2019—2023年中国肺结核与糖尿病共病患者治疗转归影响因素分析

doi:10.19982/j.issn.1000-6621.20250275

摘要/Abstract

摘要：

目的: 描述2019—2023年中国登记肺结核与糖尿病共病患者(pulmonary tuberculosis with diabetes mellitus,PTB-DM)的流行病学特征,并分析影响治疗转归的因素。方法: 通过“中国疾病预防控制信息系统”获得中国2019—2023年登记肺结核患者病例信息,采用卡方检验比较PTB-DM患者与非PTB-DM患者的特征,通过构建以患者为水平1,省份为水平2的两水平logistic回归模型,分析PTB-DM患者治疗转归的影响因素。结果: 2019—2023年共3077951例登记PTB患者纳入分析,PTB-DM患者189664例(6.16%),PTB-DM占比呈逐年上升趋势,年递增率为24.91%(Z=2.200,P=0.027)。PTB-DM患者中男性占77.95%(147848/189664),≥65岁占32.69%(62002/189664),离退/家务/待业占31.52%(59780/189664),流动人口占27.07%(51343/189664),汉族占89.92%(170554/189664),病原学阳性占74.95%(142150/189664),复治占12.11%(22977/189664),2月序痰涂片阳性占4.34%(8238/189664),未规则服药率占15.15%(26134/172497),均高于非PTB-DM患者[68.08%(1966270/2888287)、27.55%(795676/2888287)、20.52%(592653/2888287)、26.07%(752895/2888287)、83.91%(2423534/2888287)、54.80%(1583015/2888287)、8.62%(249014/2888287)、1.76%(50820/2888287)、6.85%(190277/2777768),χ²=8069.084、48737.054、22271.353、92.769、4860.105、29447.614、2695.229、69998.258、16462.024,P值均<0.001]。PTB-DM患者成功治疗率为88.57%(152780/172497),低于非PTB-DM患者[93.37%(2593733/2777768)](χ²=5831.725,P<0.001)。两水平logistic回归模型分析发现,在PTB-DM患者中,≥65岁组(OR=1.669,95%CI:1.527~1.825)、离退/家务/待业(OR=1.827,95%CI:1.097~3.042)、病原学阳性(OR=1.435,95%CI:1.024~2.011)、复治(OR=4.937,95%CI:4.554~5.353)、未规则服药(OR=178.119,95%CI:154.968~204.728)患者出现不良结局的风险更高,女性(OR=0.771,95%CI:0.722~0.824)、病原学阴性(OR=0.683,95%CI:0.485~0.961)患者出现不良结局的风险更低。结论: 中国登记肺结核患者中PTB-DM数量及占比逐年上升,应重点关注男性、65岁以上、离退/家务/待业、病原学阳性、复治、未规则服药的PTB-DM患者,强化PTB-DM患者的防治管理,以进一步提高治疗成功率,降低不良结局发生风险。

关键词: 结核,肺, 糖尿病, 共病现象, 治疗结果, 模型,统计学

Abstract:

Objective: To assess the epidemiological characteristics and the influencing factors of treatment outcomes among PTB patients comorbid with DM (PTB-DM) in China from 2019 to 2023. Methods: Notified PTB cases from 2019 to 2023 were extracted from the National Tuberculosis Management Information System. Chi-square tests were utilized to compare the characteristics of PTB patients with and without DM. A two-level logistic model with patient as level 1 and provinces as level 2, was used to analyze the influencing factors of treatment outcomes among PTB-DM patients. Results: From 2019 to 2023 in China, a total of 189664 PTB-DM patients were notified, accounted for 6.16% of the total PTB patients (3077951 cases). The proportion of PTB-DM increased during 2019—2023, the annual increase rate of PTB-DM proportion was 24.91% (Z=2.200, P=0.027). Among the PTB-DM patients, male accounted for 77.95% (147848/189664), ≥65 years accounted for 32.69% (62002/189664), retirees/houseworker/job seekers accounted for 31.52% (59780/189664), floating patients accounted for 27.07% (51343/189664), Han nationality accounted for 89.92% (170554/189664), pathogen-positive accounted for 74.95% (142150/189664), previously treated accounted for 12.11% (22977/189664), culture-positive at the end of 2nd month of treatment accounted for 4.34% (8238/189664), irregular medication rate was 15.15% (26134/172497), significantly higher than PTB patients without DM (68.08% (1966270/2888287), 27.55% (795676/2888287), 20.52% (592653/2888287), 26.07% (752894/2888287), 83.91% (2423534/2888287), 54.80% (1583015/2888287), 8.62% (249014/2888287), 1.76% (50820/2888287), 6.85% (190277/2777768), χ²=8069.084, 48737.054, 22271.353, 92.769, 4860.105, 29447.614, 2695.229, 69998.258, 16462.024, all P<0.001). The success treatment rate in PTB-DM patients (88.57% (152780/172497)) was lower than PTB patients without DM (93.37% (2593733/2777768), χ²=5831.725, P<0.001). The two-level logistic model analysis revealed that, among PTB-DM patients, aged ≥65 years (OR=1.669, 95%CI: 1.527-1.825), retirees/houseworker/job seekers (OR=1.827, 95%CI: 1.097-3.042), pathogen-positive (OR=1.435, 95%CI: 1.024-2.011), previously treated (OR=4.937, 95%CI: 4.554-5.353), irregular medication (OR=178.119, 95%CI: 154.968-204.728) patients had higher risks of adverse outcomes, while female (OR=0.771, 95%CI: 0.722-0.824), pathogen-negative (OR=0.683, 95%CI: 0.485-0.961) patients had lower risks of adverse outcomes. Conclusion: The number and proportion of PTB-DM among notified PTB patients in China have been increasing year by year. Attention should be paid to PTB-DM patients who are male, over 65 years old, retired/houseworker/unemployed, pathogen-positive, previously treated, and irregular medication. It is needed to strengthen targeted prevention, treatment and management strategies for PTB-DM patients to improve treatment success rates and reduce the risk of adverse outcomes.

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

中图分类号:

R521
R587.1

田飞飞, 李玉红, 李雪, 王嘉, 李涛, 杜昕, 赵雁林, 张慧, 刘小秋. 2019—2023年中国肺结核与糖尿病共病患者治疗转归影响因素分析[J]. 中国防痨杂志, 2025, 47(12): 1547-1555. doi: 10.19982/j.issn.1000-6621.20250275

Tian Feifei, Li Yuhong, Li Xue, Wang Jia, Li Tao, Du Xin, Zhao Yanlin, Zhang Hui, Liu Xiaoqiu. Analysis of influencing factors of treatment outcomes among pulmonary tuberculosis patients comorbid with diabetes, China, 2019—2023[J]. Chinese Journal of Antituberculosis, 2025, 47(12): 1547-1555. doi: 10.19982/j.issn.1000-6621.20250275

图/表 5

表1

表2

表3

表4

2019—2023年中国登记肺结核与糖尿病共病患者治疗转归的两水平零模型检验

参数	估计值	s $x ˉ$ 值	χ²值	P值
固定效应参数	-2.081	0.061	-34.380	<0.001
随机效应参数	0.115	0.339	1545.400	<0.001

表4

表5

2019—2023年中国登记肺结核与糖尿病共病患者治疗转归两水平模型分析

变量	β值	OR(95%CI)值	s $x ˉ$ 值	Z值	P值
性别
男性		1
女性	-0.260	0.771(0.722~0.824)	0.034	-7.732	<0.001
年龄组(岁)
0~44		1
45~64	0.055	1.057(0.970~1.151)	0.044	1.263	0.207
≥65	0.512	1.669(1.527~1.825)	0.046	11.240	<0.001
职业
儿童/学生/教师		1
职员/工人	0.338	1.402(0.835~2.354)	0.264	1.279	0.201
农牧渔民/海员	0.535	1.708(1.027~2.840)	0.259	2.064	0.039
离退/家务/待业	0.603	1.827(1.097~3.042)	0.260	2.316	0.021
不详及其他	0.591	1.805(1.062~3.068)	0.271	2.182	0.029
人口类型
本地		1
流动	0.004	1.004(0.938~1.075)	0.035	0.112	0.911
民族
汉族		1
其他	0.127	1.136(1.030~1.252)	0.050	2.562	0.010
病原学结果
无结果		1
阳性	0.361	1.435(1.024~2.011)	0.172	2.099	0.036
阴性	-0.382	0.683(0.485~0.961)	0.174	-2.189	0.029
患者分类
初治		1
复治	1.597	4.937(4.554~5.353)	0.041	38.723	<0.001
规则服药
是		1
否	5.182	178.119(154.968~204.728)	0.071	72.952	<0.001

表5

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年份	肺结核登记数(例)	PTB-DM[例,构成比(%)]	非PTB-DM[例,构成比(%)]
2019	742281	27661(3.73)	714620(96.27)
2020	636975	30620(4.81)	606355(95.19)
2021	598641	37532(6.27)	561109(93.73)
2022	520126	41120(7.91)	479006(92.09)
2023	579928	52731(9.09)	527197(90.91)
合计	3077951	189664(6.16)	2888287(93.84)

特征	肺结核 [例,构成比(%)]	PTB-DM [例,构成比(%)]	非PTB-DM [例,构成比(%)]	χ²值	P值
性别				8069.084	<0.001
男性	2114118(68.69)	147848(77.95)	1966270(68.08)
女性	963833(31.31)	41816(22.05)	922017(31.92)
年龄组(岁)				48737.054	<0.001
0~44	1127809(36.64)	26263(13.85)	1101546(38.14)
45~64	1092464(35.49)	101399(53.46)	991065(34.31)
≥65	857678(27.87)	62002(32.69)	795676(27.55)
职业				22271.353	<0.001
儿童/学生/教师	207368(6.74)	970(0.51)	206398(7.15)
职员/工人	257732(8.37)	14770(7.79)	242962(8.41)
农牧渔民/海员	1865241(60.60)	108371(57.14)	1756870(60.83)
离退/家务/待业	652433(21.20)	59780(31.52)	592653(20.52)
不详及其他	95177(3.09)	5773(3.04)	89404(3.09)
人口类型				92.769	<0.001
本地	2273713(73.87)	138321(72.93)	2135392(73.93)
流动	804238(26.13)	51343(27.07)	752895(26.07)
民族				4860.105	<0.001
汉族	2594088(84.28)	170554(89.92)	2423534(83.91)
其他	483863(15.72)	19110(10.08)	464753(16.09)
病原学结果				29447.614	<0.001
无结果	65011(2.11)	1571(0.83)	63440(2.20)
阳性	1725165(56.05)	142150(74.95)	1583015(54.80)
阴性	1287775(41.84)	45943(24.22)	1241832(43.00)
2月序痰涂片				69998.258	<0.001
无结果	417276(13.56)	28848(15.21)	388428(13.45)
阳性	59058(1.92)	8238(4.34)	50820(1.76)
阴性	2601617(84.52)	152578(80.45)	2449039(84.79)
治疗分类				2695.229	<0.001
初治	2805960(91.16)	166687(87.89)	2639273(91.38)
复治	271991(8.84)	22977(12.11)	249014(8.62)
规则服药				16462.024	<0.001
是	2733854(92.66)	146363(84.85)	2587491(93.15)
否	216411(7.34)	26134(15.15)	190277(6.85)
治疗转归				5831.725	<0.001
治疗成功	2746513(93.09)	152780(88.57)	2593733(93.37)
不良结局	203752(6.91)	19717(11.43)	184035(6.63)

特征	合计 [例,构成比(%)]	治疗成功 [例,构成比(%)]	不良结局 [例,构成比(%)]	χ²值	P值
性别				107.429	<0.001
男性	134326(77.87)	118403(88.15)	15923(11.85)
女性	38171(22.13)	34377(90.06)	3794(9.94)
年龄组(岁)				430.085	<0.001
0~44	23919(13.87)	21340(89.22)	2579(10.78)
45~64	92389(53.56)	82949(89.78)	9440(10.22)
≥65	56189(32.57)	48491(86.30)	7698(13.70)
职业				319.477	<0.001
儿童/学生/教师	881(0.51)	837(95.01)	44(4.99)
职员/工人	13528(7.84)	12322(91.09)	1206(8.91)
农牧渔民/海员	99187(57.50)	88432(89.16)	10755(10.84)
离退/家务/待业	53723(31.15)	46644(86.82)	7079(13.18)
不详及其他	5178(3.00)	4545(87.78)	633(12.22)
人口类型				444.702	<0.001
本地	126821(73.52)	113555(89.54)	13266(10.46)
流动	45676(26.48)	39225(85.88)	6451(14.12)
民族				16.486	<0.001
汉族	155426(90.10)	137821(88.67)	17605(11.33)
其他	17071(9.90)	14959(87.63)	2112(12.37)
病原学结果				1697.651	<0.001
无结果	1417(0.82)	1270(89.63)	147(10.37)
阳性	128285(74.37)	111263(86.73)	17022(13.27)
阴性	42795(24.81)	40247(94.05)	2548(5.95)
2月序痰涂片				28818.819	<0.001
无结果	24458(14.18)	13931(56.96)	10527(43.04)
阳性	7502(4.35)	6331(84.39)	1171(15.61)
阴性	140537(81.47)	132518(94.29)	8019(5.71)
患者分类				2883.223	<0.001
初治	152438(88.37)	137289(90.06)	15149(9.94)
复治	20059(11.63)	15491(77.23)	4568(22.77)
规则服药				20153.561	<0.001
是	146363(84.85)	136360(93.17)	10003(6.83)
否	26134(15.15)	16420(62.83)	9714(37.17)