肺结核合并糖尿病的影像学及临床相关特点研究分析

发布时间：2018-06-15 09:53

本文选题：肺结核 + 糖尿病　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的研究讨论肺结核与糖尿病两病并发时的影像与临床相关特点及治疗后,患者病情的转归情况,从而增加对肺结核合并糖尿病的理解与认识,提高对合并有糖尿病的肺结核早期诊断的准确性,判断预后,指导临床治疗。方法收集2013年1月~2016年4月在宁夏医科大学总医院确诊的并发糖尿病的肺结核病患者52例以及同期无糖尿病并发的单纯肺结核患者52例的临床相关资料,分别作为观察组(DM-PTB组)和对照组(PTB组)。通过分析总结两组患者的诊疗资料,从而探讨合并糖尿病的肺结核组患者相对于不合并糖尿病的单纯肺结核患者在发病、临床症状、辅助检查、预后等方面的特征性表现。结果在观察组中:男性有32例,女性有20例,60岁及以上的患者共32例(61.5%);糖尿病相对于肺结核先诊断者有35例(67.3%),无典型结核中毒症状者20例(38.46%),结核分枝杆菌阳性38例(73.08%);病灶分布于上叶前段的有9例(17.31%),干酪样坏死18例(34.62%),形成空洞21例(40.38%);病灶广泛分布,累及多个肺叶33例(63.46%);血糖控制良好的有14例,出现空洞2例(14.29%),血糖控制差的38例,出现空洞19例(50%);经2个月治疗后,提示治疗有效46例(88.46%),其中血糖控制良好37例,病情均有好转。在对照组中:男性35例,女性16例,60岁及以上患者有33例(63.5%),无典型结核中毒症状者5例(9.62%),结核分枝杆菌阳性27例(51.92%);病灶位于上叶前段的有2例(3.85%),干酪样坏死6例(11.54%),空洞9例(17.31%);病灶较为局限,累及单一肺叶29例(55.77%)。治疗2个月后,52例患者病灶均有不同水平的减小和吸收。结论(1)DM-PTB组患者中,男性和60岁以上的老年者居多,与肺结核相比,糖尿病先被诊断的比例多。(2)肺结核患者当并发有糖尿病时,相比于单纯肺结核,常常缺少肺结核典型的中毒症状,这部分无明显临床症状、体征的患者比例及TB菌阳性率均较高。(3)DM-PTB组患者,他们的影像学特点是病变范围广泛,常累及多个肺叶,但与痰菌阳性无相关性,不典型病灶也较多出现在肺上叶的前段。相对于对照组患者,也更容易出现干酪样病变及空洞,且空洞常为厚壁空洞。(4)观察组中,血糖控制水平会影响空洞的形成,血糖控制良好者空洞性病变的发生率明显低于血糖控制较差者。(5)体内高血糖水平不利于病灶的吸收,经治疗后,血糖控制良好者治疗有效率更高。
[Abstract]:Objective to study and discuss the imaging and clinical features of pulmonary tuberculosis and diabetes mellitus, and the prognosis of the patients after treatment, so as to increase the understanding and understanding of pulmonary tuberculosis complicated with diabetes mellitus. To improve the accuracy of early diagnosis and prognosis of pulmonary tuberculosis complicated with diabetes mellitus and to guide clinical treatment. Methods from January 2013 to April 2016, 52 patients with pulmonary tuberculosis complicated with diabetes mellitus and 52 patients with simple pulmonary tuberculosis without diabetes mellitus who were diagnosed in General Hospital of Ningxia Medical University were collected. As observation group (DM-PTB group) and control group (PTB group). By analyzing and summarizing the data of diagnosis and treatment of the two groups of patients, this paper discusses the characteristic manifestations of the pulmonary tuberculosis patients with diabetes mellitus in the aspects of morbidity, clinical symptoms, auxiliary examination, prognosis and so on compared with the simple pulmonary tuberculosis patients without diabetes. Results in the observation group, there were 32 males, There were 20 female patients aged 60 and above, 32 patients with cancer, 35 patients with diabetes and tuberculosis, 20 patients with no typical symptoms of tuberculosis poisoning, 38 patients with mycobacterium tuberculosis and 38 patients with mycobacterium tuberculosis. 9 lesions were located in the anterior segment of the upper lobe. There were 18 caseous necrosis cases (34.62%), 21 cavities (40.38%), and the lesions were widely distributed. There were 33 cases with multiple lobes involved, 14 cases with good blood glucose control, 2 cases with cavity, 38 cases with poor blood glucose control, 19 cases with cavity 50%. After 2 months of treatment, 46 cases were suggested to be effective, among which 37 cases had good blood glucose control. The condition has improved. In the control group: 35 males, Of the 16 female patients aged 60 years and over, 33 cases were treated with cytomegaloids, 5 cases with no typical symptoms of tuberculosis poisoning, 5 cases with mycobacterium tuberculosis positive in 27 cases with mycobacterium tuberculosis positive and 51.92%, 2 cases with lesions located in the anterior segment of the upper lobe with 3. 85T, 6 cases with caseous necrosis with 11.54 and 9 cases with cavity 17. 31%. There were 29 cases involving single lobes, 55.77% of them were involved in monopulmonary lobes. After 2 months of treatment, the lesions of 52 patients were decreased and absorbed at different levels. Conclusion in the DM-PTB group, male patients and the elderly over 60 years old are the majority. Compared with pulmonary tuberculosis, the proportion of patients diagnosed with diabetes is higher than that of pulmonary tuberculosis. There is often a lack of typical toxic symptoms of pulmonary tuberculosis. This part has no obvious clinical symptoms. The proportion of patients with signs and the positive rate of TB bacteria are higher. The imaging features of the patients in the DM-PTB group are extensive lesions, often involving multiple lobes. However, there was no correlation between sputum positive and atypical lesions in the anterior segment of the upper lobe of the lung. Compared with the control group, caseous lesions and cavities were more likely to appear, and the cavities were usually thick-walled cavities.) in the observation group, the level of blood glucose control affected the formation of cavities. The incidence of cavity lesions in patients with good blood glucose control was significantly lower than that in those with poor blood glucose control. The hyperglycemia level was not conducive to the absorption of the lesions. After treatment, the effective rate of treatment was higher in the patients with good blood glucose control.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R521

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