本文選題：結(jié)核病 + 糖尿病��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:(1)分析糖尿病(DM)合并肺結(jié)核(TB)患者對(duì)異煙肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、鏈霉素(SM)四種常用一線抗結(jié)核藥物耐藥情況,為糖尿病合并肺結(jié)核患者抗結(jié)核治療提供參考依據(jù);(2)對(duì)于糖尿病合并肺結(jié)核患者,根據(jù)不同糖化血紅蛋白水平對(duì)耐藥率進(jìn)行比較,為該類患者提供血糖控制水平依據(jù)。方法:(1)收集重慶市肺科醫(yī)院2016年01月~2016年12月痰培養(yǎng)陽(yáng)性肺結(jié)核患者350例,并對(duì)其痰抗酸桿菌涂片、菌型鑒定和耐藥測(cè)驗(yàn)進(jìn)行回顧性分析。(2)根據(jù)耐藥檢測(cè)結(jié)果對(duì)單純肺結(jié)核組(對(duì)照組)、糖尿病合并肺結(jié)核組(觀察組)患者一線抗結(jié)核藥物耐藥情況進(jìn)行分析。(3)觀察組中按照糖化血紅蛋白(GHbA1c)水平,評(píng)估不同GHbA1c水平時(shí)耐藥率的差別。結(jié)果:(1)350例肺結(jié)核患者中,對(duì)照組共計(jì)236例,其中,痰抗酸桿菌涂片陽(yáng)性率為51.7%(122/236),觀察組共計(jì)58例,其中,痰抗酸桿菌涂片陽(yáng)性率75.9%(44/58)。觀察組痰抗酸桿菌涂片陽(yáng)性率明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。(2)294例患者進(jìn)行藥敏實(shí)驗(yàn)總耐藥率為60.9%(179/294),對(duì)照組總耐藥率59.3%(140/236),觀察組總耐藥率67.2%(39/58),觀察組總耐藥率雖高于對(duì)照組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(3)單耐藥率、多耐藥率、耐多藥率、廣泛耐藥率在對(duì)照組與觀察組中分別為10.2%/12.1%、11.4%/13.8%、24.6%/17.2%、13.1%/24.1%;廣泛耐藥率對(duì)照組明顯低于觀察組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),單耐藥率、多耐藥率、耐多藥率兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(4)對(duì)照組與觀察組任一耐h、r、s、e耐藥率分別為39.0%/44.8%、38.6%/41.4%、47.9%/51.7%、21.2%/24.1%,對(duì)照組耐藥率均低于觀察組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(5)58例觀察組中,糖化血紅蛋白㩳7%時(shí),耐藥率為30%(3/10),7%~9%時(shí),耐藥病例比例79.5%(31/39),9%時(shí),耐藥率為55.6%(5/9),不同糖化血紅蛋白水平下的耐藥率比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:(1)肺結(jié)核對(duì)一線結(jié)核藥物(h、r、s、e)耐藥率均大于20%,多耐藥率、耐多藥率、廣泛耐藥率大于10%,臨床上要高度重視。(2)肺結(jié)核患者患糖尿病時(shí),其耐藥率較單純肺結(jié)核者高;不同糖化血糖蛋白水平耐藥率有明顯差異,對(duì)于該類患者,不僅要積極降糖治療,而且應(yīng)進(jìn)行結(jié)核分枝桿菌培養(yǎng)及藥敏實(shí)驗(yàn),通過(guò)藥敏結(jié)果抗結(jié)核治療,降低耐藥率,提高療效。
[Abstract]:Objective: (1) to analyze the drug resistance of isoniazid (INH), rifampicin (RFP), ethambutol (EMB) and streptomycin (SM) in the patients with diabetes (DM) combined with pulmonary tuberculosis (TB), and to provide reference for the anti tuberculosis treatment of diabetic patients with pulmonary tuberculosis. (2) for diabetic patients with pulmonary tuberculosis, according to different saccharification red eggs The rate of drug resistance was compared in white level. Methods: (1) 350 cases of sputum positive pulmonary tuberculosis in Chongqing lung hospital, 01 months ~2016 2016, were collected, and the sputum acid bacilli smear, bacterial identification and drug resistance test were retrospectively analyzed. (2) according to the results of resistance detection to Dan Chunfei Tuberculosis group (control group), diabetes combined with tuberculosis group (observation group) patients with anti tuberculosis drug resistance analysis. (3) in the observation group in accordance with the level of glycated hemoglobin (GHbA1c), the assessment of different GHbA1c levels of the difference in drug resistance. Results: (1) 350 cases of pulmonary tuberculosis, the control group of 236 cases, including sputum acid bacilli smear positive The rate of sex was 51.7% (122/236), and 58 cases in the observation group, of which the positive rate of sputum acid bacilli smear positive was 75.9% (44/58). The positive rate of acid bacilli smear in the observation group was significantly higher than that of the control group (P0.05). (2) the total drug resistance rate of 294 patients was 60.9% (179/294), the total resistance rate of the control group was 59.3% (140/236), the total of the observation group was total. The drug resistance rate was 67.2% (39/58), although the total resistance rate of the observation group was higher than that of the control group, but the difference was not statistically significant (P0.05). (3) the single drug resistance rate, the multidrug resistance rate, the multidrug resistance rate and the widespread resistance rate were 10.2%/12.1%, 11.4%/13.8%, 24.6%/17.2% and 13.1%/24.1% in the control group and the observation group, and the rate of widespread resistance was significantly lower than that in the observation group. There was no significant difference in the single drug resistance rate, multidrug resistance rate and multidrug resistance rate (P0.05). (4) the resistance rates of the control group and the observation group were 39.0%/44.8%, 38.6%/41.4%, 47.9%/51.7%, 21.2%/24.1%, respectively, h, R, s, e, respectively, but there was no significant difference between the control group and the control group, but there was no statistical significance (P0.05). (5) in 58 observation groups, sugar (5) When hemoglobin was 7%, the rate of drug resistance was 30% (3/10), the proportion of drug-resistant cases was 79.5% (31/39), and the resistance rate was 55.6% (5/9) at 9%. The resistance rate under different glycosylated hemoglobin levels was statistically significant (P0.05). Conclusion: (1) the resistance rates of pulmonary nodules to first-line tuberculosis drugs (h, R, s, e) were greater than 20%, multidrug resistance and multidrug resistance. The widespread drug resistance rate is greater than 10%. (2) the drug resistance rate of the patients with tuberculosis is higher than that of those with simple pulmonary tuberculosis, and the resistance rate of glycated glycemic protein is significantly different. For this type of patients, it is not only necessary to actively reduce sugar, but also to carry out the culture of Mycobacterium tuberculosis and the drug sensitivity test, and to resist the drug sensitivity results. Tuberculosis treatment, reduce the drug resistance rate, improve the curative effect.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1;R521

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