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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logrank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。
Objective To analyze whether there is any difference in anti-tuberculosis treatment effect between PTB-DM group and PTB group by using survival analysis method and analyze the factors influencing the prognosis of PTB-DM. Methods The prospective cohort study design was used. The follow-up data of 116 patients with tuberculosis complicated with diabetes and 120 patients with simple tuberculosis registered in Zhenjiang Hospital Affiliated to Medical College of Jiangsu University from June 2013 to December 2014 were For example, Kaplan-Meier survival analysis was used to evaluate the rate of unacceptable pulmonary tuberculosis. The logrank test and Cox proportional hazards regression model were used to evaluate the prognosis of patients with PTB-DM by univariate and multivariate analysis. Results The survival curves showed that the cumulative rate of non-improvement in patients with pulmonary tuberculosis complicated with diabetes was significantly higher than that in patients with simple diabetes (Log-rank test, P = 0.001). Univariate analysis showed that there were significant differences among the five factors (Log-rank test, P <0.05) in age, combination cavity, retreatment tuberculosis, drug resistance and anti-TB drug-induced liver damage. Cox proportional hazards regression model to do multivariate analysis showed that age, relapse TB, resistance to these three factors were statistically significant (P <0.05). Conclusion Diabetes can reduce the therapeutic effect of tuberculosis. Regular monitoring and effective control of patients with high-risk patients with tuberculosis, especially those with high risk of tuberculosis prognosis, can improve the rate of TB improvement and improve its prognosis.