2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶和空洞发生的危险因素分析  

Analysis of risk factors for extensive lung focus and cavities in type 2 diabetes mellitus patients complicated with newly treated pulmonary tuberculosis

作　　者：汪敏[1] 袁园[1] 谭守勇[1] 杨子龙 冯治宇[1] 张宏[1] 吴迪 陈泽莹 黄显林 邝浩斌[1] Wang Min;Yuan Yuan;Tan Shouyong;Yang Zilong;Feng Zhiyu;Zhang Hong;Wu Di;Chen Zeying;Huang Xianlin;Kuang Haobin(State Key Laboratory of Respiratory Disease/Department of Internal Medicine-Tuberculosis,Guangzhou Chest Hospital,Guangzhou 510095,China;Graduate School,Guangzhou Medical University,Guangzhou 511436,China)

机构地区：[1]呼吸疾病国家重点实验室/广州市胸科医院结核内科,广州510095 [2]广州医科大学研究生院,广州511436

出　　处：《中国防痨杂志》2023年第8期761-767,共7页Chinese Journal of Antituberculosis

基　　金：广东省医学科研基金(B2023259);广州市医学重点学科-结核病学(2021—2023)。

摘　　要：目的:探讨2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶和空洞发生的危险因素,为慢性病的治疗管理提供参考。方法:采用回顾性研究方法,收集2013年1月至2018年1月在广州市胸科医院首次住院的2型糖尿病合并初治菌阳肺结核患者,筛选出符合研究条件的955例患者,通过电子病历和医院信息管理系统采集患者的年龄、性别、糖尿病病程、肺部病灶范围、肺部空洞、糖化血红蛋白、淋巴细胞、中性粒细胞/淋巴细胞比值(NLR)、二甲双胍是否在近3个月连续稳定使用等。分别以肺部广泛病灶(影像学检查证实肺部病灶≥3个肺野)和肺部空洞为因变量,上述其他因素为自变量进行单因素和多因素logistic回归分析。结果:955例患者中,病灶广泛者753例(78.8%),出现空洞者659例(69.0%)。多因素logistic回归分析结果显示,二甲双胍使用史(OR=0.656,95%CI:0.449~0.957)及淋巴细胞水平高(OR=0.608,95%CI:0.404~0.915)为两病合并时肺部病灶广泛的保护因素,出现空洞(OR=2.094,95%CI:1.498~2.926)、NLR水平高(OR=2.681,95%CI:1.860~3.864)为肺部广泛病灶的危险因素;肺部病灶广泛(OR=1.945,95%CI:1.390~2.719)、糖化血红蛋白水平高(OR=1.206,95%CI:1.078~1.350)及NLR水平高(OR=1.390,95%CI:1.012~1.991)为发生空洞的危险因素。结论:2型糖尿病合并初治菌阳肺结核患者肺部常出现广泛病灶和空洞,两者互为危险因素。对于2型糖尿病患者,可首选含二甲双胍降糖干预的方案,并积极进行糖化血红蛋白、淋巴细胞及NLR指标的监测和管理,以减轻并发肺结核时的病情。Objective:To explored the risk factors of extensive lung focus and cavities in type 2 diabetes mellitus(T2DM)patients complicated with newly treated pulmonary tuberculosis(PTB),to provide reference for clinical treatment strategies.Methods:Through electronic medical records and hospital information system,955 T2DM patients complicated with newly diagnosed positive PTB who were hospitalized in Guangzhou Chest Hospital for the first time from January 2013 to January 2018 were collected for a conducted retrospective study.Univariate and multivariate logistic regression analysis was conducted with extensive lung focus(imaging lung lesions≥3 lung fields)and cavity as dependent variables,and age,gender,diabetes course,glycosylated hemoglobin,lymphocyte(LY),neutrophil ratio(NLR),and whether metformin was used in recent three months as independent variables.Results:Among the 955 patients,753(78.8%)had extensive focus and 659(69.0%)had cavities.The multivariate logistic regression analysis showed that the history of usage of metformin(OR=0.656,95%CI:0.449-0.957)and the high level of LY(OR=0.608,95%CI:0.404-0.915)were protective factors for the extensive focus of both diseases.The occurrence of cavities(OR=2.094,95%CI:1.498-2.926)and the high level of NLR(OR=2.681,95%CI:1.860-3.864)were risk factors for the extensive focus of both diseases.The extensive focus(OR=1.945,95%CI:1.390-2.719)and high level of glycosylated hemoglobin(OR=1.206,95%CI:1.078-1.350),the high level of NLR(OR=1.390,95%CI:1.012-1.991)were the risk factors for cavitation.Conclusion:When T2DM complicated with PTB,the extensive focus and cavities were common,and both were risk factors for each other.Treatment that includes metformin should be the first choice for T2DM patients,and active monitoring and management of glycated hemoglobin,lymphocyte and NLR indicators should be carried out to alleviate the disease condition when complicated with tuberculosis.

关 键 词：糖尿病 2型 结核 肺 病灶感染 因素分析 统计学 

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