2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析  

Risk Factors of Respiratory Failure in Type 2 Diabetes Mellitus Patients Complicated with Pulmonary Tuberculosis

作　　者：王孝微 骆宝建[1] 张楠[1] 刘秋月[1] 康万里[2] 李琦[3] 陈效友[3] Wang Xiaowei;Luo Baojian;Zhang Nan;Liu Qiuyue;Kang Wanli;Li Qi;Chen Xiaoyou(Department of Intensive Care Unit, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京胸科医院重症医学科,101149 [2]首都医科大学附属北京胸科医院流行病研究室,101149 [3]首都医科大学附属北京胸科医院结核三科,101149

出　　处：《结核病与胸部肿瘤》2018年第1期26-30,共5页Tuberculosis and Thoracic Tumor

基　　金：北京市医院管理局“登峰”计划（DFL20151501）

摘　　要：目的分析2型糖尿病并发肺结核（ type 2 diabetes mellitus complicated with pulmonary tuberculosis, T2DM-PTB ）患者发生呼吸衰竭的危险因素，为临床治疗提供参考依据。方法回顾性分析2012年1月至2015年12月期间北京胸科医院住院的200例T2DM．PTB患者，其中100例发生呼吸衰竭者为A组；100例未发生呼吸衰竭者为B组。收集两组患者的临床资料；采用logstic回归分析筛选危险因素。结果对A、B两组患者的临床资料进行单因素分析发现，年龄（χ^2=18．588，P=0．000）、病灶所占肺野个数（χ^2=11．808，P=0．001）、肺结核空洞（χ^2=16．330，P=0．000）、咯血（χ^2=8．753，P=0．003）、使用糖皮质激素（χ^2=10．485，P=0．001）、长期应用抗生素（χ^2=4．750，P=0．029）、结核病病程（χ^2=9．469，P=0．009）、酮症酸中毒（χ^2=8．414，P=0．004）和体质量指数（χ^2=14．474，P=0．001）差异有统计学意义。对这些因素进一步行多因素分析显示，年龄[Wald χ^2=15．527，P=0．000，OR=4．055（95％CI：2．021-8．136）]、病灶所占肺野个数[Wildχ^2=11．938，P=0．001，OR=3．689（95％CI：1．759-7．735）、肺结核空洞[Waldχ^2=4．844，P=0．028，OR=0．463（95％CI：0．233-0．919）、使用糖皮质激素[Waldχ^2=7．374，P=0．007，OR=4．765（95％CI：544-14．707）和酮症酸中毒[Waldχ^2=6．077，P=0．014，OR=4．859（95％CI：1．383-17．079）1为T2DM-PTB患者发生呼吸衰竭的危险因素。结论本研究发现年龄、病灶所占肺野个数、结核空洞、使用糖皮质激索和酮症酸中毒为T2DM-PTB患者发生呼吸衰竭的重要危险因素。Objective To analyze the risk factors of respiratory failure in patients with type 2 diabetes mellitus complicated with pulmonary tuberculosis, so as to provide reference for clinical treatment. Methods A total of 200 cases of pulmonary tuberculosis cases in Beijing Chest Hospital from January 2012 to December 2015 were retro-spectively investigated and divided into two groups. Group A ： 100 cases of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis, with respiratory failure ; group B ： 100 cases of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis, without respiratory failure. The clinical data of all patients was collected. Logistic regression analysis was used to screen risk factors. Results The clinical data of group A and group B was analyzed by single factor analysis. Significant statistical difference was found in age （ χ^ 2= 18.588, P=0.000）, number of affected lung fields （χ^2 = 11.808, P=0.001）, tuberculous cavity （χ^2 = 16.330, P=0. 000）, hemoptysis （χ ^2 =8.753, P=0.003）, glucocorticoids （ χ ^2 =10.485, P=0.001）, long-term use of antibiotics （ χ 2=4.750, P=0.029）, tuberculosis course （ χ 2 = 9.469, P= 0.009）, ketoacidosis （ χ ^2 = 8. 414, P= 0. 004）, and body mass index （ χ 2 =14. 474, P=-0. 001）. Multivariable analysis of these factors further revealed that age （Wald χ^2 = 15.527, P=0.000, OR=4. 055 （95% CI： 2.021- 8.136））, number of affected lung fields （Waldχ ^2 = 11.938, P = 0.001,OR = 3.689 （95%CI ： 1.759 - 7.735））, tuberculous cavity （Waldχ^2 = 4.844, P = 0.028, OR = 0.463 （ 95% CI： 0.233 - 0.919））, glucocorticoids （Waldχ2 =7.314, P=0.007, OR=4.765 （95%CI： 1.544 - 14.707））, and ketoacidosis （Wald χ^ 2 =6.077, P=0. 014, OR=4.859 （95%CI： 1.383-17.079））, the results had a significant statistical difference. Conclusion The results indicated that age, number of affected lung fields, tuberculous cavity, glucocorticoids application and ketoacidosis were

关 键 词：糖尿病 2型 结核 肺 共病现象 呼吸功能不全 危险因素 

分 类 号：R521[医药卫生—内科学]