血清糖化血红蛋白、空腹血糖、胰岛素抵抗指数对2型糖尿病合并涂阳肺结核患者强化期治疗后痰菌未阴转的预测价值

目的探讨2型糖尿病合并涂阳肺结核患者2个月强化期治疗后痰菌未阴转的影响因素以及早期血清糖化血红蛋白(HbA1c)、空腹血糖(FBG)及胰岛素抵抗指数(HOMA-IR)对痰菌未阴转的预测价值。方法选取在本院治疗的2型糖尿病合并涂阳肺结核患者87例,同时选取同期40例单纯肺结核患者为对照组,分析2型糖尿病合并涂阳肺结核患者痰菌未阴转的危险因素,并通过绘制ROC曲线分析早期血清HbA1c、FBG、HOMA-IR对强化期治疗后痰菌未阴转的预测价值。结果2型糖尿病合并涂阳肺结核组治疗后痰菌阴转率明显低于对照组,且血清HbA1c、FBG及HOMA-IR较治疗前明显降低(P<0.05)。有空洞及治疗前、2个月强化期治疗后血清HbA1c、FBG、HOMA-IR的高水平均是影响2型糖尿病合并涂阳肺结核患者痰菌未阴转的独立危险因素(P<0.05)。血清HbA1c、FBG预测痰菌未转阴的AUC均明显高于HOMA-IR(P<0.05);HbA1c预测痰菌未转阴的敏感度>FBG>HOMA-IR,而HOMA-IR的特异度>HbA1c=FBG。结论早期、定期对血清HbA1c、FBG及HOMA-IR进行综合监测对提高2型糖尿病合并涂阳肺结核患者2个月强化期治疗后痰菌阴转率具有重要价值。

The predictive value of serum HbA1c,FBG and HOMA-IR in patients with type 2 diabetes mellitus and smear positive pulmonary tuberculosis after intensive treatment without negative conversion of sputum bacteria

Objective To investigate the influencing factors of sputum bacteria negative conversion in type 2 diabetes mellitus patients with smear positive pulmonary tuberculosis after 2 months of intensive treatment and the predictive value of early serum glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG) and insulin resistance index(HOMA-IR) on sputum bacteria negative conversion.Methods A total of 87 patients with type 2 diabetes and smear-positive pulmonary tuberculosis treated in our hospital were selected,and 40 patients with simple tuberculosis were selected as control group at the same time.The ROC curve was used to analyze the predictive value of early serum HbA1c,FBG,and HOMA-IR on the non-negative conversion of sputum after intensive treatment.Results After treatment of type 2 diabetes combined with smear positive pulmonary tuberculosis group,the negative conversion rate of sputum was significantly lower than that of the control group,and serum HbA1c,FBG and HOMA-IR were significantly lower than before treatment(P<0.05).There are holes and high levels of serum HbA1c,FBG,and HOMA-IR before treatment and after 2 months of intensive treatment are independent risk factors that affect the sputum of patients with type 2 diabetes with smear-positive pulmonary tuberculosis(P<0.05).The serum HbA1c and FBG predicted that the sputum was not negative,and the AUC was significantly higher than that of HOMA-IR(P<0.05).The sensitivity of HbA1c predicting positive sputum>FBG>HOMA-IR,and the specificity of HOMA-IR>Hb A1 c= FBG were observed.Conclusion Early and regular comprehensive monitoring of serum HbA1c,FBG and HOMA-IR are of great value in improving sputum negative conversion rate of type 2 diabetes mellitus patients with smear positive tuberculosis after 2 months of intensive treatment.