厦门2017-2020年肺结核合并糖尿病患者临床特征及耐药情况分析  

Clinical Characteristics and Drug Resistance of Pulmonary Tuberculosis Patients with Diabetes in Xiamen 2017-2020

作　　者：简丽娟[1] 伍定辉[1] 姚向阳[1] JIAN Lijuan;WU Dinghui;YAO Xiangyang(The First Affiliated Hospital of Xiamen University,Xiamen 361000,China;不详)

机构地区：[1]厦门大学附属第一医院,福建厦门361000

出　　处：《中外医学研究》2022年第17期165-169,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:研究厦门地区肺结核合并糖尿病患者的临床特点及耐药情况。方法:选择2017年1月1日-2020年12月31日厦门大学附属第一医院收治的肺结核合并糖尿病患者,分为耐药组和敏感组,收集一般资料、临床症状、糖化血红蛋白(HbA1c)、肺部CT、痰结核菌病原学等资料进行对比。结果:320例糖尿病合并肺结核患者,其中耐药组87例,敏感组233例,与敏感组对比,耐药组未接受教育比例更高(P<0.05);症状上,耐药组更容易出现咯血、呼吸困难(P<0.05);耐药组HbA1c≥9%比例高及血清白蛋白水平低(P<0.05);耐药组影像学空洞、病灶≥3叶、毁损肺比例高(P<0.05);耐药组痰涂阳率更高(P<0.05);其中初治250例,复治70例,复治组各种耐药率均明显高于初治组(P<0.05)。耐药顺位前5位为链霉素(SM)、异烟肼(INH)、利福平(RFP)、喹诺酮类、乙胺丁醇(EMB),复治组耐喹诺酮类占比更高(P<0.05)。结论:肺结核合并糖尿病以中老年男性为主,耐药患者多为复治者,受教育程度低,有更多患者血糖控制欠佳,更易出现肺部病灶广泛,出现空洞毁损肺,有更高的排菌量。复治患者耐药率高,喹诺酮类耐药有增加趋势。Objective:To study the clinical characteristics and drug resistance of pulmonary tuberculosis patients with diabetes in Xiamen.Method:The patients with pulmonary tuberculosis and diabetes who were admitted to the First Affiliated Hospital of Xiamen University from January 1,2017 to December 31,2020 were divided into drug-resistant group and sensitive group,and general information,clinical symptoms,glycosylated hemoglobin(HbA1c),lung CT,sputum tuberculosis etiology were collected for comparison.Result:A total of 320 diabetic patients with pulmonary tuberculosis,of which 87 were in the drug-resistant group,233 were in the sensitive group.The drug-resistant group had higher rate of non-education patients and were more likely to had hemoptysis and dyspnea than those of the sensitive group(P<0.05).The drug-resistant group had higher rate with HbA1c≥9%,and had lower serum albumin level(P<0.05).The lung imaging of the drug-resistant group were more likely to show cavities,lesions≥3 lobes,and damaged lungs(P<0.05),and the sputum smear positive rate was also higher(P<0.05).All patients were divided into 250 cases of the initially-treated group and 70 cases of re-treated group.The rates of various resistance stations in the re-treated group were significantly higher than those in the initially-treated group(P<0.05).The top 5 resistances were SM,INH,RFP,Quinolone,and EMB in any drug resistance rate.The proportion of Quinolone resistance in the re-treated group was higher than that in the initially-treated group(P<0.05).Conclusion:The majority of patients with pulmonary tuberculosis and diabetes are middle-aged and elderly men,and drug-resistant patients are mostly re-treated patients with lower education.The drug-resistant patients show bad-blood sugar control,more cavities and destroyed lung,resulting in higher excretion of bacteria.The re-treated patients has higher rate of anti-tuberculosis drug resistance,the Quinolone resistance is increasing.

关 键 词：肺结核 糖尿病 耐药 

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