2型糖尿病合并急性血行播散性肺结核的临床特征分析  

Clinical analysis on patients with type 2 diabetes mellitus complicated with acute hematogenous disseminated pulmonary tuberculosis

作　　者：李强[1] 冯秀莉[2] 高孟秋[1] 宋艳华[1] 陈红梅[1] 谢莉[1] 马丽萍[1] Li Qiang;Feng Xiuli;Gao Mengqiu;Song Yanhua;Chen Hongmei;Xie Li;Ma Liping(The Second Department of Tuberculosis, 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结核二科,101149 [2]河北省胸科医院结核一科

出　　处：《北京医学》2019年第3期179-182,共4页Beijing Medical Journal

基　　金：国家科技重大专项(2015ZX10003001);北京市医院管理局"登峰"计划(DFL20151501)

摘　　要：目的探讨2型糖尿病(diabetes mellitus, DM)合并急性血行播散性肺结核(pulmonary tuberculosis, PTB)临床特征。方法回顾性分析2011年1月至2017年12月于首都医科大学附属北京胸科医院住院的29例2型DM合并急性血行播散性PTB患者的临床资料。结果 29例患者平均年龄(62.9±14.0)岁,65岁以上16例。19例营养风险筛查评分≥3分。24例进行糖化血红蛋白(haemoglobin A1c, HbA1c)测定,16例HbA1c≥7%。患者以发热、咳嗽、咳痰、胸闷为PTB主要症状。29例中确诊PTB 14例,临床诊断PTB 15例。21例在入院前被误诊。2例因进食差未使用降糖药物,27例予胰岛素和(或)口服降糖药物积极控制血糖。2例因严重药物不良反应未行抗结核治疗,27例予抗结核治疗,其中,25例出院时病情好转。结论 2型DM合并急性血行播散性PTB以老年人多见,血糖控制不理想,且误诊率高,如能积极控制血糖及抗结核治疗,绝大部分患者预后尚好。Objective To investigate the clinical characteristics of type 2 diabetes mellitus (DM) complicated with acute hematogenous disseminated pulmonary tuberculosis (PTB). Methods The clinical data of 29 patients with type 2 DM complicated with acute hematogenous disseminated PTB admitted to Beijing Chest Hospital from January 2011 to December 2017 were retrospectively analyzed. Results Among the 29 patients, the average age was (62.9± 14.0) years, and 16 cases aged over 65 years. According to nutrition risk screening (NRS), there were 19 patients with NRS scored. Twentypatients were tested for HbA 1 c, and there were 16 cases with HbAlc≥7%. The main clinical manifestations were fever, cough, expectoration and chest tightness. There were 14 cases of confirmed PTB and 15 cases of clinically diagnosed PTB. Twentyone cases were misdiagnosed before admission. Two cases did not use hypoglycemic drugs because of poor eating, while 27 received insulin and (or) oral hypoglycemic drugs to control blood glucose. Two cases didn't received anti-TB treatment because of severe adverse drug reactions. The other 27 cases were all treated with anti-TB drugs, and 25 cases improved the condition at discharge. Conclusions Type 2 DM complicated with acute hematogenous disseminated PTB is common in the elderly, the control of blood glucose is not satisfied , and the rate of misdiagnosis is high. If the control of blood glucose and anti- TB treatment could be conducted actively, the prognosis of most patients is good.

关 键 词：肺结核 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R521[医药卫生—内科学]