优化血糖控制对糖尿病合并结核病患者治疗结局的影响：系统评价和荟萃分析。
The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis.
机构信息
Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, China.
Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
JMIR Public Health Surveill. 2024 Apr 2;10:e53948. doi: 10.2196/53948.
BACKGROUND
Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB), and optimal glycemic control has been shown to reduce the risk of complications and improve the TB treatment outcomes in patients with DM.
OBJECTIVE
This study aims to investigate the role of glycemic control in improving TB treatment outcomes among patients with DM.
METHODS
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) assessing the impact of oral glycemic control in patients with TB who have DM. Outcomes of interest were radiological findings, treatment success, sputum positivity, and mortality. Evaluations were reported as risk ratios (RRs) with 95% CIs using weighted random-effects models.
RESULTS
The analysis included 6919 patients from 7 observational studies. Our meta-analysis showed significant differences between patients with optimal glycemic control and those with poor glycemic control with regard to improved treatment outcomes (RR 1.13, 95% CI 1.02-1.25; P=.02; I²=65%), reduced sputum positivity (RR 0.23, 95% CI 0.09-0.61; P=.003; I²=66%), and fewer cavitary lesions (RR 0.59, 95% CI 0.51-0.68; P<.001; I²=0%) in radiological findings. There was no significant difference between the 2 groups in terms of mortality (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%), multilobar involvement (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%) on radiologic examination, and upper lobe (RR 0.94, 95% CI 0.76-1.17; P=.58; I²=0%) and lower lobe (RR 1.05, 95% CI 0.48-2.30; P=.91; I²=75%) involvement on radiologic examination.
CONCLUSIONS
We concluded that optimal glycemic control is crucial for reducing susceptibility, minimizing complications, and improving treatment outcomes in patients with TB with DM. Emphasizing effective health management and health care strategies are essential in achieving this control. Integrating comprehensive care among patients with TB with DM will enhance patient outcomes and alleviate the burden of disease in this population.
TRIAL REGISTRATION
PROSPERO CRD42023427362; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362.
背景
糖尿病（DM）会增加患结核病（TB）的风险，而血糖控制优化已被证明可降低 DM 患者并发症风险并改善 TB 治疗结局。
目的
本研究旨在探讨血糖控制在改善 DM 合并 TB 患者 TB 治疗结局中的作用。
方法
检索 MEDLINE、Embase 和 Cochrane 对照试验中心注册数据库，以评估口服降糖治疗对合并 DM 的 TB 患者的影响。感兴趣的结局包括影像学发现、治疗成功、痰菌阳性和死亡率。使用加权随机效应模型，以风险比（RR）和 95%置信区间（CI）报告评估结果。
结果
该分析纳入了来自 7 项观察性研究的 6919 例患者。我们的荟萃分析显示，与血糖控制不佳的患者相比，血糖控制优化的患者在治疗结局改善（RR 1.13，95%CI 1.02-1.25；P=.02；I²=65%）、痰菌阴转（RR 0.23，95%CI 0.09-0.61；P=.003；I²=66%）和减少空洞病变（RR 0.59，95%CI 0.51-0.68；P<.001；I²=0%）方面存在显著差异。两组在死亡率（RR 0.57，95%CI 0.22-1.49；P=.25；I²=0%）、影像学检查多肺叶受累（RR 0.57，95%CI 0.22-1.49；P=.25；I²=0%）和影像学检查上叶（RR 0.94，95%CI 0.76-1.17；P=.58；I²=0%）和下叶（RR 1.05，95%CI 0.48-2.30；P=.91；I²=75%）受累方面无显著差异。
结论
我们得出结论，血糖控制优化对于降低 DM 合并 TB 患者的易感性、最小化并发症和改善治疗结局至关重要。强调有效的健康管理和医疗保健策略对于实现这一控制至关重要。在 DM 合并 TB 患者中整合综合护理将改善患者结局并减轻该人群的疾病负担。
试验注册
PROSPERO CRD42023427362；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362。
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