影响耐多药结核病的治疗结局：系统评价和荟萃分析。
Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis.
机构信息
Department of Preventive Medicine, Public Health Administration College, Jiangsu Health Vocational College, 69 Huang-shanling Road, Pukou District, Nanjing, Jiangsu Province, 211800, China.
Department of Hygiene, Luhe District Center for Disease Control and Prevention, 8 Meteorological Road, Luhe District, Nanjing, Jiangsu Province, 211500, China.
出版信息
BMC Infect Dis. 2023 Nov 20;23(1):813. doi: 10.1186/s12879-023-08765-0.
BACKGROUND
Both tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. TB patients with DM have a higher bacterial burden and affect the absorption and metabolism for anti-TB drugs. Drug-resistant TB (DR-TB) with DM make control TB more difficult.
METHODS
This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. This study was registered with PROSPERO, number CRD: 42,022,350,214.
RESULTS
A total of twenty-five studies involving 16,905 DR-TB participants were included in the meta-analysis, of which 10,124 (59.89%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% CI: 1.24-1.96) for unsuccessful outcomes, 0.64 (95% CI: 0.44-0.94) for cured treatment outcomes, 0.63 (95% CI: 0.46-0.86) for completed treatment outcomes, and 1.28 (95% CI: 1.03-1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% CI: 1.20-2.04) for unsuccessful treatment outcomes, 0.55 (95% CI: 0.35-0.87) for cured treatment outcomes, 0.66 (95% CI: 0.46-0.93) for treatment completed treatment outcomes and 1.37 (95% CI: 1.08-1.75) for treatment failure.
CONCLUSION
DM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favorite prognosis of TB. Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and it is needed to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients.
背景
结核病（TB）和糖尿病（DM）都是威胁全球健康的主要公共卫生问题。患有 DM 的结核病患者细菌负担更高，并且影响抗结核药物的吸收和代谢。合并糖尿病的耐药结核病（DR-TB）使结核病控制更加困难。
方法
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。我们检索了截至 2022 年 7 月在 PubMed、Excerpta Medica Database（EMBASE）、Web of Science、ScienceDirect 和 Cochrance Library 上发表的英文文献，报道了 DR-TB 和耐多药结核病（MDR-TB）患者中 DM 与治疗结局之间关系的文献。关联强度以比值比（OR）及其 95%置信区间（CI）表示，采用固定效应或随机效应模型。本研究已在 PROSPERO 注册，编号 CRD：42,022,350,214。
结果
荟萃分析共纳入 25 项研究，涉及 16905 例 DR-TB 参与者，其中 10124 例（59.89%）为 MDR-TB 患者，1952 例（11.54%）有 DM 病史。在 DR-TB 患者中，治疗结局不良的汇总 OR 为 1.56（95%CI：1.24-1.96），治愈结局的 OR 为 0.64（95%CI：0.44-0.94），治疗完成结局的 OR 为 0.63（95%CI：0.46-0.86），治疗失败的 OR 为 1.28（95%CI：1.03-1.58）。在 MDR-TB 患者中，治疗结局不良的汇总 OR 为 1.57（95%CI：1.20-2.04），治愈结局的 OR 为 0.55（95%CI：0.35-0.87），治疗完成结局的 OR 为 0.66（95%CI：0.46-0.93），治疗失败的 OR 为 1.37（95%CI：1.08-1.75）。
结论
DM 是 DR-TB 或 MDR-TB 患者不良结局的危险因素。控制高血糖可能有助于改善结核病的预后。我们的研究结果支持在 DR-TB/MDR-TB 患者中诊断 DM 的重要性，并且需要在治疗 DR-TB/MDR-TB 患者期间控制血糖和进行治疗监测。
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