血糖控制与结核病风险:基于人群队列研究

Glycemic control and the risk of tuberculosis:a population-based cohort study

目的 探讨血糖控制与结核病发病风险之间的关系。方法 在中国东部地区对40 311名研究对象开展队列研究,通过10年的随访,探讨结核病发病的危险因素。排除了基线调查时发现的结核病患者,通过与南京市结核病管理信息系统进行匹配发现结核病患者。主要通过匹配身份证号码、姓名、年龄、出生日期和地址。并建立了Cox比例风险模型,调整了年龄、性别、吸烟状况等因素。结果 经过10年(中位随访时间为8.4年)的随访,共发现204名活动性结核病患者,发病密度为59.0/10万人年(95%CI:51.3~67.5)。其中,糖尿病患者有25人,占12.3%,发病密度为71.3/10万人年(95%CI:47.2~103.8)。共发现7名血糖控制不佳糖尿病患者发病,发病密度为84.4/10万人年(95%CI:50.8~132.4)。当把人群按照FPG是否≥7.0 mmol/L分组时,研究发现,与FPG<7.0 mmol/L相比,FPG≥7.0 mmol/L人群发生结核病的风险提高0.89倍[风险比(hazard ratio,HR)=1.89,95%CI:1.13~3.13,P=0.014]。结论 此次大规模的人群队列研究发现,糖尿病患者血糖控制不佳增加了其发生结核病的风险。因此,加强对血糖控制不佳糖尿病患者的筛查可以及早发现结核病,有利于降低中国结核病的发生与流行。

Objective To evaluate the association between glycemic control among diabetes and active tuberculosis.Methods We conducted a population-based census in eastern China including 40 311 individuals.We investigated risk factors for active tuberculosis by excluding tuberculosis at baseline and linked all participants to the Infectious Disease Reporting Management System and tuberculosis Management Information System of Nanjing City.We followed participants for ten years.We matched participants using unique health identity card numbers,name,age,birthdate,and address.We constructed Cox Proportional hazard models adjusting for age,sex,smoking.Results After 10 years follow-up,204 individuals progressed to tuberculosis(incidence rate,71.3 per 100 000 person-years,95% CI:51.3-67.5),of whom 25 were diabetes,accounting for 12.3%(incidence rate,59.0 per 100 000 person-years,95% CI:47.2-103.8) and 7 diabetes were with poor glycemic control(incidence rate,84.4 per 100 000 person-years,95% CI:50.8-132.4).Diabetic patients had a significantly higher hazard of tuberculosis [hazard ratio(HR)=1.56,95% CI:1.01-2.39,P=0.044].Diabetics with FPG≥7.0 mmol/L showed nearly one-fold increased risk of active tuberculosis(HR=1.89,95% CI:1.13-3.13,P=0.014).Conclusions In this large population-based cohort study in a medium tuberculosis burden region,we found that diabetes increased the hazard of tuberculosis disease and diabetics with poor glycemic control control aggravated this relationship.Strengthening the screening of diabetes patients with poor glycemic control control can improve the efficiency of tuberculosis detection in diabetes patients and help reduce the prevalence of tuberculosis in China.