Study On The Influence Of Diabetes Mellitus On Drug Resistance Risk Of Pulmonary Tuberculosis Patients And Its Risk Factors

Objective:Drug resistance leads to poor curative effect,prolonged treatment time,increased treatment failure rate,relapse rate and mortality rate of pulmonary tuberculosis(PTB).At the same time,drug resistance increases the transmission risk of tuberculosis and brings severe challenges to the control of tuberculosis epidemic.The clinical symptoms of pulmonary tuberculosis patients complicated with diabetes mellitus(DM)are more serious and the risk of failure of anti-tuberculosis treatment and death of patients is significantly increased.However,there is still no conclusion as to whether diabetes mellitus will increase the drug resistance risk of tuberculosis patients.This study intends to conduct an epidemiological cohort study to determine whether diabetes mellitus increases the risk of drug resistance in pulmonary tuberculosis patients.At the same time,the risk factors of drug resistance in patients with pulmonary tuberculosis complicated with diabetes mellitus(PTB-DM)were discussed to provide scientific basis for prevention and control of drug resistance in tuberculosis patients.Methods:In the first part,the historical cohort study method was used to collect pulmonary tuberculosis patients who were hospitalized in a thoracic hospital from December 1,2013 to May 1,2018 with positive sputum culture.The patients were divided into simple pulmonary tuberculosis group and PTB-DM group.The two groups were 1:1matched according to the principle of the same sex and difference of age(±3)years old,and the influence of diabetes on drug resistance risk of PTB patients was investigated.The general demographic characteristics,clinical characteristics,lifestyle,behavioral factors and various indexes of laboratory examinationof the patients were collected from clinical medical records.Whether hypoproteinemia occurs or not is adopted to reflect the nutritional status of the body.Conditional Logistic regression was used for single factor and multi-factor analysis,and odds ratios(OR)and 95% confidence interval(CI)of OR values were calculated.In the second part,historical cohort study and prospective cohort study were used to collect patients with pulmonary tuberculosis complicated with diabetes mellitus(PTB-DM)who were hospitalized in the hospital from December 1,2013 to December 31,2018 and had positive sputum culture,and to explore the risk factors of drug resistance in PTB-DM patients.Informations of some patients were collected from clinical medical records at the beginning of the investigation.Diabetes characteristics and other informations of other patients were collected through questionnaires and clinical medical records to track the occurrence of drug resistance.Whether hypoproteinemia occurs or not is adopted to reflect the nutritional status of the body.Binary Logistic regression analysis was used to analyze the influencing factors of drug resistance in patients with PTB-DM,and the ratio ratio and 95%confidence interval were calculated.Results:In the first part of the study,270 patients with pulmonary tuberculosis were included,of which 64 patients developed drug resistance and 206 patients did not develop drug resistance.Univariate conditional Logistic regression analysis found that retreatment,sputum smear positive and tuberculosis antibody positive may be risk factors for drug resistance of tuberculosis patients.Multivariate conditional Logistic regression analysis showed that after adjustment of retreatment(OR=2.35,95% CI:1.36~4.04),sputum smear grade 1+~3+(OR=2.14,95% CI: 1.02~4.49)and sputum smear grade 4+(OR=2.89,95% CI: 1.38~6.07)and other risk factors,diabetes mellitus was significantly associated with increased drug resistance risk(OR=1.76,95% CI: 1.00~3.08).In the second part of the study,153 patients with PTB-DM were included,of which 36 patients developed drug resistance and 117 patients did not develop drug resistance.Univariate Logistic regression analysis showed that relapse,diabetic course ≥ 5 years,smoking and sputum smear grade 4+ may be risk factors for drug resistance in pulmonary tuberculosis patients complicated with diabetes.Multivariate Logistic regression analysis showed that compared with PTB-DM patients with diabetic course < 5 years,the risk of drug resistance in patients with diabetic course ≥ 5 years increased by more than 3 times(OR=4.18,95% CI:1.50~11.62).Reperfusion is a risk factor for drug resistance in PTB-DM patients(OR=3.58,95% CI: 1.43~9.00).The patients with PTB-DM with sputum smear classification of 4+ are more prone to drug resistance than those with negative sputum smear(OR=5.24,95% CI: 1.53~17.95).Conclusion:Diabetes mellitus is significantly associated with increased risk of drug resistance.Risk factors for drug resistance in patients with PTB-DM include: duration of diabetes 5 years or more,retreatment,sputum smear grade 4+.This study suggests that clinical attention should be paid to the threat of tuberculosis drug resistance caused by diabetes mellitus,and drug resistance screening should be strengthened for tuberculosis patients with diabetes mellitus.In the prevention and control of drug resistance in patients with PTB-DM,emphasis should be placed on strengthening the drug resistance monitoring of patients with diabetes for 5 years or more,relapse,sputum smear grade 4+ and timely adjusting the management plan for patients with PTB-DM.The research can provide important scientific basis for drug resistance prevention and control of active pulmonary tuberculosis.