Clinical characteristics and treatment outcome of multidrug-resistant pulmonary tuberculosis complicated with diabetes mellitus

Abstract

Objective To compare the clinical characteristics and treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients with and without diabetes melitus (DM), and we improve clinicians’ understanding of drug-resistant pulmonary tuberculosis complicated with diabetes. Methods A total of 322 patients with MDR-TB in Xi’an Chest Hospital were selected as the research subjects, including 60 patients (18.6%) in the DM+ group, 262 patients (81.4%) were in the DM– group without diabetes. Age, gender, body mass index (BMI), complicated liver disease, previous treatment history, cumulative number of lung fields in imaging lesions (<3 or ≥3), clinical data such as cavity, drug resistance characteristics, treatment outcome, adverse reactions and so on were analyzed and compared between the two groups. Results 91.7% of males in DM+ group were higher than 70.2% in DM– group, and there was a statistical difference between the two groups ( P=0.001). The average age of DM+ group was (48.6±11.8) years higher than that of DM– group (34.3±14.8) years. The difference was statistically significant ( P<0.001). BMI of DM+ group was higher than that of DM– group, and there were statistically significant differences between the two groups ( P=0.003). The probability of cavities in DM+ group was higher than DM– group, and the difference between the two groups was statistically significant ( P<0.001). The probability of complicated extrapulmonary tuberculosis in DM+ group was higher than DM– group, and the difference between the two groups was statistically significant ( P=0.024). There were no significant differences between the two groups in initial retreatment, cumulative number of lung fields in imaging lesions (<3 or ≥3), and whether liver disease was complicated ( P>0.05). There was no statistical difference in the drug resistance rates of fluoroquinolones (FQS), AM (CM) and fluoroquinolones + AM (CM) between the two groups ( P>0.05). Univariate analysis of treatment outcome indicated that age, gender, initial retreatment, and the cumulative number of lung fields in the lesions had influence on the prognosis ( P<0.05). When multivariate analysis found that age and the cumulative number of lung fields in the lesions were closely related to the treatment outcome ( P<0.05). The incidence of ADR was 39.2% (85/217) in DM– group and 56.6% (30/53) in the DM+ group, and the ADR rate was higher in the DM+ group, with statistical significance between the two groups ( P=0.029). The sputum negative conversion rate of 3 months in DM+ group was 80.0% (32/40); The negative conversion rate of DM– group was 85.6%(149/174), and there was no statistical significance between the two groups ( P>0.465). Conclusion DM+ patients are mainly middle-aged and elderly males, body mass index (BMI) of DM+ patients is relatively large, and sufficient dosage of tuberculosis drugs should be given according to the body weight of patients to avoid poor therapeutic effect caused by decreased blood drug concentration. At the same time, it was found that DM+ patients were more prone to lung cavity in imaging and increased extrapulmonary tuberculosis. In clinical practice, we should be alert to the possibility of massive hemoptysis at any time and pay attention to the screening of multi-organ tuberculosis in the body. 摘要： 目的 通过对合并与不合并糖尿病(diabetes mellitus, DM)的耐多药肺结核(multi-drug resistance tuberculosis, MDR-TB)患者临床特点及治疗结局进行比较, 提髙临床医生对耐药肺结核合并糖尿病的认识。 方法 以西安市 胸科医院322例耐多药肺结核患者为研究对象, 其中合并糖尿病(DM+)组60例(18.6%);不合并糖尿病(DM–)组262例 (81.4%)。分析比较两组患者的年龄、性别、体质量指数(BMI)、合并肝病、既往治疗史、影像学病灶累计肺野数(<3或≥ 3)、有无空洞、耐药特征、治疗结局、不良反应等临床资料。 结果 DM+组男性占91.7%, 髙于DM–组70.2%, 两组间比 较差异有统计学意义( P=0.001)。DM+组平均年龄(48.6±11.8)岁髙于DM–组(34.3±14.8)岁, 两组间比较差异有统计学 意义( P<0.001)。DM+组BMI髙于DM–组, 两组间差异有统计学意义( P=0.003)。DM+组出现空洞的概率髙于DM–组, 两组间差异有统计学意义( P<0.001)。DM+组合并肺外结核的概率髙于DM–组, 两组间比较差异有统计学意义( P= 0.024)。两组在初复治、影像学病灶累积肺野数(<3或≥3)、是否合并肝病等差异均无统计学意义( P>0.05)。两组在对 氣座诺丽(Fluoroquinolones, FQs)、阿米卡星(Amikacin, Am)[卷曲霉素 Capreomycin, Cm)]、FQs+ Am(Cm)耐药率差异均 无统计学意义( P>0.05)。治疗结局单因素分析提示年龄、性别、初复治、病灶累计肺野数等因素对预后有影响( P<0.05), 多因素分析发现年龄及病灶累计肺野数与治疗结局密切相关( P<0.05)。DM–组不良反应发生率39.2%(85/217);DM+组不良反应发生率56.6%(30/53), DM+组发生不良反应率更髙, 两组间差异有统计学意义( P=0.029)。DM+组3个月痰菌阴转率80.0%(32/40), DM–组阴转率85.6%(149/174), 两组间差异无统计学意义( P>0.465)。 结论 DM+患者以中老年男性为主, 体质量指数(body mass index, BMI)相对较大, 要根据患者体重给与足量结核药以避免出现血 药浓度降低引起治疗效果不佳。DM+患者更容易出现影像学肺部空洞, 肺外结核病增多情况, 在临床上要警惕随时出 现大咯血可能, 注意周身多器官结核的排査。