2型糖尿病并发肺结核病的危险因素探讨

目的 探讨2型糖尿病并发肺结核病（DM-PTB）的危险因素.方法 对2001年10月至2002年10月收集的87例新发DM-PTB患者和同期129例单纯2型糖尿病患者进行成组病例对照研究,采用经因子分析改进后的多因素非条件logistic回归模型探索DM-PTB的危险因素.结果 不良接触因子、糖尿病病情重、不良习惯因子及食盐摄入量少可增加DM-PTB的发生危险,其比值比（OR）和95%可信区间（95%CI）分别为1.778（1.248～2.534）、1.749（1.221～2.506）、1.614（1.136～2.294）和1.586（1.19～2.248）,而良好习惯因子、社会经济地位高、高血压、居住条件好及患糖尿病后饮食控制好可降低DM-PTB的发生危险,其OR值和95%CI分别为0.333（0.218～0.508）、0.508（0.346～0.745）、0.517（0.350～0.764）、0.599（0.413～0.868）和0.630（0.447～0.889）.结论 不同性别和年龄的2型糖尿病患者易并发肺结核病的危险因素或保护因素不同,应针对不同人群制定不同的防治策略.

Risk factors for the development of pulmonary tuberculosis among type 2 diabetes mellitus patients

Objective To explore risk factors for pulmonary tuberculosis among type 2 diabetes mellitus patients(DM-PTB). Methods A hospital-based case-control study was conducted at three hospitals in Tianjin during October 2001 to October 2002. 87 newly-diagnosed PTB patients with type 2 DM were recruited as cases, and 129 type 2 DM patients were chosen as controls. Information on risk factors was collected through face-to-face interview. Univariate unconditional logistic regression model and multivariate logistic regression modified by the factor analysis were conducted to explore the risk factors for DM-PTB and final main effect functions were built by age and sex. Results 31 variables were found to be associated with DM-PTB in the univariate analysis. The modified multivariate logistic regression analysis found that bad contact factor( OR= 1.778, 95%CI: 1.248- 2.534), severe state of DM( OR= 1.749,95%CI: 1.221- 2.506),bad habits factor( OR= 1.614, 95%CI: 1.136- 2.294) and low intake of salt( OR= 1.586, 95%CI: 1.119- 2.248) were generally associated with increased risk of DM-PTB in the final model; while factors as good habits( OR= 0.333, 95%CI: 0.218- 0.508), high socioeconomic level( OR= 0.508, 95%CI: 0.346- 0.745),hypertension( OR= 0.517, 95%CI: 0.350- 0.764), good housing condition( OR= 0.599, 95%CI: 0.413- 0.868) and beneficial change of diet after DM( OR= 0.630, 95%CI: 0.447- 0.889) were shown to be reversely associated with DM-PTB. Conclusion Different genders and different ages have different risk factors or protective factors. Thus, to reduce the progressively increased incidence of PTB among DM patients, preventive strategies and measures should be focused on the most vital predisposing factors in corresponding risk populations.