本文關(guān)鍵詞：HIV或2型糖尿病合并肺結(jié)核與單純肺結(jié)核臨床特征的研究　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 肺結(jié)核 2型糖尿病 HIV 臨床特征

【摘要】：肺結(jié)核是一種慢性、消耗性、傳染性疾病,嚴(yán)重危害人類(lèi)健康。我國(guó)結(jié)核病的人數(shù),位居全球第二位,僅次于印度,第四次結(jié)核病流行病學(xué)調(diào)查顯示,我國(guó)感染結(jié)核菌的人數(shù)約5.5億,目前傳染性肺結(jié)核患者約150萬(wàn),其中約14萬(wàn)耐多藥病例,占全球總耐藥人數(shù)的1/3。結(jié)核病第五次流行病學(xué)調(diào)查發(fā)現(xiàn),我國(guó)結(jié)核病年發(fā)病人數(shù)約130萬(wàn),占全球14.3%。隨著全球人類(lèi)免疫缺陷病毒(human immunodeficiency virus,HIV)感染人數(shù)的增加,HIV合并肺結(jié)核病例也呈現(xiàn)明顯上升,WHO(World Health Organization,世界衛(wèi)生組織)統(tǒng)計(jì)數(shù)據(jù)顯示,全世界每年直接死于結(jié)核菌感染的HIV患者約占總數(shù)12%,而每年新增HIV并發(fā)結(jié)核菌雙重感染者大約63萬(wàn)。糖尿病是以高血糖為特點(diǎn)的一組代謝性疾病。根據(jù)2013年國(guó)際糖尿病聯(lián)盟調(diào)查報(bào)告顯示,全球范圍內(nèi)的糖尿病患者總數(shù)可達(dá)3.82億,而中國(guó)患有糖尿病的患者數(shù)位居第一,據(jù)統(tǒng)計(jì)大約可達(dá)9840萬(wàn)糖尿病患者,推測(cè)2035年糖尿病的患病人數(shù)可達(dá)1.43億。由于糖代謝紊亂影響蛋白質(zhì)及脂肪的代謝,導(dǎo)致機(jī)體的免疫功能下降,易并發(fā)多種感染。國(guó)外研究資料顯示,糖尿病患者并發(fā)肺結(jié)核的患病率較正常人高4~8倍,糖尿病是肺結(jié)核的獨(dú)立危險(xiǎn)因素。在我國(guó)糖尿病患者中肺結(jié)核患病率較正常人高3-10倍。綜上所述,目前我國(guó)肺結(jié)核患病人數(shù)仍位居世界前列,HIV感染可誘發(fā)結(jié)核桿菌活動(dòng)從而容易合并肺結(jié)核;糖尿病作為非感染性疾病,是肺結(jié)核感染的獨(dú)立危險(xiǎn)因素;然而,關(guān)于上述兩種疾病并發(fā)肺結(jié)核的臨床特征、影像表現(xiàn)和輔助檢查特點(diǎn)的研究多數(shù)來(lái)源于國(guó)外,尤其非洲人群的調(diào)查,缺乏我國(guó)人群的資料,特別是HIV與肺結(jié)核雙重感染。目的:探索成人HIV或2型糖尿病合并肺結(jié)核與單純肺結(jié)核患者的臨床表現(xiàn)、影像特點(diǎn)及相關(guān)輔助檢查的異同,研究其各自特征,探索其中的規(guī)律,以利于早期診斷和及時(shí)正確治療。創(chuàng)新性將HIV與肺結(jié)核雙重感染和2型糖尿病合并肺結(jié)核以及單純肺結(jié)核三者相互比較;并探討Gene Xpert MTB早期快速檢測(cè)方法的臨床應(yīng)用價(jià)值,尤其針對(duì)HIV或2型糖尿病合并肺結(jié)核患者的作用和意義。材料與方法:回顧性順次選取大連市結(jié)核病醫(yī)院2013年6月-2015年8月HIV合并肺結(jié)核患者22人,并隨機(jī)分別選取2型糖尿病合并肺結(jié)核患者和單純肺結(jié)核患者各22人,收集上述患者臨床表現(xiàn)、體格檢查和輔助檢查信息進(jìn)行分析。研究對(duì)象符合相應(yīng)肺結(jié)核、HIV和2型糖尿病診斷標(biāo)準(zhǔn)。排除標(biāo)準(zhǔn)包括存在冠心病、高血壓、心力衰竭、肺部其他疾病等基礎(chǔ)疾病。結(jié)果:1.基本特征:單純肺結(jié)核組男性13人,女性9人,平均年齡40.27歲(18-62);2型糖尿病合并肺結(jié)核組男性18人,女性4人,平均年齡54.14歲(25-77),HIV合并肺結(jié)核組均為男性,平均年齡38.41歲(24-61)。糖尿病合并肺結(jié)核患者平均年齡高于單純肺結(jié)核組(p=0.01)、HIV并發(fā)肺結(jié)核組(p=0.00),而單純肺結(jié)核組與HIV并發(fā)肺結(jié)核組的平均年齡無(wú)統(tǒng)計(jì)學(xué)差異(p=0.615)。三組性別存在顯著差異(p=0.001)。2.臨床特征:單純肺結(jié)核組出現(xiàn)咯血、胸痛和肺部Up音的比率高于糖尿病合并肺結(jié)核組(p0.05);而糖尿病合并肺結(jié)核組痰抗酸桿菌涂片和Gene Xpert MTB檢查陽(yáng)性率均明顯高于單純肺結(jié)核組(p0.05)。兩組的肺部CT特征無(wú)明顯差異(p0.05)。單純肺結(jié)核組出現(xiàn)乏力的比率高于HIV合并肺結(jié)核組(p0.05);而HIV合并肺結(jié)核組出現(xiàn)發(fā)熱的比率高于單純肺結(jié)核組(p0.05)。HIV合并肺結(jié)核組CT影像出現(xiàn)淋巴結(jié)腫大的比率較單純肺結(jié)核組高(p0.05)。糖尿病合并肺結(jié)核組出現(xiàn)乏力的比率高于HIV合并肺結(jié)核組(p0.05);而HIV合并肺結(jié)核組出現(xiàn)發(fā)熱的比率高于糖尿病合并肺結(jié)核組(p0.05)。糖尿病合并肺結(jié)核組CT影像出現(xiàn)空洞影的比率高于HIV合并肺結(jié)核組(p0.05);而HIV合并肺結(jié)核組CT影像出現(xiàn)淋巴結(jié)腫大的比率較糖尿病合并肺結(jié)核組高(p0.05)。糖尿病合并肺結(jié)核組LAM-Ab陽(yáng)性率高于HIV合并肺結(jié)核組(p0.05)。HIV合并肺結(jié)核組Pa CO2的數(shù)值低于糖尿病合并肺結(jié)核組(p0.05);HIV合并肺結(jié)核組紅細(xì)胞和血紅蛋白數(shù)值低于糖尿病合并肺結(jié)核組(p0.05)。糖尿病合并肺結(jié)核和HIV合并肺結(jié)核患者痰Gene Xpert MTB檢查陽(yáng)性率均明顯高于痰抗酸桿菌涂片檢查(p0.05)。但單純肺結(jié)核患者痰Gene Xpert MTB與抗酸桿菌涂片檢查陽(yáng)性率的差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1.HIV合并肺結(jié)核患者發(fā)熱的比率和CT影像淋巴結(jié)腫大的幾率高于單純肺結(jié)核組和糖尿病合并肺結(jié)核組;其紅細(xì)胞和血紅蛋白數(shù)值低于糖尿病合并肺結(jié)核組。2.糖尿病合并肺結(jié)核患者痰抗酸桿菌涂片和Gene Xpert MTB檢查陽(yáng)性率高于單純肺結(jié)核組;其CT影像空洞影比率和血LAM-Ab陽(yáng)性率高于HIV合并肺結(jié)核組。3.糖尿病和HIV合并肺結(jié)核患者痰Gene Xpert MTB檢查陽(yáng)性率均明顯高于痰抗酸桿菌涂片檢查,故糖尿病或HIV患者應(yīng)及時(shí)進(jìn)行痰Gene Xpert MTB的篩查。
[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.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R521;R587.1;R512.91

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