南京市2015—2022年肺结核合并糖尿病患者的流行特征和时间趋势

Epidemiological characteristics and temporal trends of pulmonary tuberculosis complicated diabetes in Nanjing,2015-2022

目的分析江苏省南京市肺结核合并糖尿病的流行特征和时间趋势,为治疗肺结核合并糖尿病提供科学依据。方法运用《结核病信息管理系统》按照现住址导出2015—2022年的肺结核患者个案,使用Join-point 4.9.0.0软件分析肺结核患者和肺结核合并糖尿病患者发病率变化,根据肺结核患者是否合并糖尿病这一特点,使用SPSS 22.0软件分别分析二者人群、地区和诊疗特征差异。结果2015—2022年南京市共登记肺结核合并糖尿病患者566例,8年平均报告发病率0.82/10万,从2015年的0.21/10万上升至2022年的2.40/10万,年报告发病率整体呈上升趋势,且差异有统计学意义(APC=50.0%,95%CI:37.4%~63.8%,t=11.3,P<0.001)。性别上,合并糖尿病者男女性别比为4.60∶1,高于未合并糖尿病者男女性别比(2.12∶1),差异有统计学意义(χ^(2)=50.63,P<0.001);年龄上,合并糖尿病者65~75岁年龄组患者数最多,占28.45%(161/566),未合并糖尿病者25~35岁年龄组患者数最多,占19.59%(3620/18477);地区上,合并糖尿病者农村占比73.85%(418/566),未合并糖尿病者农村占比58.22%(10758/18477),呈现出农村高于城市的特点(χ^(2)=54.68,P<0.001);诊疗特征上,合并糖尿病者有高病原学阳性比例、低成功治疗比例、高耐多药比例、高合并其他部位结核比例,占比依次为75.80%vs 51.45%,67.67%vs 89.43%,2.65%vs 1.85%,13.60%vs 6.28%,且以上占比差异均有统计学意义(P<0.001)。结论2015—2022年江苏省南京市肺结核合并糖尿病年报告发病率整体呈上升趋势,今后应加大此类患者的防控力度。

Objective To analyze the epidemiological characteristics and temporal trends of tuberculosis complicated with diabetes in Nanjing,Jiangsu Province,to provide scientific basis for the treatment of pulmonary tuberculosis complicated with diabetes.Methods The Tuberculosis Information Management System was used to derive cases of tuberculosis patients from 2015-2022 according to their current residential address,and the temporal trends in the incidence of pulmonary tuberculosis complicated diabetes were analyzed using the Join-point 4.9.0.0 software.According to whether tuberculosis patients had diabetes,SPSS 22.0 software was used to analyze the differences in population,regional,and diagnostic characteristics between the two groups.Results From 2015 to 2022,a total of 566 patients with pulmonary tuberculosis complicated diabetes were registered in Nanjing.The average annual reported incidence rate over 8 years was 0.82 per 100000,rising from 0.21 per 100000 in 2015 to 2.40 per 100000 in 2022.The annual reported incidence rate showed an overall upward trend,with a statistically significant difference(APC=50.0%,95%CI:37.4%-63.8%,t=11.3,P<0.001).In terms of gender,the sex ratio of those with diabetes was 4.60∶1,which was higher than that of those without diabetes(2.12∶1),with a statistically significant difference(χ^(2)=50.63,P<0.001);in terms of age,the highest number of patients with pulmonary tuberculosis complicated diabetes was in the 65-75 years age group,accounting for 28.45%(161/566),while the highest number of patients with pulmonary tuberculosis without diabetes was in the 25-35 years age group,accounting for 19.59%(3620/18477);regionally,the proportion of rural areas for those with diabetes was 73.85%(418/566),and the proportion of rural areas for those without diabetes was 58.22%(10758/18477),which showed that rural areas were higher than urban areas(χ^(2)=54.68,P<0.001).In terms of the characteristics of diagnosis and treatment,the patients with diabetes had a higher proportion of positive pathology,a lower proportion of successful treatment,a higher proportion of multi-drug resistance,and a higher proportion of extra-pulmonary tuberculosis,with the proportions of 75.80%vs 51.45%,67.67%vs 89.43%,2.65%vs 1.85%,and 13.60%vs 6.28%,respectively.All these differences were statistically significant(P<0.001).Conclusions The overall annual reported incidence of pulmonary tuberculosis complicated diabetes in Nanjing from 2015 to 2022 showed an overall upward trend over time.Hence,more efforts should be made in the prevention and control of such patients.