二甲双胍对复治肺结核并发糖尿病患者的疗效初探

Study on the treatment effect of metformin in retreatment pulmonary tuberculosis patients with diabetes mellitus

目的探讨复治肺结核并发糖尿病患者口服二甲双胍降糖药对复治肺结核的预后影响。方法收集2009年7月至2016年7月期间多家结核病防治机构治疗报告的复治肺结核并发2型糖尿病患者42例，均随访达3年，进行回顾性队列分析。根据是否应用二甲双胍药物分为两组：Ⅰ组10例，为应用二甲双胍降糖＋抗结核药物治疗的患者；Ⅱ组32例，为未应用二甲双胍降糖（采用其他降糖药）＋抗结核药物治疗的患者。比较两组患者的治疗转归、预后和相关危险因素。结果两组患者在治疗2个月末痰培养阴转率分别为Ⅰ组70．0％（7／10）和Ⅱ组78．1％（25／32）、治愈率分别为Ⅰ组80．0％（8／10）和Ⅱ组65．6％（21／32）、治疗成功率分别为Ⅰ组90．0%（9／10）和Ⅱ组71．9％（23／32），两组各项比较差异均无统计学意义（χ2值分别为0．01、0．22、0．56，P值均〉O．05）。Ⅰ组失败率[10．0%（1／10）]和随访3年复发率[11.1％（1／9）]均低于Ⅱ组[失败率为15．6%（5／32）。随访3年复发率为21．7％（5／23）]，但两组比较差异均无统计学意义（Fisher确切概率法，P值均〉O．05）。胸片显示病变吸收率分别为Ⅰ组80．0％（8／10）和Ⅱ组89．3％（25／28）；空洞闭合和缩小率分别为Ⅰ组66．7G（4／6）和Ⅱ组71．4G（15／21），两组比较差异也均无统计学意义（Fisher确切概率法，P=0．559和P=1．000）。患者预后（复发）的危险因素分析表明，既往药物治疗在1～6个月和≥7个月复发的患者分别占16．7％（1／6）和83．3％（5／6），未复发的患者分别占76．9％（20／26）和23．i％（6／26），差异有统计学意义（Fisher确切概率法，P=0．011）；说明既往用药时间在7个月以上，肺结核并发2型糖尿病患者复治后复发风险可能增加。结论Ⅰ组对复治肺结核并发2型糖尿病患者的治疗失败率和随访3年复发率均低于Ⅱ组，虽无统计学意义，但值得扩大样本进行深入研究。

Objective To explore the treatment effect of metformin in retreatment pulmonary tuberculosis （PTB） patients with diabetes mellitus （DM）. Methods A retrospective analysis was conducted among 42 retreat- ment PTB patients with type 2 DM from different tuberculosis control and prevention institutes from July 2009 to July 2016 and all cases were followed up for 3 years. Patients were divided into two groups according to metformin taken in regimen or not, 10 cases with metformin plus anti-tuberculosis drugs in group I , and 32 cases without metformin （other hypoglycemic drugs） in group 2. The treatment outcomes and prognosis were compared in two groups. Results Sputum negative conversion rate was 70.0% （7/10） and 78.1% （25/32）, cure rate was 80.0% （8/10） and 65.6% （21/32）, treatment success rate was 90.0% （9/10） and 71.9% （23/32） at the end of the 2nd month in group I and group Ⅱ, respectively. The differences were no significant statistically （χ2 values were 0.01, 0.22 and 0.56, respectively, P〉0.05）. The failure rate （10.0% （1/10）） and relapse rate （11.1% （1/9）） of 3 years follow-up in group I were lower than those （15.6% （5/32）） vs. 21.7% （5/23）） in group Ⅱ , but with- out significant differences statistically （Fisher test, P〉0.05）. The differences of lesions absorption rate （80. 0% （8/10） vs. 89.3% （25/28））, cavity closure rate （66.7% （4/6） vs. 71.4% （15/21）） were no significant statisti cally in group I and group Ⅱ （Fisher test, P=0. 059 and P= 1. 000）. Risk factors analysis of prognosis （relapse）showed that patients＇ treatment history with 1 -6 months or no less than 7 months occurred relapse rate was 16.7% （1/6） and 83.3% （5/6）, respectively, and no relapse accounted for 76.9% （20/26） and 23.1% （6/26）, respectively （Fisher test, P=0. 011）. It implied that treatment history above 7 months may be increased risk of relapse in PTB patients with type 2 DM. Conclusion The failure rate and relapse rate of 3 years follow-up in retreatment PTB patients with DM in group I are lower than those in group Ⅱ without statistically significant. It needs to enlarge sizes of the samples to study further in the future although no statistically significant in this project.