不同给药方式治疗糖尿病合并肺结核近期疗效观察

目的对胰岛素泵、胰岛素皮下注射与口服降糖药三种方法治疗糖尿病合并肺结核进行近期疗效观察,为患者选择经济、方便、有效的控制血糖方法提供依据。方法 92例糖尿病合并初治肺结核患者被随机分为胰岛素泵组、胰岛素注射组和口服降糖药组。胰岛素泵组采用胰岛素泵入治疗,胰岛素皮下注射治疗组每日早、晚餐前2次皮下注射治疗;口服降糖药组采用阿卡波糖联合二甲双胍缓释片治疗。结核病治疗方案均为HREZ。观察3组控制血糖达标时间、临床症状、痰菌阴转及肺部病灶吸收好转情况。结果使用胰岛素泵组血糖达标（平均4d）,胰岛素注射组血糖达标（平均7.5d）,口服降糖药组血糖达标（平均15d）,其中有20例未达标,第一组与第二组、第二组与第三组比较差异有统计学意义（P〈0.05）。胰岛素泵组痰菌转阴快,治疗4周时达83.3%,胰岛素注射组转阴率为42.1%,2组差异有统计学意义（=6.68,P〈0.05）。胰岛素注射组与口服降糖药痰菌阴转率（22.2%）比较,差异有统计学意义（=8.3,P〈0.05）。前两组患者治疗后临床症状好转,胸CT显示肺部病灶吸收情况（治疗4周后）差异无统计学意义（=0.097,P〉0.05）;但与口服降糖药比较,差异有统计学意义（=6.67,P〈0.05）。结论糖尿病合并肺结核使用胰岛素泵治疗时,血糖控制达标快,肺结核痰菌阴转快,但胰岛素泵价格、耗材昂贵;而口服降糖药无论是血糖达标、临床症状好转、病灶吸收等情况均与胰岛素泵组和胰岛素皮下注射组比较相差甚远,而胰岛素皮下注射,经济、方便、能较快控制血糖,肺结核痰菌阴转、临床症状好转、肺部病灶吸收均较快。建议糖尿病合并肺结核首选外源胰岛素皮下注射治疗控制血糖。

Efficacy of Diabetes Mellitus Patients Complicated with Pulmonary Tuberculosis treated by Insulin Pump,Insulin Subcutaneous Injection and Oral Hypoglycemic.

Objective Observe the efficacy of Diabetes Mellitus patients complicated with pulmonary tuberculosis treated by insulin pump, insulin subcutaneous injection and oral hypoglycemic respectively, giving patients and clinic economical, convenient and effective reference views. Methods A short-term （4 weeks） , randomized, controlled study was conducted. 92 cases of DM complicated with PTB patients were divided randomly into insulin pump group, treated by insulin pump, insulin subcutaneous injection group, treated by insulin subcutaneous injection twice a day before breakfast and supper, and oral hypoglycemic group, treated by having acarbose combined with metformin release tablets. Observe the time of achieving normal blood glucose, clinical symptoms, the rates of sputum native conversion and the shrink of lung focus. Results In the insulin pump group, the blood glucose achieved to normal in an average of 4 days. In insulin subcutaneous injection group, the blood glucose achieved to normal in an average of 7.5 days. And the oral hypoglyeemic group achieved normal blood glucose in an average of 15 days, among this group ,20 cases didnt achieve the normal level. The difference was statistically significant（ P 〈 0. 05 ; P 〈 0. 05 ）. The time of sputum negative conversion is fast in the insulin pump group, up to 33.3% at the fourth week of treatment. There were 42. 1% of patients in the insulin subcutaneous injection group who achieved sputum negative conversion. There was significant difference between two groups which has statistically slgmfieance（x^2 =6. 68, P 〈0. 05）. And the rates of sputum negative conversion in insulin subcutaneous injection and oral hypoglycemie group（ 22. 2% ）have statistically significance（ x^2 = 8.3, P 〈 0. 05 ）. After the treatment, the clinical symptoms of former two groups is improved, and the lung focus shrinking on chest CT（ after 4 weeks of treatment） have no statistically slgmficance（ x^2 = 0. 097,P 〉 0. 05 ）. However compared with the oral hypogl