胰岛素泵治疗糖尿病合并肺结核近期疗效观察

Short-term efficacy of insulin pump in Diabetes Mellitus complicated with pulmonary tuberculosis

目的比较胰岛素泵与胰岛素皮下注射2种方法治疗糖尿病合并肺结核近期效果,为临床提供参考。方法为期8周的随机、开放的比较观察。63例糖尿病合并肺结核患者被随机分为胰岛素泵治疗组和胰岛素皮下治疗组,胰岛素泵治疗组采用胰岛素泵入治疗方案,胰岛素皮下治疗组采用每日早、晚餐前2次皮下注射方案,观察2组控制血糖达标所需时间、血糖波动情况、低血糖反应及其他不良反应,观察2组痰菌转阴情况及肺结核病灶吸收好转情况。结果使用胰岛素泵治疗组很快血糖控制达标(平均3.5d)。空腹和餐后血糖波动很小(平均2.0mmol/L),2组第2～7d的血糖值变化差异有统计学意义(P<0.05,P<0.01)。胰岛素泵治疗组低血糖发生次数显著低于胰岛素皮下组(χ2=11.67,P<0.01),胰岛素用量及其他不良反应差异无统计学意义(t=1.321,P>0.05),胰岛素泵治疗组痰菌转阴速度快,治疗4周时痰菌转阴率为79.1%,治疗8周时为91.7%;而胰岛素皮下注射治疗组痰菌转阴率治疗4周时为36.1%,治疗8周时为59.1%,2组差异有统计学意义(χ2=8.67,P<0.05;χ2=5.02,P<0.05)。2组患者治疗后肺部病灶X线胸片变化差异无统计学意义(χ2=0.57,P>0.05)。结论糖尿病合并肺结核患者采用胰岛素泵治疗方案时,血糖控制达标快,血糖波动小,且低血糖反应发生率少,对肺结核痰菌转阴更为有效。

Objectives To compare the efficacy of Diabetes Mellitus patients complicated with pulmonary tuberculosis treated by continuous subcutaneous insulin infusion（CSⅡ） and insulin subcutaneous injection respectively. Methods A randomized, open and compared observation for 8 weeks was conducted. 63 patients with DM complicated with PTB were divided randomly into group Ⅰ , treated by CSⅡ, and group Ⅱ, treated by insulin subcutaneous injection twice a day. We observed the items as follows, time that blood glucose achieved normal, blood glucose fluctuation, hypoglycemic reaction and other side effects. Meanwhile, the rates of sputum negative conversion and lung focus shrinking were also observed between two groups. Results In Group Ⅰ , the blood glucose achieved to normal in a short time（average 3.5 days） and the fluctuation of fasting blood glucose and postprandial blood glucose was relatively stable（average 2.0 mmol/L）. In group Ⅱ , the fluctuation of blood glucose was quite obvious druing the second to the seventh day. The frequence of hypoglycemic reaction in group I was lower than that of group Ⅱ. The dosage of in： sulin and other side effects were similar in two groups without statistically significant. The period of sputum negative conversion in group Ⅰ was shorter than that of group Ⅱ with statistically significance. In group Ⅰ , the rate of sputum negative conversion was 79.1% at the fourth week and 91.7% at the eighth week. In group Ⅱ, the rate of Sputum negative conversion was 36.1% at the fourth week and 59.1% at the eighth week. The lung focus shrinking on chest X-ray was not significantly different in two groups. Conclusions Due to blood glucose achieving to normal quickly, glucose fluctuation stable, low frequence of hypoglycemic reaction and high rate of sputum negative conversion in patients with DM complicated by PTB treated by CSⅡ, CSⅡ should be used in these patients widely.