糖尿病患者血糖控制与结核病的影像学表现
Glycemic control and radiographic manifestations of tuberculosis in diabetic patients.
作者信息
Chiang Chen-Yuan, Lee Jen-Jyh, Chien Shun-Tien, Enarson Donald A, Chang You-Cheng, Chen Yi-Ting, Hu Ting-Yu, Lin Chih-Bin, Suk Chi-Won, Tao Jui-Ming, Bai Kuan-Jen
机构信息
International Union Against Tuberculosis and Lung Disease, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
出版信息
PLoS One. 2014 Apr 3;9(4):e93397. doi: 10.1371/journal.pone.0093397. eCollection 2014.
BACKGROUND
Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB.
METHODS
Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005-2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients' diabetic status. Films with any discordant reading were read by a third reader.
RESULTS
1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46-1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%-9%, and 1.62 (95% CI 1.12-2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46-1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20-2.84) for A1C 7%-9%, and 3.71 (95% CI 2.64-5.22) for A1C>9%, relative to patients without DM.
CONCLUSIONS
Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.
背景
先前已有关于糖尿病（DM）患者肺结核（TB）影像学表现的报道，但结果并不一致。我们开展了一项研究，以调查血糖控制是否会对肺结核的影像学表现产生影响。
方法
选取2005年至2010年期间在三家三级医疗机构中连续纳入的痰培养阳性且患有糖尿病的肺结核患者进行回顾性分析，并与数量相近的非糖尿病患者进行比较。通过糖化血红蛋白A1C（HbA1C）评估血糖控制情况。由两名对患者糖尿病状态不知情的合格肺科医生独立解读治疗前的胸部X光片。对于任何有分歧的读片结果，由第三位阅片者进行判读。
结果
共纳入1209例痰培养阳性的肺结核患者（581例患有糖尿病，628例未患糖尿病）。与非糖尿病患者相比，糖尿病合并肺结核患者在下肺野出现实变、广泛实质病变、任何空洞、多个空洞及大空洞（>3 cm）的可能性显著更高。糖化血红蛋白A1C（HbA1C）<7%的糖尿病患者下肺野实变的相对风险为0.80（95%可信区间0.46 - 1.42），HbA1C为7% - 9%的患者为2.32（95%可信区间1.36 - 3.98），HbA1C>9%的患者为1.62（95%可信区间1.12 - 2.36）；相对于非糖尿病患者，HbA1C<7%的糖尿病患者有空洞与无空洞的相对风险为0.87（95%可信区间0.46 - 1.62），HbA1C为7% - 9%的患者为1.84（95%可信区间1.20 - 2.84），HbA1C>9%的患者为3.71（95%可信区间2.64 - 5.22）。
结论
血糖控制对糖尿病合并肺结核患者的肺结核影像学表现有显著影响。
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