血糖控制对糖尿病合并肺结核影像学表现的影响

Influence of blood glucose control on imaging findings of diabetes mellitus complicated with pulmonary tuberculosis

目的探讨血糖控制对糖尿病合并肺结核影像学表现的影响。方法收集60例初治菌阳肺结核合并糖尿病患者,根据糖化血红蛋白值分为血糖控制良好组(n=18)、血糖控制一般组(n=22)、血糖控制差组(n=20),比较三组之间血糖控制对糖尿病合并肺结核影像学表现的影响。结果三组患者相比,血糖控制差组干酪样渗出、空洞等病变最常见且病灶范围更广泛,病灶多位于下叶基底段及右肺中叶,差异具有统计学意义(P<0.05)。三组患者中病灶空洞个数、病灶累及肺叶数与糖化血红蛋白水平存在明显正相关性,差异具有统计学意义(P<0.05)。经3个月抗结核治疗后,与血糖控制差组相比,血糖控制良好及控制一般的两组患者病灶吸收好转率更高,且血糖控制良好组患者影像学病变特征(班片/大片状影、单个/多个空洞、支气管播散)好转率高于血糖控制一般组,差异具有统计学意义(P<0.05)。结论血糖控制与糖尿病合并肺结核患者影像学表现密切相关,糖化血红蛋白水平与肺部病灶范围及空洞个数呈显著正相关性,临床上良好的血糖控制对糖尿病合并肺结核患者肺部病灶的吸收产生积极的影响。

Objective To explore the influence of blood glucose control on imaging manifestations of diabetes mellitus complicated with pulmonary tuberculosis.Methods 60 patients with newly treated bacteriological positive pulmonary tuberculosis complicated with diabetes mellitus were collected and divided into the good blood glucose control group(n=18),the general blood glucose control group(n=22)and the poor blood glucose control group(n=20)according to the glycosylated hemoglobin value.The effect of blood glucose control on imaging manifestations of diabetes mellitus complicated with pulmonary tuberculosis was compared among the three groups.Results Compared with the rest two groups,lesions such as caseous exudation and cavitation were the most common and more extensive,and the lesions were mostly located in the basal segment of the lower lobe and the middle lobe of the right lung in the poor control group(P<0.05).There was significant positive correlation between the number of focal cavities and the number of lung lobes involved and the level of HBA1c among the three groups(P<0.05).After 3 months of antituberculosis therapy,the good and general glycemic control groups had higher rate of imaging findings absorption improvement than the poor control group,and the good control group had higher rate of focal improvement in patch shadow,cavitation and bronchial dissemination than the general control group did(P<0.05).Conclusion Blood glucose control is closely related to the imaging findings of patients with diabetes mellitus complicated with pulmonary tuberculosis,and the level of HBA1c has a significant positive correlation with the scope of lung lesions and the number of cavities.Good clinical blood glucose control has a positive impact on the absorption of lung lesions in patients with diabetes mellitus complicated with pulmonary tuberculosis.