糖尿病合并初治肺结核患者临床特点

为探讨糖尿病合并初治肺结核患者的临床特点及与糖尿病控制水平的相关性,将首都医科大学附属北京胸科医院结核内科2011年1月1日至2012年12月31日收治的糖尿病合并初治肺结核患者544例,根据入院后次日检测的糖化血红蛋白（HbA1c）结果分为2组：HbA1c＜ 7.0％（Ⅰ组）,65例;HbA1c≥7.0％（Ⅱ组）,479例.将同期抽取的单纯初治肺结核437例作为对照组（Ⅲ组）,对3组患者的痰菌情况及胸部影像学病变特点进行比较.计量资料采用成组t检验,当方差不齐时用校正t检验,采用多元线性回归分析计量资料的线性依存关系.率的比较应用,检验.结果发现,HbA1c水平与空腹血糖及餐后2h血糖存在明显的线性依存关系（P＜0.01）.其回归方程为：HbA1c水平=4.885 ＋0.24×空腹血糖＋0.204×餐后2h血糖.Ⅱ组患者痰菌阳性424例,痰菌阳性率88.5％（424/479）,明显高于Ⅰ组的52.3％（34/65）和Ⅲ组的50.6％ （221/437）（χ^2=163.76,P＜0.01）.Ⅱ组患者干酪渗出性病变422例,干酪渗出性病变发现率88.1％（422/479）,明显高于Ⅰ组的50.8％（33/65）和Ⅲ组的47.6％ （208/437） （χ^2=180.10,P＜0.01）.Ⅱ组患者多发空洞病变270例,多发空洞发现率56.4％ （270/479）,明显高于Ⅰ组的23.1％ （15/65）和Ⅲ组的22.4％（98/437）（χ^2=118.07,P＜0.01）.Ⅱ组患者虫蚀样空洞病变119例,虫蚀样空洞发现率24.8％（119/479）,明显高于Ⅰ组的12.3％（8/65）和Ⅲ组的11.2％ （49/437）（χ^2=30.34,P＜0.01）.Ⅱ组患者干酪性空洞病变251例,干酪性空洞发现率52.4％（251/479）,明显高于Ⅰ组的21.5％（14/65）和Ⅲ组的26.3％ （115/437）（χ^2=74.20,P＜0.01）.研究结果表明糖尿病合并初治肺结核患者的临床表现与糖尿病控制程度可能相关.

Clinical features of the diabetes combined with primary pulmonary tuberculosis

To analyze the clinical features of the diabetes combined with primary pulmonary tuberculosis and the relationgship with the level of the diabetes control in the diabetes.There were 544 cases who were the hospitalized patients of diabetes combined with primary pulmonary tuberculosis in our hospital from January 1,2011 to December 31,2012.According to the glycosylated hemoglobin （HbA1c） after admission,the patients were divided into group Ⅰ （n =65）,group Ⅱ （n =479）.There were 437 cases who were the primary pulmonary tuberculosis without diabetes randomly selected in the same period as group Ⅲ （the control group）.Comparisons were taken on the sputum positive rate and the characteristics of pulmonary lesions between the three groups.Group t test for measurement data,Multiple linear regression analysis for the linear dependence of measurement data,χ^2 test for count data.The results showed the sputum positive rate in group Ⅱ （88.5% （424/479）） was much higher than group Ⅰ （52.3% （34/65））and group Ⅲ （50.6% （221/437）,χ^2 =163.76,P 〈 0.01）.The discovery rate of caseous lesions in group Ⅱ （88.1% （422/479）） was much higher than the group Ⅰ （50.8% （33/65）） and group Ⅲ （47.6% （208/437）,χ^2 =180.10,P 〈0.01）.The discovery rate of multiple cavities in group Ⅱ was much higher than the group Ⅰ and group Ⅲ （56.4% （270/479）,vs 23.1% （15/65）vs 22.4% （98/437）,χ^2 =118.07,P 〈 0.0 1）.The discovery rate of worm-eaten-like cavities in group Ⅱ was much higher than group Ⅰ and group Ⅲ （24.8% （119/479） vs 12.3 % （8/65） vs 11.2% （49/437）,χ^2 =30.34,P 〈 0.01）.The discovery rate of caseous cavities in the Ⅲ group was much higher than group Ⅰ,group Ⅱ and group Ⅳ （52.4% （251/479）vs 21.5% （14/65） vs 26.3% （115/437）,χ^2 =74.20,P 〈 0.01）.In a conclusion,there is a close correlation between the clinical features and the level of the diabetes control in the diabetes combined with primary pulmonary tuberculosis.