Sidibe At, Dembele M, Diarra As, Cisse I, Bocoum A, Traore Ak, Traore Ha
Mali Med. 2005;20(1-2):43-7.
The depression of cellular immunity among diabetic patients exposes them to tuberculosis considered as one of the major diseases of immune-depressive people. The purpose of our study was to evaluate the frequency, gravity, treatment and evolution of pulmonary tuberculosis among our patients affected with diabetes. For that purpose, two descriptive retrospective and prospective studies were undertaken from January 1982 to December 1992 in the Internal Medicine (Internal medicine) department of Hospital of Point G, the national hospital. Thus, 54 diabetics patients hospitalised out of 1 365 had tuberculosis at a frequency rate of 3,95%. The average age of our patients was 49 years + 12 and the sex ratio was 2,18 in favour of men. The infection was also more frequent in diabetes type 1 (51,9%) then in type 2 (48,1%), and concerned mainly men (68.51%) who were more than 37 years old (57.41%). Clinically, the common signs to both affections were prevalent namely asthenia: 85,2%, anorexia: 53,7%, weight loss: 66,7%, associated to cough: 81,5% and to dyspnea: 29,6%. However, for a third of the patients (22,2%), tuberculosis was discovered during a systematic check up. All the patients had a glycemia higher than 8mmol/l, with extremes up to 8mmol/l and32mmol/l, 63% of patient had a febricula. The intradermo cutaneous reaction to tuberculosis (IDR) was negative in 44,4%. The bacilloscopy during direct testing or through the liquid obtained by casing was positive in 64,82%. Tubercular lesions were localised at the top: 91,8%, with an equal attack of the two lungs. During the treatment six products were mainly used comprising Rifampicine (R) isoniazid (INH or H), Streptomycine (S), Ethambutol (E), Thiacetazone (T), and Pyrazinamide (Z). Insulin treatment was done on all patients until tuberculosis was cured. The evolution was favourable after 2 to 3 months of treatment for 48 patients (88,88%) among whom 4: (8,33%) fell sick again. Six patients out of 54 died, i.e. 11,12%.
糖尿病患者的细胞免疫功能低下，使他们易患肺结核，而肺结核被认为是免疫功能低下人群的主要疾病之一。我们研究的目的是评估我院糖尿病患者中肺结核的发病率、严重程度、治疗及转归情况。为此，于1982年1月至1992年12月在国家医院点G医院内科开展了两项描述性回顾性和前瞻性研究。在1365名住院的糖尿病患者中，有54例患肺结核，发病率为3.95%。我们患者的平均年龄为49岁±12岁，男女比例为2.18，男性居多。1型糖尿病患者的感染更常见（51.9%），其次是2型糖尿病患者（48.1%），且主要累及年龄超过37岁的男性（68.51%），占该年龄段男性的57.41%。临床上，两种疾病的常见症状都很普遍，即乏力：85.2%，厌食：53.7%，体重减轻：66.7%，伴有咳嗽：81.5%，伴有呼吸困难：29.6%。然而，三分之一的患者（22.2%）是在系统检查时发现肺结核的。所有患者血糖均高于8mmol/L，最高可达8mmol/L至32mmol/L，63%的患者有低热。结核菌素皮肤试验（IDR）阴性率为44.4%。直接检测或通过痰液获取的液体进行的细菌学检查阳性率为64.82%。结核病变主要位于上叶：91.8%，两肺受累情况相同。治疗期间主要使用六种药物，包括利福平（R）、异烟肼（INH或H）、链霉素（S）、乙胺丁醇（E）、氨硫脲（T）和吡嗪酰胺（Z）。所有患者均接受胰岛素治疗直至肺结核治愈。48例患者（88.88%）治疗2至3个月后病情好转，其中4例（8.33%）复发。54例患者中有6例死亡，即11.12%。
