Analysis of risk factors for extensive lung focus and cavities in type 2 diabetes mellitus patients complicated with newly treated pulmonary tuberculosis

doi:10.19982/j.issn.1000-6621.20230147

Abstract

Abstract:

Objective: To explored the risk factors of extensive lung focus and cavities in type 2 diabetes mellitus (T2DM) patients complicated with newly treated pulmonary tuberculosis (PTB), to provide reference for clinical treatment strategies. Methods: Through electronic medical records and hospital information system, 955 T2DM patients complicated with newly diagnosed positive PTB who were hospitalized in Guangzhou Chest Hospital for the first time from January 2013 to January 2018 were collected for a conducted retrospective study. Univariate and multivariate logistic regression analysis was conducted with extensive lung focus (imaging lung lesions ≥3 lung fields) and cavity as dependent variables, and age, gender, diabetes course, glycosylated hemoglobin, lymphocyte (LY), neutrophil ratio (NLR), and whether metformin was used in recent three months as independent variables. Results: Among the 955 patients, 753 (78.8%) had extensive focus and 659 (69.0%) had cavities. The multivariate logistic regression analysis showed that the history of usage of metformin (OR=0.656, 95%CI: 0.449-0.957) and the high level of LY (OR=0.608,95%CI: 0.404-0.915) were protective factors for the extensive focus of both diseases. The occurrence of cavities (OR=2.094, 95%CI: 1.498-2.926) and the high level of NLR (OR=2.681, 95%CI: 1.860-3.864) were risk factors for the extensive focus of both diseases. The extensive focus (OR=1.945, 95%CI: 1.390-2.719) and high level of glycosylated hemoglobin (OR=1.206, 95%CI: 1.078-1.350), the high level of NLR (OR=1.390, 95%CI: 1.012-1.991) were the risk factors for cavitation. Conclusion: When T2DM complicated with PTB, the extensive focus and cavities were common, and both were risk factors for each other. Treatment that includes metformin should be the first choice for T2DM patients, and active monitoring and management of glycated hemoglobin, lymphocyte and NLR indicators should be carried out to alleviate the disease condition when complicated with tuberculosis.

Key words: Diabetes mellitus, type 2, Tuberculosis, pulmonary, Focal infection, Factor analysis, statistical

CLC Number:

R521
R587.1

Wang Min, Yuan Yuan, Tan Shouyong, Yang Zilong, Feng Zhiyu, Zhang Hong, Wu Di, Chen Zeying, Huang Xianlin, Kuang Haobin. Analysis of risk factors for extensive lung focus and cavities in type 2 diabetes mellitus patients complicated with newly treated pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(8): 761-767. doi: 10.19982/j.issn.1000-6621.20230147

Figures/Tables 4

临床特征	肺部病灶					统计检验值	P值		空洞					统计检验值		P值
临床特征	≥3个(753例)		<3个(202例)			统计检验值	P值		有(659例)			无(296例)		统计检验值		P值
年龄(岁, $x ˉ$ ±s)	55.88±12.63		55.52±11.68			t=0.362	0.717		54.98±11.91			57.63±13.36		t=-3.063		0.002
年龄组[例(构成比,%)]
0~29岁	18(2.4)		1(0.5)			χ²=2.043^a	0.153		13(2.0)			6(2.0)		χ²=0.003		0.956
30~49岁	209(27.7)		61(30.2)			χ²=0.469	0.494		198(30.0)			72(24.3)		χ²=3.297		0.069
50~64岁	353(46.9)		97(48.0)			χ²=0.083	0.773		314(47.7)			136(46.0)		χ²=0.237		0.626
≥65岁	173(23.0)		43(21.3)			χ²=0.259	0.611		134(20.3)			82(27.7)		χ²=6.337		0.012
性别[例(构成比,%)]						χ²=0.051	0.821							χ²=1.390		0.238
男性	606(80.5)		164(81.2)						538(81.6)			232(78.4)
女性	147(19.5)		38(18.8)						121(18.4)			64(21.6)
糖尿病病程[年,M(Q₁,Q₃)]	1.00(0.00,6.00)		1.00(0.00,6.00)			Z=-0.463	0.643		1.00(0.00,6.00)			1.00(0.00,6.00)		Z=-1.707		0.088
糖尿病病程分组[例(构成比,%)]
<2年	384(51.0)		106(52.5)			χ²=0.139	0.709		350(53.1)			140(47.3)		χ²=2.763		0.096
2~3年	87(11.5)		27(13.4)			χ²=0.498	0.480		76(11.5)			38(12.8)		χ²=0.331		0.565
4~5年	78(10.4)		15(7.4)			χ²=1.559	0.212		62(9.4)			31(10.5)		χ²=0.263		0.608
≥6年	204(27.1)		54(26.7)			χ²=0.010	0.919		171(26.0)			87(29.4)		χ²=1.228		0.268
淋巴细胞计数[×10⁹个/L,M(Q₁,Q₃)]	1.26(0.89,1.63)		1.56(1.14,1.95)			Z=-5.928	0.000		1.35(0.93,1.70)			1.26(0.93,1.75)		Z=-0.204		0.838
淋巴细胞水平[例(构成比,%)]						χ²=21.588	0.000							χ²=1.625		0.202
<1.1×10⁹个/L	301(40.0)		45(22.3)						230(34.9)			116(39.2)
≥1.1×10⁹个/L	452(60.0)		157(77.7)						429(65.1)			180(60.8)
NLR值[M(Q₁,Q₃)]	4.98(3.36,7.84)		3.19(2.30,4.94)			Z=-8.251	0.000		4.7(3.13,7.04)			4.46(2.67,7.44)		Z=-1.060		0.289
NLR水平[例(构成比,%)]						χ²=55.219	0.000							χ²=7.211		0.007
≥3.13	589(78.2)		105(52.0)						496(75.3)			198(66.9)
<3.13	164(21.8)		97(48.0)						163(24.7)			98(33.1)
糖化血红蛋白值[%,M(Q₁,Q₃)]	9.38(7.6,11.82)		8.94(7.43,11.23)			Z=-1.734	0.083		9.52(7.98,11.84)			8.61(7.06,11.00)		Z=-4.506		0.000
糖化血红蛋白水平[例(构成比,%)]
<7%	118(15.7)		36(17.8)			χ²=0.545	0.460		85(12.9)			69(23.3)		χ²=16.373		0.000
7%~<9%	215(28.5)		67(33.2)			χ²=1.631	0.202		190(28.8)			92(31.1)		χ²=0.497		0.481
9%~<11%	171(22.7)		47(23.2)			χ²=0.028	0.867		157(23.8)			61(20.6)		χ²=1.199		0.274
11%~<13%	127(16.9)		24(11.9)			χ²=2.973	0.085		118(17.9)			33(11.1)		χ²=7.006		0.008
≥13%	122(16.2)		28(13.9)			χ²=0.659	0.417		109(16.6)			41(13.9)		χ²=1.115		0.291
二甲双胍方案[例(构成比,%)]						χ²=4.035	0.045							χ²=4.273		0.039
是	152(20.2)		54(26.7)						130(19.7)			76(25.7)
否	601(79.8)		148(73.3)						529(80.3)			220(74.3)
病灶所占肺野数[例(构成比,%)]													χ²=23.661		0.000
<3个		-		-	-			-		111(16.8)	91(30.7)
≥3个		-		-	-			-		548(83.2)	205(69.3)
空洞[例(构成比,%)]					χ²=23.661			0.000
有		548(72.8)		111(55.0)						-	-		-		-
无		205(27.2)		91(45.0)						-	-		-		-

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
使用二甲双胍	-0.422	0.193	4.795	0.029	0.656(0.449~0.957)
出现空洞	0.739	0.171	18.725	0.000	2.094(1.498~2.926)
淋巴细胞水平高	-0.497	0.208	5.705	0.017	0.608(0.404~0.915)
NLR水平高	0.986	0.186	27.975	0.000	2.681(1.860~3.864)

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
肺部病灶广泛	0.665	0.171	15.134	0.000	1.945(1.390~2.719)
NLR水平高	0.330	0.162	4.126	0.042	1.390(1.012~1.991)
糖化血红蛋白水平高	0.188	0.057	10.662	0.001	1.206(1.078~1.350)

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