肺结核合并2型糖尿病临床观察分析

目的分析肺结核合并2型糖尿病患者的临床特点及其治疗与预后的关系。方法回顾总结和比较2002年1月-2006年6月收治的60例肺结核合并2型糖尿病（研究组）和76例单纯肺结核患者（对照组）的临床资料。两组在性别、年龄及初、复治比例方面比较差异无统计学意义（P〉0．05）,具有可比性。初治肺结核采用异烟肼和利福平的三药或四药联合;复治肺结核采用丙硫异烟胺和利福喷汀的三药或四药联合,疗程6～15个月。合并糖尿病的患者在饮食控制基础上,给予口服降糖药或皮下注射胰岛素控制血糖。结果研究组发热、盗汗、咯血、合并空洞、痰菌阳性率分别为46．67％,25．Do％,43．33％,46．67％,48．33％,明显高于对照组（P〈O．05）;研究组血糖控制〈8．5mmol／L者痰菌阴转率和结核病灶吸收好转率分别为95．45％、90．91％,明显高于血糖≥8．5mmol／L者的50.00％、56．52％（P〈0．05）。结论合并2型糖尿病的肺结核患者较单纯肺结核患者病情严重;严格控制血糖水平是肺结核治疗的重要辅助手段。

Clinical Observation and Analysis of Pulmonary Tuberculosis Complicated with Type 2 Diabetes Mellitus

Objective To analyze the clinical features, treatment and prognosis of pulmonary tuberculosis with type 2 diabetes mellitus. Methods The clinical characteristics and therapeutic effects of 60 pulmonary tuberculosis cases complicated with type 2 diabetes mellitus （study group） and 76 simple pulmonary tuberculosis cases （control group） were retrospectively reviewed from January 2002 to June 2006. There was no significant difference in gender, age and proportion of initial and retreated patients between two groups （P〉0. 05）. The initial treatment often used three or four drugs including isoniazid and rifampicin, and the retreatment used three or four drugs including rifapentin and protionamide. The course was 6 to 15 months. Blood sugar of patients with diabetes mellitus was controlled by oral hypoglycemic agents or subcutaneous insulin based on diet control. Results The incidence of fever, night sweats, hemoptysis, merging empties in lesions, sputum-positive rates in the study group were 46.67%, 25.00%, 43. 33%, 46.67%, 48. 33% respectively, which were significantly higher than those of the control group （P〈0. 05）. Besides, in the study group, sputum conversion rate and lesion absorption rates for those whose blood glucose was under 8. 5 mmol/L were 95. 45% and 90. 91% respectively, which were significantly higher than those whose blood glucose above 8. 5 mmol/L （50. 00% and 56.52% respectively） （P〈0. 05）. Conclusion General status of pulmonary tuberculosis patients with type 2 diabetes is more serious than that of simple pulmonary tuberculosis, and strict control of blood glucose is an important auxiliary to the treatment of tuberculosis.