HIV或2型糖尿病合并肺结核与单纯肺结核临床特征的研究

发布时间：2018-01-07 20:05

本文关键词：HIV或2型糖尿病合并肺结核与单纯肺结核临床特征的研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

更多相关文章： 肺结核 2型糖尿病 HIV 临床特征

【摘要】：肺结核是一种慢性、消耗性、传染性疾病,严重危害人类健康。我国结核病的人数,位居全球第二位,仅次于印度,第四次结核病流行病学调查显示,我国感染结核菌的人数约5.5亿,目前传染性肺结核患者约150万,其中约14万耐多药病例,占全球总耐药人数的1/3。结核病第五次流行病学调查发现,我国结核病年发病人数约130万,占全球14.3%。随着全球人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染人数的增加,HIV合并肺结核病例也呈现明显上升,WHO(World Health Organization,世界卫生组织)统计数据显示,全世界每年直接死于结核菌感染的HIV患者约占总数12%,而每年新增HIV并发结核菌双重感染者大约63万。糖尿病是以高血糖为特点的一组代谢性疾病。根据2013年国际糖尿病联盟调查报告显示,全球范围内的糖尿病患者总数可达3.82亿,而中国患有糖尿病的患者数位居第一,据统计大约可达9840万糖尿病患者,推测2035年糖尿病的患病人数可达1.43亿。由于糖代谢紊乱影响蛋白质及脂肪的代谢,导致机体的免疫功能下降,易并发多种感染。国外研究资料显示,糖尿病患者并发肺结核的患病率较正常人高4~8倍,糖尿病是肺结核的独立危险因素。在我国糖尿病患者中肺结核患病率较正常人高3-10倍。综上所述,目前我国肺结核患病人数仍位居世界前列,HIV感染可诱发结核杆菌活动从而容易合并肺结核;糖尿病作为非感染性疾病,是肺结核感染的独立危险因素;然而,关于上述两种疾病并发肺结核的临床特征、影像表现和辅助检查特点的研究多数来源于国外,尤其非洲人群的调查,缺乏我国人群的资料,特别是HIV与肺结核双重感染。目的:探索成人HIV或2型糖尿病合并肺结核与单纯肺结核患者的临床表现、影像特点及相关辅助检查的异同,研究其各自特征,探索其中的规律,以利于早期诊断和及时正确治疗。创新性将HIV与肺结核双重感染和2型糖尿病合并肺结核以及单纯肺结核三者相互比较;并探讨Gene Xpert MTB早期快速检测方法的临床应用价值,尤其针对HIV或2型糖尿病合并肺结核患者的作用和意义。材料与方法:回顾性顺次选取大连市结核病医院2013年6月-2015年8月HIV合并肺结核患者22人,并随机分别选取2型糖尿病合并肺结核患者和单纯肺结核患者各22人,收集上述患者临床表现、体格检查和辅助检查信息进行分析。研究对象符合相应肺结核、HIV和2型糖尿病诊断标准。排除标准包括存在冠心病、高血压、心力衰竭、肺部其他疾病等基础疾病。结果:1.基本特征:单纯肺结核组男性13人,女性9人,平均年龄40.27岁(18-62);2型糖尿病合并肺结核组男性18人,女性4人,平均年龄54.14岁(25-77),HIV合并肺结核组均为男性,平均年龄38.41岁(24-61)。糖尿病合并肺结核患者平均年龄高于单纯肺结核组(p=0.01)、HIV并发肺结核组(p=0.00),而单纯肺结核组与HIV并发肺结核组的平均年龄无统计学差异(p=0.615)。三组性别存在显著差异(p=0.001)。2.临床特征:单纯肺结核组出现咯血、胸痛和肺部Up音的比率高于糖尿病合并肺结核组(p0.05);而糖尿病合并肺结核组痰抗酸杆菌涂片和Gene Xpert MTB检查阳性率均明显高于单纯肺结核组(p0.05)。两组的肺部CT特征无明显差异(p0.05)。单纯肺结核组出现乏力的比率高于HIV合并肺结核组(p0.05);而HIV合并肺结核组出现发热的比率高于单纯肺结核组(p0.05)。HIV合并肺结核组CT影像出现淋巴结肿大的比率较单纯肺结核组高(p0.05)。糖尿病合并肺结核组出现乏力的比率高于HIV合并肺结核组(p0.05);而HIV合并肺结核组出现发热的比率高于糖尿病合并肺结核组(p0.05)。糖尿病合并肺结核组CT影像出现空洞影的比率高于HIV合并肺结核组(p0.05);而HIV合并肺结核组CT影像出现淋巴结肿大的比率较糖尿病合并肺结核组高(p0.05)。糖尿病合并肺结核组LAM-Ab阳性率高于HIV合并肺结核组(p0.05)。HIV合并肺结核组Pa CO2的数值低于糖尿病合并肺结核组(p0.05);HIV合并肺结核组红细胞和血红蛋白数值低于糖尿病合并肺结核组(p0.05)。糖尿病合并肺结核和HIV合并肺结核患者痰Gene Xpert MTB检查阳性率均明显高于痰抗酸杆菌涂片检查(p0.05)。但单纯肺结核患者痰Gene Xpert MTB与抗酸杆菌涂片检查阳性率的差异无统计学意义(p0.05)。结论:1.HIV合并肺结核患者发热的比率和CT影像淋巴结肿大的几率高于单纯肺结核组和糖尿病合并肺结核组;其红细胞和血红蛋白数值低于糖尿病合并肺结核组。2.糖尿病合并肺结核患者痰抗酸杆菌涂片和Gene Xpert MTB检查阳性率高于单纯肺结核组;其CT影像空洞影比率和血LAM-Ab阳性率高于HIV合并肺结核组。3.糖尿病和HIV合并肺结核患者痰Gene Xpert MTB检查阳性率均明显高于痰抗酸杆菌涂片检查,故糖尿病或HIV患者应及时进行痰Gene Xpert MTB的筛查。
[Abstract]:Tuberculosis is a chronic infectious disease, consumption, and serious harm to human health. The number of tuberculosis in China, ranked second in the world, second only to India, fourth tuberculosis epidemiological survey, about 550 million people infected with TB in China, at present, about 1 million 500 thousand of patients with infectious tuberculosis, of which about 140 thousand multi drug resistant cases. The world's total number of fifth 1/3. resistant tuberculosis epidemiological survey found that about 1 million 300 thousand of China's annual tuberculosis incidence, accounting for the global 14.3%. with the global human immunodeficiency virus (human immunodeficiency virus, HIV) increased the number of infections, HIV with pulmonary tuberculosis cases also showed a marked increase of WHO (World Health Organization, WHO) statistics every year in the world, directly died of tuberculosis infection in patients with HIV accounted for about 12%, while the annual increase of HIV and TB co infection in large About 630 thousand. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose. According to the investigation report of the 2013 International Diabetes Federation, worldwide diabetes up to 382 million, and China patients suffering from diabetes mellitus ranked first, according to the statistics about up to 98 million 400 thousand diabetic patients, the prevalence of diabetes in 2035 that due to up to 143 million. The metabolism of glucose metabolism disorders affecting protein and fat, leading to decreased immune function, easy with multiple infections. Foreign research data shows that the rate is higher than normal 4~8 times the prevalence of diabetes complicated with pulmonary tuberculosis and diabetes are independent risk factors of pulmonary tuberculosis in patients with diabetes. Our tuberculosis prevalence rate than normal people 3-10 times higher. In summary, the prevalence of tuberculosis in our country is still at the forefront of the world, HIV infection can induce Mycobacterium tuberculosis to let Yi He And pulmonary tuberculosis; diabetes as a non infectious disease are independent risk factors for pulmonary tuberculosis infection; however, the clinical features of the two diseases complicated with pulmonary tuberculosis, imaging manifestations and examination characteristics of the majority of studies from abroad, especially the African population survey, the lack of China's population, especially with HIV pulmonary tuberculosis. Objective: To explore the clinical manifestations of adult HIV or type 2 diabetes complicated with pulmonary tuberculosis and pulmonary tuberculosis patients, the similarities and differences between image features and related auxiliary examination, study their respective features, explore the regularity, in order to facilitate the early diagnosis and timely correct treatment. The innovative HIV with pulmonary tuberculosis and type 2 diabetes mellitus complicated with pulmonary tuberculosis and pulmonary tuberculosis three compared with each other; and to explore the method for rapid detection of Gene Xpert MTB in the early stage of clinical application, especially for HIV or type 2 diabetes complicated with pulmonary disease The role and significance of tuberculosis patients. Materials and methods: retrospective sequentially selected Dalian tuberculosis hospital in June 2013 August -2015 HIV with pulmonary tuberculosis in 22 patients, and randomly selected patients with type 2 diabetes complicated with pulmonary tuberculosis in patients with pulmonary tuberculosis and 22 people, collecting the clinical manifestations of patients, analysis of physical examination and auxiliary check the information. The research object with the corresponding pulmonary tuberculosis, HIV and diagnostic criteria of type 2 diabetes mellitus. Exclusion criteria included the presence of coronary heart disease, hypertension, heart failure, lung disease and other diseases. Other basic results: 1. basic characteristics: simple pulmonary tuberculosis group of 13 male and 9 female, the average age of 40.27 years (18-62); type 2 diabetes mellitus pulmonary tuberculosis group of 18 male and 4 female, the average age of 54.14 years (25-77), pulmonary tuberculosis group HIV patients were male, the average age of 38.41 years (24-61). The average age of patients with diabetes mellitus complicated with pulmonary tuberculosis is high In pulmonary tuberculosis group (p=0.01), HIV and pulmonary tuberculosis group (p=0.00), while there was no significant difference in the average age of pulmonary tuberculosis complicated with pulmonary tuberculosis group and HIV group (p=0.615). There was significant difference between three groups in gender (p=0.001).2. clinical features: simple pulmonary tuberculosis group, hemoptysis, chest pain and pulmonary Up the ratio is higher than that of pulmonary tuberculosis with diabetes mellitus group (P0.05); and diabetes mellitus complicated with pulmonary tuberculosis group sputum smear and Gene Xpert MTB positive rate were significantly higher than that of pulmonary tuberculosis group (P0.05). No significant difference in lung CT characteristics of the two groups (P0.05). Pulmonary tuberculosis group is higher than that of HIV with weak ratio pulmonary tuberculosis group (P0.05); HIV group of pulmonary tuberculosis with fever rate higher than that of pulmonary tuberculosis group (P0.05) in patients with pulmonary tuberculosis in.HIV group CT imaging ratio of lymph node enlargement simple pulmonary tuberculosis group (P0.05). Diabetes mellitus complicated with pulmonary tuberculosis group Fatigue rate is higher than HIV with pulmonary tuberculosis group (P0.05); HIV group of pulmonary tuberculosis with fever ratio higher than that of pulmonary tuberculosis with diabetes mellitus group (P0.05). The ratio of empty shadow of diabetes complicated with pulmonary tuberculosis group CT images than HIV with pulmonary tuberculosis group (P0.05); and the ratio HIV and pulmonary tuberculosis group CT images of lymph nodes with pulmonary tuberculosis with diabetes mellitus group (P0.05). The positive rate of diabetes complicated with pulmonary tuberculosis complicated with pulmonary tuberculosis is higher than that of HIV group LAM-Ab group (P0.05) value of.HIV combined with pulmonary tuberculosis group Pa CO2 was lower than that of diabetes complicated with pulmonary tuberculosis (P0.05); group HIV with pulmonary tuberculosis group of red blood cell and hemoglobin values below diabetes complicated with pulmonary tuberculosis group (P0.05). The positive rate of diabetes complicated with pulmonary tuberculosis and pulmonary tuberculosis in HIV Gene Xpert MTB check sputum was significantly higher than that of sputum smear examination (P0.05). But the simple pulmonary tuberculosis patients Gene Xpert There was no significant difference between MTB and acid fast bacilli smear positive rate (P0.05). Conclusion: the odds ratio and CT imaging of lymph nodes in 1.HIV patients complicated with pulmonary tuberculosis fever than the tuberculosis group with pulmonary tuberculosis group and diabetes with lung; the red blood cell and hemoglobin values lower than diabetes complicated with pulmonary tuberculosis group.2. diabetes complicated with pulmonary tuberculosis patients with sputum smear and Gene Xpert MTB positive rate is higher than that of pulmonary tuberculosis group; the CT image of empty hole ratio and serum LAM-Ab positive rate was higher than the positive rate of HIV group.3. diabetes complicated with pulmonary tuberculosis and pulmonary tuberculosis in HIV Gene Xpert MTB check sputum was significantly higher than that of sputum smears, diabetes or HIV patients screening the sputum Gene Xpert MTB.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521;R587.1;R512.91

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