贫血和血清镁水平在肺结核患者痰菌转阴临床研究

Effect of anemia and serum magnesium levels in the sputum conversion on pulmonary tuberculosis patients

目的:研究贫血和血清镁水平在肺结核患者痰菌转阴中的作用。方法 :选择在我院最新确诊的痰菌阳性的TB患者124例作为观察组,同期在我院进行治疗的痰菌阴转TB患者100例作为对照组1,健康人100例作为对照组2。对初始痰菌阳性的患者治疗两个月后进行痰涂片检测,在强化期使用常规的抗结核治疗方法(ATT)进行治疗,强化期之后,进行抗酸杆菌痰涂片检测,如果痰涂片阴性,使用利福平和异烟肼进行4个月的巩固期,如果涂阳,则建议患者增加一个月的ATT用药。观察组进行强化治疗两个月后,对三组患者分别进行血红蛋白、铁蛋白、血清铁和血清镁含量测定,并根据WHO的贫血诊断指标对贫血的不同严重程度进行分类。结果:与对照组1和对照组2相比,观察组患者的血红蛋白、血清铁含量、铁蛋白含量和血清镁含量显著较低(P<0.05)。对照组1血红蛋白、血清铁和血清镁含量显著低于对照组2(P<0.05)。两组患者在贫血人数及贫血分级中的人数比例有显著性差异,观察组显著高于对照组(P<0.05)。痰菌阳性患者中有15例(12.10%)患者出现痰菌阴转延迟现象,其中有9例有严重的缺铁性贫血,6例存在中度贫血。观察组发生延迟痰菌阴转的患者中,血清镁水平<1.7mg/dl的患者比例显著高于血清镁水平>1.7mg/dl的患者比例(P<0.05)。结论:贫血和血镁水平低与TB痰菌阳性患者中痰菌阴转的延迟具有一定的关系,随着贫血程度的增加以及血清镁含量的降低,发生痰菌阴转延迟的患者增加。但是贫血与低镁症影响痰菌阴转的机制尚未明确,应加大样本量进行进一步的研究。

Obiective:The effect of anemia and serum magnesium levels in the sputum conversion on pulmonary tuberculosis patients were studied in this paper.Methods:124 newly diagnosed sputum positive TB patients in our hospital were selected as the observation group,in the same period,100 cases of sputum negative TB patients treated in our hospital were used as the control group 1,and 100 healthy people were used as the control group.Two months after the initial treatment of sputum positive patients,sputum smear tests were performed.In the intensive phase,conventional antituberculosis treatment(ATT)was used for treatment.After the intensive period,an acid-fast bacillus sputum smear test was performed.If the sputum smear was negative,rifampicin and isoniazid were used for a consolidation period of 4 months.If the sputum was smeared,the patient was advised to add one month of ATT drug.Two months after the intensive treatment in the observation group,hemoglobin,ferritin,serum iron,and serum magnesium levels were measured in three groups of patients,and the severity of anemia was classified according to WHO's anemia diagnostic index.Results:Compared with control group 1 and control group 2,patients in the observation group had significantly lower hemoglobin,serum iron,ferritin and serum magnesium(P<0.05).The levels of hemoglobin,serum iron,and serum magnesium in the control group were significantly lower than those in the control group 2(P<0.05).There was a significant difference in the proportion of anemia and anaemia in the two groups,which was significantly higher in the observation group than in the control group(P<0.05).15(12.10%)patients in the positive sputum-positive patients had delayed sputum negative transformation,of which 9 had severe iron deficiency anemia and 6 had moderate anemia.In patients with delayed sputum negative conversion in the observation group,the proportion of patients with serum magnesium levels<1.7 mg/dl was significantly higher than the proportion of patients with serum magnesium levels>1.7 mg/dl(P<0.05).Conclusion:The low level of anemia and blood magnesium is related to the delay of sputum negative conversion in patients with TB sputum positive.With the increase of anemia and the decrease of serum magnesium,there is an increase in the incidence of sputum negative transformation.However,the mechanism of anemia and hypomagnesemia affecting the sputum negative transformation has not yet been clarified,and we should increase the sample size for further study.