糖尿病合并SARS的临床特点及救治体会  

Clinical feature and therapeutic experience in diabetic patients with severe acute respiratory syndrome

作　　者：柳洁[1] 秦洁[1] 邵晋康[1] 薛雪华[1] 苗芳[1] 杨艳兰[1] 

机构地区：[1]山西省人民医院内分泌科,太原030012

出　　处：《中华内分泌代谢杂志》2004年第1期3-5,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的　分析 15例糖尿病感染严重急性呼吸综合征 (SARS)患者的临床特点和糖皮质激素治疗、胰岛素强化控制血糖对预后的影响。方法　选自 2 0 0 3年 3月～ 5月期间临床诊断SARS患者 89例 ,其中 15例为糖尿病患者 (糖尿病SARS组 ) ,74例为非糖尿病患者 (非糖尿病SARS组 )。对两组患者原则上采用相同的综合治疗方案。糖尿病感染SARS按重症SARS对待 ,住院后采用胰岛素强化治疗和糖皮质激素治疗。比较两组患者的肺部感染情况、血白细胞总数、T淋巴细胞亚群、乳酸脱氢酶 (LDH)等指标。结果　15例糖尿病SARS患者肺受累共计 43叶 ,每例平均 2 .9叶 ,较非糖尿病组 (69例 ) 10 8叶 ,每例平均 1.6叶增多 ,但差异无显著性。反映肺损伤的指标LDH在糖尿病组为 (3 3 7± 186)IU/L ,与非糖尿病组的 (187± 13 6)IU/L比较差异有显著性 (P <0 .0 5 )。糖尿病感染SARS患者使用糖皮质激素治疗后 ,糖代谢紊乱加重 ,容易继发细菌感染。需要及时采用多次胰岛素强化治疗 ,尽可能地严格控制血糖。结论　糖尿病患者对SARS病毒易感 ,患病年龄大 ,病情重 ,继发细菌感染多 ,住院时间长。治疗时需严格控制血糖和给予适当剂量的糖皮质激素。Objective To analyse the clinical feature and therapeutic effect of glucocorticoid and intensive insulintherapyonprognosisindiabetic patients with severe acute respiratory syndrome (SARS). Methods Eighty-nine patients with a clinical diagnosis of SARS were observed between March and May 2003, including 15 diabetic cases (diabetes SARS group) and 74 non-diabetic cases (non-diabetes SARS group). All patients were treated essentially with the same scheme. Diabetes SARS group was treated by glucocorticoids and intensive insulin therapy. Pulmonary lesion, leucocyte count, T lymphocyte subgroup, lactate dehydrogenase (LDH) etc. were observed in both groups. Results By X-ray examination, 43 lobes of lungs were infected in 15 diabetic patients with SARS (average 2.9 lobes per case) and 108 lobes in 69 non-diabetic patients with SARS (average 1.6 lobes per case), but there was no statistical significance between 2 groups. LDH level can reflect the extent of pulmonary lesions and there was a significant difference between diabetes SARS group (337±186)IU/L and non-diabetic SARS group (187±136)IU/L (P<0.05). During glucocorticoid therapy, the diabetics showed marked disturbance of glucose metabolism and were susceptible to the secondary infection by bacteria, so that these patients had to be treated by intensive insulin therapy for blood glucose control. Conclusion Diabetes is a susceptible factor to the infection of SARS. As compared with non-diabetes SARS group, diabetes SARS patients were older and had more severe manifestations, more chances to secondary bacterial infections and prolonged hospitalization. It is necessary to control hyperglycemia and to apply appropriate dose of glucocorticoid in diabetic SARS patients.

关 键 词：糖尿病 SARS 临床特点 救治 

分 类 号：R587.1[医药卫生—内分泌] R563.1[医药卫生—内科学]