2017—2021年云南省肺结核与糖尿病共病患者抗结核治疗效果及影响因素分析

doi:10.19982/j.issn.1000-6621.20240006

摘要/Abstract

摘要：

目的: 分析云南省利福平敏感肺结核与糖尿病共病患者(简称“共病患者”)抗结核治疗效果及影响治疗效果的危险因素,为改善共病患者抗结核治疗效果提供依据。方法: 通过“中国疾病预防控制信息系统”子系统“监测报告管理系统”获取2017年1月1日至2021年12月31日云南省登记的共病患者病案信息,包括社会人口学信息、结核病诊断信息、抗结核治疗信息和抗结核治疗结局判定信息等,最终纳入3984例。分析共病患者抗结核治疗效果,并运用Cox回归模型分析影响共病患者治疗结局的危险因素。结果: 3984例共病患者抗结核成功治疗率为89.36%(3560/3984),不良治疗结局发生率为10.64%(424/3984),死亡占4.27%(170/3984),治疗过程中丢失占2.46%(98/3984),失败占2.31%(92/3984),因药物不良反应中断治疗占1.61%(64/3984)。44.22%(179/424)的不良结局发生在治疗的前2个月。Cox回归模型分析显示,≥65岁者出现不良治疗结局的风险较<35岁者高(HR=2.612,95%CI:1.483~4.601),复治患者出现不良治疗结局的风险是初治患者的1.405倍(95%CI:1.072~1.843),病原学阳性者出现不良治疗结局的风险是阴性或未查患者的1.473倍(95%CI:1.183~1.834)。结论: 云南省共病患者抗结核治疗效果不佳,应重视共病患者,尤其是≥65岁老年人、复治、病原学阳性患者,抗结核治疗过程中治疗效果监测及健康管理,及时给予干预。

关键词: 结核,肺, 糖尿病, 共病现象, 治疗结果, 因素分析,统计学

Abstract:

Objective: To analyze the treatment outcomes and risk factors among patients with rifampicin-sensitive tuberculosis-diabetes mellitus comorbidity (PTB-DM) patients in Yunnan Province, to provide evidence for improving the effect of anti-tuberculosis treatment for PTB-DM by. Methods: The medical data of PTB-DM patients registered in Yunnan Province from January 1, 2017 to December 31, 2021 were obtained through the “Monitoring Report Management System” of the “China Disease Prevention and Control Information System” subsystem, including sociodemographic information, tuberculosis diagnosis, anti-tuberculosis treatment and judgment of the treatment, 3984 cases were finally included. The effectiveness of anti-tuberculosis treatment in PTB-DM patients was analyzed, and the risk factors of the treatment outcome were analyzed using Cox regression model. Results: The success rate of anti-tuberculosis treatment in 3984 PTB-DM patients was 89.36% (3560/3984), the incidence of adverse treatment outcomes of 10.64% (424/3984), the mortality was 4.27% (170/3984), and 2.46% (98/3984) were lost during treatment, with failure of 2.31% (92/3984) and discontinuation of treatment due to adverse drug reactions of 1.61% (64/3984). Of adverse outcomes, 44.22% (179/424) occurred in the first 2 months of treatment. Cox regression model analysis showed that individuals aged ≥65 had a higher risk of adverse treatment outcomes compared to those who aged <35 (HR=2.612, 95%CI: 1.483-4.601); the risk of adverse treatment outcomes in retreated patients was 1.405 times higher than that in newly treated patients (95%CI: 1.072-1.843), and the risk of adverse treatment outcomes in pathogen positive patients was 1.473 times higher than that in other patients (95%CI: 1.183-1.834). Conclusion: The effectiveness of anti-tuberculosis treatment for PTB-DM patients in Yunnan Province is not satisfactory, and attention should be paid to PTB-DM patients, especially elderly people aged 65 and above, re-treated, and pathogen-positive patients. During the anti-tuberculosis treatment, monitoring of treatment effectiveness and health management should be carried out, and timely intervention should be given.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Treatment outcome, Factor analysis, statistical

中图分类号:

R52
R193

杨蕊, 李玲, 陈金瓯, 许琳. 2017—2021年云南省肺结核与糖尿病共病患者抗结核治疗效果及影响因素分析[J]. 中国防痨杂志, 2024, 46(5): 519-524. doi: 10.19982/j.issn.1000-6621.20240006

Yang Rui, Li Ling, Chen Jinou, Xu Lin. Analysis of influencing factors of anti-tuberculosis treatment effect for pulmonary tuberculosis patients complicated with diabetes in Yunnan Province from 2017 to 2021[J]. Chinese Journal of Antituberculosis, 2024, 46(5): 519-524. doi: 10.19982/j.issn.1000-6621.20240006

图/表 4

表1

表2

表3

表4

参考文献 25

[1]	舒薇, 刘宇红. 世界卫生组织《2023年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5(1): 15-19. doi:10.19983/j.issn.2069-8493.2024006.
[2]	International Diabetes Federation. Global Diabetes data report 2000—2045[EB/OL]. [2024-03-26]. https://diabetesatlas.org/data/en/world/.
[3]	World Health Organization. Tuberculosis and diabetes: invest for impact. Geneva: World Health Organization, 2023.
[4]	杨敏, 付亮, 邓国防. 结核病并发糖尿病治疗管理相关进展. 中国防痨杂志, 2021, 43(1): 87-90. doi:10.3969/j.issn.1000-6621.2021.01.016.
[5]	Noubiap JJ, Nansseu JR, Nyaga UF, et al. Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2.3 million patients with tuberculosis. Lancet Glob Health, 2019, 7(4): e448-e460. doi:10.1016/S2214-109X(18)30487-X.
[6]	中华人民共和国国家卫生和计划生育委员会. WS 196—2017 结核病分类. 2017-11-09.
[7]	赵雁林, 陈明亭. 中国结核病防治工作技术指南. 北京: 人民卫生出版社, 2021.
[8]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 2017-11-09.
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中华糖尿病杂志, 2018, 10(1): 4-67. doi:10.3760/cma.j.issn.1674-5809.2018.01.003.
[10]	国家感染性疾病临床医学研究中心, 深圳市第三人民医院, 国家代谢性疾病临床医学研究中心, 等. 结核病与糖尿病共病的治疗管理专家共识. 中国防痨杂志, 2021, 43(1): 12-22. doi:10.3969/j.issn.1000-6621.2021.01.004.
[11]	Zhou ZR, Wang WW, Li Y, et al. In-depth mining of clinical data: the construction of clinical prediction model with R. Ann Transl Med, 2019, 7(23): 796. doi:10.21037/atm.2019.08.63.
[12]	吴蔚, 邱玉冰, 陈金瓯, 等. “十三五”期间云南省结核病新型防治服务模式实施效果研究. 卫生软科学, 2023, 37(6): 1-4. doi:10.3969/j.issn.1003-2800.2023.06.001.
[13]	Yoon YS, Jung JW, Jeon EJ, et al. The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study. Thorax, 2017, 72(3): 263-270. doi:10.1136/thoraxjnl-2015-207686. pmid: 27553224
[14]	Delgado-Sánchez G, García-García L, Castellanos-Joya M, et al. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000—2012. PLoS One, 2015, 10(6): e0129312. doi:10.1371/journal.pone.0129312.
[15]	Ma Y, Huang ML, Li T, et al. Role of diabetes mellitus on treatment effects in drug-susceptible initial pulmonary tuberculosis patients in China. Biomed Environ Sci, 2017, 30(9): 671-675. doi:10.3967/bes2017.089. pmid: 29081342
[16]	裴宁, 卢水华. 特殊人群结核病的诊断和治疗. 结核病与肺部健康杂志, 2017, 6(1): 25-27. doi:10.3969/j.issn.2095-3755.2017.01.007.
[17]	游楠楠, 陆伟, 竺丽梅, 等. 糖尿病及血糖状况对结核病患者治疗转归的影响. 中华疾病控制杂志, 2020, 24(1): 90-96. doi:10.16462/j.cnki.zhjbkz.2020.01.018.
[18]	梁达, 赵晓银, 商越, 等. 青海省结核病患者治疗结局影响因素分析及贝叶斯网络模型研究. 疾病监测, 2022, 37(2): 210-213. doi:10.3784/jbjc.202103230151.
[19]	刘海妮, 华中秋, 张少茹, 等. 结核病患者心理困扰现状及其影响因素分析. 现代预防医学, 2020, 47(4): 665-668.
[20]	蒋泽顺, 杨正贵, 李江平, 等. 宁夏结核病治疗转归影响因素分析及预测模型的建立. 现代预防医学, 2021, 48(16): 2905-2910.
[21]	周勇, 闫世春, 韩雪, 等. 2017—2021年黑龙江省肺结核合并糖尿病登记率及变化趋势. 疾病监测, 2023, 38(4): 426-431. doi:10.3784/jbjc.202211210511.
[22]	Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ, 2020, 369: m997. doi:10.1136/bmj.m997.
[23]	Kumar Nathella P, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology, 2017, 152(1): 13-24. doi:10.1111/imm.12762. pmid: 28543817
[24]	Perez-Navarro LM, Restrepo BI, Fuentes-Dominguez FJ, et al. The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes. Tuberculosis(Edinb), 2017, 103: 83-91. doi:10.1016/j.tube.2017.01.006.
[25]	邓国防, 成诗明. 浅谈我国结核病与糖尿病共病治疗管理现状. 中国防痨杂志, 2021, 43(1): 23-25. doi:10.3969/j.issn.1000-6621.2021.01.005.

治疗时间(月)	死亡	丢失	失败	不良反应	合计
<1	43(25.29)	2(2.04)	0(0.00)	9(14.06)	54(12.74)
1	29(17.06)	17(17.35)	3(3.26)	13(20.31)	62(14.62)
2	24(14.12)	20(20.41)	1(1.09)	18(28.13)	63(14.86)
3	15(8.82)	13(13.27)	3(3.26)	5(7.81)	36(8.49)
4	19(11.17)	11(11.23)	18(19.56)	3(4.68)	51(12.02)
5	12(7.06)	8(8.16)	34(36.96)	3(4.69)	57(13.44)
6	12(7.06)	5(5.10)	20(21.74)	7(10.94)	44(10.38)
7	5(2.94)	5(5.10)	3(3.26)	2(3.13)	15(3.54)
8	2(1.18)	3(3.06)	2(2.17)	4(6.25)	11(2.59)
9	1(0.59)	4(4.08)	1(1.09)	0(0.00)	6(1.42)
10	7(4.12)	2(2.04)	1(1.09)	0(0.00)	10(2.36)
11	1(0.59)	2(2.04)	0(0.00)	0(0.00)	3(0.71)
≥12	0(0.00)	6(6.12)	6(6.52)	0(0.00)	12(2.83)
总计	170(100.00)	98(100.00)	92(100.00)	64(100.00)	424(100.00)

因素	患者数 (例)	构成比 (%)	成功治疗		不良治疗结局		χ²值	P值
因素	患者数 (例)	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	χ²值	P值
性别							1.471	0.225
男性	2897	72.72	2576	88.92	321	11.08
女性	1087	27.28	984	90.52	103	9.48
年龄(岁)							28.852	<0.001
<35	206	5.17	193	93.69	13	6.31
35~64	2708	67.97	2454	90.62	254	9.38
≥65	1070	26.86	913	85.33	157	14.67
民族							0.597	0.440
汉族	2859	71.76	2561	89.58	298	10.42
少数民族	1125	28.24	999	88.80	126	11.20
职业							12.339	0.006
农民	2937	73.72	2620	89.21	317	10.79
离退人员	478	12.00	412	86.19	66	13.81
家务及待业	135	3.39	127	94.07	8	5.93
其他	434	10.89	401	92.40	33	7.60
治疗分类							6.132	0.013
初治	3589	90.09	3227	89.91	362	10.09
复治	395	9.91	333	84.30	62	15.70
病原学检查							10.897	0.010
阳性	2666	66.92	2350	88.15	316	11.85
阴性或未查	1318	33.08	1210	91.81	108	8.19
从出现症状到就诊时间(d)							0.175	0.676
≤25	1996	50.19	1780	89.18	216	10.82
>25	1981	49.81	1774	89.55	207	10.45
从就诊到诊断时间(d)							0.052	0.820
≤3	2026	51.08	1810	89.34	216	10.66
>3	1940	48.92	1734	89.38	206	10.62

变量	赋值
因变量	成功治疗=0;不良治疗结局=1
性别	女性=1;男性=2
年龄	<35岁=1;35~64岁=2;≥65岁=3
职业	农民=1;离退人员=2;家务及待业=3;其他=4
病原学检查	阴性或未查=1;阳性=2
治疗分类	初治=1;复治=2

因素	β值	$s_{\bar{x}}$值	Wald χ²值	P值	HR(95%CI)值
年龄(岁)
<35				<0.001	1.000
35~64	0.445	0.284	2.447	0.118	1.561(0.894~2.726)
≥65	0.960	0.289	11.048	0.001	2.612(1.483~4.601)
治疗分类
初治					1.000
复治	0.340	0.138	6.074	0.014	1.405(1.072~1.843)
病原学检查
阴性或未查					1.000
阳性	0.387	0.112	12.019	0.001	1.473(1.183~1.834)