Zafar Mohammad Ishraq, Chen Lu-Lu, Xiaofeng Ye, Gao Feng
Department of Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, China.
Curr Med Imaging Rev. 2019;15(6):543-554. doi: 10.2174/1573405614666180806124416.
Studies on the influence of diabetes mellitus on the radiological presentation of pulmonary tuberculosis performed so far yielded inconsistent results. We aimed to summarize the relevant evidence on this topic systematically.
We systematically searched PubMed/MEDLINE (1980-2016) and the references of related articles (English-language reports) for observational studies that compared the radiological presentation of pulmonary tuberculosis in diabetes and non-diabetes patients.
A total of fifteen studies that enrolled 2,020 diabetic patients and 5,280 controls were included in this systematic review. None of the included studies showed any significant difference in the upper lobe involvement and or in bilateral disease between diabetes and non-diabetes patients. However, lower lung field cavitary disease was found to be more frequent (relative risks ranging from 2.76, 95% CI 2.28-3.35 to 4.47, 95% CI 2.62-7.62) in patients with poor glycemic control (HbA1C >9%). Similarly, a significantly higher proportion of cavitary disease in diabetes patients was reported by 7 out of 15 studies, the meta-analysis of cavities of any size/site also showed the significantly higher risk of cavitary disease in diabetes patients (p-value = 0.0008). Three studies stratified the presence of cavities by diabetes control status, finding a higher proportion of cavities in uncontrolled diabetic patients (relative risks ranging from 1.85, 95%CI 1.34-2.55 to 3.59, 95%CI 2.53-5.11). One out of four studies found a significantly higher proportion of nodular infiltrations in diabetes versus non-diabetes patients.
While there is no difference in localization of lung lesions between patients with diabetes and non-diabetes, our review found that the risk of cavitary disease is relatively higher in diabetes patients. It is essential for researchers to unify the criteria for diabetes diagnosis, patient selection, and radiographic severity and stratify the results by the potentially confounding factors.
迄今为止，关于糖尿病对肺结核影像学表现影响的研究结果并不一致。我们旨在系统总结该主题的相关证据。
我们系统检索了PubMed/MEDLINE（1980 - 2016年）以及相关文章（英文报告）的参考文献，以查找比较糖尿病患者和非糖尿病患者肺结核影像学表现的观察性研究。
本系统评价共纳入15项研究，涉及2020例糖尿病患者和5280例对照。纳入的研究均未显示糖尿病患者和非糖尿病患者在上叶受累及双侧病变方面存在任何显著差异。然而，血糖控制不佳（糖化血红蛋白>9%）的患者下肺野空洞性病变更为常见（相对风险范围为2.76，95%置信区间2.28 - 3.35至4.47，95%置信区间2.62 - 7.62）。同样，15项研究中有7项报告糖尿病患者空洞性病变的比例显著更高，对任何大小/部位空洞的荟萃分析也显示糖尿病患者空洞性病变的风险显著更高（p值 = 0.0008）。3项研究按糖尿病控制状态对空洞的存在进行分层，发现未控制的糖尿病患者空洞比例更高（相对风险范围为1.85，95%置信区间1.34 - 2.55至3.59，95%置信区间2.53 - 5.11）。4项研究中有1项发现糖尿病患者结节状浸润的比例显著高于非糖尿病患者。
虽然糖尿病患者和非糖尿病患者肺部病变的定位没有差异，但我们的综述发现糖尿病患者空洞性病变的风险相对较高。研究人员必须统一糖尿病诊断、患者选择和影像学严重程度的标准，并按潜在混杂因素对结果进行分层。
