肺结核合并糖尿病320例临床分析

[目的]探讨肺结核(PTB)合并糖尿病(DM)的临床症状、影像学特征及临床疗效.[方法]选择PTB合并DM患者320例(DM+PTB组),同时选择320例同期住院非DM的PTB患者作为对照组(PTB组),随访时间为6～24个月,比较两组临床症状、影像学特征及临床疗效.[结果]与PTB组相比,DM+PTB组咳嗽、咯血、纳差乏力、消瘦、呼吸困难、大叶性浸润并形成空洞、干酪样肺炎较为明显( P <0.05);PTB组以上叶病变为主,纤维增殖病灶较DM+PTB组明显( P <0.05),两组慢性纤维空洞型肺结核的比较无显著性差异( P >0.05);DM+PTB组痰菌阳性率显著高于PTB组( P <0.05),痰菌阴转率及病灶吸收率显著低于PTB组( P <0.05);两组病例中病变程度轻型者经治疗后病灶吸收情况无统计学差异( P >0.05);DM+PTB组中型和重型组经治疗后病灶吸收情况差于PTB组( P <0.05);DM+PTB组肝损害较PTB组明显( P <0.05).[结论]①DM+PTB组中临床症状、痰菌阳性率、肝损害发生率明显高于PTB组;②DM+PTB组影像学改变多分布中、下叶肺野,以空洞及干酪性肺炎多见;③DM+PTB组痰菌阴转率及治疗疗效低于PTB组;④肺结核合并DM时二者互有不利影响,严格控制血糖水平是治疗PTB合并DM的关键,抗痨治疗疗程亦应延长.

Clinical Analysis of 320 Cases of Pulmonary Tuberculosis Complicated with Diabetes Mellitus

[Objective]To explore the clinical symptoms, imaging features and clinical efficacy of pulmonary tuberculosis（PTB） complicated with diabetes mellitus（DM）. [Methods] Totally 320 cases of PTB patients with DM（DMq-PTB group） were selected. Meanwhile, 320 hospitalized PTB patients without DM were selected as the control group（PTB group）. The follow-up time was 6 to 24 months. Clinical symptoms, imaging features and clinical efficacy were compared between two groups. [Results] Compared with PTB group, symptoms such as cough, hemoptysis, poor fatigue, weight loss, dyspnoea, large lobe infiltration complicated with cavity and case- ous pneumonia in DM＋PTB group were more obvious（ P〈0.05）. Most of PTB group were superior lobe le- sions. Fibroplasia lesion in PTB group was more obvious than that in DM＋PTB group（ P 〈0.05）. There was no significant difference in chronic fibrotic cavity lung tuberculosis between two groups（ P 〉0.05）. Sputum-positive rate in DM＋PTB group was obviously higher that in PTB group（ P 〈0.05）. Sputum negative conversion rate and lesion absorption in DM＋PTB group were obviously lower than those in PTB group（ P 〈0.05）. There was no significant difference in lesion absorption of mild patients after treatment between two groups（ P〉0.05）. The lesion absorption in middle and severe patients of DM＋PTB group after treatment was poorer than that in PTB group（ P 〈0.05）. Liver damage in DM＋PTB group was more obvious than that in PTB group（ P〈0.05）. [Conclusion] Clinical symptoms, sputum-positive rate and the incidence of liver damage in DM＋PTB group are obviously higher than those in PTB group. Imaging changes in DMq-PTB group are frequently distributed in mid- dle and lower lung field. Cavities and caseous pneumonia are commonly seen. Sputum negative conversion rate and the efficacy in DM＋PTB group are lower than those in PTB group. PTB complicated with DM have an adverse impact on each other. Strict control of blood glucose is the key for the treatment of PTB with DM. Anti-tuberculo- sis treatment course should be extended.