【作者】 汪求真； 马爱国； 韩秀霞； 赵善良； 蔡静； 马云波； 赵杰； 王玉文； 董怀峰； 赵振蕾； 魏来； 于涛； 陈沛学； EvertG.Schouten； Frans J.Kok； Anil Kapur；

【Author】 Qiuzhen Wang;Aiguo Ma;Xiuxia Han;Shanliang Zhao;Jing Cai;Yunbo Ma;Jie Zhao;Yuwen Wang;Huaifeng Dong;Zhenlei Zhao;Lai Wei;Tao Yu;Peixue Chen;Evert G Schouten;Frans J Kok;Anil Kapur;School of Public Health/Institute of Nutrition and Health,Qingdao University;Linyi Chest Hospital;Yishui Tuberculosis Clinic;Tancheng Tuberculosis Clinic;Yinan Tuberculosis Clinic;Lanshan Tuberculosis Clinic;Feixian Tuberculosis Clinic;Pingyi Tuberculosis Clinic;Cangshan Tuberculosis Clinic;Division of Human Nutrition,Wageningen University;World Diabetes Foundation;

【机构】 青岛大学公共卫生学院/营养与健康研究院； 临沂市胸科医院； 沂水县结核病防治所； 郯城县结核病防治所； 沂南县结核病防治所； 兰山区结核病防治所； 费县结核病防治所； 平邑县结核病防治所； 苍山县结核病防治所； 瓦赫宁根大学人类营养学系； 世界糖尿病基金会；

【摘要】 2型糖尿病(DM)患者患肺结核(PTB)的风险较高;此外,合并DM与PTB治疗效果差有关。以社区为基础的结核病患者中,DM和DM前期患病率数据缺乏,发展中国家尤为突出。因此,我们进行了一项前瞻性研究,以调查中国农村地区新发现PTB患者中DM和DM前期的患病率,并评估存在DM的危险因素。在2010年至2012年进行的一项基于社区的前瞻性研究中,对临沂市7个结核病防治所新发现的6382名PTB患者的代表性样本进行了DM测试。来自同一社区的6674名非结核病对照人群也进行了测试。结核病患者的糖尿病患病率(6.3%)高于对照组的患病率(4.7%,p<0.05)。与对照组相比,PTB患者有更高的DM风险(aOR:3.17,95%CI:1.14-8.84)。DM的患病率随年龄增加而增加,在30岁以上的结核病患者中DM的患病率更高(p<0.05)。在结核病患者中,体重正常者(BMI:18.5-23.9)的糖尿病患病率最低(5.8%)。年龄增长、DM家族史、痰涂片阳性、胸腔X线检查和较高的年收入(≥10000元)呈与DM正相关,而频繁的户外活动与DM呈负相关。PTB患者中DM的患病率高于非TB对照组,其患有DM的调整后比值比高出3倍。鉴于中国的DM患病率不断上升且结核病负担仍然很高,DM与PTB之间的这种关联可能代表着预防和治疗这两种疾病的新的公共卫生挑战。更多还原

【Abstract】 Patients with type 2 diabetes(DM) have a higher risk of developing pulmonary tuberculosis(PTB);moreover,DM co-morbidity in PTB is associated with poor PTB treatment outcomes.Community based prevalence data on DM and prediabetes(pre-DM) among TB patients is lacking,particularly from the developing world.Therefore,we conducted a prospective study to investigate the prevalence of DM and pre-DM and evaluated the risk factors for the presence of DM among newly detected PTB patients in rural areas of China.In a prospective community based study carried out from 2010 to 2012,a representative sample of 6382 newly detected PTB patients from 7 TB clinics in Linyi were tested for DM.A population of 6674 non-TB controls from the same community was similarly tested as well.The prevalence of DM in TB patients(6.3%) was higher than that in non-TB controls(4.7%,p<0.05).PTB patients had a higher odds of DM than non-TB controls(adjusted OR 3.17,95%CI:1.14-8.84).The prevalence of DM increased wth age and was significantly higher in TB patients in the age categories above 30 years(p<0.05).Among TB patients,those wiuth normal weight(BMI 18.5-23.9) had the lowest prevalence of DM(5.8%).Increasing age,family history of DM,positive sputum smear,cavity on chest X-ray and higher yearly income(≥10000 RMB yuan) were positively associated and frequent outdoor activity was negatively associated with DM in PTB patients.The prevalence of DM in PTB patients was higher than in non-TB controls wth a 3 fold higher adjusted odds ratio of having DM.Gven the increasing DM prevalence and still high burden of TB in China,this association may represent a new public health challenge concerning the prevention and treatment of both diseases.更多还原