肺结核并发糖尿病患者临床特征及淋巴细胞亚群检测结果分析  

Analyses of clinical features and lymphocyte subsets in patients with pulmonary tuberculosis complicated with diabetes mellitus

作　　者：梁建琴[1] 白雪娟[1] 王金河[1] 陈志[1] 郭东霖 吴雪琼[1] LIANG Jian-qin;BAI Xue-juan;WANG Jin-he;CHEN Zhi;GUO Dong-lin;WU Xue-qiong(Tuberculosis Department,the Tuberculosis Research Institute,the 8th Medical Center of Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]解放军总医院第八医学中心,全军结核病研究所结核科,全军结核病防治重点实验室结核病诊疗新技术北京市重点实验室,北京100091

出　　处：《中国防痨杂志》2020年第10期1075-1079,共5页Chinese Journal of Antituberculosis

摘　　要：目的探讨肺结核并发糖尿病(pulmonary tuberculosis complicated with diabetes mellitus,PTB-DM)患者临床特征及淋巴细胞亚群特点。方法回顾性收集2018年4月1日至2019年5月31日在解放军总医院第八医学中心结核二科住院的符合纳入标准的肺结核患者。根据是否并发糖尿病将其分为两组:PTB-DM组85例,单纯肺结核组(PTB组)96例。对两组患者临床特征包括性别、年龄、治疗史和胸部CT检查结果进行比较分析;对两组患者淋巴细胞亚群和结核分枝杆菌特异性反应T细胞检测结果分别进行比较分析。结果PTB-DM组男性和女性分别占76.4%(65/85)和23.6%(20/85),PTB组分别占57.3%(55/96)和427%(41/96),差异有统计学意义(χ^2=7.42,P=0.006)。PTB-DM组<25岁、25-60岁和>60岁的患者分别占24%(2/85)、68.2%(58/85)和29.4%(25/85);PTB组则分别占25.0%(24/96)、63.5%(61/96)和11.5%(11/96),差异有统计学意义(χ^2=23.55,P=0.000)。PTB-DM组初治和复治患者分别占74.1%(63/85)和25.9%(22/85),PTB组分别占84.4%(81/96)和15.6%(15/96),差异无统计学意义(χ^2=2.92,P=0.088)。PTB-DM组胸部CT扫描显示无空洞、有空洞、病变范围<3个肺叶和≥3个肺叶者分别占23.5%(20/85)、76.5%(65/85)、31.8%(27/85)和68.2%(58/85);PTB组分别为53.1%(51/96)、46.9%(45/96)、54.2%(52/96)和45.8%(44/96);PTB-DM组胸部CT有空洞和病变范围≥3个肺叶的患者明显多于PTB组,差异有统计学意义(χ^2=16.56,P=0.000和χ^2=9.20,P=0.002)。PTB-DM组结核分枝杆菌特异性反应T细胞阳性率为81.3%(65/80),PTB组阳性率为74.2%(66/89),差异无统计学意义(χ^2=1.22,P=0.270)。PTB-DM组总T淋巴细胞绝对计数、CD4+T淋巴细胞绝对计数、CD8+T淋巴细胞绝对计数、自然杀伤细胞(NK细胞)绝对计数、NK样T淋巴细胞绝对计数和总B淋巴细胞绝对计数的中位数(四分位数)值分别为1069.00(753.50,2372.50)、548.00(381.00,787.50)、380.00(270.50,574.50)、184.00(111.00,294.50)、60.00(36.00,120.50)和162.00(80.50,244.00Objective To investigate the clinical features and lymphocyte subsets in patients with pulmonary tuberculosis complicated with diabetes mellitus(PTB-DM).Methods A total of 85 PTB-DM patients who were hospitalized from April 1,2018 to May 31,2019 were enrolled as the PTB-DM group,and 96 PTB patients hospitalized at the same time were selected as the PTB group.Clinical features including gender,age,treatment history,chest CT examination,and lymphocyte subsets absolute counts and Mycobacterium tuberculosis-specific T cells response were compared between the two groups.Results Males and females were 76.4%(65/85)and23.6%(20/85)respectively in PTB-DM group,while those were 57.3%(55/96)and 42.7%(41/96)respectively in PTB group(χ^2=7.42,P=0.006).2.4%(2/85),68.2%(58/85)and 29.4%(25/85)of the patients were<25,25-60 and>60 years old in PTB-DM group,respectively,while 25.0%(24/96),63.5%(61/96)and11.5%(11/96)were in PTB group,respectively,with significant difference(χ^2=23.55,P=0.000).The rate of initial-and retreatment patients were 74.1%(63/85)and 25.9%(22/85)in PTB-DM group,and those were84.4%(81/96)and 15.6%(15/96)in PTB group,respectively,with no significant statistical difference(χ^2=2.92,P=0.088).In PTB-DM group,the rate of no cavity,cavity,lesion area<3 lobes and≥3 lobes in chest CT were 23.5%(20/85),76.5%(65/85),31.8%(27/85)and 68.2%(58/85),respectively,while those were53.1%(51/96),46.9%(45/96),54.2%(52/96)and 45.8%(44/96)respectively in PTB group.The patients with cavity and lesions≥3 lobes in chest CT in PTB-DM group was significantly higher than those in PTB group(χ^2=16.56,P=0.000 andχ^2=9.20,P=0.002).The positive rate of Mycobacterium tuberculosis-specific T cell reaction was 81.3%(65/80)in PTB-DM group,and that was 74.2%(66/89)in PTB group,with no significant difference(χ^2=1.22,P=0.270).The median of absolute counts of total T lymphocytes,CD4^+,CD8^+,NK-like T lymphocytes,natural killer cells(NK cells)and total B lymphocytes in the PTB-DM group were 1069.00(753.50,2372.50),548.00(381.00,787.50),380.0

关 键 词：结核 肺 糖尿病 共病现象 淋巴细胞亚群 结果评价(卫生保健) 对比研究 

分 类 号：R521[医药卫生—内科学] R587.1[医药卫生—临床医学]