结核病与糖尿病：相互关系和诊治的研究新进展

摘要/Abstract

摘要： 糖尿病（diabetes mellitus,DM）流行对全球健康构成挑战,DM是结核病（tuberculosis,TB）的重要相关疾病之一。DM对TB产生较大影响,特别是可导致痰培养转阴延迟、增加TB治疗失败、复发和死亡率的风险。TB疫情依然严重,仍然在全球流行,其中一个重要原因可能是DM患者的增多,DM的流行可能影响WHO“终止TB策略”,尤其TB合并DM患者防治形势雪上加霜。近年来越来越多的证据支持TB-DM的相互关系,这有助于更好理解贯彻TB-DM的综合防治的重要性。WHO提出到2035年终止结核病,提醒我们TB-DM的防治绝不可放松,否则结局仅是一个口号。本文综述了近年来全球TB与DM相互关系及其诊治新进展,提出了防治TB-DM新的双向筛查和早期诊治策略,包括加强TB患者DM监测,DM患者中TB的监测,DM患者中TB的抗结核治疗和TB患者中DM的降糖治疗及其管理,分别遵照DM和TB各领域制定的指南或国际标准进行。探索并切实贯彻“早发现、早报告、早诊断、早治疗、早隔离”的一体化、高效的TB合并DM有效的防控策略。

关键词: 结核病, 糖尿病, 防治, 策略

Abstract: The growing epidemic of diabetes mellitus (DM) is set to become one of the major global health challenges. The rising DM epidemic could contribute to an increase in TB burden. DM also has a major effect on TB treatment outcomes; in particular, it is associated with delayed sputum culture conversion, increased risk of treatment failure, and increased risk of TB relapse and mortality. The tuberculosis epidemic is still serious and is still prevalent globally. One of the important reasons may be the rise of diabetes patients, and the prevalence of DM may affect WHO's “End TB strategy”, especially the prevention and treatment situation of patients with tuberculosis and diabetes.. With the accumulation of recent evidence supporting the TB-DM association, there is a need for an updated understanding of the magnitude of the TB-DM association. This understanding is critical for the implementation of comprehensive TB - DM control programs. The WHO's proposal to end tuberculosis by 2035 reminds us that the prevention and treatment of tuberculosis and diabetes must not be relaxed, otherwise the “End TB”is just a slogan. This paper reviews the recent progress on the relationship between tuberculosis and diabetes and its diagnosis and treatment. A new bi-directional screening and early diagnosis and treatment strategy for the prevention and control of global TB-DM was put forward. These included strengthening the monitoring of tuberculosis in patients with diabetes, of diabetes in patients with tuberculosis, anti-tuberculosis treatment in patients with DM and hypoglycemic therapy and its management in TB patients with. The treatment were determined respectively according to the DM and TB guidelines or international standards. In the end,an effective and integrated strategy of prevention and control for twin-epidemic of DM-TB by early detection, early reporting, early diagnosis, early treatment and early isolation might be explored and implemented.

Key words: Tuberculosis, Diabetes mellitus, Preventionandtreatment, Strategy

杨松, 严晓峰. 结核病与糖尿病：相互关系和诊治的研究新进展[J]. 新发传染病电子杂志, 2018, 3(4): 234-238.

YANG Song, YAN Xiao-feng. New advance in diabetes and tuberculosis: interrelation, diagnosis and treatment[J]. Electronic Journal of Emerging Infectious Diseases, 2018, 3(4): 234-238.

参考文献

[1] World Health Organization. Global tuberculosis control 2017[R/OL]. Geneva: World Health Organization, 2012. (2017-11-07) [2017-11-07]. http://www.who.int/tb/publications/global report/2011/gtbr11 full.pdf.
[2] Lin Y, Yuan Y, Zhao X, et al.The change in blood glucose levels in tuberculosis patients before and during anti-tuberculosis treatment in China[J]. Glob Health Action,2017, 10(1):1289737.
[3] Cheng J,Zhang H,Zhao YL,et al.Mutual Impact of Diabetes Mellitus and Tuberculosis in China[J]. Biomed Environ Sci,2017,30(5):384-389.
[4] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南2017年版[J]. 中华糖尿病杂志,2018,10(1):4-67.
[5] Lachmandas E,Thiem K,van den Heuvel C,et al. Patients with type 1 diabetes mellitus have impaired IL-1β production in response to Mycobacterium tuberculosis[J]. Eur J Clin Microbiol Infect Dis,2018,37(2):371-380.
[6] Al-Rifai RH,Pearson F,ritchley JA,et al. Association between diabetes mellitus and active tuberculosis:A systematic review and meta-analysis[J]. PLoS ONE,2017,12(11):e0187967.
[7] Pavlovic JM,Pavlovic AD,Bulaji MV,et al.Prevalence of diabetes mellitus (DM) in tuberculosis (TB) patients:clinical and radiologic features in the TB-DM association based on a five-year hospital study[J]. Infez Med,2018,26(1):22-27.
[8] Liu QQ,Li W,Xue M,et al,Diabetes mellitus and the risk of multidrug resistant tuberculosis:a meta-analysis[J]. Sci Rep,2017,7(1):1090.
[9] Saktiawati AMI,Subronto YW.Influence of Diabetes Mellitus on the Development of Multi Drug Resistant-Tuberculosis in Yogyakarta[J]. Acta Med Indones,2018,50(1):11-17.
[10] Rumende CM.Risk Factors for Multidrug-resistant Tuberculosis[J]. Acta Med Indones,2018,50(1):1-2.
[11] Lopez LN,Martinez AGR,Garcia-Hernandez MH,et al.Type-2 diabetes alters the basal phenotype of human macrophages and diminishes their capacity to respond,internalise,and control Mycobacterium tuberculosis[J]. Mem Inst Oswaldo Cruz, 2018,113(4):e170326.
[12] Hossain MD,Ahmed JU,Rahim MA,et al.Bangladesh national guidelines on the management of tuberculosis and diabetes mellitus co-morbidity (summary)[J]. Indian J Endocrinol Metab,2016,20(6):853-857.
[13] Wang X,Ma A,Han X,et al.T Cell Profile was Altered in Pulmonary Tuberculosis Patients with Type 2 Diabetes. Med SciMonit,2018,24:636-642.
[14] Wang XH,Ma AG,Han XX,et al.Protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene single nucleotide polymorphisms and its interaction with T2DM on pulmonary tuberculosis in Chinese Uygur population. Oncotarget,2017,8(39):65601-65608.
[15] Wang XH,Ma AG,Han XX,et al.Relationship between Toll-like receptor 4 and type-2 diabetes mellitus complicated bytuberculosis[J]. Int J Tuberc Lung Dis,2017,21(8):910-915.
[16] Barron MM,Shaw KM,Bullard KM,et al.Diabetes is associated with increased prevalence of latent tuberculosis infection: Findings from the National Health and Nutrition Examination Survey, 2011-2012[J]. Diabetes Res ClinPract,2018,139:366-379.
[17] Ma Y,Huang ML,Li T,et al.Role of Diabetes Mellitus on Treatment Effects in Drug-susceptible Initial Pulmonary Tuberculosis Patients in China. Biomed Environ Sci,2017,30(9):671-675.
[18] Shewade HD,Jeyashree K,Mahajan P,et al.Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes:A systematic review[J]. PLoS ONE,2017,12(10):e0186697.
[19] Zheng CL,Hu X,Zhao L,et al.Clinical and pharmacological hallmarks of rifapentine’s use in diabetes patients with active and latent tuberculosis: do we know enough?[J]. Drug Design, Development and Therapy,2017,11:2957-2968.
[20] Lee YJ,Han SK,Park JH,et al.The effect of metformin on culture conversion in tuberculosis patients with diabetes mellitus[J]. The Korean Journal of Internal Medicine,2018,33(5):933-940.
[21] Degner NR,Wang JY,Golub JE,et al.Metformin Use Reverses the Increased Mortality Associated With Diabetes Mellitus During Tuberculosis Treatment[J]. Clin Infect Dis,2018,66(2):198-205.
[22] Ma Y,Pang Y,Shu W,et al.Metformin reduces the relapse rate of tuberculosis patients with diabetes mellitus:experiences from 3-year follow-up[J]. Eur J ClinMicrobiol Infect Dis,2018,37(7):1259-1263.
[23] Putra IGNE,Astuti PAS,Suarjana IK,et al.Factors Associated with Participation in Pulmonary Tuberculosis Screening Using Chest X-Ray among Diabetes Mellitus Type II Patients in Denpasar, Bali, Indonesia[J].Tuberc Res Treat,2018,20:9285195.