本文選題：肺結(jié)核　切入點(diǎn)：糖尿病　出處：《青島大學(xué)》2014年碩士論文

【摘要】：目的肺結(jié)核合并糖尿病(PTB-DM)患者在營(yíng)養(yǎng)狀況及臨床治療等方面有別于單純肺結(jié)核(PTB)患者。本文旨在通過(guò)了解住院PTB-DM患者膳食特點(diǎn)及短期臨床療效,為PTB-DM患者的飲食指導(dǎo)及臨床診療提供參考依據(jù)和可行性建議。方法選取某市胸科醫(yī)院2011年12月至2013年6月間住院的]88例肺結(jié)核合并糖尿病患者為PTB-DM組,另選取該院同期住院的188例單純肺結(jié)核患者為PTB組,比較兩組膳食多樣化評(píng)分(DDS)、膳食結(jié)構(gòu)、營(yíng)養(yǎng)指標(biāo)及營(yíng)養(yǎng)相關(guān)疾病等方面的差異；比較兩組住院治療2個(gè)月間,在臨床表現(xiàn)、痰涂片結(jié)果、胸部CT表現(xiàn)等方面的差異。結(jié)果膳食調(diào)查結(jié)果顯示,PTB-DM組與PTB組DDS得分均大于3分,分布差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。PTB-DM組蔬菜、禽畜肉類、奶及奶制品的攝入量分別為471.45g、103.76g、126.78g,均高于PTB組的414.75g、89.92g、87.83g(P均0.05)；兩組禽畜肉類攝入量均高于膳食寶塔推薦攝入量(50g-70g)。營(yíng)養(yǎng)狀況分析顯示,偏瘦人群在PTB組(18.62%)較PTB-DM組(10.64%)高(χ2=4.792,P0.05),超重人群在PTB-DM組(29.26%)較PTB組(16.49%)高(χ2=8.684,P0.05)。TC和TG水平PTB-DM組分別為4.39mmol/L和1.38mmol/L,高于PTB組的3.98mmol/L和1.00mmol/L(t值分別為-3.86、-4.13,P值均0.05)。高脂血癥、高膽固醇血癥和高血壓患病率PTB-DM組分別為23.4%、19.7%和31.7%,均顯著高于PTB組的5.9%、8.5%和19.1%(χ2值分別為23.19、9.69、7.80,P值均0.05)。入院治療前,PTB-DM患者痰血比例達(dá)32.5%、痰涂片陽(yáng)性率為76.1%、肺部空洞率為56.4%,均分別高于單純PTB組的18.6%、68.60%和45.7%(P值均0.05)。治療2個(gè)月后,PTB-DM組患者咳痰、胸悶癥狀改善率和痰菌轉(zhuǎn)陰率達(dá)到20.9%、56.3%和52.4%,均顯著低于PTB組36.8%、74.1%和69.8%(P值均0.05)。PTB-DM組肺部病變廣泛,累及肺葉個(gè)數(shù)顯著高于PTB組(P0.05),且下肺野結(jié)核的發(fā)生率高于PTB組(P0.05)。結(jié)論與單純肺結(jié)核相比,PTB-DM患者膳食結(jié)構(gòu)不夠合理,在較為普遍的營(yíng)養(yǎng)狀況不良情況下,部分超重人群又存在營(yíng)養(yǎng)過(guò)剩的問(wèn)題,同時(shí)臨床表現(xiàn)較重,強(qiáng)化期治療2個(gè)月后療效較差,故臨床上應(yīng)加強(qiáng)飲食指導(dǎo),及時(shí)調(diào)整和強(qiáng)化PTB-DM治療并適當(dāng)延長(zhǎng)治療時(shí)間。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R521;R587.1

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