| Research background and purpose:The prevalence of diabetes mellitus(DM)has increased dramatically in recent years,and patients are at a much greater risk of contracting TB than those without diabetes;the incidence and mortality of tuberculosis(TB)is also increasing,and TB can also affect glycemic control in diabetic patients,which in turn worsens the condition of diabetes.Therefore,the co-morbidity of TB and diabetes has become one of the public health issues of clinical concern.In this study,we analyzed the imaging manifestations,clinical characteristics,and glycemic parameters of patients hospitalized with tuberculosis combined with diabetes mellitus(TB-DM),aiming to investigate the characteristics of TB-DM disease occurrence and the impact of diabetes mellitus and glycemic control status on TB.The results of the study provide a reference for the clinical treatment and prognosis of TB-DM patients.Data Source and Method:A total of 3756 tuberculosis patients hospitalized in the tuberculosis ward of the Chengdu Public Health Clinical Medical Center from January 1,2019 to December 31,2021 were retrospectively included,and a further 3393 patients with both TB and DM were screened and included according to inclusive and exclusive criteria.Data related to age,gender,glycosylated hemoglobin(HbA1c),fasting blood glucose(Fasting plasma glucose FPG),imaging,bacteriology were collected from the study subjects.Analyzing their age and gender distribution characteristics and dividing the patients into groups with and without cavitation according to the occurrence of cavitation in the lungs;sputum bacterium positive group and sputum negative group according to the sputum bacterium examination results;According to the distribution of lesions,they were divided into intrapulmonary lesion group,extrapulmonary lesion group and both intra-extra pulmonary group.According to the baseline glycemic control status,they were divided into good glycemic control group,fair glycemic control group and poor glycemic control group.Differences in cavitation occurrence,sputum positivity and lesion distribution between the good,fair and poor glycemic control groups were analyzed using t-test;Exploring the relationship between cavity formation,sputum positivity and lesion distribution with blood glucose index using Spearman correlation analysis;Investigation of factors influencing cavity formation,sputum positivity and distribution using multiple stepwise regression analysis.Bilateral P<0.05 was considered a statistically significant difference.Results:1.Clinical general data of 3393 patients with tuberculosis combined with diabetes mellitusA total of 3756 patients with TB in this retrospective study had a prevalence of diabetes of 90.3%(3393/3756),In the study cohort of 3393 cases of TB combined with DM,the majority of patients were male,with a male to female ratio of 4.54:1,and most patients were between 40 and 60 years old,with a mean age of 57.44 ± 13.22 years.Of these patients,16.8%(569/3393)had cavitation,52.2%(1770/3393)were sputum positive,30.4%(1030/3393)had intrapulmonary lesions alone,68.1%(2311/3393)had both intrapulmonary and extrapulmonary lesions,and 68.2%(2314/3393)had poor glycemic control,and only 31.8%(979/3393)of the patients had good glycemic control.2.Comparison of clinical characteristics between cavitary pulmonary tuberculosis and non-cavitary pulmonary tuberculosisBoth FPG and HbAlc at admission were higher in the cavitary TB group than in the non-cavitary TB group,with a difference of 1.44mmol/L for FPG and 0.93%for HbAlc between the two groups,and a comparison of 13.04mmol/L and 11.60mmol/L in FPG at admission and HbAlc at admission between the two groups;8.33%and 7.99%,respectively,with statistically significant(P<0.001).The FPG at discharge was similar between the two groups;8.33mmol/L and 7.99mmol/L,respectively,with a difference of only 0.34mmol/L,with no statistically significant difference between the groups(P>0.05).3.Comparison of clinical characteristics of the three groups with negative,positive and unexamined sputum examination resultsThe FPG at admission and HbAlc at admission were higher between the sputum-negative and sputum-positive groups than the sputum-uninspected group,with FPG at admission of 12.40mmol/L,12.49mmol/L and 10.89mmol/L in the three groups,respectively,and HbAlc at admission comparing 9.17%,9.34%and 8.40%,with statistically significant comparisons between groups(P<0.001).The FPG at admission and HbAlc at admission were similar between the sputum-negative and sputum-positive groups,with a comparison of 12.40mmol/L and 12.49mmol/L for FPG at admission and 9.17%and 9.34%for HbAlc at admission,respectively,and the difference in FPG between the two groups was only 0.09mmol/L,with statistically significant comparisons between all groups(P<0.001).FPG at discharge was 8.30mmol/L,8.00mmol/L and 8.05mmol/L in the three groups compared,with no statistically significant comparison between groups(P>0.05).4.Comparison of clinical characteristics among the Intrapulmonary TB,extrapulmonary TB and both intra-extra pulmonary TB three groupsFPG and HbAlc at admission were higher in the intrapulmonary TB alone group than in the extra-pulmonary alone and both intrapulmonary and extra-pulmonary with lesions groups,with FPG comparisons of 12.59mmol/L,9.83mmol/L and 11.56mmol/L at admission and HbAlc comparisons of 9.23%,7.07%and 8.86%at admission in the three groups,respectively.All comparisons between groups were statistically significant(P<0.001),especially in the group with intrapulmonary TB alone compared with the group with extrapulmonary TB alone,the FPG at admission was 12.59mmol/L and 9.83mmol/L,respectively,with a difference of 2.76mmol/L,and the HbAlc at admission was 9.23%and 7.07%,respectively,with a difference of 2.16%.All comparisons between groups were statistically significant(P<0.001).5.Comparison of clinical characteristics of three groups with good,fair and poor glycemic control on admissionAmong the 3393 patients,the largest proportion of patients with poor glycemic control at admission(68.2%,2314/3393),and more male patients,average age 56 years,only 15.8%(537/3393)of patients with good glycemic control,16%(542/3393)of patients with average glycemic control,the average admission FPG of the three groups with good,average and poor glycemic control were 4.96 mmol/L,6.94 mmol/L,and 14.59 mmol/L,respectively,and the mean admission HbAlc was 7.18%,7.46%,and 9.66%,respectively.The differences in FPG and HbAlc at admission between the two groups with good and poor glycemic control were 9.63 mmol/L and 2.48%,respectively.The overall cavitation rate and sputum positivity rate were 16.8%and 52.2%,respectively;in the comparison between the poor and good glycemic control groups,the percentage of cavitation rate was 19.0%and 12.8%,the percentage of sputum positivity rate was 55.4%and 44.7%,and the percentage of intrapulmonary lesions was 31.6%and 27.0%,respectively,and the percentage of each clinical feature was higher in the poor glycemic control group than in the The difference was statistically significant in the group with good glycemic control(P<0.05).6.Comparison of clinical characteristics of the two groups with and without discharge glucose standardsThe rate of glucose compliance at discharge was 50.9%(1728/3393)in 3393 patients,which was significantly improved compared with that at admission(15.8%).The percentage of cavitation incidence was 15.1%and 18.5%,and the percentage of intrapulmonary lesions was 26.6%and 34.3%,respectively,in the discharged glucose compliance group compared with the glucose non-compliance group,and the percentage of cavitation incidence and intrapulmonary lesions were higher in the glucose non-compliance group than in the glucose compliance group,and the differences were statistically significant(P<0.05),while the sputum bacterial examination results In the comparison,the percentage of positive sputum bacteriological results was 51.9%in the glucose compliance group and 52.4%in the glucose non-compliance group,and the difference was not statistically significant(P>0.05).7.Correlation and Multivariate logistic regression analysis of cavity formation,sputum bacterial results and lesion sites with blood glucose parametersSpearman correlation analysis showed that FPG,HbAlc and poor glycemic control at admission were statistically significantly and positively correlated with cavity formation,sputum bacilli positivity and intrapulmonary lesions in patients(P<0.05).Regression analysis showed that HbAlc,FPG and glycemic control status at admission were the main risk factors for TB cavity formation,sputum positivity and disease progression,and conversely,pulmonary cavity formation,sputum positivity and intrapulmonary lesions were also the main influencing factors for poor glycemic control in patients.Conclusion:Tuberculosis combined with diabetes mellitus is predominant in men over 40 years of age.The incidence of cavitation was 16.8%,the rate of sputum positivity was 52.2%,and the distribution of lesions was intra-pulmonary and extra-pulmonary in 98.5%of the patients,while extra-pulmonary lesions alone were rare.The incidence of cavitation and sputum positivity were higher in those with poor glycemic control.HbAlc,FPG and glycemic control status at admission were the main risk factors for TB cavity formation,sputum positivity and disease progression,and conversely,pulmonary cavity formation,sputum positivity and intrapulmonary lesions were also the main influencing factors for poor glycemic control in patients.Strict glycemic control for such patients is necessary to reduce the incidence of cavitation and to promote negative sputum bacteria. |
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