关键词: 结核,肺, 糖尿病, 共病现象, 疾病特征, 因素分析,统计学

Abstract:

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 ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^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 (χ²=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.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Disease characteristics, Factor analysis, statistical