2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析

Risk factors of respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis

目的分析2型糖尿病并发肺结核（type 2 diabetes mellitus complicated with pulmonary tuberculosis，T2DM-PTB）患者发生呼吸衰竭的危险因素，为临床治疗提供参考依据。方法回顾性分析2012年1月至2015年12月期间北京胸科医院住院的200例T2DM-PTB患者，其中100例发生呼吸衰竭者为A组；100例未发生呼吸衰竭者为B组。收集两组患者的临床资料；采用logistic回归分析筛选危险因素。结果对A、B两组患者的临床资料进行单因素分析发现，年龄（χ2=18．588，P=0．000）、病灶所占肺野个数（χ2=11．808，P=0．001）、肺结核空洞（χ2=16．330，P=0．000）、咯血（χ2=8．753，P=0．003）、使用糖皮质激素（χ2=10．485，P=0．001）、长期应用抗生素（χ2=4．750，P=0．029）、结核病病程（χ2=9．469，P=0．009）、酮症酸中毒（χ2=8．414，P=0．004）和体质量指数（χ2=14．474，P=0．001）差异有统计学意义。对这些因素进一步行多因素分析显示，年龄[Wald χ2=15．527，P=0．000，OR=4．055（95%CI：2．021～8．136）]、病灶所占肺野个数[Wald χ2=11．938，P=0．001，OR=3．689（95％CI：1．759-7．735）]、肺结核空}同EWald χ2=4．844，P=0．028，OR=0．463（95％C1：0．233-0．919）]、使用糖皮质激素[Wald χ2=7．374，P=0．007，OR=4．765（95％CI：1．544～14．707）]和酮症酸中毒[Wald χ2=6．077，P=0．014，OR=4．859（95％CI：1．383-17．079）]为T2DM-PTB患者发生呼吸衰竭的危险因素。结论本研究发现年龄、病灶所占肺野个数、结核空洞、使用糖皮质激素和酮症酸中毒为T2DM-PTB患者发生呼吸衰竭的重要危险因素。

Objective To analyze the risk factors of respiratory failure in patients with type 2 diabetes mellitus complicated with pulmonary tuberculosis, so as to provide reference for clinical treatment. Methods A total of 200 cases of pulmonary tuberculosis cases in Beijing Chest Hospital from January 2012 to December 2015 were retro spectively investigated and divided into two groups. Group A： 100 cases of type 2 diabetes mellitus patients compli cated with pulmonary tuberculosis, with respiratory failure; group B： 100 cases of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis, without respiratory failure. The clinical data of all patients was collected. Logistic regression analysis was used to screen risk factors. Results The clinical data of group A and group B was analyzed by single factor analysis. Significant statistical difference was found in age （χ2= 18. 588,P=0. 000）,num ber of affected lung fields （χ2 = 11.808, P = 0.001）, tuberculous cavity （χ2 = 16.330, P = 0. 000）, hemoptysis （χ2 = 8. 753, P=0. 003）, glucocorticoids （χ2= 10. 485, P=0. 001）, longterm use of antibiotics （χ2 = 4. 750, P= 0. 029）, tuberculosis course （χ2 = 9. 469, P= 0. 009）, ketoacidosis （χ2 = 8. 414, P= 0. 004）, and body mass index （χ2 =- 14. 474,P= 0. 001）. Multivariable analysis of these factors further revealed that age （Waldχ2= 15. 527, P=0. 000, OR=4. 055 （95%CI：2. 021-8. 136））, number of affected lung fields （Wald）χ2 = 11. 938,P=0. 001,OR=3. 689 （95%CI： 1. 759 - 7. 735））, tuberculous cavity （Wald χ2 = 4. 844, P = 0. 028, OR = 0. 463 （95% CI： 0. 233 - 0. 919））, glucocorticoids （Wald）χ2 = 7. 374, P=0. 007,0R=4. 765 （95%CI： 1. 544- 14. 707））, and ketoacidosis （Wald ,χ2 =6. 077,P=0. 014,OR=4. 859 （95 %CI： 1. 383-17. 079））, the results had a significant statistical difference Conclusion The results indicated that age, number of affected lung fields, tuberculous cavity, glucocorticoids application and ketoacidosis were important risk factors that led to respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis.