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Abstract：
BACKGROUND: Growing evidence suggests that chronic inflammation caused by tuberculosis (TB) may increase the incidence of diabetes. However, the relationship between post-TB pulmonary abnormalities and diabetes has not been well characterized.
METHODS: We analyzed data from a cross-sectional study in KwaZulu-Natal, South Africa, of people 15 years and older who underwent chest X-ray and diabetes screening with hemoglobin A1c testing. The analytic sample was restricted to persons with prior TB, defined by either (1) a self-reported history of TB treatment, (2) radiologist-confirmed prior TB on chest radiography, and (3) a negative sputum culture and GeneXpert. Chest X-rays of all participants were evaluated by the study radiologist to determine the presence of TB lung abnormalities. To assess the relationships between our outcome of interest, prevalent diabetes (HBA1c ≥6.5%), and our exposure of interest, chest X-ray abnormalities, we fitted logistic regression models adjusted for potential clinical and demographic confounders. In secondary analyses, we used the computer-aided detection system CAD4TB, which scores X-rays from 10 to 100 for detection of TB disease, as our exposure interest, and repeated analyses with a comparator group that had no history of TB disease.
RESULTS: In the analytic cohort of people with prior TB (n = 3,276), approximately two-thirds (64.9%) were women, and the average age was 50.8 years (SD 17.4). The prevalence of diabetes was 10.9%, and 53.0% of people were living with HIV. In univariate analyses, there was no association between diabetes prevalence and radiologist chest X-ray abnormalities (OR 1.23, 95%CI 0.95-1.58). In multivariate analyses, the presence of pulmonary abnormalities was associated with an 29% reduction in the odds of prevalent diabetes (aOR 0.71, 95%CI 0.53-0.97, p = 0.030). A similar inverse relationship was observed for diabetes with each 10-unit increase in the CAD4TB chest X-ray scores among people with prior TB (aOR 0.92, 95%CI 0.87-0.97; p = 0.002), but this relationship was less pronounced in the no TB comparator group (aOR 0.96, 95%CI 0.94-0.99).
CONCLUSIONS: Among people with prior TB, pulmonary abnormalities on digital chest X-ray are inversely associated with prevalent diabetes. The severity of radiographic post-TB lung disease does not appear to be a determinant of diabetes in this South African population.
METHODS: We analyzed data from a cross-sectional study in KwaZulu-Natal, South Africa, of people 15 years and older who underwent chest X-ray and diabetes screening with hemoglobin A1c testing. The analytic sample was restricted to persons with prior TB, defined by either (1) a self-reported history of TB treatment, (2) radiologist-confirmed prior TB on chest radiography, and (3) a negative sputum culture and GeneXpert. Chest X-rays of all participants were evaluated by the study radiologist to determine the presence of TB lung abnormalities. To assess the relationships between our outcome of interest, prevalent diabetes (HBA1c ≥6.5%), and our exposure of interest, chest X-ray abnormalities, we fitted logistic regression models adjusted for potential clinical and demographic confounders. In secondary analyses, we used the computer-aided detection system CAD4TB, which scores X-rays from 10 to 100 for detection of TB disease, as our exposure interest, and repeated analyses with a comparator group that had no history of TB disease.
RESULTS: In the analytic cohort of people with prior TB (n = 3,276), approximately two-thirds (64.9%) were women, and the average age was 50.8 years (SD 17.4). The prevalence of diabetes was 10.9%, and 53.0% of people were living with HIV. In univariate analyses, there was no association between diabetes prevalence and radiologist chest X-ray abnormalities (OR 1.23, 95%CI 0.95-1.58). In multivariate analyses, the presence of pulmonary abnormalities was associated with an 29% reduction in the odds of prevalent diabetes (aOR 0.71, 95%CI 0.53-0.97, p = 0.030). A similar inverse relationship was observed for diabetes with each 10-unit increase in the CAD4TB chest X-ray scores among people with prior TB (aOR 0.92, 95%CI 0.87-0.97; p = 0.002), but this relationship was less pronounced in the no TB comparator group (aOR 0.96, 95%CI 0.94-0.99).
CONCLUSIONS: Among people with prior TB, pulmonary abnormalities on digital chest X-ray are inversely associated with prevalent diabetes. The severity of radiographic post-TB lung disease does not appear to be a determinant of diabetes in this South African population.
摘要：
背景：越来越多的证据表明，由结核病（TB）引起的慢性炎症可能会增加糖尿病的发病率。然而,结核病后肺部异常与糖尿病之间的关系尚未得到很好的表征.
方法：我们分析了夸祖鲁-纳塔尔省一项横断面研究的数据，南非,15岁及以上的患者接受了胸部X线检查和血红蛋白A1c检测的糖尿病筛查。分析样本仅限于先前患有结核病的人，定义为（1）自我报告的结核病治疗史，（2）放射科医师在胸部X线摄影上确认的先前结核病，(3)痰培养和GeneXpert阴性。研究放射科医生评估了所有参与者的胸部X射线，以确定是否存在TB肺部异常。为了评估我们感兴趣的结果之间的关系，普遍的糖尿病（HBA1c≥6.5%），以及我们的兴趣暴露，胸部X线异常,我们拟合了经潜在临床和人口统计学混杂因素校正的logistic回归模型.在二级分析中，我们使用计算机辅助检测系统CAD4TB，对10到100的X光片进行检测，以检测结核病，作为我们的曝光兴趣，并与没有TB病史的比较组重复分析。
结果：在先前结核病患者的分析队列中（n=3,276），大约三分之二(64.9%)是女性，平均年龄50.8岁(SD17.4)。糖尿病患病率为10.9%,53.0%的人感染了艾滋病毒。在单变量分析中，糖尿病患病率与放射科医师胸部X线检查异常之间无关联(OR1.23,95CI0.95-1.58).在多变量分析中，肺部异常的存在与糖尿病患病率降低29%相关(aOR0.71,95CI0.53~0.97,p=0.030).糖尿病患者的CAD4TB胸部X线评分每增加10个单位，观察到类似的反比关系（aOR0.92，95CI0.87-0.97；p=0.002），但这种关系在无TB比较组中不太明显(aOR0.96,95CI0.94-0.99).
结论：在先前患有结核病的人群中，数字胸部X线片上的肺部异常与普遍的糖尿病呈负相关。结核病后肺部疾病的严重程度似乎不是该南非人群中糖尿病的决定因素。
方法：我们分析了夸祖鲁-纳塔尔省一项横断面研究的数据，南非,15岁及以上的患者接受了胸部X线检查和血红蛋白A1c检测的糖尿病筛查。分析样本仅限于先前患有结核病的人，定义为（1）自我报告的结核病治疗史，（2）放射科医师在胸部X线摄影上确认的先前结核病，(3)痰培养和GeneXpert阴性。研究放射科医生评估了所有参与者的胸部X射线，以确定是否存在TB肺部异常。为了评估我们感兴趣的结果之间的关系，普遍的糖尿病（HBA1c≥6.5%），以及我们的兴趣暴露，胸部X线异常,我们拟合了经潜在临床和人口统计学混杂因素校正的logistic回归模型.在二级分析中，我们使用计算机辅助检测系统CAD4TB，对10到100的X光片进行检测，以检测结核病，作为我们的曝光兴趣，并与没有TB病史的比较组重复分析。
结果：在先前结核病患者的分析队列中（n=3,276），大约三分之二(64.9%)是女性，平均年龄50.8岁(SD17.4)。糖尿病患病率为10.9%,53.0%的人感染了艾滋病毒。在单变量分析中，糖尿病患病率与放射科医师胸部X线检查异常之间无关联(OR1.23,95CI0.95-1.58).在多变量分析中，肺部异常的存在与糖尿病患病率降低29%相关(aOR0.71,95CI0.53~0.97,p=0.030).糖尿病患者的CAD4TB胸部X线评分每增加10个单位，观察到类似的反比关系（aOR0.92，95CI0.87-0.97；p=0.002），但这种关系在无TB比较组中不太明显(aOR0.96,95CI0.94-0.99).
结论：在先前患有结核病的人群中，数字胸部X线片上的肺部异常与普遍的糖尿病呈负相关。结核病后肺部疾病的严重程度似乎不是该南非人群中糖尿病的决定因素。
