复治涂阳肺结核并发糖尿病患者临床特点及耐药性相关分析

Clinical characteristics and drug resistance of retreated smear positive pulmonary tuberculosis patients with diabetes mellitus

目的分析复治涂阳肺结核并发糖尿病患者临床特点及耐药情况,为临床治疗提供参考。方法收集2018年12月至2021年1月成都市公共卫生临床医疗中心住院的287例复治涂阳肺结核患者[并发糖尿病患者(并发糖尿病组)169例,未并发糖尿病患者(未并发糖尿病组)118例)]作为研究对象,收集并分析研究对象的性别、年龄、体质量指数(BMI)、咯血、发热、复治次数、有无自行停药、病灶累及肺野、肺部空洞等信息,采用微孔板法分析患者的耐药情况。结果与未并发糖尿病组相比,并发糖尿病组男性患者占比较多[88.8%(150/169)、73.7%(87/118)],年龄更大[55.0(47.5,63.0)岁、37.0(27.0,50.0)岁],BMI较高[21.1(18.9,24.1)、19.0(17.6,21.2)],有咯血、肺部空洞>3个的患者较多[46.2%(78/169)、30.5%(36/118);57.4%(97/169)、42.4%(50/118)],肺部病变累及肺野较广泛[4.0(3.0,6.0)个、3.0(2.0,4.0)个],差异均有统计学意义(χ^(2)=10.909,P=0.001;Z=-7.548,P<0.001;Z=-4.366,P<0.001;χ^(2)=7.103、6.277,P=0.008、0.012;Z=-3.810,P<0.001)。并发糖尿病患者耐药率前3位:异烟肼[50.3%(85/169)]、利福平[41.4%(70/169)]、链霉素[27.8%(47/169)],未并发糖尿病组患者耐药率前3位:异烟肼[27.1%(32/118)]、利福平[22.9%(27/118)]、链霉素[17.8%(21/118)];与未并发糖尿病组比较,并发糖尿病组耐多药率[35.5%(60/169)、22.0%(26/118)]较高,差异有统计学意义(χ^(2)=6.007,P=0.014)。两组准广泛耐药:耐多药+二线注射剂耐药率[7.7%(13/169)、4.2%(5/118)]、耐多药+氟喹诺酮类药物耐药率[6.5%(11/169)、4.2%(5/118)]及广泛耐药率[4.7%(8/169)、1.7%(2/118)]比较,差异均无统计学意义(χ^(2)=1.411、0.681、1.908,P=0.235、0.409、0.167)。结论复治涂阳肺结核并发糖尿病患者,咯血发生率更高,肺野病变更广泛,空洞较多,耐多药情况可能更为严峻。应该重视糖尿病与结核病共病的筛查及治疗,了解其药敏检测结果,精准制定抗结核治疗方案。

Objective To analyze the clinical characteristics and drug resistance of retreated smear positive pulmonary tuberculosis(PTB)patients with diabetes mellitus(DM),so as to provide reference for treatment.Methods We collected 287 retreated smear positive PTB patients hospitalized in Public Health Clinical Center of Chengdu from December 2018 to January 2021,including 169 cases in DM group and 118 cases in non-DM group.The gender,age,body mass index(BMI),hemoptysis,fever,frequency of retreatment,self-medication withdrawal,pulmonary lesions,lung cavity and drug resistance were collected and analyzed.The drug resistance of patients was tested by microplate phenotypic methods. Results Compared with the non-DM group,DM group had more male patients(88.8%(150/169),73.7%(87/118)),older patients(55.0(47.5,63.0)years old,37.0(27.0,50.0)years old),higher BMI(21.1(18.9,24.1),19.0(17.6,21.2)),more patients with hemoptysis or pulmonary cavity>3(46.2%(78/169),30.5%(36/118);57.4%(97/169),42.4%(50/118)),and broader lung lesions sites(4.0(3.0,6.0),3.0(2.0,4.0)),all with a statistically significant difference (χ^(2)=10.909,P=0.001;Z=-7.548,P<0.001;Z=-4.366,P<0.001;χ^(2)=7.103,6.277,P=0.008,0.012;Z=-3.810,P<0.001).The top three drug resistance rates in the DM group were isoniazid(INH)(50.3%(85/169)),rifampin(RFP)(41.4%(70/169))and Streptomycin(Sm)(27.8%(47/169)),and in non-DM group the top three were also INH(27.1%(32/118)),RFP(22.9%(27/118))and Sm(17.8%(21/118)).Compared with the non-DM group,the rate of multi-drug resistance(MDR)was higher in the DM group(35.5%(60/169),22.0%(26/118)),the difference was statistically significant(χ^(2)=6.007,P=0.014).There was no significant difference in the resistance rates of MDR plus second-line injection(7.7%(13/169),4.2%(5/118)),MDR plus fluoroquinolone(6.5%(11/169),4.2%(5/118))and extensive drug-resistant(4.7%(8/169),1.7%(2/118))between the two groups (χ^(2)=1.411,0.681,1.908,P=0.235,0.409,0.167). Conclusion The retreated smear positive PTB patients with DM had higher incidence of hemoptysis,more extensive lung lesions,more cavities and possibly higher drug resistance rates.We should pay attention to the screening and treatment of TB and DM comorbidities,and understand the results of drug sensitivity tests,then formulate accurate anti-tuberculosis regimen.