糖尿病合并肺结核病的临床特点

The Clinical Investigation of the Treatment of Patients with Pulmonary DM and TB

目的:探讨糖尿病合并肺结核病的临床特点,使这些患者能够得到早期诊断,合理治疗,最终治愈的目的。方法:对近5 a来收治的80名糖尿病合并肺结核病患者(初治)进行回顾性调查,同时选择年龄,病变范围相当的非糖尿病患者进行对比观察。结果:肺结核治疗二组均采用标准化疗法。糖尿病治疗先采用饮食控制及磺脲类口服降糖药,控制不好时加用胰岛素。对强化治疗2个月后的症状,痰菌阴转及X线表现情况进行比较。结果:糖尿病合并肺结核组治疗后症状消失40例;41例痰结核菌阳性中有35例阴转;X线病变明显吸收、空洞缩小28例,轻度吸收40例,20例无变化。而非糖尿病组,症状消失65例,40例痰菌阳性中38例转阴;X线病变明显吸收45例,轻度吸收30例,10例无改变。糖尿病合并肺结核患者无论从痰结核菌阴转情况还是病变吸收情况都远不如非糖尿病患者。结论:糖尿病患者由于抵抗力低下,易于发生多种感染。糖尿病合并肺结核的发病率明显高于非糖尿病人群,病灶多呈渗出干酪性,易形成空洞。从本组病例资料可以看出,糖尿病合并肺结核后对抗痨治疗的反应明显较非糖尿病组差。这除了糖尿病使机体抵抗力下降之外,也与糖尿病控制较差,胰岛素使用较晚及使用病例较少等有很大关系。

Objective To discuss clinical aspects of pulmonary tuberculosis in patients with diabetes mellitus, Methods Retrospectively analysed 80 cases pulmonary tuberculosis with diabetes mellitus submit in 5 year recently, comparewithAge,pathology area. Two groupe treat with standar antituber culosis. The patient with diabetes mellitus alsodiet control , insulin, symptoms, X ray ResultsSymptoms .of 40 cases Pulmonary tuberculosis with diabetes disappear, 35 of 41 casessputum tubercle bacillus （＋） change （-）, 28 cases cavity minimal in x-ray, 40 cases absorbed slightly,20 cases without change. While in non diabetes mellitus group, symptoms of 65 cases disappear, 45 cases absorbed obviously in X-ray, 30 cases absorbed slightly, 10 cases with signifficent change, antituberculosis. Conclusions cavity treatment The patients with diabetes mellitus has lowresistibi lity ,incline to suffer from varies infections, incidence of tuberculosis higher than contrast ,pathological changes present cheeselike ,tend to form cavity. The patient with diabetes mellitus than who without diabetes mellitus ;While antituberculosis react.