糖尿病合并肺结核的CT表现及其预后的影响因素

CT Manifestations and Influencing Factors for Prognosis of Diabetes with Pulmonary Tuberculosis

目的:总结糖尿病合并肺结核的临床特点及CT表现,探讨影响其预后的相关因素。方法:回顾性分析2019年1月至2020年12月我院收治的肺结核初治患者的临床及CT资料。将患者分为糖尿病组和非糖尿病组,比较两组患者的肺部CT表现(实变、树芽征、空洞、干酪灶)及支气管结核的差异。对糖尿病组患者治疗6个月后患者的预后情况进行观察,比较预后良好组及预后不良组患者的一般资料(年龄、性别)、肺部CT表现、入院时血糖水平、血糖控制情况之间的差异,探寻影响患者预后的相关因素。结果:386例肺结核患者合并有糖尿病的有43例,占比11.14%。糖尿病组男性患者所占比例为67.44%高于非糖尿病组,差异有统计学意义(χ^(2)=5.050,P=0.025)。糖尿病组患者在实变、空洞及干酪灶方面所占比例要高于非糖尿病组。43例糖尿病合并肺结核患者中预后良好组15例和预后不良组28例,两组患者在实变、干酪灶、血糖控制情况方面有显著性差异(P<0.05),多因素Logistic回归分析显示,出现干酪灶及血糖控制不良显著增加了糖尿病合并肺结核出现预后不良的机会(OR分别为4.521和8.354)。结论:糖尿病更易合并肺结核,其CT表现具有一定的特征性,更容易出现实变、空洞及干酪灶,出现干酪灶多提示预后不良,在治疗的过程中需积极控制患者血糖水平。

Objective:To summarize the clinical characteristics and CT findings of diabetes mellitus complicated with pulmonary tuberculosis,and to explore the related factors that affect the prognosis.Methods:The clinical and CT data of newly treated pulmonary tuberculosis patients admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed.The patients were divided into diabetic and non-diabetic groups,and the differences in lung CT findings(consolidation,tree bud sign,cavity,cheese foci)and bronchial tuberculosis were compared between the two groups.The prognosis of patients in the diabetes group after 6 months of treatment were collected,and the general information(age,gender),lung CT manifestations,blood glucose level at admission,and blood glucose control between the good prognosis group and the poor prognosis group were compared.Differences,explore the relevant factors that affect the prognosis of patients.Results:There were 43 cases of 386 pulmonary tuberculosis patients with diabetes,accounting for 11.14%.The proportion of male patients in the diabetic group was 67.44% higher than that in the non-diabetic group,and the difference was statistically significant(χ^(2)=5.050,P=0.025).The proportion of consolidation,cavities and cheese foci in the diabetic group was higher than that in the non-diabetic group.Among the 43 diabetic patients with pulmonary tuberculosis,there were 15 cases in the good prognosis group and 28 cases in the poor prognosis group.There were significant differences between the two groups in consolidation,cheese foci,and blood sugar control(P<0.05).Multivariate logistic regression analysis showed that,The appearance of cheese foci and poor blood glucose control significantly increased the chance of poor prognosis of diabetes complicated with pulmonary tuberculosis(OR 4.521 and 8.354,respectively).Conclusion:Diabetes is more likely to be associated with pulmonary tuberculosis,and its CT findings have certain characteristics,and it is easier to show realistic changes,cavities and cheese foci.The presence of cheese foci often indicates a poor prognosis,and the patient’s blood glucose level needs to be actively controlled during the treatment.