糖尿病合并肺结核患者补充维生素D3的临床价值

Clinical value of vitamin D3 supplementation in diabetes complicated with pulmonary tuberculosis patients

目的研究补充维生素D3对糖尿病合并肺结核患者的疗效及其临床应用价值。方法选择2012年12月至2014年12月就诊于永康市第一人民医院的106名初治糖尿病合并肺结核患者，随机分为实验组（59例）及对照组（47例），实验组给予标准抗结核和血糖控制治疗联合800IU／d的维生素D3滴剂，对照组仅给予标准抗结核和血糖控制治疗。分析两组患者治疗第8周痰涂片阴转率。血糖控制情况、T细胞亚群及免疫因子的组间差异等。结果治疗后，实验组25-OHD）水平为（54．4±15．2）ng／mL，高于对照组的（39．7±8．4）ng/mL，差异有统计学意义（t=2．643，P〈0．05）；实验组治疗后空腹血糖及餐后2h血糖水平分别为（5．3±1．3）和（9．7±2．0）mmol／L）均明显低于对照组（t=-1．541和-1．749，P均〈0．05）。在T细胞亚群方面，实验组CD4＋百分率为（46．2±7．4）％，CD4＋/CD8＋比值（1．8±0．5），均高于对照组（t=1．789和2．344，P均〈0．05）。在细胞因子方面，实验组治疗后IL-2水平和IFNγ水平分别为（2．3±1．7）和（10．8±4．2）pg/mL，低于对照组（t=-2．132和-2．786，P均〈0．05），而IL-10水平为（23．4±6．5）pg／mL，高于对照组（t=2．215，P〈0．05）。治疗第8周时，实验组痰涂片阴转率高于对照组（79．7％：59．6％），差异具有统计学意义（x2=6．116，P〈0．05）。结论糖尿病合并肺结核患者补充维生素D3有助于提高治疗效果）具有一定的临床应用价值。

Objective To investigate the therapeutic effect and the clinical value of vitamin D3 supplementation in treating diabetes complicated with pulmonary tuberculosis patients. Methods From December 2012 to December 2014, there were 106 diabetes complicated with pulmonary tuberculosis patients with initial treatment. All patients were randomly divided into treatment group （59 cases） and control group （47 cases）. The treatment group was treated with standard tuberculosis and blood glucose control regimen with 800 IU/d vitamin D3 drops. The control group was only treated with standard tuberculosis and blood glucose control regimen. The sputum smear conversion, improvements on images, blood glucose control, the levels of T lymphocyte subgroups and immune factor were analyzed after 8-week treatment. Results After treatment, the serum 25-hydroxyvitamin D3 level of treatment group was higher than the control group [（54.4±15.2） ng/mL vs （39.7±8.4） ng/mL], and the difference had statistical significance （t=2.643, P〈0.05）. The fasting glucose level and 2-hour postprandial blood glucose of the treatment group were （5.3±1.3） mmol/L and（9.7±2.0） mmol/L, and were both lower than the control group（t=-1.541 and -1.749, Pboth〈 0.05）. In respect ofT lymphocyte subgroups, the percentage of CD4＋ and CD4＋/CD8＋ were （46.2±7.4）% and （1.8± 0.5 ）, were both higher than the control group （t=1.789 and 2.344, P both〈0.05）. In respect of cell factor, the levels of IL-2 and IFNγ/were （2.3±1.7） pg/mL and （10.8±4.2） pg/mL, and were lower than those in control group （t=-2.132 and -2.786, P both〈0.05）. The level of IL-10 was （23.4±6.5） pg/mL, and was higher than the control group （t=2.215, P〈 0.05）. After 8-week treatment, the rate of sputum smear conversion of treatment group was higher than that in the control group （79.7% vs 59.6%, P〈0.05）, and the difference had statistical significance （x2=6.116, P〈0.05）. Conclusions Vitamin D3 supplementation can improve the therapeutic effect in diabetes complicated with pulmonary tuberculosis patients, and have certain clinical value.