天津市城区肺结核合并糖尿病的流行病学特征分析  

Epidemiological characteristic analysis on tuberculosis with diabetes in urban area of Tianjin city

作　　者：张国钦[1] 陈盛玉 张玉华[1] 李培艳[1] 宋娜[1] 唐智多 傅衍勇 钟达[1] 

机构地区：[1]天津市结核病控制中心门诊部,天津300041

出　　处：《中国慢性病预防与控制》2016年第1期14-18,共5页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的了解天津市城区肺结核合并糖尿病流行状况及特征,为两病联合防治提供依据。方法利用2010-2013年天津市城内五区确诊登记的2 928例活动性肺结核病例流行病资料进行分析,并根据是否合并糖尿病,将肺结核患者分为合并糖尿病组（DM-TB）和未合并糖尿病组（TB）。采用单因素、多因素统计学方法分析合并与不合并糖尿病的肺结核患者的流行病学特征及临床表现。结果活动性肺结核患者中9.36%同时合并糖尿病;男性患者合并糖尿病风险高于女性（OR=1.95）;患者合并糖尿病风险随年龄增高而呈升高趋势,但以45~54岁年龄组最高（OR=28.47）;外来人口合并糖尿病风险低于本市人口（OR=0.47）;但与患者学历、职业、初复治和就转诊无统计学关联（P〉0.05）。DM-TB组患者更易出现痰菌涂片阳性的结果（涂片2＋、3＋的OR值分别为2.08和2.02）,更易伴发空洞（OR=1.91）,但合并肺外结核的风险低于TB组患者（OR=0.52）;是否合并糖尿病与患者结核症状、受累肺野和菌株耐药性无统计学关联（P〉0.05）。DM-TB组患者治疗失败或死亡率为5.11%,高于TB组患者（1.24%）,差异有统计学意义（P〈0.01）。结论男性、高年龄、本市户籍的肺结核患者是合并糖尿病的高危人群;DM-TB患者更易出现痰菌阳性、病灶空洞和不良治疗结局;有必要开展对两病的双向筛查和管理。Objective To understand the prevalence and characters of tuberculosis（TB） with diabetes in urban area of Tianjin city,and to provide the basis for prevention strategy of the two diseases. Methods The data of 2 928 active TB patients registered in five districts of Tianjin urban area from 2010 to 2013 was analyzed. The TB patients were divided into TB with diabetes group（DM-TB） and TB group. Univariate analysis and multivariate analysis were used to analyze the epidemiological characters and clinical manifestation of TB and DM-TB patients. Results The proportion of DM-TB patients in active pulmonary TB patients was9.36%. The risk of DM-TB in male TB patients was significantly higher than that in female TB patients（OR=1.95）; the risk of DM-TB increased with age, but the risk of DM-TB in 45-54 years old group was the highest（OR=28.47）; the risk of DM-TB in migrants was significantly lower than that in local residents（OR=0.47）. The risk of DM-TB was not statistically associated with education level, occupation, treatment type or transfer hospital（P〉0.05）. The positive sputum smear rate in DM-TB patients was high（OR for smear 2＋ and 3＋ were 2.08 and 2.02, respectively）; the cavity rate in DM-TB patients was high（OR =1.91）; but the risk of extra-pulmonary TB in DM-TB patients was lower than that in TB patients（OR=0.52）; symptom manifestations, lung fields affected by TB and drug resistance were not statistically associate with DM-TB（P0.05）. The proportion（5.11%） of treatment failure and death among DM-TB patients was significantly higher than that（1.24%） among TB patients（P〈0.01）. Conclusion Male,elder age, local residents are the risk factors of DM-TB; the positive sputum smear rate, cavity rate on chest X-ray and unfavorable treatment outcome rate in DM-TB patients are higher. It is necessary to conduct the screen and management of diabetes and TB.

关 键 词：肺结核 糖尿病 流行病学特征 

分 类 号：R587.1[医药卫生—内分泌]