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Increased Risk of Active Tuberculosis in Diabetic Patients: A Nationwide Population-Based Study

糖尿病患者有較高活動性結核病的風險-以全國人口為對象之研究

摘要


背景:雖然許多的研究都顯示出糖尿病和活動性結核病的正相關性,但是其中大多數的研究都是進行於病例對照研究法或侷限於研究對象的數目。這次我們利用臺灣全國性的資料庫的優勢,針對糖尿病和結核病的關係進行本次研究。方法:我們使用臺灣國家健康保險資料庫設計此一以全國人口為基礎的世代追蹤研究。排除了最近三年內才診斷感染結核病的人數,研究組共有47,353位是糖尿病患者,相對於910,577位非糖尿病患者作為控制組。結果:在西元2005至2009年間的追蹤內,患有第二型糖尿病的患者,得到結核病感染的機率是有意義的高於控制組(2.87% vs 0.72%, P<0.0001)。不論是否有糖尿病,累計發生率都是隨著年紀增加。危險比值(risk ratio)分析顯示在所有年齡組別中,糖尿病患者的風險都是比非糖尿病患者高,尤其是小於四十歲的男性糖尿病患者。總結來說,粗估危險比(crude hazard ratio, HR)是4.019,完全校正危險比(fully adjusted HR)(年齡、性別、高血壓、癌症、血脂異常、慢性阻塞性肺疾、肝臟疾病、中風、腎臟病、塵肺症及自體免疫疾病)仍然是有意義的1.597(P<0.0001)。結論:根據此次以全國人口為對象的研究,糖尿病本身就是增加結核病感染的風險,而且具有統計上的意義。

關鍵字

年齡 糖尿病 風險 結核病

並列摘要


Background: Although several studies have shown a positive correlation between diabetes mellitus (DM) and active tuberculosis (TB), a majority of these studies were conducted with a case-control design or a limited number study subjects. Using a nationwide, population-based database in Taiwan, we conducted a study to examine the relationship between DM and TB. Methods: We designed a population-based cohort study using the Taiwan National Health Insurance database. After excluding patients who had TB infections diagnosed in the most recent 3 years, we were able to include 47,353 patients with type 2 DM as the study group and 910,577 non-diabetic patients as the control group. Results: The rate of TB infection during the 2005-2009 follow-up was significantly higher in patients with type 2 DM than in the control group (2.87% vs 0.72%, P<0.0001). The cumulative incidence increased with age among both the diabetic and non-diabetic patients. Risk ratio analysis revealed that diabetic patients had a higher risk than non-diabetic patients in all age groups, especially diabetic males aged <40 years. Overall, the crude hazard ratio (HR) was 4.019 and the fully adjusted HR (age, gender, hypertension, malignancy, dyslipidemia, chronic obstructive pulmonary disease, liver disease, stroke, nephropathy, pneumoconiosis, and autoimmune diseases) was significant at 1.597 (P<0.0001). Conclusion: In this national population-based study, we found that DM itself would independently and significantly increase the risk of TB.

並列關鍵字

age diabetes mellitus risk tuberculosis

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