本文選題：肺結核 + 糖尿病��； 參考：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：目的研究討論肺結核與糖尿病兩病并發(fā)時的影像與臨床相關特點及治療后,患者病情的轉歸情況,從而增加對肺結核合并糖尿病的理解與認識,提高對合并有糖尿病的肺結核早期診斷的準確性,判斷預后,指導臨床治療。方法收集2013年1月~2016年4月在寧夏醫(yī)科大學總醫(yī)院確診的并發(fā)糖尿病的肺結核病患者52例以及同期無糖尿病并發(fā)的單純肺結核患者52例的臨床相關資料,分別作為觀察組(DM-PTB組)和對照組(PTB組)。通過分析總結兩組患者的診療資料,從而探討合并糖尿病的肺結核組患者相對于不合并糖尿病的單純肺結核患者在發(fā)病、臨床癥狀、輔助檢查、預后等方面的特征性表現。結果在觀察組中:男性有32例,女性有20例,60歲及以上的患者共32例(61.5%);糖尿病相對于肺結核先診斷者有35例(67.3%),無典型結核中毒癥狀者20例(38.46%),結核分枝桿菌陽性38例(73.08%);病灶分布于上葉前段的有9例(17.31%),干酪樣壞死18例(34.62%),形成空洞21例(40.38%);病灶廣泛分布,累及多個肺葉33例(63.46%);血糖控制良好的有14例,出現空洞2例(14.29%),血糖控制差的38例,出現空洞19例(50%);經2個月治療后,提示治療有效46例(88.46%),其中血糖控制良好37例,病情均有好轉。在對照組中:男性35例,女性16例,60歲及以上患者有33例(63.5%),無典型結核中毒癥狀者5例(9.62%),結核分枝桿菌陽性27例(51.92%);病灶位于上葉前段的有2例(3.85%),干酪樣壞死6例(11.54%),空洞9例(17.31%);病灶較為局限,累及單一肺葉29例(55.77%)。治療2個月后,52例患者病灶均有不同水平的減小和吸收。結論(1)DM-PTB組患者中,男性和60歲以上的老年者居多,與肺結核相比,糖尿病先被診斷的比例多。(2)肺結核患者當并發(fā)有糖尿病時,相比于單純肺結核,常常缺少肺結核典型的中毒癥狀,這部分無明顯臨床癥狀、體征的患者比例及TB菌陽性率均較高。(3)DM-PTB組患者,他們的影像學特點是病變范圍廣泛,常累及多個肺葉,但與痰菌陽性無相關性,不典型病灶也較多出現在肺上葉的前段。相對于對照組患者,也更容易出現干酪樣病變及空洞,且空洞常為厚壁空洞。(4)觀察組中,血糖控制水平會影響空洞的形成,血糖控制良好者空洞性病變的發(fā)生率明顯低于血糖控制較差者。(5)體內高血糖水平不利于病灶的吸收,經治療后,血糖控制良好者治療有效率更高。
[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.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R521

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