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目的探讨糖尿病肺结核特征性影像学改变与相关因素。方法 (1)2009年4月—2009年9月间住院糖尿病初次治疗肺结核患者86例,排除使用糖皮质激素及免疫抑制药物、非结核分枝杆菌病及HIV阳性患者;(2)记录人口学资料、糖尿病发病时间、糖尿病治疗方法、结核病症状出现时间;(3)评定肺部影像学改变、支气管镜检查结果,记录入院3 d内测定的空腹血糖浓度、痰抗酸杆菌涂片结果及可获取的糖化血红蛋白比值;(4)统计软件SPSS15.0对数据处理,卡方检验及多因素Lo-gistic分析。结果 (1)86例糖尿病初治肺结核者男性71例、占82.6%,女性15例中肺部干酪性病变者15例;(2)46.5%患者糖尿病程在5年及以上,69.6%患者糖化血红蛋白超过8%;(3)糖尿病肺结核特征性影像学变化干酪性病变为主者占81.4%;总体痰菌阳性率为77.9%,肺部干酪病变痰菌阳性率为87.1%;(4)不同程度空腹血糖水平之间肺部干酪病变发生率虽差异无统计学意义,但空腹血糖超过10 mmol/L者干酪病变发生率增高;(5)不同的结核发病时间及是否合并支气管结核,肺部特异性病变无明显差异;(6)多因素Logistic回归分析显示,空腹血糖浓度水平、糖尿病病程以及结核病程,对肺结核干酪病变发生率有显著影响(分别在P=0.001、P=0.019 7、P=0.026 5),糖尿病病程中以小于6个月、结核病程在3个月之内者肺干酪病变发生率较高。糖尿病不同的控制方法、是否合并支气管结核及不同性别之间对干酪病变形成无明显统计学意义。结论糖尿病肺结核影像学的干酪性病变特征主要为血糖控制水平较差引起。因此,积极控制好血糖是预防、治疗糖尿病合并肺结核以及改善预后的关键。
Objective To investigate the characteristic imaging changes and related factors of diabetic pulmonary tuberculosis. Methods (1) From April 2009 to September 2009, 86 first-time patients with pulmonary tuberculosis admitted to hospital for diabetes were excluded from using glucocorticoid, immunosuppressive drugs, non-tuberculous mycobacterium and HIV positive patients; (2) (3) assessment of lung imaging changes, bronchoscopy results, record the fasting blood glucose concentration measured within 3 days of admission, sputum acid-fast bacilli smear results and (4) statistical software SPSS15.0 data processing, Chi-square test and multi-factor Lo-gistic analysis. Results (1) There were 71 males and 82.6% of the 86 newly diagnosed cases of diabetes mellitus in the 86 cases, and 15 cases of pulmonary cheeses lesions in 15 females. (2) 46.5% patients had diabetes mellitus at 5 years and above, 69.6% Hemoglobin more than 8%; (3) the characteristic imaging changes of diabetic pulmonary tuberculosis accounted for 81.4% of the main cheese disease; the overall sputum positive rate was 77.9%, the lung cheese sputum positive rate was 87.1%; (4) different The level of fasting blood glucose levels between the incidence of pulmonary cheese disease, although the difference was not statistically significant, but the fasting blood glucose of more than 10 mmol / L cheese disease increased; (5) different tuberculosis onset and whether bronchial tuberculosis, lung (6) Multivariate Logistic regression analysis showed that fasting blood glucose levels, diabetes duration and tuberculosis duration had significant effects on the incidence of pulmonary tuberculosis (P = 0.001, P = 0.019 7, P = 0.026 5), the duration of diabetes was less than 6 months, and the incidence of pulmonary disease was higher within 3 months. Diabetes different control methods, whether the merger of bronchial tuberculosis and gender differences in the formation of cheese lesions no statistically significant. Conclusions The features of cheese lesions in diabetic pulmonary tuberculosis are mainly caused by poor blood sugar control. Therefore, active control of blood glucose is the key to preventing and treating diabetes complicated with tuberculosis and improving prognosis.