背景:建模研究表明,所有结核病(TB)病例中约有20%可能患有糖尿病(DM)。DM使发展为活动性TB疾病的风险增加2-3倍。艾滋病毒感染者(PLHIV)更有可能患上结核病,结核病是导致艾滋病毒感染者住院和死亡的主要原因。尽管印度的DM和艾滋病毒负担很大,很少有研究评估活动性结核病病例中DM和HIV的患病率,及其对结核病治疗结果的影响。这项研究评估了2019年奥里萨邦结核病病例中HIV和DM的负担及其对结核病治疗结果的影响。
方法:该研究利用了来自NIKSHAY门户的2019年奥里萨邦结核病患者的数据,印度结核病健康管理信息系统(HMIS)。这是一项基于回顾性观察登记的队列研究,评估了社会人口预测因素之间的联系,临床诊断和治疗预测因子,治疗时间预测因子,和结核病的合并症。在Microsoft-Excel中以电子方式检索数据,并使用STATA16(StataCorp。2019,学院站,TX:StataCorpLLC)。
结果:从2019年的Nikshay申请中提取了作为研究人群的奥里萨邦47,831例TB病例的数据。患病率最高(31.1%,在15-30岁的年轻参与者中观察到14,863/47,831)的结核病,而14岁以下儿童的患病率最低(4.4%,2124/47,831)。男性结核病患病率较高(66.7%,31,878/47,831)。在纳入研究的47,831例TB病例中,7.6%(3659/47,831)患有糖尿病(DM),还有TB。1.2%(571/47,831)患有艾滋病毒和结核病,而只有0.08%(37/47,831)同时患有DM和HIV以及TB。88.2%(3148/3569)的DM和TB病例具有良好的结局,与82.3%(449/541)的HIV和TB病例相比。与患有TB和DM的患者相比,没有DM的TB患者具有明显更高的有利结果(OR1.6,95%CI1.5-1.8)。同样,未感染HIV的TB病例与感染TB和HIV的病例相比具有显著更高的有利结果(OR2.4,95%CI1.9-3.0)。
结论:我们的研究表明,结核病患者中DM和/或HIV的存在对结核病治疗结果有影响。迫切需要预防糖尿病和HIV等合并症的发生,并优先考虑这些疾病的早期诊断和管理。
BACKGROUND: Modelling studies have indicated that approximately 20% of all tuberculosis (TB) cases may suffer from diabetes mellitus (DM). DM increases the risk of developing active TB disease by 2-3 times. People living with HIV (PLHIV) are more likely to develop TB disease, and TB is a leading cause of hospitalization and death among PLHIV. Despite the substantial burden of DM and HIV in India, few studies have evaluated the prevalence of DM and HIV among active cases of TB, and its impact on the treatment outcome for TB. This study evaluated the burden of HIV and DM in TB cases from
Odisha during 2019, and its impact on the TB treatment outcome.
METHODS: The study utilized data on TB patients of
Odisha during 2019, from the NIKSHAY portal, the health management information system (HMIS) of TB in India. This is a retrospective observational registry-based cohort study, which evaluated a linkage between socio-demographic predictors, clinical diagnostic and treatment predictors, time of treatment predictors, and co-morbidity with TB. Data were retrieved electronically in Microsoft-Excel and analysis was done using STATA 16 (StataCorp. 2019, College Station, TX: StataCorp LLC).
RESULTS: Data for 47,831 TB cases of
Odisha as study population was extracted from the Nikshay application for the year 2019. The highest prevalence (31.1%, 14,863/47,831) of TB was observed among young participants aged 15-30 years, whereas the prevalence was least among children <14 years (4.4%, 2124/47,831). Males had a higher prevalence of TB (66.7%, 31,878/47,831). Of the 47,831 TB cases included in the study, 7.6% (3659/47,831) had diabetes mellitus (DM), along with TB. 1.2% (571/47,831) had HIV along with TB, while only 0.08% (37/47,831) had both DM and HIV along with TB. 88.2% (3148/3569) of cases with DM and TB had a favorable outcome, compared to 82.3% (449/541) of cases with HIV and TB. People with TB who did not have DM had a significantly higher favorable outcome (OR 1.6, 95% CI 1.5-1.8) compared to those with TB and DM. Similarly, TB cases who did not have HIV infection had a significantly higher favorable outcome (OR 2.4, 95% CI 1.9-3.0) compared to those with TB and HIV.
CONCLUSIONS: Our study showed that presence of DM and/or HIV in TB patients had an impact on the TB treatment outcome. There is a crucial need to prevent comorbidities such as DM and HIV from occurring and to prioritize early diagnosis and management of these conditions.