188例肺结核合并糖尿病患者短期临床疗效分析

目的 了解肺结核合并糖尿病（PTB-DM）患者的临床特征，为PTB-DM患者的临床诊疗提供参考依据和可行性建议。 方法 选取青岛市胸科医院2011年12月至2013年6月间住院的PTB-DM患者188例作为研究对象，同期住院的单纯肺结核（PTB）患者392例，根据年龄段进行分层，并按照各年龄段两组患者比例尽量一致的原则，依患者住院号顺序采用随机数字表法抽取得到188例，作为对照组，分析比较两组患者治疗2个月后临床症状（咯痰、痰中带血或咯血、胸闷等）及临床症状改善情况、痰菌转阴率、肺部CT（病灶形态、病灶部位）等，采用χ^2验或U检验对资料进行分析。 结果 入院时，PTB-DM组患者痰中带血或咯血发生率（32.45%，61/188）显著高于PTB组（18.62%，35/188）（χ^29.456，P〈0.05）。治疗2个月后，PTB-DM组患者仍存在咯痰、痰中带血或咯血、胸闷症状的比例分别为66.49%（125/188）、5.32%（10/188）和23.94%（45/188），显著高于PTB组的51.06%（96/188）、1.60%（3/188）和14.89%（28/188）（χ^2分别为9.231、3.904、4.913，P值均〈0.05）。PTB组患者咯痰、胸闷症状的改善率［36.84%（56/152）、74.07%（80/108）］优于PTB-DM组［20.89%（33/158）、56.31%（58/103）］（χ^2分别为9.637、7.352，P值均〈0.05）。两组患者在治疗2个月后，PTB-DM组患者痰菌转阴率（53.15%，76/143）显著低于PTB组（69.77%，90/129）（χ^28.609，P=0.003）。PTB组患者条索、钙化发生率［34.04%（64/188）、13.83%（26/188）］高于PTB-DM组［22.87%（43/188）、2.13%（4/188）］（χ^2分别为5.761、17.532，P值均〈0.05），结节、空洞发生率［7.98%（15/188）、45.74%（86/188）］低于PTB-DM组［14.89%（28/188）、56.38%（106/188）］（χ^2分别为4.438、4.257，P值均〈0.05）；PTB-DM组患者肺部病变在下叶背段及下叶基底段的发生率［74.47%（140/188）、46.28%（87/188）］高于PTB组［63.30%（119/188）、26.60%（50/188）］（χ^2分别为5.472、15.721，P值均〈0.05）。 结论 与PTB患者相比，PTB-DM患者临床表现较重，短期治疗后疗效较差，需要及时根据情况调整和强化PTB-DM患者的治疗并适当延长治疗时间。

Analysis of short-term clinical therapeutic efficacy in 188 pulmonary tuberculosis patients with diabetes mellitus

Objective The objective of this study was to find out the clinical characteristics of the pulmonary tuberculosis patients with diabetes mellitus （PTB-DM） and provide the reference frame and the feasible suggestions for their clinical treatment. Methods One hundred and eighty-eight inpatients with pulmonary tuberculosis complicated with diabetes mellitus patients in Qingdao Chest Hospital from December 2011 to June 2013 were recruited as objects in the study. And 188 pulmonary tuberculosis inpatients without diabetes mellitus in the same period were selected as the control group. Between the two groups, we analyzed and compared the clinical manifestation （expectoration, hemoptysis and chest tightness）, the incidences of sputum smear negative conversion and the lung CT （shape and position of lung lesions）. The Chi-square test or the U-test was used to analyze data. And the significance level of alpha is 0.05. Results At the time of admission to hospital, the incidence of hemoptysis or bloody sputum in PTB-DM patients （32.45%, 61/188） was significantly higher than PTB group （18.62%,35/188） （χ^29.456, P〈0.05）. After 2 months of treatment, the proportion of PTB-DM patients with expectoration, hemoptysis and chest tightness were 66.49% （125/188）, 5.32% （10/188） and 23.94% （45/188） respectively, which were significantly higher than 51.06% （96/188）, 1.60% （3/188） and 14.89% （28/188） in PTB group（χ^29.231, 3.904, 4.913, all P〈0.05）. The improvement rate of expectoration and chest tightness in PTB group （36.84%（56/152）,74.07%（80/108）） was better than the PTB-DM group （20.89%（33/158）,56.31%（58/103）） （χ^29.637, 7.352, all P〈0.05）. The sputum negative conversion rate of PTB-DM patients was 53.15% （76/143）, which was significantly lower than 69.77% （90/129） of PTB group （χ^28.609,P=0.003）. The incidences of cord like high density shadow and calcification in PTM group （34.04%（64/188）,13.83%（26/188）） were higher than those in PTB-DM group （22.87%（43/188）,2.13%（4/188）） （χ^25.761, 17.532, all P〈0.05）. The incidences of nodules and cavity in PTB group （7.98%（15/188）,45.74%（86/188）） were lower than those in PTB-DM group （14.89%（28/188）,56.38%（106/188）） （χ^24.438, 4.257, all P〈0.05）; The incidence of lung lesion that occurred in the back section and lower lobe basal segment was higher in PTB-DM group （74.47%（140/188）,46.28%（87/188）） than that in PTB group （63.30%（119/188）,26.60%（50/188）） （χ^25.472, 15.721, all P〈0.05）. Conclusion Compared with PTB group, the PTB-DM patients’ clinical manifestation are more serious and have less effect after short-term treatment. It is suggested that we should timely adjust and enhance the treatment for the PTB-DM patients and extend the treatment duration suitably.