糖尿病前期肺结核患者临床特征分析

Clinical characteristics among patients with pulmonary tuberculosis complicated by prediabetes mellitus

目的:分析糖尿病前期(Pre-DM)肺结核(PTB)的临床特征,提高对糖尿病前期肺结核(PreDM-PTB)患者的认识及诊断水平。方法:回顾性分析首都医科大学附属北京胸科医院2015年1月至2016年1月行糖化血红蛋白(HbA1c)检测的住院PTB患者109例的临床资料,依据HbA1c检查结果分为PreDM-PTB组45例和非糖尿病前期肺结核(N-PreDMPTB)组64例。收集患者的一般人口学信息、临床特征、影像学资料、细菌学及其他实验室检查结果进行综合分析。结果:PreDM-PTB组年龄、体质量指数均大于N-PreDMPTB组,PreDM-PTB组既往有吸烟史(46.7%)的比例高于N-PreDMPTB组(25.0%);PreDM-PTB组出现咳痰(88.9%)、发热(55.6%)、纳差(17.8%)、胸闷(31.1%)、气短(28.9%)、体质量减轻(40.0%)、胸腔积液(22.2%)的比例均高于N-PreDMPTB组;PreDM-PTB组患者更易出现贫血(55.6%)、低蛋白血症(55.6%)、低密度脂蛋白升高(26.7%);PreDM-PTB组D-二聚体(93.2%)、C反应蛋白(86.7%)、动态红细胞沉降率(79.1%)升高;PreDM-PTB组患者痰结核分枝杆菌涂片阳性率(74.4%)高于N-PreDMPTB组,两组耐药情况差异无统计学意义(P>0.05);PreDM-PTB组血结核抗体阳性率、血结核感染T细胞检测阳性率分别为60.9%、84.6%,N-PreDMPTB组分别为50.9%、95.2%,两组差异均无统计学意义(P=0.321、0.066)。结论:处于Pre-DM的PTB患者较N-PreDMPTB患者已出现了不同的临床表现及辅助检查特点,需引起临床医生重视,积极早期干预,避免Pre-DM发展成为糖尿病。

Objective:To analyze the clinical characteristics of pulmonary tuberculosis(PTB)in patients with prediabetes mellitus(PreDM)and improve the understanding and diagnosis of pulmonary tuberculosis complicated by prediabetes mellitus(PreDM-PTB).Methods:The clinical data of 109 inpatients with PTB who underwent glycated hemoglobin A1c(HbA1c)examination admitted to Beijing Chest Hospital,Capital Medical University from January 2015 to January 2016 were retrospectively analyzed.These patients were divided into the PreDM-PTB group(n=45)and the non-PreDM-PTB group(N-PreDMPTB group,n=64)according to HbA1c test results.Patient demographic data,clinical features,imaging data,bacteriological results,and other laboratory results were collected from all patients.Results:The mean age and body mass index(BMI)were higher in the PreDM-PTB group than the N-PreDMPTB group.The proportion of patients having a smoking history was higher in the PreDM-PTB group than the N-PreDMPTB group(46.7%vs.25.0%).The proportions of patients who had a cough(88.9%),fever(55.6%),anorexia(17.8%),chest tightness(31.1%),shortness of breath(28.9%),weight loss(40.0%),and pleural effusion(22.2%)were higher in the PreDM-PTB group than the N-PreDMPTB group.Patients with PreDM-PTB were more prone to develop anemia(55.6%),hypoproteinemia(55.6%),and increased low-density lipoprotein(26.7%)compared with patients with N-PreDMPTB.The levels of D-Dimer(93.2%),C-reactive protein(86.7%),and erythrocyte sedimentation rate(79.1%)were increased in the PreDM-PTB group compared with the N-PreDMPTB group.Sputum smear results showed that the positivity of mycobacterium tuberculosis was higher in the PreDM-PTB group(74.4%)compared with the N-PreDMPTB group.There was no significant difference in drug resistance between the two groups(P>0.05).The positivity of blood tuberculosis antibody and blood T-cell spot test for tuberculosis infection were 60.9%and 84.6%respectively in the PreDM-PTB group and they were 50.9%and 95.2%respectively in the N-PreDMPTB group.There were no significant differences in these two indices between the two groups(P=0.321,0.066).Conclusion:Patients with Pre-DMPTB have different clinical manifestations and auxiliary examination characteristics compared with patients with N-PreDMPTB patients,which should be paid more attention to by clinicians.Early intervention should be actively adopted to prevent diabetes development from pre-DM.