2型糖尿病并发肺结核的肺部CT特征及与糖化血红蛋白水平关系分析

CT characteristics of type 2 diabetes mellitus complicated with pulmonary tuberculosis and its relationship with HbAlc level

目的 分析2型糖尿病并发肺结核的肺部CT特征及与糖化血红蛋白（HbAlc）水平的关系.方法 选择2014年6月至2017年6月大同市煤矿集团有限责任公司二医院诊治的2型糖尿病并发肺结核患者120例为研究对象,根据HbA1c水平将患者分为三组,其中A组（HbA1c＜7％）32例,B组（7％≤HbA1c≤9％）40例,C组（HbA1c ＞9％）48例,分别于治疗前及治疗后6个月进行肺部CT检查,比较三组患者肺内病变形态学特征及治疗效果.结果 C组病灶最大径线均值（6.1±2.1）cm,显著高于A组的（3.4±1.2）cm及B组的（4.3±1.7）cm,B组病灶最大径线均值显著高于A组,差异均有统计学意义（t=9.478、6.735、3.039,均P ＜0.05）.C组中大片状影（83.3％）、多发空洞（83.3％）、虫蚀样空洞（75.0％）的比例显著高于A组及B组,B组中大片状影、多发空洞、虫蚀样空洞的比例显著高于A组,差异有统计学意义（x2=9.525、7.018、6.865,均P＜0.05）.C组淋巴结肿大的比例（83.3％）显著高于A组,差异均有统计学意义（x2 =4.444,P＜0.05）.经6个月规范化抗结核治疗,C组治疗有效率（68.8％）显著低于B组（85.0％）及A组（100.0％）,B组治疗有效率显著低于A组,差异均有统计学意义（x2 =5.236、12.308、3.171,均P＜0.05）.结论 2型糖尿病并发肺结核的肺部CT特征与HbA1c水平存在密切关系,随着HbA1c水平的升高,肺内病灶径线增大,侵袭性增加.

Objective To analyze the CT features of type 2 diabetes mellitus complicated with pulmonary tuberculosis and its relationship with glycosylated hemoglobin （HbAlc） level.Methods A total of 120 patients with type 2 diabetes mellitus complicated with pulmonary tuberculosis were selected from January 2015 to January 2017 in the Second Hospital of Datong Coal Mine Group LTD.According to the level of HbA1 c,the patients were divided into three groups,of which A group（HbA1c 〈 7%） 32 cases,B group（HbA1c,7% ～ 9%）40cases,C group （HbA1c 〉9%）48cases.MSCT examinations were performed before treatment and 6 months after treatment.The morphological characteristics and therapeutic effects of pulmonary lesions were compared among the three groups.Results The mean lesiondiameter of C group [（6.1 ± 2.1） cm] was significantly higher than that of A group [（3.4 ± 1.2） cm] and B group [（4.3 ± 1.7） cm],which of B group was significantly higher than that of A group,the differences were statistically significant （t =9.478,6.735,3.039,all P 〈 0.05）.The large shadow （83.3 %）,multiple cavities （83.3 %）,and cavitation（75.0%） in C group were significantly higher than those in A group and B group,which in B group were significantly higher than those in A group,the differences were statistically significant（x2 =9.525,7.018,6.865,all P 〈 0.05）.The proportion of lymph node enlargement in C group（83.3%） was significantly higher than that in A group,the difference was statistically significant（x2 =4.444,P 〈 0.05）.After 6 months of standardized anti tuberculosis treatment,the effective rate of C group（68.8%） was significantly lower than that of B group（85.0%）and A group （100.0%）,which of B group was significantly lower than that of A group,the difference were statistically significant （x2 =5.236,12.308,3.171,all P 〈 0.05）.Conclusion The CT features of type 2 diabetes mellitus complicated with pulmonary tuberculosis are closely related to the level of HbAlc.With the increase of HbAlc level,the diameter of lung lesions increased and invasively increased.