摘要
目的对比糖尿病合并肺结核(TBDM)与单纯肺结核(TB)患者CT征象的差异,并对比TBDM治疗前后的动态影像变化。方法收集2013年7月至2015年9月西南医科大学附属医院登记检查、治疗且资料完整的初治涂阳TBDM患者51例(TBDM组)与TB患者55例(TB组)的临床资料进行回顾性分析,在抗结核治疗前及治疗2、6个月末进行CT及痰涂片检查,TBDM组患者于治疗6个月末检查糖化血红蛋白,对2组患者抗结核治疗前后痰菌转阴情况和相应CT征象进行对比分析。结果TB组患者治疗前后活动性肺结核CT征象检出率比较,差异有统计学意义(P<0.05)。2组患者中,病变仅局限于好发部位、累及非好发部位、病变累及多个肺叶(≥2个)者比较,差异均无统计学意义(P>0.05);TBDM组患者病灶多样,其中大范围干酪性肺炎、肺实变内的虫蚀状多发空洞发生率明显高于TB组,差异均有统计学意义(P<0.05)。TBDM组患者经控制血糖及抗结核治疗后血糖控制良好者痰菌转阴率与TB组比较,差异无统计学意义(P>0.05);血糖控制不良者痰菌转阴率低于TB组。结论涂阳TBDM、TB患者在肺部病变的范围及分布方面无明显差异,但TBDM患者更易发生大范围干酪性肺炎及肺实变内的虫蚀状多发空洞。TBDM患者在治疗过程中血糖控制良好与否是抗结核治疗能否有效的重要因素,且CT征象变化可作为TBDM患者疗效的评价标准。
Objective To compare the differences of CT features between pulmonary tuberculosis(TB)complicating diabetes mellitus(TBDM)and simple pulmonary TB and the changes of dynamic imaging between before and after treatment in TBDM.Methods The clinical data in 51 patients with initial smear positive TBDM and complete data registered and treated in the Affiliated Hospital of Southwest Medical University from July 2013 to September 2015 as the TBDM group and 55 patients with TB as the TB group were retrospectively analyzed.The CT scan and bacterial sputum negative conversion smear examination were performed before anti-TB treatment and at the end of 2,6 months treatment.The TBDM group performed the HbA1c examination at the end of 6 months treatment.The CT features and sputum smear negative conversion situation in the two groups were compared between before and after anti-TB treatment.Results The CT signs detection rate of active TB in the TB group had statistical differences between before and after treatment(P<0.05).The patients with lesions confining to the prone site,involving the non-prone site and multiple lung lobes(≥2)had no statistical differences between the two groups(P>0.05).the lesions in the TBDM group were diversity,in which the occurrence rates of massive range caseous pneumonia and multiple wormlike cavities within lung consolidation were significantly higher than those in the TB group,and the differences were statistically significant(P<0.05).The difference between the patients with good blood glucose control after controlling blood glucose and anti-TB treatment in the TBDM group and the patients with bacterial sputum negative conversion in the TB group had no statistical significance(P>0.05).The sputum bacterial negative conversion rate in the patients with poor blood glucose control in the TBDM group was lower than that in the TB group.Conclusion The smear positive TBDM patients and TB patients have no obvious difference in the aspects of lung lesion range and distribution.But the TBDM patients are easier to develop massive range caseous pneumonia and multiple wormlike cavities within lung consolidation.Whether or not better controlling blood glucose during the treatment course in the TBDM patients is an important factor for effective anti-TB treatment,moreover the CT features change can serve as the evaluation standard of the curative effect in the TBDM patients.
作者
曾晟
韩福刚
ZENG Sheng;HAN Fugang(The First People′s Hospital of Yibin,Yibin,Sichuan 644000,China;The AffiliatedHospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《现代医药卫生》
2019年第19期2961-2964,共4页
Journal of Modern Medicine & Health
关键词
结核
肺/并发症
糖尿病并发症
体层摄影术
X线计算机
治疗结果
Tuberculosis,pulmonary/complications
Diabetes complications
Tomography,X-ray computed
Treatment outcome