上海市徐汇区和长宁区老年2型糖尿病患者结核分枝杆菌潜伏感染筛查情况及影响因素分析

目的: 分析上海市老年2型糖尿病患者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)筛查情况及其影响因素。方法: 顺序纳入2019年9—12月在上海市徐汇区和长宁区参加公共卫生服务项目体格检查且符合入组标准的60岁及以上老年2型糖尿病患者,共计885例(长宁区430例,徐汇区455例),采用γ-干扰素释放试验检测其LTBI状况。采用调查问卷收集研究对象社会人口学信息、行为生活方式、既往糖尿病和其他慢性病病史及肺结核患者接触史,以及体格检查情况等信息。采用非条件二分类logistic回归分析的方法分析老年糖尿病患者发生LTBI的影响因素。结果: 885例研究对象检出LTBI阳性者130例,阳性率为14.7%;其中,长宁区研究对象LTBI阳性率(17.4%,75/430)高于徐汇区研究对象(12.1%,55/455),差异有统计学意义(χ²=5.057,P=0.025);吸烟者LTBI阳性率(22.5%,20/89)明显高于不吸烟者(13.8%,110/796),差异有统计学意义(χ²=4.783,P=0.039)。logistic回归分析显示,吸烟是老年糖尿病患者发生LTBI的危险因素OR(95%CI)=1.891(1.031~3.468)]。结论: 上海市老年2型糖尿病患者LTBI阳性率处于较低水平,可对检测阳性患者采取增加随访频次及加强健康教育等措施,并对有吸烟史的老年糖尿病患者开展LTBI筛查。

Screening of latent infection of Mycobacterium tuberculosis and analysis of influencing factors in elderly patients with type-2 diabetic mellitus in Xuhui and Changning Districts in Shanghai

Objective: To investigate the screening and risk factors of latent tuberculosis infection (LTBI) in elderly patients with type-2 diabetic mellitus (DM) in Shanghai. Methods: According to inclusion criteria, 885 type-2 DM patients aged over 60 years old in Xuhui (n=430) and Changning Districts (n=455)were sequentially selected. All of them were participated in community physical examination of basic public health service program from September to December 2019. γ-interferon release test was conducted to detect LTBI. The demographics, life behavior, history of DM and other chronic diseases, and tuberculosis contact information, as well as physical examination results,etc., were collected by questionnaire. Dichotomous unconditional logistic regression were used to analyze the risk factors of LTBI in elderly type-2 DM patients. Results: Of the 885 patients, 130 were positive in LTBI test with the positive rate of 14.7%, and the positive rate in Changning District was significantly higher than that in Xuhui District (17.4% (75/430) vs. 12.1% (55/455),χ²=5.057, P=0.025). The positive rate in patients with smoking behavior was significantly higher than that in patients without smoking behavior (22.5% (20/89) vs. 13.8% (110/796), χ ²=4.783,P=0.039). According to logistic regression, smoking was a risk factor of LTBI in elderly type-2 DM patients (OR (95%CI)=1.891 (1.031-3.468)). Conclusion: The prevalence of LTBI in elderly type-2 DM patients in Shanghai is relatively lower. Follow up and health education should be strengthened to DM patients with LTBI. LTBI screening could be conducted in elderly DM patients with smoking behavior.