日照市复治肺结核住院患者合并糖尿病的临床特征及危险因素分析

Clinical features and risk factors analysis of retreated pulmonary tuberculosis inpatients complicated with diabetes in Rizhao

目的通过对日照市复治肺结核合并与不合并糖尿病(DM)患者临床特征的分析及相关危险因素的探讨,提高临床医生对我市复治肺结核合并糖尿病的认识。方法收集2020年1月至2023年1月我市各级结核防治机构住院的复治肺结核患者164例,按照是否患有糖尿病分为复治肺结核合并糖尿病组(有DM组)与单纯复治肺结核组(无DM组),其中复治肺结核合并糖尿病组86例,单纯复治肺结核组78例,收集并分析研究对象的性别、年龄、体重指数(BMI)、发热、胸闷、复治次数、影像学检查等信息,运用多因素非条件Logistic回归分析复治肺结核合并糖尿病的危险因素。结果有DM组男性占比(69.8%)高于无DM组男性患者(53.8%),差异有统计学意义(P<0.05)。有DM组年龄≥40岁患者(86%)高于无DM组(67.9%),差异有统计学意义(P<0.05)。有DM组BMI异常高于无DM组,差异有统计学意义(P<0.001)。有DM组复治次数≥2次占比高于无DM组复治次数≥2次的占比,差异有统计学意义(P=0.001)。有DM组出现毁损肺的概率高于无DM组,差异有统计学意义(P=0.032)。两组在发热、胸闷、纵膈淋巴结肿大及合并肺外结核等方面差异均无统计学意义(P>0.05)。复治肺结核患者≥40岁、男性、体重指数异常及复治次数≥2次是复治肺结核合并糖尿病的危险因素,OR(95%CI)值分别为3.717(1.486~9.300),3.115(1.413~6.864),2.982(1.726~5.152),4.676(2.140~10.214)。有DM组不良反应发生率(77.8%)高于无DM组不良反应发生率(47.8%),差异有统计学意义(χ^(2)=13.578,P<0.001)。有DM组不良反应种数≥2的患者概率(52.8%)高于无DM组(37.7%),差异有统计学意义(χ^(2)=5.529,P=0.019)。结论我市复治肺结核合并糖尿病患者体重指数多异常,影像学毁损肺多见,治疗过程不良反应大。复治次数≥2、男性、年龄≥40岁、体重指数异常是复治肺结核合并糖尿病的危险因素,临床应给与重视。

Objective Through the analysis of the clinical characteristics and the risk factors for retreated pulmonary tuberculosis with and without diabetes(DM)in Rizhao city,clinicians can improve their understanding of retreated pulmonary tuberculosis complicated with diabetes.Methods From January 2020 to January 2023,164 patients with retreated pulmonary tuberculosis in our hospital were collected and divided into retreated pulmonary tuberculosis combined with diabetes group(DM group)and simple retreated pulmonary tuberculosis group(no DM group)according to whether they had diabetes.There were 86 patients in the DM group and 78 patients in the no DM group.Gender,age,body mass index(BMI),fever,chest tightness,number of retreatment,imaging examination and other information of the subjects were collected.Multivariate Logistic regression was used to analyze the related factors of retreated pulmonary tuberculosis complicated with diabetes.Results The proportion of male patients in DM group(69.8%)was higher than that in no DM group(53.8%),which was statistically significant(P<0.05).Proportion of patients aged 40 years or older in the DM group(86%)was higher than in the no DM group(67.9%),which was statistically significant(P<0.05).The abnormal BMI in the DM group was higher than that in the no DM group,which was statistically significant(P<0.001).The proportion of patients with≥2 times of retreatment in the DM group was higher than that in the no DM group,whichwas statistically significant(P=0.001).The probability of lung damage in the DM group was higher than the no DM group,which was statistically significant(P=0.032).There were no significant differences in fever,chest tightness,mediastinal lymph node enlargement and extrapulmonary tuberculosis between the two groups(P>0.05).Age≥40 years old,male,with weight abnormality and retreatment≥2 times were the risk factors for the combination of diabetes mellitus with retreated pulmonary tuberculosis,and the OR(95%CI)values were 3.717(1.486-9.300),3.115(1.413-6.864),2.982(1.726-5.152),and 4.676(2.140-10.214),respectively.The incidence of adverse reactions in the DM group(77.8%)was higher than that in the no DM group(47.8%),which was statistically significant(χ^(2)=13.578,P<0.001).The probability of patients with≥2 adverse reactions in the DM group(52.8%)was higher than that in the no DM group(37.7%),which was statistically significant(χ^(2)=5.529,P=0.019).Conclusion For the retreated pulmonary tuberculosis patients complicated with diabetes in our city,body mass index has higher probability of abnormalities,their lungs are more common to have imaging damage,and the treatment process is often accompanied by adverse reaction.The number of retreatment≥2,male,age≥40,and abnormal body mass index are risk factors for retreatment of pulmonary tuberculosis complicated with diabetes,which should be taken seriously in clinical practice.