2型糖尿病并发肺结核的危险因素研究
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摘要
目的:探索2型糖尿病并发肺结核(T2DM-PTB)的环境危险因素。
方法:采用以医院为基础的1:2配比病例对照研究方法,以T2DM-PTB患者60例作为病例组,2型糖尿病不合并肺结核患者120例作为对照组,病例和对照按照性别和年龄进行1:2的配比。采用统一的调查表进行面对面的调查,调查内容包括社会人口学特征、现病史(肺结核和糖尿病)、既往病史、接触史、家族史、生活方式和行为因素(饮食、运动、吸烟、饮酒、饮茶、粉尘接触和居住环境)、社会心理因素(性格、应激事件)等。并进行体格检查和实验室检测。采用单因素条件Logistic回归分析探索T2DM-PTB的危险因素,对于由配比因素引入的新混杂,用分层分析的方法予以控制。对单因素分析中有意义的变量进行相关分析和多重共线性诊断,拟合主成分,进行条件Logistic回归分析,拟合主效应模型,并对进入模型的变量进行交互作用分析。
结果:单因素条件Logistic回归分析结果显示,T2DM-PTB的影响因素如下:职业(OR=0.056 95%CI:0.013～0.253)、文化程度(OR=0.377 95%CI:0.251～0.567)、经济收入(OR=0.036 95%CI:0.005～0.254)、DM病程(OR=0.543 95%CI:0.391～0.755)、血糖监测(OR=5.723 95%CI:2.183～15.003)、空腹血糖控制(OR=4.69595%CI:2.213～9.963)、有无并发症(OR=0.137 95%CI:0.060～0.316)、患糖尿病后体重变化(OR=0.611 95%CI:0.423～0.881)、DM家族史(OR=2.19695%CI:1.165～4.142)、是否锻炼身体(OR=0.133 95%CI:0.047～0.270)、每天锻炼时间(OR=0.316 95%CI:0.196～0.509)、锻炼年限(OR=0.410 95%CI:0.254～0.662)、饮茶(OR=0.246 95%CI:0.114～0.530)、饮酒指数(OR=0.70095%CI:0.510～0.961)、每日主食量(OR=0.600 95%CI:0.362～0.993)、家庭人均居住面积(OR=0.365 95%CI:0.232～0.573)、室内阳光是否充足(OR=0.21295%CI:0.114～0.393)、应激事件(OR=10.986 95%CI:3.806～31.710)、既往最高体
Objective: To detect environmental risk factors of type 2 diabetes mellitus complicated with pulmonary tuberculosis (T2DM-PTB) .Methods: A hospital-based 1:2 matched case-control study was conducted with 60 type 2 diabetes mellitus patients who developed pulmonary tuberculosis as cases and 120 type 2 diabetes mellitus patients who did not develop pulmonary tuberculosis as controls. Cases and controls were matched by gender and age. Investigator administrated questionnaire was conducted to investigate information including demographic characteristics, disease history, disease family history, living and behavioral pattern, social psychological characteristics and clinical data. Physical and laboratory data were collected through physical examination and laboratory test. Conditional logistic regression was used to explore the risk factors of T2DM-PTB with stratified analysis to exclude the confounding caused by matching factors. Multivariate logistic regression analysis was conducted with factors selected by principal component analysis and factor analysis to detect the main risk factors of T2DM-PTB and main effect model was acquired. Interaction was analyzed among those factors included in the model.Results: Those factors associated with T2DM-PTB found by univariate conditional logistic regression were occupation (OR=0.056 95%CI:0.013-0.253), education (OR=0.377 95%CI:0.251-0.567), income (OR=0.036 95%CI:0.005-0.254), duration of DM (OR=0.543 95%CI:0.391-0.755), testing blood sugar periodically (OR=5.723 95%CI:2.183-15.003), blood sugar control (OR=4.695 95%CI:2.213-9.963), complicated disease of DM (OR=0.137 95%CI:0.060-0.316), weight lossafter DM (OR= 0.611 95%CI:0.423-0.881), family history of DM (OR=2.19695%CI: 1.165-4.142), physical exercise (OR=0.133 95%CI: 0.047-0.270), daily exercise time ( OR=0.316 95%CI: 0.196-0.509 ) , years of exercise (OR=0.410 95%CI:0.254-0.662), drinking tea (OR=0.246 95%CI:0.114-0.530), index of alcohol drinking (OR=0.700 95%CI: 0.510-0.961), daily cereal intake (OR=0.600 95%CI:
0.362-0.993), living density (OR=0.365 95%CI:0.232-0.573), house lighting (OR=0.212 95%CI:0.114-0.393), stress (OR=10.986 95%CI:3.806-31.710), highest body mass index (BMI) (OR=0.264 95%CI: 0.152-0.461) .Multivariate logistic regression analysis with factors selected by principal component analysis and factor analysis found factors associated with T2DM-PTB including education (OR=0. 292 95%CI: 0. 082-1. 044), physical exercise index (OR=0. 340 95%CI: 0. 116-0.994), living density (0R=0. 263 95%CI:0. 070-0. 989),which were reversely associated with the development of T2DM-PTB, family history of DM (0R=6. 372 95%CI: 0.979-41.452), not testing blood sugar periodically (OR=5.723 95%CI:2.183-15.003), stress (OR=104.465 95%CI: 4.236-2575.933), which were positively associated with the development of T2DM-PTB. Living density and physical exercise index, family history of DM and stress, family history of DM and testing blood sugar periodically were found having two steps multiple interaction. Conclusion: Education, living density and physical index were found to be protective factors and family history of DM, stress and not testing blood sugar periodically were found to be risk factors of T2DM-PTB. Two steps multiple interaction were found between living density and physical index, family history of DM and stress, family history of DM and not testing blood sugar periodically.
方法:采用以医院为基础的1:2配比病例对照研究方法,以T2DM-PTB患者60例作为病例组,2型糖尿病不合并肺结核患者120例作为对照组,病例和对照按照性别和年龄进行1:2的配比。采用统一的调查表进行面对面的调查,调查内容包括社会人口学特征、现病史(肺结核和糖尿病)、既往病史、接触史、家族史、生活方式和行为因素(饮食、运动、吸烟、饮酒、饮茶、粉尘接触和居住环境)、社会心理因素(性格、应激事件)等。并进行体格检查和实验室检测。采用单因素条件Logistic回归分析探索T2DM-PTB的危险因素,对于由配比因素引入的新混杂,用分层分析的方法予以控制。对单因素分析中有意义的变量进行相关分析和多重共线性诊断,拟合主成分,进行条件Logistic回归分析,拟合主效应模型,并对进入模型的变量进行交互作用分析。
结果:单因素条件Logistic回归分析结果显示,T2DM-PTB的影响因素如下:职业(OR=0.056 95%CI:0.013～0.253)、文化程度(OR=0.377 95%CI:0.251～0.567)、经济收入(OR=0.036 95%CI:0.005～0.254)、DM病程(OR=0.543 95%CI:0.391～0.755)、血糖监测(OR=5.723 95%CI:2.183～15.003)、空腹血糖控制(OR=4.69595%CI:2.213～9.963)、有无并发症(OR=0.137 95%CI:0.060～0.316)、患糖尿病后体重变化(OR=0.611 95%CI:0.423～0.881)、DM家族史(OR=2.19695%CI:1.165～4.142)、是否锻炼身体(OR=0.133 95%CI:0.047～0.270)、每天锻炼时间(OR=0.316 95%CI:0.196～0.509)、锻炼年限(OR=0.410 95%CI:0.254～0.662)、饮茶(OR=0.246 95%CI:0.114～0.530)、饮酒指数(OR=0.70095%CI:0.510～0.961)、每日主食量(OR=0.600 95%CI:0.362～0.993)、家庭人均居住面积(OR=0.365 95%CI:0.232～0.573)、室内阳光是否充足(OR=0.21295%CI:0.114～0.393)、应激事件(OR=10.986 95%CI:3.806～31.710)、既往最高体
Objective: To detect environmental risk factors of type 2 diabetes mellitus complicated with pulmonary tuberculosis (T2DM-PTB) .Methods: A hospital-based 1:2 matched case-control study was conducted with 60 type 2 diabetes mellitus patients who developed pulmonary tuberculosis as cases and 120 type 2 diabetes mellitus patients who did not develop pulmonary tuberculosis as controls. Cases and controls were matched by gender and age. Investigator administrated questionnaire was conducted to investigate information including demographic characteristics, disease history, disease family history, living and behavioral pattern, social psychological characteristics and clinical data. Physical and laboratory data were collected through physical examination and laboratory test. Conditional logistic regression was used to explore the risk factors of T2DM-PTB with stratified analysis to exclude the confounding caused by matching factors. Multivariate logistic regression analysis was conducted with factors selected by principal component analysis and factor analysis to detect the main risk factors of T2DM-PTB and main effect model was acquired. Interaction was analyzed among those factors included in the model.Results: Those factors associated with T2DM-PTB found by univariate conditional logistic regression were occupation (OR=0.056 95%CI:0.013-0.253), education (OR=0.377 95%CI:0.251-0.567), income (OR=0.036 95%CI:0.005-0.254), duration of DM (OR=0.543 95%CI:0.391-0.755), testing blood sugar periodically (OR=5.723 95%CI:2.183-15.003), blood sugar control (OR=4.695 95%CI:2.213-9.963), complicated disease of DM (OR=0.137 95%CI:0.060-0.316), weight lossafter DM (OR= 0.611 95%CI:0.423-0.881), family history of DM (OR=2.19695%CI: 1.165-4.142), physical exercise (OR=0.133 95%CI: 0.047-0.270), daily exercise time ( OR=0.316 95%CI: 0.196-0.509 ) , years of exercise (OR=0.410 95%CI:0.254-0.662), drinking tea (OR=0.246 95%CI:0.114-0.530), index of alcohol drinking (OR=0.700 95%CI: 0.510-0.961), daily cereal intake (OR=0.600 95%CI:
0.362-0.993), living density (OR=0.365 95%CI:0.232-0.573), house lighting (OR=0.212 95%CI:0.114-0.393), stress (OR=10.986 95%CI:3.806-31.710), highest body mass index (BMI) (OR=0.264 95%CI: 0.152-0.461) .Multivariate logistic regression analysis with factors selected by principal component analysis and factor analysis found factors associated with T2DM-PTB including education (OR=0. 292 95%CI: 0. 082-1. 044), physical exercise index (OR=0. 340 95%CI: 0. 116-0.994), living density (0R=0. 263 95%CI:0. 070-0. 989),which were reversely associated with the development of T2DM-PTB, family history of DM (0R=6. 372 95%CI: 0.979-41.452), not testing blood sugar periodically (OR=5.723 95%CI:2.183-15.003), stress (OR=104.465 95%CI: 4.236-2575.933), which were positively associated with the development of T2DM-PTB. Living density and physical exercise index, family history of DM and stress, family history of DM and testing blood sugar periodically were found having two steps multiple interaction. Conclusion: Education, living density and physical index were found to be protective factors and family history of DM, stress and not testing blood sugar periodically were found to be risk factors of T2DM-PTB. Two steps multiple interaction were found between living density and physical index, family history of DM and stress, family history of DM and not testing blood sugar periodically.
引文
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77 Ariyothai N, Podhipak A, Akarasewi P, et al. Cigarette smoking and its relation to pulmonary tuberculosis in adults. Southeast Asian J Trop Med Public Health. 2004;35(1): 219-27.
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79 Alcaide J, Alter MN, Plans P, et al. Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study. Tuber Lung Dis. 1996;77(2): 112-6.
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