Effect of diabetes mellitus and blood sugar status on treatment outcome of tuberculosis patients
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摘要: 糖尿病患者是结核病的高危人群, 而结核病又是诱发、加重糖尿病急性并发症的重要原因之一。目前中国面临着严重的结核病和糖尿病双重流行, 给我国人民健康造成极大危害, 同时也给我国社会经济带来极大的负担。本文通过PubMed、Web of Science、中国知网以及万方数据知识服务平台等数据库对相关文献进行检索和阅读, 对结核病患者并发糖尿病流行病学现况、糖尿病及血糖状况对结核病患者治疗转归的影响以及糖尿病影响结核病患者治疗转归的机理研究进展进行了分析和总结, 为今后我国结核病患者的治疗与管理提供部分参考依据。Abstract: Diabetes mellitus patients are at high risk of tuberculosis, and tuberculosis is one of the important reasons for inducing and aggravating acute complications of diabetes. At present, China is facing a serious dual epidemic of tuberculosis and diabetes, which has caused great harm to the health of our people, but also brought great burden to our social economy. In this paper, PubMed, Web of Science, CNKI and Wanfang data knowledge service platform were used to search the relevant literature. Research progress on the epidemiology of tuberculosis patients complicated with diabetes, the effect of diabetes and blood glucose on the treatment outcome of tuberculosis patients, and the mechanism of diabetes affecting the treatment outcome of tuberculosis patients were analyzed and summarized, and some references were provided for the treatment and management of tuberculosis patients in China in the future.
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Key words:
- Tuberculosis /
- Diabetes mellitus /
- Glycemic control /
- Hyperglycemia /
- Treatment outcomes
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表 1 糖尿病和血糖控制与结核病患者治疗期间的痰菌阴转情况
Table 1. Diabetes or glycemic control and conversion of sputum during anti-tuberculosis treatment
研究者 时间(年) 地区 研究对象 样本量(人) 研究类型 治疗方案 研究结果 Dooley[30] 2009 美国 成人 297 回顾性研究 / 糖尿病患者痰菌阴转时间长(P=0.090)。 Yoon[18] 2017 韩国 成人 661 前瞻性研究 / 血糖控制差(HbA1c≥7.0 mmol/L)是2月末痰培养阳性(ORadj=2.11, P=0.042)的独立危险因素。 Alisjahbana[20] 2007 印度尼西亚 ≥15岁 634 前瞻性研究 标准方案 糖尿病患者的2月末痰涂片阳性率高, 6月末痰培养阳性(ORadj=7.65, P=0.004)。 Faurholt-Jepsen[24] 2013 坦桑尼亚 成人 1 250 前瞻性研究 / 合并糖尿病者与普通结核患者在2月末和5月末痰菌阳性率无差异。 Jimenez-Corona[25] 2013 墨西哥 > 15岁 1 262 前瞻性研究 标准方案 糖尿病患者痰菌转换延迟(OR=1.51, 95% CI:1.09~2.10)。 Siddiqui[29] 2016 印度 ≥15岁 316 前瞻性研究 标准方案 糖尿病患者的2月末痰菌阳性率较高(OR=1.25, 95% CI:0.54~2.89)。 赵艳民[36] 2013 中国 成人 216 临床试验 标准方案 血糖控制较差者(FBGa > 7.0 mmol/L)痰菌转阴率低(P < 0.050)。 Mi[37] 2013 中国 全人群 1 589 回顾性研究 标准方案 糖尿病患者的2月末痰涂片阳性率(RR=3.85, 95% CI:2.24~6.63)。 Park[38] 2012 韩国 全人群 492 回顾性研究 / 血糖控制差(HbA1c≥7.0 mmol/L)的2月末痰培养阳性率高(OR=4.32, P=0.017)。 Degner[39] 2018 中国台湾 ≥13岁 2 416 回顾性研究 / 糖尿病患者2月末痰培养阳性率高(OR=1.72, 95% CI:1.25~2.38)。 Ma[3] 2017 中国 ≥15岁 1 313 前瞻性研究 / 糖尿病患者2月末痰涂片阳性率高(ORadj=2.83, 95% CI:1.78~4.49)。 注:aFBG (fasting blood sugar)表示空腹血糖。 表 2 糖尿病和血糖控制对结核病患者治疗失败和死亡的影响
Table 2. Effects of diabetes or glycemic control on treatment failure and death in tuberculosis patients
研究者 时间(年) 地区 研究对象 样本量(人) 研究类型 治疗方案 研究结果 Dooley[30] 2009 美国 成人 297 回顾性研究 / 糖尿病患者的结核病死亡率高(ORadj=6.5, 95% CI:1.1~38.0)。 Yoon[18] 2017 韩国 成人 661 前瞻性研究 / 血糖控制差(HbA1c≥7.0 mmol/L)是治疗失败或死亡(ORadj=4.11, P=0.022)的独立危险因素。 Nandakumar[22] 2013 印度 全人群 3 116 回顾性研究 标准方案 血糖控制较差可能与结核病不良治疗结局有关(RR=2.0, 95% CI:0.97~4.13)。 Chang[23] 2011 中国台湾 成人 192 前瞻性研究 标准方案 糖尿病患者的治疗失败率高(P < 0.010)。 Faurholt-Jepsen[24] 2013 坦桑尼亚 成人 1 250 前瞻性研究 / 糖尿病增加结核病患者死亡风险(RR=5.09, 95% CI:2.36~11.02)。 Jimenez-Corona[25] 2013 墨西哥 > 15岁 1 262 前瞻性研究 标准方案 糖尿病患者治疗失败率高(OR=2.93, 95% CI:1.18~7.23)且更易复发(HRadj=1.83, 95% CI:1.04~3.23)。 Syed[26] 2012 马来西亚 成人 600 队列研究 / 合并糖尿病的老年患者死亡风险更高(ORadj=12.3) Hongguang[27] 2015 中国 成人 1 126 前瞻性研究 标准方案 糖尿病与死亡(OR=5.58, 95% CI:2.18~14.27)和治疗失败(OR=6.696, 95% CI:2.02~22.20)有关。 Mukhtar[28] 2016 巴基斯坦 ≥15岁 614 前瞻性研究 标准方案 糖尿病患者更容易出现不良结局(OR=2.6, 95% CI:1.48~4.56)。 Siddiqui[29] 2016 印度 ≥15岁 316 前瞻性研究 标准方案 糖尿病患者更易出现不良结局(OR=1.18, 95% CI:0.31~4.46) Kang[32] 2013 韩国 成人 1 407 回顾性研究 / 糖尿病增加结核病患者治疗失败(HR=1.59, 95% CI:1.01~2.50)和死亡风险。 Fielder[33] 2002 美国 成人 174 回顾性研究 标准方案 糖尿病增加结核病患者死亡风险(ORadj=3.8, 95% CI:1.4~10.3) Mi[37] 2013 中国 全人群 1 589 回顾性研究 标准方案 糖尿病患者的治疗失败高(RR=4.46, 95% CI:1.96~10.18)。 Barss[34] 2018 加拿大 成人 690 回顾性研究 / 糖尿病与结核病死亡率(OR=2.68, 95% CI:1.42~5.06)和治疗失败(OR=2.81, 95% CI:1.55~5.09)密切相关。 Degner[39] 2018 中国台湾 ≥13岁 2 416 回顾性研究 / 糖尿病患者的死亡风险高(OR=1.91, 95% CI:1.51~2.40)。 Boillat-Blanco[44] 2016 坦桑尼亚 成人 1 035 病例对照研究 标准方案 高血糖(DMa和pre-DMb)患者治疗失败或死亡高(ORadj=3.3, 95% CI:1.2~9.3)。 Moreira[45] 2018 巴西 成人 473 回顾性研究 / 高血糖(抗结核治疗期间2次FBGc > 126 mg/dl)增加了结核病不良结局(P < 0.001)和死亡(HRadj=3.72, 95% CI:2.17~6.38)风险。 Delgado-Sanchez[9] 2015 墨西哥 成人 181 378 回顾性研究 标准方案 糖尿病增加治疗失败风险(OR=1.34, 95% CI:1.11~1.61)。 Ma[3] 2017 中国 ≥15岁 1 313 前瞻性研究 / 糖尿病增加治疗失败(ORadj=2.120, 95% CI:1.565~3.477)和死亡率(ORadj=1.536, 95% CI:1.011~2.628)。 Perez-Navarro[46] 2017 墨西哥 ≥15岁 507 队列研究 / 糖尿病增加治疗失败(HR=2.04, 95% CI:1.07~3.80)和复发(HR=1.86, 95% CI:1.09~3.10)。 注:aDM(Diabetes Mellitus)糖尿病; b表示糖尿病前期; cFBG(Fasting Blood Sugar)空腹血糖 -
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