肺结核合并糖尿病患者的抗结核治疗效果及其影响因素

目的 应用生存分析方法分析本地区合并糖尿病的肺结核患者(PTB-DM组)和单纯肺结核患者(PTB组)的抗结核治疗效果是否存在差别，并分析影响PTB-DM预后的因素。 方法 采用前瞻性队列研究设计方案，以2013年6月—2014年12月江苏大学医学院附属镇江三院登记治疗的116例合并糖尿病的肺结核患者和120例单纯肺结核患者的8个月随访资料为例，采用Kaplan-Meier生存分析方法评估肺结核未好转率，分别采用log-rank检验和Cox比例风险回归模型对PTB-DM患者的预后进行单因素和多因素分析。 结果 生存曲线结果显示，合并糖尿病的肺结核患者的累积未好转率明显高于单纯糖尿病患者(Log-rank检验，P=0.001)。单因素分析表明年龄、合并空洞、复治结核、产生耐药、发生抗结核药物性肝损害这5个因素差异具有统计学意义(Log-rank检验，P＜0.05)。应用Cox比例风险回归模型做多因素分析发现，年龄、复治结核、产生耐药这3个因素差异具有统计学意义(P＜0.05)。 结论 糖尿病会降低结核病的治疗效果。对结核病患者尤其是合并有其他影响结核病预后的高危患者，规律地监测并有效控制患者的血糖水平，可提高结核病的好转率，并改善其预后。 

Effects of anti-TB treatment in patients with Pulmonary tuberculosis and diabetes and influencing factors

Objective To compare the curative effect of anti-TB treatment in patients with pulmonary tuberculosis and diabetes(PTB-DM group) and pulmonary tuberculosis without diabetes(PTB group) with survival analysis.And discuss the impact factors on PTB-DM prognosis. Methods A prospective cohort study on the follow-up data of 116 pulmonary tuberculosis complicated with diabetes patients and 120 pulmonary tuberculosis without diabetes patients in our hospital were performed.Kaplan-Meier method was used to evaluate the inefficiency.The log-rank test and Cox proportional hazard regression model were used for univariate and multivariate analysis of the prognosis of patients with PTB-DM. Results The survival curve showed that the cumulative inefficiency rate was higher in PTB-DM group than that in PTB group(Log-rank test,P=0.001).Univariate factor analysis indicated that the age,cavities in the lung,retreatment TB,drug resistance and drug-induced hepatotoxicity were statistically significant(Log-rank test,P<0.05).In Cox proportional hazard regression model,multivariate factor analysis showed that the age,retreatment TB,drug resistance were statistically significant(P<0.05). Conclusion Diabetes can weaken the curative effect of TB treatment.For TB patients,especially the patients with other high risk factors affecting tuberculosis prognosis,regularly monitoring and effectively controlling their blood glucose can increase TB improvement rate and improve the prognosis of patients.