机构地区:[1]四川大学华西医院呼吸与危重症医学科,四川成都610000
出 处:《临床军医杂志》2023年第8期776-780,785,共6页Clinical Journal of Medical Officers
基 金:国家自然科学基金项目(81870015)。
摘 要:目的 探讨2型糖尿病合并肺结核感染患者的初诊临床特征。方法 选取四川大学华西医院自2011年1月至2019年12月收治的827例肺结核感染患者为研究对象。根据患者结核分枝杆菌感染状态及是否合并2型糖尿病将其分为单纯活动性肺结核(ATB)组(n=241)、2型糖尿病合并活动性肺结核(DM-ATB)组(n=266)、单纯潜伏性肺结核(LTBI)组(n=220)、2型糖尿病合并潜伏性肺结核(DM-LTBI)组(n=100)。根据初诊时糖化血红蛋白(HbA1c)数值将205例2型糖尿病合并肺结核患者分为A组(HbA1c<7%,血糖控制达标单纯活动性肺结核,n=28)、B组(HbA1c≥7%,血糖控制未达标单纯活动性肺结核,n=120)、C组(HbA1c<7%,血糖控制达标潜伏性肺结核,n=14)、D组(HbA1c≥7%,血糖控制未达标潜伏性肺结核,n=43)。分别比较DM-ATB组、ATB组、DM-LTBI组、LTBI组与A组、B组、C组、D组患者的人口学基本特征、肺结核相关临床症状、实验室检查结果。结果 DM-ATB组患者咳嗽、咯血比例均高于ATB组,胸痛、其他症状比例均低于ATB组,差异均有统计学意义(P<0.05);DM-LTBI组患者发热、咳嗽、胸痛比例均低于LTBI组,差异均有统计学意义(P<0.05)。DM-ATB组患者降钙素原、白细胞介素6、血沉、肌酐、胱抑素C均高于ATB组,血小板计数、血红蛋白、白蛋白均低于ATB组,差异均有统计学意义(P<0.05);DM-LTBI组患者CD4+、白细胞介素6、肌酐、胱抑素C均高于LTBI组,CD8+、血小板计数、血红蛋白、球蛋白均低于LTBI组,差异均有统计学意义(P<0.05)。B组患者咯血症状比例高于A组,差异有统计学意义(P<0.05);D组患者胸痛症状比例低于C组,差异有统计学意义(P<0.05)。B组患者CD8+、血沉、血红蛋白、血小板计数均高于A组,差异均有统计学意义(P<0.05)。结论 降钙素原、血沉升高的活动性肺结核患者应加强血糖及HbA1c筛查,CD8+、血小板计数降低与肌酐、胱抑素C升高可能为2型糖尿病合并肺结�Objective To investigate the initial clinical features of type 2 diabetes mellitus patients with pulmonary tuberculosis infec-tion.Methods A total of 827 patients with tuberculosis infection admitted to West China Hospital of Sichuan University from January 2011 to December 2019 were selected as the study objects.According to the status of mycobacterium tuberculosis infection and whether patients were combined with type 2 diabetes,the patients were divided into simple active tuberculosis disease(ATB)group(n=241),type 2 diabetes with diabetes mellitus-active tuberculosis disease(DM-ATB)group(n=266),simple latent tuberculosis infection(LTBI)group(n=220),and type 2 diabetes with diabetes mellitus-latent tuberculosis infection(DM-LTBI)group(n=100).Accord-ing to the HbA1c value at initial diagnosis,205 patients with type 2 diabetes mellitus complicated with pulmonary tuberculosis were di-vided into group A(HbA1c<7%,blood glucose control up to standard with simple active pulmonary tuberculosis,n=28),group B(HbA1c≥7%,blood glucose control up to standard with simple active pulmonary tuberculosis,n=120),group C(latent pulmonary tuberculosis with HbA1c<7%,blood glucose control up to standard,n=14),and group D(latent pulmonary tuberculosis with HbA1c≥7%and substandard blood glucose control,n=43).The basic demographic characteristics,clinical symptoms and laboratory test results of patients in DM-ATB group,ATB group,DM-LTBI group,LTBI group and groups A,B,C and D were compared,respec-tively.Results The proportion of cough and hemoptysis in DM-ATB group was higher than that in ATB group,and the proportion of chest pain and other symptoms was lower than that in ATB group,with statistical significance(P<0.05).The proportions of fever,cough and chest pain in DM-LTBI group were lower than those in LTBI group,and the differences were statistically significant(P<0.05).The procalcitonin,interleukin-6,erythrocyte sedimentation rate,creatinine and cystatin-C in DM-ATB group were higher than those in ATB group,and the platelet coun
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