肺结核合并糖尿病患者临床特征及血脂水平分析

Analysis of clinical characteristics and serum lipid level in pulmonary tuberculosis patients with diabetes mellitus

目的了解肺结核合并糖尿病(PTB-DM)患者的临床特征与营养状况,为其临床诊疗与营养支持提供具有针对性的建议。方法选取青岛市胸科医院2011年12月至2012年8月间住院的116例PTB-DM患者为PTB-DM组,另按照每个年龄段内两组的性别比例尽量一致且单纯肺结核(PTB)组人数不少于PTB-DM组人数的原则,依患者住院号顺序采用随机数字表法进行调整,最终从该院同期住院的320例PTB患者中选出患者136名作为PTB组,比较两组入院时临床症状的发生率、血红细胞沉降率(ESR)加快率、痰涂片阳性率和营养状况相关指标如总胆固醇(TC)、甘油三酯(TG)及淋巴细胞计数(TLC)。将PTB-DM患者按入院时空腹血糖水平分为血糖控制良好组(34例)与控制不佳组(82例),分析血糖控制水平对入院时临床特征的影响。结果PTB-DM组患者咳嗽、咯痰、咯血、乏力、食欲减退、ESR加快和痰涂片阳性的比率分别为97.4%(113/116)、90.5%(105/116)、31.0%(36/116)、68.1%(79/116)、39.7%(46/116)、81.9%(95/116)和78.4%(91/116),PTB组分别为88.2%(120/136)、80.9%(110/136)、14.0%(19/136)、55.1%(75/136)、27.9%(38/136)、66.9%(91/136)和66.2%(90/136),PTB-DM组均显著高于PTB组(χ2值分别为7.565、4.639、10.684、4.422、3.866、7.272、4.659,P值均<0.05)。血糖控制良好组咯痰、咯血、乏力的发生率及痰涂片阳性率分别为79.4%(27/34)、17.6%(6/34)、52.9%(18/34)和64.7%(22/34),明显低于控制不佳组的95.1%(78/82)、36.6%(30/82)、74.4%(61/82)和84.1%(69/82)(χ2值分别为6.911、4.028、5.090、5.373,P值均<0.05)。营养状况分析显示,TC和TG水平PTB-DM组分别为(4.39±1.17)mmol/L和(1.43±0.91)mmol/L,PTB组分别为(3.97±0.97)mmol/L和(1.01±0.51)mmol/L,PTB-DM组均明显高于PTB组(t=-3.237,t′=-4.457,P值均<0.05);PTB-DM组的TLC为(1.36±0.52)×109/L,明显低于PTB组的(1.52±0.64)×109/L(t′=2.000,P<0.05)。结论与PTB患者相比,PTB-DM患者的病情较重,TC和TG水平也相对较高,临床上应给予具有针对性的诊疗措施及饮食指导。

Objective The objective of this study was to find out the clinical characteristics and nutritional status of the pulmonary tuberculosis patients with diabetes mellitus （PTITDM） and provide the targeted suggest for their clinical treatment and nutritional support. Methods One hundred and sixteen inpatients with pulmonary tu- berculosis complicated with diabetes mellitus in Qingdao Chest Hospital from 2011.12 to 2012.8 were recruited as the PTB-DM group. And 136 pulmonary tuberculosis inpatients without diabetes mellitus of this hospital in the same period were selected as the PTB group. Between the two groups, compared the incidences of clinical symp- toms, erythrocyte sedimentation rate （ESR） sped up, sputum smear positive and the nutrition status indicators in- cluding total cholesterol （TC）, triglyceride （TG） and total lymphocyte count （TLC）. Divided the PTB-DM group into well-controlled group（34 cases） and poor-controlled group（82 cases） according to their fasting blood glucose, and analysed the effect of glycemic control on clinical characteristics at the time of admission. Results The inci- dences of cough, expectoration, hemoptysis, fatigue, anorexia, ESR sped up and positive sputum smear in PTB-DM group were 97.4% （113/116）, 90.5% （105/116）, 31.0% （36/116）, 68.1% （79/116）, 39.7% （46/116）, 81.9% （95/116）and 78.4%（91/116）, while those of PTB group were 88. 2% （120/136）, 80. 9% （110/136）, 14.0% （19/ 136） ,55.1%（75/136）, 27.90/oo （38/136）, 66.9% （91/136） and 66.2% （90/136） respectively. These values in PTB- DM group were obviously higher than those in PTB grouP（X2 = 7. 565,4. 639,10. 684,4. 422,3. 866,7. 272,4. 659 respectively;all P〈0.05）. The incidences of expectoration, hemoptysis, fatigue and positive sputum smear in well- controlled group were 79.4% （27/34）, 17.6 % （6/34）, 52.9% （18/34） and 64.70/00 （22/34）, which were significantly lower than 95.1% （ 78/82 ）, 36.6% （ 30/82 ）, 74.4%（ 61/82 ） and 84. 1% （ 69/82 ） in poor-controlled group （Z2 = 6.911,4. 028,5. 090,5. 373 respectively; all P（0.05）. The analyses of nutrition status showed that TC and TG in PTDDM group were（4.39±1. 17） mmol/L and （1.43±0.91） mmol/I, while those in PTB group were （3.97± 0.97） mmol/L and （1.01 ± 0.51） retool/L, PTB-DM group was higher than PTB group with significant statistic differences（t=-- 3. 237,t= --4. 457 respectively;all P〈0.05） ;the TLC of PTB-DM group was（1.36±0.52） × 109/L,which was lower than（1.52±0.64）×109/L in PTB group（t＇=2. 000,P〈0.05）. Conclusion The PTB- DM patients＇ condition are more serious and the TC and TG are higher. They should be given targeted diagnosis, treatment measures and diet guidances clinically.