2016—2022年汕头市肺结核合并糖尿病患者临床特征及其影响因素分析

Analysis of the clinical characteristics and influencing factors of pulmonary tuberculosis patients with diabetes mellitus in Shantou City from 2016 to 2022

目的:分析肺结核合并糖尿病(pulmonary tuberculosis with diabetes mellitus,PTB-DM)患者临床特征及其影响因素,为提高共病患者的病例发现和治疗效果提供依据。方法:通过“中国疾病预防控制信息系统”子系统“汕头市结核病监测报告管理系统”获取2016—2022年在汕头市各结核病定点医疗机构登记并治疗的肺结核患者临床资料[包括登记患者数、社会人口学特征(包括年龄、性别、民族、居住地、职业和流动人口等)、临床特征(包括肺结核的病原学分型、既往治疗史和合并糖尿病)和抗结核治疗信息(包括就诊途径和抗结核治疗结果)],分析有无糖尿病患者的疾病特征,采用logistic回归模型分析影响肺结核是否合并糖尿病的相关因素。结果:2016—2022年汕头市共登记肺结核患者21085例,纳入符合标准的20968例患者作为研究对象。肺结核患者合并糖尿病的比例为8.08%(1694/20968),从2016年的1.97%(67/3406)上升到2022年的15.78%(346/2192),呈逐年增长趋势(χ_(趋势)^(2)=438.749,P<0.001)。1个月内就诊的PTB-DM患者[39.27%(665/20968)]明显低于未合并糖尿病的肺结核患者[46.99%(9056/20968)],差异有统计学意义(χ^(2)=42.536,P<0.001)。多因素logistic回归分析结果显示,相较于本地居民、30岁以下人群、农民/渔民/工人、因症就诊、病原学阴性、治愈患者、治疗2个月末痰检阴性、1个月内就诊的患者,流动人口、30~59岁患者、60~95岁患者、管理干部/医务人员、家政、离退人群、商业服务人员、追踪到位、健康体检、病原学阳性、失访人群、治疗2个月末痰检阳性、1~3个月内就诊、3~6个月内和6~12个月内就诊的患者更可能合并糖尿病[OR(95%CI)=1.294(1.156~1.449)、17.026(10.783~26.882)、20.966(13.240~33.199)、2.521(1.401~4.536)、1.943(1.709~2.210)、3.630(2.755~4.783)、2.945(1.953~4.442)、1.598(1.354~1.887)、1.820(1.190~2.783)、2.554(2.151~3.031)、2.114(1.572~2.843)、2.717(2.085~3.540)、1.229(1.094~1.381)、1.312(1.101~1.563)、1.244(1.001~1.544)]。结论:汕头市PTB-DM患者比例明显低于国际上报告的平均水平,但其逐年上升的患病率已超过国际报告水平,应引起重视。另外,应加强流动人口、高年龄、轻体力劳动、追踪到位、结核分枝杆菌初始和治疗2个月末痰检仍为阳性,以及未能在1个月内就诊的肺结核患者中糖尿病的早期发现和治疗效果监测,并及时给予干预。

Objective:To analyze the clinical characters and influencing factors for pulmonary tuberculosis(PTB)patients with diabetes mellitus(DM),so as to provide basis for improving the case detection and treatment effect of comorbid patients.Methods:The clinical data of tuberculosis patients registered and treated in designated tuberculosis hospitals in Shantou from 2016 to 2022 were obtained through the“Shantou Tuberculosis Surveillance and Report Management System”,a subsystem of the“China Disease Control and Prevention Information System”.The data included the number of registered patients,sociodemographic characteristics(including age,gender,ethnicity,place of residence,occupation and floating population,etc.),clinical characteristics(including the type of tuberculosis,previous treatment history and diabetes mellitus)and anti-tuberculosis treatment information(including the pathway of patient visit and anti-tuberculosis treatment outcomes).The disease characteristics of patients with or without diabetes mellitus were analyzed.Logistic regression model was used to analyze the relevant factors affecting whether pulmonary tuberculosis was combined with diabetes.Results:From 2016 to 2022,a total of 21085 pulmonary tuberculosis patients were registered in Shantou City,and 20968 eligible patients were included as the study subjects.The proportion of tuberculosis patients with diabetes was 8.08%(1694/20968),and increased from 1.97%(67/3406)in 2016 to 15.78%(346/2192)in 2022 with annual increasing trend(χ_(trend)^(2)=438.749,P<0.001).The proportion of PTB-DM who visited the clinic within one month(39.27%(665/20968))was significantly lower than that of the tuberculosis patients without diabetes(46.99%(9056/20968)),with a statistically significant difference(χ^(2)=42.536,P<0.001).The results of multivariate analysis showed that compared with local reseidents,people aged<30 years,farmer/fisherman/worker,patients with symptoms,negative etiology,cured,negative sputum result at the end of two month of treatment,patient who visited clinic within one month,floating population,patients aged 30-59 years or 60-95 years old,management cadres/medical personnel,housekeeping,retired persons,business service personnel,patients detected by tracking,health examination,positive etiology,people lost to follow-up,positive sputum result at the end of 2 months of treatment,patients who visited within 1-3 months,3-6 months and 6-12 months were more likely to have diabetes(OR(95%CI)=1.294(1.156-1.449),17.026(10.783-26.882),20.966(13.240-33.199),2.521(1.401-4.536),1.943(1.709-2.210),3.630(2.755-4.783),2.945(1.953-4.442),1.598(1.354-1.887),1.820(1.190-2.783),2.554(2.151-3.031),2.114(1.572-2.843),2.717(2.085-3.540),1.229(1.094-1.381),1.312(1.101-1.563),1.244(1.001-1.544)).Conclusion:The average prevalence of PTB-DM patients in Shantou is significantly lower than the previous reported average level,but its annual increasing rate has exceeded the reported average level,which should be paid attention to.In addition,the early detection and treatment monitoring of diabetes among the floating population,the elderly patients,the light physical labor,patients by tracing,the patients with positive sputum test at initial diagnosis and the end of 2 months of treatment,and patients failed to visit clinic within one month should be strengthened,and timely intervention should be provided.