肺结核合并糖尿病住院患者膳食调查及短期临床疗效分析

发布时间：2018-04-09 09:20

本文选题：肺结核　切入点：糖尿病　出处：《青岛大学》2014年硕士论文

【摘要】：目的肺结核合并糖尿病(PTB-DM)患者在营养状况及临床治疗等方面有别于单纯肺结核(PTB)患者。本文旨在通过了解住院PTB-DM患者膳食特点及短期临床疗效,为PTB-DM患者的饮食指导及临床诊疗提供参考依据和可行性建议。方法选取某市胸科医院2011年12月至2013年6月间住院的]88例肺结核合并糖尿病患者为PTB-DM组,另选取该院同期住院的188例单纯肺结核患者为PTB组,比较两组膳食多样化评分(DDS)、膳食结构、营养指标及营养相关疾病等方面的差异；比较两组住院治疗2个月间,在临床表现、痰涂片结果、胸部CT表现等方面的差异。结果膳食调查结果显示,PTB-DM组与PTB组DDS得分均大于3分,分布差异无统计学意义(P0.05)。PTB-DM组蔬菜、禽畜肉类、奶及奶制品的摄入量分别为471.45g、103.76g、126.78g,均高于PTB组的414.75g、89.92g、87.83g(P均0.05)；两组禽畜肉类摄入量均高于膳食宝塔推荐摄入量(50g-70g)。营养状况分析显示,偏瘦人群在PTB组(18.62%)较PTB-DM组(10.64%)高(χ2=4.792,P0.05),超重人群在PTB-DM组(29.26%)较PTB组(16.49%)高(χ2=8.684,P0.05)。TC和TG水平PTB-DM组分别为4.39mmol/L和1.38mmol/L,高于PTB组的3.98mmol/L和1.00mmol/L(t值分别为-3.86、-4.13,P值均0.05)。高脂血症、高胆固醇血症和高血压患病率PTB-DM组分别为23.4%、19.7%和31.7%,均显著高于PTB组的5.9%、8.5%和19.1%(χ2值分别为23.19、9.69、7.80,P值均0.05)。入院治疗前,PTB-DM患者痰血比例达32.5%、痰涂片阳性率为76.1%、肺部空洞率为56.4%,均分别高于单纯PTB组的18.6%、68.60%和45.7%(P值均0.05)。治疗2个月后,PTB-DM组患者咳痰、胸闷症状改善率和痰菌转阴率达到20.9%、56.3%和52.4%,均显著低于PTB组36.8%、74.1%和69.8%(P值均0.05)。PTB-DM组肺部病变广泛,累及肺叶个数显著高于PTB组(P0.05),且下肺野结核的发生率高于PTB组(P0.05)。结论与单纯肺结核相比,PTB-DM患者膳食结构不够合理,在较为普遍的营养状况不良情况下,部分超重人群又存在营养过剩的问题,同时临床表现较重,强化期治疗2个月后疗效较差,故临床上应加强饮食指导,及时调整和强化PTB-DM治疗并适当延长治疗时间。
[Abstract]:Objective the nutritional status and clinical treatment of patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB) were different from those of patients with pulmonary tuberculosis (PTB).The purpose of this article is to provide reference basis and feasible suggestions for dietary guidance and clinical diagnosis and treatment of PTB-DM patients by understanding the dietary characteristics and short-term clinical efficacy of PTB-DM patients.Methods 88 cases of pulmonary tuberculosis complicated with diabetes mellitus were selected as PTB-DM group, and 188 cases of simple pulmonary tuberculosis patients in the same period were selected as PTB group.The dietetic diversity scores, dietary structure, nutritional index and nutrition-related diseases were compared between the two groups, and the clinical manifestations, sputum smear results and chest CT findings were compared between the two groups during 2 months of hospitalization.Results the results of dietary survey showed that the DDS scores of PTB-DM group and PTB group were higher than 3, and there was no significant difference in distribution between PTB-DM group and PTB-DM group.The prevalence rates of hyperlipidemia, hypercholesterolemia and hypertension in the PTB-DM group were significantly higher than those in the PTB group (19.7% and 31.7%, respectively), which were significantly higher than those in the PTB group (P < 0.05).After 2 months of treatment, the rate of expectoration, improvement of chest tightness and sputum negative rate in PTB-DM group were 20.9% and 52.4%, respectively, which were significantly lower than those in PTB group (36.8% and 69.8%).The number of pulmonary lobes involved was significantly higher than that in PTB group (P 0.05), and the incidence of tuberculosis in lower lung field was higher than that in PTB group (P 0.05).Conclusion compared with simple pulmonary tuberculosis, the dietary structure of PTB-DM patients is not reasonable. Under the condition of common malnutrition, some overweight people have the problem of excessive nutrition, and the clinical manifestation is more serious.The curative effect was poor after 2 months of intensive treatment, so we should strengthen diet guidance, adjust and strengthen PTB-DM treatment in time and extend the treatment time properly.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R521;R587.1

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