糖尿病肺结核影像学特点与血糖相关性分析  

Association of radiographic Features with fasting blood glucose level in diabetic patients with pulmonary tuberculosis

作　　者：尹洪云[1] 刘一典[1] 史祥[1] 何娅[1] 马俊[1] 张忠顺[1] 

机构地区：[1]同济大学附属上海市肺科医院,上海200433

出　　处：《中国防痨杂志》2010年第10期652-655,共4页Chinese Journal of Antituberculosis

基　　金：上海市结核重点实验室开放基金项目(2009k07)

摘　　要：目的探讨糖尿病肺结核特征性影像学改变与相关因素。方法 (1)2009年4月—2009年9月间住院糖尿病初次治疗肺结核患者86例,排除使用糖皮质激素及免疫抑制药物、非结核分枝杆菌病及HIV阳性患者;(2)记录人口学资料、糖尿病发病时间、糖尿病治疗方法、结核病症状出现时间;(3)评定肺部影像学改变、支气管镜检查结果,记录入院3 d内测定的空腹血糖浓度、痰抗酸杆菌涂片结果及可获取的糖化血红蛋白比值;(4)统计软件SPSS15.0对数据处理,卡方检验及多因素Lo-gistic分析。结果 (1)86例糖尿病初治肺结核者男性71例、占82.6%,女性15例中肺部干酪性病变者15例;(2)46.5%患者糖尿病程在5年及以上,69.6%患者糖化血红蛋白超过8%;(3)糖尿病肺结核特征性影像学变化干酪性病变为主者占81.4%;总体痰菌阳性率为77.9%,肺部干酪病变痰菌阳性率为87.1%;(4)不同程度空腹血糖水平之间肺部干酪病变发生率虽差异无统计学意义,但空腹血糖超过10 mmol/L者干酪病变发生率增高;(5)不同的结核发病时间及是否合并支气管结核,肺部特异性病变无明显差异;(6)多因素Logistic回归分析显示,空腹血糖浓度水平、糖尿病病程以及结核病程,对肺结核干酪病变发生率有显著影响(分别在P=0.001、P=0.019 7、P=0.026 5),糖尿病病程中以小于6个月、结核病程在3个月之内者肺干酪病变发生率较高。糖尿病不同的控制方法、是否合并支气管结核及不同性别之间对干酪病变形成无明显统计学意义。结论糖尿病肺结核影像学的干酪性病变特征主要为血糖控制水平较差引起。因此,积极控制好血糖是预防、治疗糖尿病合并肺结核以及改善预后的关键。Objective To investigate the association of radiographic manifestation with fasting plasma glucose level, duration of diabetes and other factors in patients with diabetes and pulmonary tuberculosis （DM-PTB）. Methods （1） 86 new patients with PTB and diabetes Mellitus（DM） were enrolled from April 2009 to September 2009, cases with using steroids and immunosuppressive drugs, non-tuberculous mycobacterial disease and HIV positive were excluded. （2）The demographic data, the time of diabetes onset, the methods of diabetes treatment and the duration of TB initial symptoms were recorded. （3）The radiographic manifestations on lung lesions and bronchoscopy results were assessed, meanwhile the value of fasting blood glucose（FBG）, the smear result of sputum, and the ratio of glycated hemoglobin（HbAlc） available on first three days of hospitalization were also recorded. （4）Data were analyzed by Chi-square test and Logistic regression. All data processing and statistical analysis were done with SPSS 15.0 software. Results （1）Male patients accounted for 82.6% （71/86）. There were 15 female cases with caseous pneumonia or caseous cavities. （2）The duration of diabetes in 46.5% of cases were beyond five years. HbAlc in 69.6% of patients was more than 8%. （3）There were caseous lesions, which was specific imaging feature in patients with pulmonary tuberculosis complicated by diabetes mellitus, in 81.4% （70/86）, and smear-positive in 77.9% of all cases while there were sputum-positive in 81.4% of patients with caseous lesions. （4）There was no statistical difference with caseous lesion in patients with various FBG, but high incidence of caseous lesions took place in patients with more than 10mmol/L FBG. （5）No significant difference was found between lung-specific lesions with different duration of TB, and with bronchial tuberculosis. （6） Logistic regression analysis showed that the incidence of PTB caseous lesions was associated strongly with the value of fasting blood glu

关 键 词：糖尿病/并发症 结核 肺/放射摄影术 血糖 

分 类 号：R587.1[医药卫生—内分泌] R521[医药卫生—内科学]