论文部分内容阅读
目的了解肺结核合并糖尿病(PTB-DM)患者的临床特征与营养状况,为其临床诊疗与营养支持提供具有针对性的建议。方法选取青岛市胸科医院2011年12月至2012年8月间住院的116例PTB-DM患者为PTB-DM组,另按照每个年龄段内两组的性别比例尽量一致且单纯肺结核(PTB)组人数不少于PTB-DM组人数的原则,依患者住院号顺序采用随机数字表法进行调整,最终从该院同期住院的320例PTB患者中选出患者136名作为PTB组,比较两组入院时临床症状的发生率、血红细胞沉降率(ESR)加快率、痰涂片阳性率和营养状况相关指标如总胆固醇(TC)、甘油三酯(TG)及淋巴细胞计数(TLC)。将PTB-DM患者按入院时空腹血糖水平分为血糖控制良好组(34例)与控制不佳组(82例),分析血糖控制水平对入院时临床特征的影响。结果PTB-DM组患者咳嗽、咯痰、咯血、乏力、食欲减退、ESR加快和痰涂片阳性的比率分别为97.4%(113/116)、90.5%(105/116)、31.0%(36/116)、68.1%(79/116)、39.7%(46/116)、81.9%(95/116)和78.4%(91/116),PTB组分别为88.2%(120/136)、80.9%(110/136)、14.0%(19/136)、55.1%(75/136)、27.9%(38/136)、66.9%(91/136)和66.2%(90/136),PTB-DM组均显著高于PTB组(χ2值分别为7.565、4.639、10.684、4.422、3.866、7.272、4.659,P值均<0.05)。血糖控制良好组咯痰、咯血、乏力的发生率及痰涂片阳性率分别为79.4%(27/34)、17.6%(6/34)、52.9%(18/34)和64.7%(22/34),明显低于控制不佳组的95.1%(78/82)、36.6%(30/82)、74.4%(61/82)和84.1%(69/82)(χ2值分别为6.911、4.028、5.090、5.373,P值均<0.05)。营养状况分析显示,TC和TG水平PTB-DM组分别为(4.39±1.17)mmol/L和(1.43±0.91)mmol/L,PTB组分别为(3.97±0.97)mmol/L和(1.01±0.51)mmol/L,PTB-DM组均明显高于PTB组(t=-3.237,t′=-4.457,P值均<0.05);PTB-DM组的TLC为(1.36±0.52)×109/L,明显低于PTB组的(1.52±0.64)×109/L(t′=2.000,P<0.05)。结论与PTB患者相比,PTB-DM患者的病情较重,TC和TG水平也相对较高,临床上应给予具有针对性的诊疗措施及饮食指导。
Objective To understand the clinical features and nutritional status of patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM) and to provide targeted clinical advice and nutritional support. Methods One hundred and sixty-six PTB-DM patients hospitalized in Qingdao Chest Hospital from December 2011 to August 2012 were selected as PTB-DM group. The sex ratio of the two groups was the same as that of PTB-DM group in each age group. PTB ) Group is not less than the number of PTB-DM group, according to the patient’s hospital number sequence using a random number table method to adjust the final outpatient hospital in the same period from 320 patients with PTB 136 patients were selected as the PTB group, compared with two The incidence of clinical symptoms, the rate of erythrocyte sedimentation rate (ESR), the positive rate of sputum smear and nutrition related indicators such as total cholesterol (TC), triglyceride (TG) and lymphocyte count (TLC) According to the fasting blood glucose level in hospital, PTB-DM patients were divided into two groups: control group (34 cases) and control group (82 cases). The influence of blood glucose control level on clinical features at admission was analyzed. Results In the PTB-DM group, the rates of cough, expectoration, hemoptysis, fatigue, loss of appetite, acceleration of ESR and sputum smear positive were 97.4% (113/116), 90.5% (105/116) and 31.0% (81/116), 81.9% (95/116), and 78.4% (91/116) in the PTB group, 88.1% (79/116), 39.7% (46/116), 81.9% (90/136), 14.0% (19/136), 55.1% (75/136), 27.9% (38/136), 66.9% (91/136) and 66.2% (90/136) in PTB-DM group Which was significantly higher than PTB group (χ2 values were 7.565,4.639,10.684,4.422,3.866,7.272,4.659, P <0.05). The positive rate of expectoration, hemoptysis and fatigue in patients with good glycemic control were 79.4% (27/34), 17.6% (6/34), 52.9% (18/34) and 64.7% (22/34) 34) were significantly lower than 95.1% (78/82), 36.6% (30/82), 74.4% (61/82) and 84.1% (69/82) in the poorly controlled group (χ2 = 6.911, 4.028 , 5.090,5.373, P <0.05). Nutritional status analysis showed that the levels of TC and TG were (4.39 ± 1.17) mmol / L and (1.43 ± 0.91) mmol / L in PTB-DM group and (3.97 ± 0.97) mmol / L and (1.01 ± 0.51 ) mmol / L, the PTB-DM group was significantly higher than the PTB group (t = -3.237, t ’= -4.457, P values were <0.05); TLC of PTB-DM group was (1.36 ± 0.52) × 109 / L , Which was significantly lower than that of PTB group (1.52 ± 0.64) × 109 / L (t ’= 2.000, P <0.05). Conclusion Compared with PTB patients, patients with PTB-DM have more severe conditions and higher levels of TC and TG. Clinically, they should give targeted diagnosis and treatment measures and diet guidance.