2014-2023年广州市肺结核并发糖尿病患者流行特征及治疗转归分析

Analysis of epidemiological characteristics and therapeutic prognosis among pulmonary tuberculosis patients complicated with diabetes mellitus in Guangzhou City from 2014 to 2023

目的:分析2014-2023年广州市登记管理的肺结核并发糖尿病(PTB-DM)患者流行特征及治疗转归,为肺结核与糖尿病共病同防工作提供依据。方法:通过“中国疾病预防控制信息系统”子系统“结核病管理信息系统”收集广州市2014-2023年登记确诊肺结核患者病案信息,采用描述性流行病学方法对肺结核并发与未并发糖尿病患者的流行特征及治疗转归进行分析,采用非条件logistic回归模型进行肺结核并发糖尿病的影响因素分析。结果:2014-2023年广州市共登记肺结核并发糖尿病患者2468例,平均登记率为1.44/10万,占肺结核患者总数的2.79%(2468/88307),所占比例总体呈上升趋势(χ^(2)_(趋势)=131.002,P<0.01)。非条件logistic回归分析结果显示,与年龄较小,女性,职业为教师和医务人员、干部,初治,健康体检来源,无就诊延误,病原学阴性的肺结核患者相比,年龄较大,男性,职业为家务及待业、农牧渔业、工人,复治,患者来源为推介、转诊、追踪,发生就诊延误和病原学阳性的肺结核患者并发糖尿病的可能性大,OR值分别为1.436、1.508、1.386、1.781、1.442、1.178、2.050、3.796、3.688、1.670、3.064。完成抗结核治疗的83490例肺结核患者中,总体治疗成功率为93.56%(78114/83490),PTB-DM患者的治疗成功率(89.52%,1990/2223)低于未并发糖尿病的肺结核患者的治疗成功率(93.67%,76124/81267),差异有统计学意义(χ^(2)=61.942,P<0.05)。结论:广州市PTB-DM患者以中老年、男性、家务及待业人群为主,具有复治比例高、病原学阳性率高、耐药率高、就诊延误率高、主动发现率低和治疗成功率低的特点,应加强双向筛查以实现疾病早发现、早治疗。

Objective:Epidemiological characteristics and therapeutic prognosis of patients suffering from pulmonary tuberculosis combined with diabetes mellitus(PTB-DM)registered in Guangzhou City from 2014 to 2023 were analyzed to provide evidence for formulating measures to prevent and treat PTB-DM.Methods:Basic information of PTB-DM patients registered in Guangzhou from 2014 to 2023 were collected from the“TB Information Management System”of the“China Disease Control and Prevention Information System”.Descriptive epidemiological method was used to analyze the epidemiological characteristics and treatment outcomes of PTB-DM patients and patients with PTB alone.Non-conditional logistic regression model was used to analyze the influencing factors of PTB-DM.Results:All of 2468 PTB-DM cases were registered in Guangzhou from 2014 to 2023 with an average annual registration rate of 1.44/100000,accounting for 2.79%(2468/88307)of all PTB patients,and the proportion showed an overall upward trend(χ^(2)_(trend)=131.002,P<0.01).Non-conditional logistic regression analysis showed that compared with PTB patients who were younger,female,teachers/medical personnel/cadres,taking primary treatment,detected from health examination,not delayed in care seeking,and etiologically negative,patients who were older,male,doing housework/unemployed/farmer/herdsmen/fishermen/workers,taking retreatment,detected from referral or tracking,delayed in care seeking,and etiologically positive were more likely to have diabetes mellitus,the odds ratios were 1.436,1.508,1.386,1.781,1.442,1.178,2.050,3.796,3.688,1.670 and 3.064,respectively.Among 83490 tuberculosis patients who had treatment outcomes recorded,the overall treatment success rate was 93.56%(78114/83490),while the success treatment rate was 89.52%(1990/2223)in PTB-DM patients,lower than 93.67%(76124/81267)in PTB patients without DM(χ^(2)=61.942,P<0.05).Conclusion:PTB-DM patients in Guangzhou were mainly middle-aged and elderly adults,male,doing housework or unemployed.They had the characteristics of high retreatment rate,high etiologically positive rate,high drug resistance rate,high patient delay rate,low active detection rate and low treatment success rate.Two-way screening for PTB-DM should be strengthened to achieve early detection and treatment.