Sidibé El Hassane
Centre médical Marc Sankalé, BP 5062, Fann Dakar, Sénégal.
Sante. 2007 Jan-Mar;17(1):29-32.
Pulmonary tuberculosis in patients with diabetes is characterized by its severity, which some physicians consider to require surgery. Many pathophysiologic explanations have been proposed for this particular disease association, in which cellular immunity is depressed with fewer T lymphocytes in the blood and a diminished capacity for blast transformation. Although the lungs are not generally considered a target organ of diabetes, the English-language literature appears to demonstrate the contrary. Non-enzymatic glycosylation and autonomic neuropathy are involved in these phenomena, which make diabetic patients more susceptible to infection, especially tuberculosis. Some authors nonetheless consider symptoms of this combination unremarkable. Thus multiple tubercular sites on the lungs are the principal observation in tuberculosis patients with and without diabetes. Prognosis is worse when associated with bacterial excretion and thus tuberculosis mortality. Patients with diabetes are more sensitive to this type of infection because of their depressed cellular immunity and cytokine production, related to harmful effect of non-enzymatic glycosylation. These factors suggest the particularity of the epidemiology, pathophysiology and symptoms of diabetes associated with tuberculosis.
糖尿病患者的肺结核具有病情严重的特点，一些医生认为这种情况需要进行手术。针对这种特殊的疾病关联，已经提出了许多病理生理学解释，其中细胞免疫受到抑制，血液中的T淋巴细胞减少，原始细胞转化能力下降。尽管肺部通常不被认为是糖尿病的靶器官，但英文文献似乎表明情况恰恰相反。非酶糖基化和自主神经病变参与了这些现象，这使得糖尿病患者更容易受到感染，尤其是肺结核。然而，一些作者认为这种合并症的症状并不明显。因此，肺部多个结核部位是糖尿病合并或未合并肺结核患者的主要观察点。当合并细菌排泄及肺结核死亡率时，预后更差。糖尿病患者由于细胞免疫和细胞因子产生受到抑制，对这种感染更为敏感，这与非酶糖基化的有害作用有关。这些因素表明了糖尿病合并肺结核在流行病学、病理生理学和症状方面的特殊性。
