并发糖尿病肺结核住院患者临床特征分析

Clinical Analysis of Pulmonary Tuberculosis Complicated by Diabetes

目的:了解武汉市并发糖尿病肺结核住院患者临床特征,为制订我市结核病防治措施提供依据。方法:对确诊的并发糖尿病肺结核患者456例临床特征进行分析。结果:并发糖尿病肺结核患者随着年龄的增大,其占总患病人数的构成比显著增加,发病人数主要集中在45岁以上人群,占89.04%;地区间存在显著性差异(P<0.01),其构成比市区高于城区,城区高于郊区。就发病特征而言,有典型糖尿病症状(之一)者仅为22.18%,并发2型糖尿病者占92.98%;与一般肺结核患者比较,并发糖尿病肺结核患者咯血、发热、痰菌阳性率、继发型肺结核、空洞形成、病灶≥2个肺野、复治肺结核等比例分别高达49.78%,41.45%,56.80%,87.94%,42.54%,89.25%,35.96%,存在显著性差异(P<0.01)。在疗效特征上,并发糖尿病肺结核规则治疗者中,痰菌2月末阴转率、空洞缩小率、病灶明显吸收率高;细菌学复发/失败率、放射学恶化率分别仅为5.64%、6.90%,与一般肺结核规则治疗者无显著性差异(P>0.05),与不规则治疗者比较均存在显著性差异(P<0.01);并发糖尿病肺结核不规则治疗者中,痰菌2个月末阴转率、空洞缩小率、病灶明显吸收率极低,细菌学复发/失败率、放射学恶化率高达26.28%,29.93%,与一般肺结核患者比较,均存在显著性差异(P<0.01)。结论:糖尿病对武汉市结核病疫情已产生了一定的影响,应重点加强城市中老年肺结核病患者的糖尿病诊断,做到早发现,及时规则治疗,最大限度地降低肺结核病的复发率、致残率和病死率。

Objective： To investigate clinical feature of pulmonary tuberculosis complicated by diabetes, and to provide basis for formulating measure of prevention and cure tuberculosis. Methods： The clinical feature of inpatients with pulmonary tuberculosis complicated by diabetes in the Tuberculosis Prevention and Cure Hospital （Institute） of Wuhan from year 2003 to 2004. Results： The older the patients with pulmonary tuberculosis complicated by diabetes were, the higher of the ratio of age-grouped patients to the whole patients was. The age of the patients was almost above 45 years. The morbidity in towns was lower than in the city and than in suburbs. In pulmonary tuberculosis complicated by diabetes, rates of hemoptysis, fever, positive sputum, recurrence of pulmonary tuberculosis, lung cavity, focus exceeding two lung lobars or retreated pulmonary tuberculosis was higher than in pulmonary tuberculosis patients without diabetes. If the two groups of pulmonary tuberculosis （with or without diabetes） had been treated the regularly, there were no differences on in rates of negative tubercle bacillus in sputum, cavity shrinking, focus absorption, recuring or treating failure, and changes on chest X-ray examination, but the difference of above indexes was significant between regularly-treating group and unregularly-treating group in the patients with diabetes （P〈0. 01）. Conclusion.The patients of pulmonary tuberculosis complicated by diabetes must be detected in the early stage and treated regularly.