2型糖尿病合并肺结核患者抗结核化疗2个月末痰菌阴转影响因素分析  

Affecting factors of the putumnegative conversion in patients with diabetes and tuberculosis after two-month intensive treatment

作　　者：汪敏[1] 邝浩斌[1] 李艳[1] 张宏[1] 冯治宇[1] 程武[1] 邝小佳[1] 蔡晓婷[1] 谭守勇[2] 

机构地区：[1]广州市胸科医院内分泌合并结核病科(内四科),510095 [2]广州市胸科医院肺结核科,国家呼吸重点实验室,510095

出　　处：《实用医学杂志》2013年第23期3808-3811,共4页The Journal of Practical Medicine

基　　金：广州市医药卫生科技计划项目(编号:20131A011077);广州市胸科医院院级科研项目(编号:2012-xk005)

摘　　要：目的:探讨影响2型糖尿病并初治涂阳肺结核2个月末痰菌阴转的关键性因素,为治疗策略的正确制定提供参考。方法:对100例2型糖尿病并初治涂阳的肺结核予2个月HRZE抗结核及积极降糖治疗,2个月治疗期末对痰菌阴转情况进行观察,以2个月末痰菌阴转状态为因变量,以性别、年龄、糖尿病病程、结核病灶范围、是否合并空洞及数量、治疗前及2个月末空腹血糖值、糖化血红蛋白值为自变量进行单因素和多因素Logistic回归分析。结果:64%的患者痰菌阴转。治疗后空腹血糖及糖化血红蛋白水平均较治疗前显著下降(P<0.05)。单因素Logistic回归分析糖尿病病程(OR=3.226,P=0.000)、治疗2个月末糖化血红蛋白水平(OR=2.397,P=0.001)、病灶范围(OR=2.331,P=0.001)、空洞及数量(OR=1.857,P=0.015)、治疗2个月末空腹血糖(OR=1.394,P=0.031)与痰阴转相关。多因素Logistic回归分析除空腹血糖外,糖尿病病程(OR=3.416,P=0.000)、病灶范围(OR=2.921,P=0.020)、空洞及数量(OR=2.433,P=0.031)、抗结核治疗2月末糖化血红蛋白水平(OR=2.296,P=0.012)均是痰菌未阴转的危险因素。结论:糖尿病合并肺结核治疗2个月末痰菌阴转受患者治疗前的糖尿病病程、肺结核病灶范围、空洞数量、强化期末糖化血红蛋白的影响。两病合并患者在治疗中,应重视定期进行糖化血红蛋白检测,对其值升高患者应加强血糖的监测,从而加强对糖尿病的控制。Objective To investigate the affecting factors of the sputum negative conversion in patients with diabetes and tuberculosis after two-month intensive treatment. Methods Standard anti-tuberculosis treatment and positive hypoglycemic therapy were applied to one hundred type 2 diabetic patients with tuberculosis of positive smear initially for two-month. The status of sputum negative conversion was observed. Taking the status of sputum negative conversation as dependent variable, then the gender, age, the course of diabetic, the voids, scope and quantity of tuberculosis, the level of fasting plasma glucose and HbAlc with two months treatment were used as independent variables, the logic regression analysis of single factor and multi-factors were performed. Results About 64% patients obtained sputum negative conversion. The fasting plasma glucose and HbAlc value were significantly decreased in patients after treatment. The single factor logic regression analysis indicated that the scope, voids and quantity of sick, the course of diabetic, level of HbAlc and fasting plasma glucose after two-month therapy were associated with the negative conversion of sputum. Results of the muhi-factors logic regression analysis indicated that these factors were the risk factors for patients with no sputum negative conversion. Conclusions To the diabetic patients with tuberculosis, the negative conversion is associated with the course of diabetic, the intensive level of HbAlc, the scope, voids and quantity of tuberculosis after two-month treatment, and the level of HbAlc should be monitored and controlled during the process of treatment.

关 键 词：糖尿病 2型 结核 肺 糖化血红蛋白 血糖 痰菌阴转 危险因素 

分 类 号：R521[医药卫生—内科学]