Biblioteca Virtual en Salud

Objective To investigate the types,incidence rate and related factors of adverse drug reactions(ADRs)in pa-tients with concomitant multi-drug resistant pulmonary tuberculosis(MDR-TB)and diabetes mellitus(DM)and those with only MDR-TB in an attempt to improve the surveillance of patients with both MDR-TB and DM.Methods A total of 359 MDR-TB patients who were diagnosed in the first batch of the 5th round of China Global Fund project in Wuhan city from December 1, 2006 to June 30,2014 and enrolled in the whole supervision process were retrospectively analyzed.They fell into MDR-TB(DM+)group(n=74;20.6%,74/359)and MDR-TB(DM -)group(n=285;79.4%,285/359).The incidence and the occurrence time of ADRs were compared between the two groups.The patients with MDR-TB(DM +)group were divided into two sub-groups in terms of the occurrence of ADRs.The treatment success rate and the effects of age,body mass index,plasma albumin level before treatment,fasting blood glucose level,smoking,alcohol consumption and other diseases on ADRs were investiga-ted.Results ①The incidence of ADRs in MDR-TB(DM+)group(39 cases,52.7%)was not significantly different from that in MDR-TB(DM -)group(141 cases,49.5%)(c2=0.245,P>0.05). ② The incidence of hypothyroidism(c2=6.08,P<0.05), hypokalemia(c2=12.37,P<0.05)and QT interval prolongation(c2=4.32,P<0.05)was significantly higher in MDR-TB(DM+)group than in MDR-TB(DM -)group during the treatment. ③ The lower body mass index(F=6.289,P<0.05),the de-creased level of plasma albumin(F=9.743,P<0.05),concomitant chronic liver disease(c2=6.000,P<0.05)and other chronic diseases(c2= 4.125,P<0.05)were associated with ADRs in patients with both MDR-TB and DM.No associations of sex,age, mean fasting blood glucose level,smoking,alcohol consumption,duration of diabetes,initial treatment and retreatment,number of resistant drugs was found with ADRs. ④There were 17 cases(43.6%,17/39)cured in ADRs group and 25 cases(71.4%,25/35)cured in non-ADRs group,with significant difference found(c2=5.825,P<0.05).Conclusion The patients with concomi-tant MDR-TB and DM are more likely to develop hypothyroidism,hypokalemia,and QT interval prolongation during the treat-ment,and need periodic monitoring and adjustment of medication.Those with the worse nutritional status(lower BMI and plas-ma albumin level)and other concomitant diseases(such as chronic liver disease,etc.)are more likely to have ADRs.Those with ADRs tend to have lower success rate of cure,and they are more likely to suffer treatment failure,loss to follow-up,interruption of treatment and so on.