肺结核合并糖尿病患者流行特征及对治疗结局的影响

Epidemiological Characteristics of Pulmonary Tuberculosis Patients with Diabetes Mellitus and Their Impact on Treatment Outcomes

摘要: 目的：分析肺结核合并糖尿病(PTB-DM)患者的流行特征，并探讨其对于抗结核治疗结局的影响。方法：本研究采用回顾性分析方法，收集2020年1月至2023年12月于汉中市第二人民医院呼吸内科二病区就诊的903例肺结核患者的病历资料。根据是否合并糖尿病将患者分为单纯肺结核组(n = 730)和肺结核合并糖尿病组(n = 173)。比较两组患者的流行病学特征、临床特征及治疗转归，采用χ²检验进行单因素分析，并运用二元logistic回归进行多因素分析以确定影响治疗结局的独立因素。结果：PTB-DM组患者中，年龄 ≥ 45岁(84.97%)、男性(81.5%)、复治(30.06%)及利福平耐药(47.4%)的比例均显著高于单纯PTB组(均P < 0.05)。PTB-DM组的治疗成功率(44.51%)显著低于单纯PTB组(66.44%) (P < 0.001)。多因素分析显示，合并糖尿病(OR = 0.42, 95% CI: 0.29~0.62)、利福平耐药(OR = 0.24, 95% CI: 0.17~0.34)、病原学阳性(OR = 0.60, 95% CI: 0.37~0.97)和就诊延迟(OR = 0.32, 95% CI: 0.22~0.46)是治疗失败的独立危险因素，而采用初治方案是保护性因素(OR = 1.58, 95% CI: 1.12~2.25)。结论：肺结核合并糖尿病患者多见于中老年男性，其治疗失败、耐药风险更高。合并糖尿病是抗结核治疗失败的独立危险因素。针对本研究发现的就诊延迟问题，建议与社区卫士合作，开展对糖尿病患者的结核病早期症状筛查宣教。并优化治疗策略，改善患者预后。

Abstract: Objective: To analyze the epidemiological characteristics of patients with pulmonary tuberculosis combined with diabetes mellitus (PTB-DM) and explore its impact on anti-tuberculosis treatment outcomes. Methods: This retrospective study collected medical records of 903 pulmonary tuberculosis patients admitted to the Department of Respiratory Medicine of the Second People’s Hospital of Hanzhong from January 2020 to December 2023. Patients were divided into a PTB-only group (n = 730) and a PTB-DM group (n = 173) based on the presence of diabetes. The epidemiological and clinical characteristics and treatment outcomes of the two groups were compared. Univariate analysis was performed using the χ² test, and binary logistic regression was used for multivariate analysis to identify independent factors affecting treatment outcomes. Results: The proportions of patients aged ≥45 years (84.97%), male (81.5%), retreatment (30.06%), and rifampicin resistance (47.4%) in the PTB-DM group were significantly higher than those in the PTB-only group (all P < 0.05). The treatment success rate in the PTB-DM group (44.51%) was significantly lower than that in the PTB-only group (66.44%) (P < 0.001). Multivariate analysis identified co-morbid diabetes (OR = 0.42, 95% CI: 0.29~0.62), rifampicin resistance (OR = 0.24, 95% CI: 0.17~0.34), positive etiological results (OR = 0.60, 95% CI: 0.37~0.97), and delayed care-seeking (OR = 0.32, 95% CI: 0.22~0.46) as independent risk factors for treatment failure, while initial treatment regimen was a protective factor (OR = 1.58, 95% CI: 1.12~2.25). Conclusion: Patients with PTB-DM are predominantly middle-aged and elderly males, with a higher risk of treatment failure and drug resistance. Co-morbid diabetes is an independent risk factor for anti-tuberculosis treatment failure. In light of the delayed diagnosis identified in this study, it is recommended to collaborate with community health workers to conduct screening and education on early symptoms of tuberculosis among diabetic patients, and to optimize treatment strategies, thereby improving patient outcomes.