Thorax：糖尿病患者肺结核防治形势严峻

　　墨西哥一项前瞻性研究发现，随着全球糖尿病患病率的增加，有必要对这些糖尿病患者进行肺结核（TB）的预防和管理及评估相应的效应。同时患有两种病的患者有全球蔓延的潜在危险，提示TB管理的重要性。相关论文12月18日在线发表于《胸腔》（Thorax）杂志。

　　研究纳入了南墨西哥于1995年至2010年通过对痰标本进行流行病学、临床微生物学评估而确诊的TB患者，每年随访一次，以确定治疗转归、有无复发和再感染。

　　结果显示，1262例肺结核患者中糖尿病患病率为29.63%（n=374）。同时患有糖尿病和肺结核的患者临床表现更差：这些患者胸部X线测得的任何尺寸空洞（aOR为1.80），痰菌转阴时间延长（aOR为1.51），治疗失败可能性更高（aOR为2.93）；再发（recurrence）和复发（relapse）的aHR分别为1.76和1.83。大多数糖尿病患者中的二次感染与第一次有着同样的基因型，但19.23%的患者菌株与第一次不同。

与肺结核相关的拓展阅读：

• 糖尿病患者肺结核防治形势严峻
• 狂犬病肺结核报告死亡均创新高
• NEJM：寻求抗击肺结核的新疗法
• PNAS：维生素D有助于治疗肺结核
• Lancet：耐药性肺结核现状敲响警钟
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Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes

Objective 

To determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM).

Methods 

We conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection.

Results 

The prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred.

Conclusions 

Given the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.