Abstract:

Objective To analyze the clinical characteristics and drug resistance of retreated smear positive pulmonary tuberculosis (PTB) patients with diabetes mellitus (DM), so as to provide reference for treatment. Methods We collected 287 retreated smear positive PTB patients hospitalized in Public Health Clinical Center of Chengdu from December 2018 to January 2021, including 169 cases in DM group and 118 cases in non-DM group. The gender, age, body mass index (BMI), hemoptysis, fever, frequency of retreatment, self-medication withdrawal, pulmonary lesions, lung cavity and drug resistance were collected and analyzed. The drug resistance of patients was tested by microplate phenotypic methods. Results Compared with the non-DM group, DM group had more male patients (88.8% (150/169), 73.7% (87/118)), older patients (55.0 (47.5,63.0) years old, 37.0 (27.0,50.0) years old), higher BMI (21.1 (18.9,24.1),19.0 (17.6,21.2)), more patients with hemoptysis or pulmonary cavity >3 (46.2% (78/169),30.5% (36/118);57.4% (97/169),42.4% (50/118)), and broader lung lesions sites (4.0 (3.0,6.0),3.0 (2.0,4.0)), all with a statistically significant difference (χ²=10.909, P=0.001; Z=-7.548, P<0.001; Z=-4.366, P<0.001; χ²=7.103, 6.277,P=0.008, 0.012; Z=-3.810, P<0.001). The top three drug resistance rates in the DM group were isoniazid (INH)(50.3% (85/169)), rifampin (RFP)(41.4% (70/169)) and Streptomycin (Sm)(27.8% (47/169)), and in non-DM group the top three were also INH (27.1% (32/118)), RFP (22.9% (27/118)) and Sm (17.8% (21/118)). Compared with the non-DM group, the rate of multi-drug resistance (MDR) was higher in the DM group (35.5% (60/169),22.0% (26/118)), the difference was statistically significant (χ²=6.007, P=0.014). There was no significant difference in the resistance rates of MDR plus second-line injection (7.7% (13/169),4.2% (5/118)),MDR plus fluoroquinolone (6.5% (11/169),4.2% (5/118)) and extensive drug-resistant (4.7% (8/169), 1.7% (2/118)) between the two groups (χ²=1.411, 0.681, 1.908, P=0.235, 0.409, 0.167). Conclusion The retreated smear positive PTB patients with DM had higher incidence of hemoptysis, more extensive lung lesions, more cavities and possibly higher drug resistance rates. We should pay attention to the screening and treatment of TB and DM comorbidities, and understand the results of drug sensitivity tests, then formulate accurate anti-tuberculosis regimen.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Disease attributes