社区2型糖尿病患者结核病发病情况及影响因素分析  

Analysis of tuberculosis incidence and influencing factors in type 2 diabetic patients in community

作　　者：姜碧佳 陈诚[2] 周金意[3] 竺丽梅[2] 苏健[3] 陆伟 Jiang Bijia;Chen Cheng;Zhou Jinyi;Zhu Limei;Su Jian;Lu Wei(School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of Chronic Communicable Disease Prevention and Control,Center for Disease Control and Prevention of Jiangsu Province,Nanjing 210009,China;Department of Chronic Noncommunicable Disease Prevention and Control,Center for Disease Control and Prevention of Jiangsu Province,Nanjing 210009,China)

机构地区：[1]南京医科大学公共卫生学院,南京211166 [2]江苏省疾病预防控制中心慢性传染病防制所,南京210009 [3]江苏省疾病预防控制中心慢性非传染病防制所,南京210009

出　　处：《中国防痨杂志》2024年第8期951-957,共7页Chinese Journal of Antituberculosis

基　　金：江苏省卫生健康委员会项目(M2020040,ZDA2020022,M2020085);江苏省医学重点学科(ZDXK202250)。

摘　　要：目的:分析社区2型糖尿病患者结核病发病情况及影响因素,为制定糖尿病与结核病两病共患防治策略提供理论依据。方法:抽取2013年12月至2019年12月间江苏省常熟市、淮安市清江浦区和淮安区3地登记管理并纳入基本公共卫生服务管理的35岁以上的社区2型糖尿病患者20053例为调查对象。利用“结核病信息管理系统”数据,获得2013年12月至2019年12月期间所有新发结核病患者信息,两部分数据进行匹配,获得研究对象中罹患结核病的患者。采用巢式病例对照研究的设计,将研究对象中非结核病患者与结核病患者进行1∶4的倾向性评分匹配,采用多因素logistic回归分析模型分析社区2型糖尿病患者结核病发病相关影响因素。结果:20053例糖尿病患者中新发结核病123例,其中肺外结核4例,累积发病率为613.37/10万(123/20053),年均发病率为102.23/10万(20.5/20053)。其中男性累积发病率为1119.31/10万(88/7862),高于女性累积发病率[287.10/10万(35/12191)],差异有统计学意义(χ^(2)=54.301,P<0.001)。农村户籍患者结核病累积发病率为718.93/10万(83/11545),高于城市户籍患者结核病累积发病率[470.15/10万(40/8508)],差异有统计学意义(χ^(2)=4.973,P=0.026)。多因素logistic回归分析结果显示,体质量指数升高(OR=0.422,95%CI:0.288~0.617)是糖尿病患者结核病发病的保护因素,而糖化血红蛋白升高(OR=2.019,95%CI:1.195~3.410)和血尿素升高(OR=1.727,95%CI:1.121~2.661)是糖尿病患者结核病发病的危险因素。2013—2019年结核病组患者结核病平均发病年限与空腹血糖值升高呈负相关(r=-0.130)。结论:社区2型糖尿病患者结核病累积发病率远高于同期同地区水平。需要重点关注糖化血红蛋白升高和血尿素升高的糖尿病患者,并采取相应的干预措施。Objective:To investigate the incidence and determinants of tuberculosis among community-dwelling patients with type 2 diabetes,aiming to establish a theoretical foundation for developing integrated prevention and treatment strategies for this comorbidity.Methods:This retrospective cohort study involved 20053 community-dwelling type 2 diabetes patients aged 35 and above,registered in the basic public health service management systems of Changshu City,Qingjiangpu District,and Huai’an District of Jiangsu Province from December 2013 to December 2019.Using the Tuberculosis Management Information System,we matched the data of newly diagnosed tuberculosis patients during the same period to identify affected individuals within the study cohort.A nested case-control study was established,matching non-tuberculosis patients to tuberculosis patients using a 1∶4 propensity score.Multivariate logistic regression was employed to analyze factors influencing the incidence of tuberculosis among type 2 diabetes patients in the community.Results:Among the 20053 diabetic patients studied,there were 123 new cases of tuberculosis,including 4 extrapulmonary cases.The cumulative incidence rate was 613.37 per 100000(123/20053),with an average annual incidence of 102.23 per 100000(20.5/20053).The cumulative incidence was significantly higher in males at 1119.31 per 100000(88/7862)compared to females at 287.10 per 100000(35/12191),with a statistically significant difference(χ^(2)=54.301,P<0.001).Additionally,rural residents exhibited a higher cumulative incidence rate of 718.93 per 100000(83/11545)compared to urban residents at 470.15 per 100000,also statistically significant(χ^(2)=4.973,P=0.026).Multivariate logistic regression analysis identified an increased body mass index as a protective factor against tuberculosis among diabetic patients,with an odds ratio(OR)of 0.422(95%CI:0.288-0.617).In contrast,elevated levels of glycosylated hemoglobin(OR=2.019,95%CI:1.195-3.410)and urea(OR=1.727,95%CI:1.121-2.661)emerged as significant ris

关 键 词：糖尿病 2型 结核 因素分析 统计学 

分 类 号：R52[医药卫生—内科学] R587.1[医药卫生—临床医学]