糖尿病及血糖状况对结核病患者治疗转归的影响

游楠楠; 陆伟; 竺丽梅; 刘巧

doi:10.16462/j.cnki.zhjbkz.2020.01.018

糖尿病及血糖状况对结核病患者治疗转归的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.018

游楠楠^{1, 2},
陆伟¹,
竺丽梅¹,
刘巧^{1, 3, ,}

1.
210009 南京, 江苏省疾病预防控制中心慢性传染病防制所
2.
210009 南京, 东南大学公共卫生学院流行病与卫生统计学系
3.
210009 南京, 南京医科大学公共卫生学院流行病与卫生统计学系

基金项目: 国家科技重大专项(2018ZX10715002); “六个一工程”拔尖人才科研项目(LGY2017083);江苏省研究生科研与实践创新计划项目(KYCX19-1131)

详细信息

通讯作者:
刘巧, E-mail:liuqiaonjmu@163.com

中图分类号: R512.91;R587.1
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出版历程
- 收稿日期: 2019-06-19
- 修回日期: 2019-09-30
- 刊出日期: 2020-01-10

Effect of diabetes mellitus and blood sugar status on treatment outcome of tuberculosis patients

YOU Nan-nan^{1, 2},
LU Wei¹,
ZHU Li-mei¹,
LIU Qiao^{1, 3
, ,}

1.
Chronic Infectious Disease Prevention and Control Institute, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
2.
Department of Epidemiology and Biostatistics, School of Public Healthy Southeast University, Nanjing 210009, China
3.
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210009, China

Funds: National Science and Technology Major Project(2018ZX10715002); "Six One Project" Top-notch Talent Research Project(LGY2017083); Postgraduate Research & Practice Innovation Program of Jiangsu Province(KYCX19-1131)

More Information

Corresponding author: LIU Qiao, E-mail:liuqiaonjmu@163.com

摘要

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。
- 结核病 /
- 糖尿病 /
- 血糖控制 /
- 高血糖 /
- 治疗结局
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.
- 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(OR_adj=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(OR_adj=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(FBG^a > 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(OR_adj=2.83, 95% CI:1.78~4.49)。
注:^aFBG (fasting blood sugar)表示空腹血糖。

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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(OR_adj=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(OR_adj=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(HR_adj=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(OR_adj=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(OR_adj=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(DM^a和pre-DM^b)患者治疗失败或死亡高(OR_adj=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FBG^c > 126 mg/dl)增加了结核病不良结局(P < 0.001)和死亡(HR_adj=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(OR_adj=2.120, 95% CI:1.565~3.477)和死亡率(OR_adj=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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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(OR_adj=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(OR_adj=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(FBG^a > 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(OR_adj=2.83, 95% CI:1.78~4.49)。
注:^aFBG (fasting blood sugar)表示空腹血糖。

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糖尿病及血糖状况对结核病患者治疗转归的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.018

通讯作者:
刘巧, E-mail:liuqiaonjmu@163.com

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Effect of diabetes mellitus and blood sugar status on treatment outcome of tuberculosis patients

Corresponding author: LIU Qiao, E-mail:liuqiaonjmu@163.com

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糖尿病及血糖状况对结核病患者治疗转归的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.018

通讯作者: 刘巧, E-mail:liuqiaonjmu@163.com

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Effect of diabetes mellitus and blood sugar status on treatment outcome of tuberculosis patients

Corresponding author: LIU Qiao, E-mail:liuqiaonjmu@163.com

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出版历程

目录

通讯作者:
刘巧, E-mail:liuqiaonjmu@163.com