Zhan Senlin, Juan Xiong, Ren Tantan, Wang Yuxiang, Fu Liang, Deng Guofang, Zhang Peize
Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China.
School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, People's Republic of China.
Ther Clin Risk Manag. 2022 May 23;18:595-602. doi: 10.2147/TCRM.S363328. eCollection 2022.
Diabetes mellitus (DM) is believed to affect tuberculosis (TB) at multiple levels in disease control and treatment efficacy, but clinical and radiological presentation resulting from interaction of the two diseases is not known.
A cross-sectional study was conducted on data obtained from medical records of 438 patients confirmed with TB-DM comorbidity at the Third people's hospital of Shenzhen from May 01, 2014, to April 30, 2019. Their CT images were reviewed, and patients were divided into subgroups according to lung cavitation: with and without cavities, and number of segments showing pulmonary infiltration: <4 segment, 4-8 segment, >8 segment infiltrates. We then compared clinical parameters between these groups.
The median age of the patients was 50.0 years (IQR 43.3-56.0) and 86% (n=375) of them were male. Pulmonary cavities were found in 80.8% patients. About 42.7% and 27.2% patients were seen to have infiltration involving 4-8 and >8 lung segments, respectively. Patients presented with cavitation and infiltration involving a greater number of lung segments had significantly higher values of WBC, MONO%, GRA%, CRP, lower LYN% level and higher bacterial burden in sputum (<0.001). Higher HbA1c and FBG were only observed in patients with lung cavities (<0.001). There was no difference in positive ELISPOT.TB and PCT level between the groups regardless of presence or absence of lung cavity (>0.9 and =0.1 respectively). Lower HGB, ALB and higher PCT were observed in patients with infiltration involving more lung segments.
Hyper-inflammation in peripheral blood was significantly associated with cavity and the number of lung lesions. Hyperglycemia was significantly associated with the development of lung cavity. Glycemic control and inflammation influenced radiographic manifestations in patients with TB-DM.
糖尿病（DM）被认为在疾病控制和治疗效果的多个层面影响结核病（TB），但两种疾病相互作用导致的临床和影像学表现尚不清楚。
对2014年5月1日至2019年4月30日在深圳市第三人民医院确诊为结核 - 糖尿病合并症的438例患者的病历数据进行横断面研究。对他们的CT图像进行回顾，并根据肺空洞情况将患者分为亚组：有空洞和无空洞，以及显示肺部浸润的节段数：<4个节段、4 - 8个节段、>8个节段浸润。然后我们比较了这些组之间的临床参数。
患者的中位年龄为50.0岁（四分位间距43.3 - 56.0），其中86%（n = 375）为男性。80.8%的患者发现有肺空洞。分别约有42.7%和27.2%的患者肺部浸润累及4 - 8个和>8个肺段。出现空洞且累及更多肺段浸润的患者白细胞、单核细胞百分比、粒细胞百分比、C反应蛋白值显著更高，淋巴细胞百分比水平更低，痰中细菌载量更高（<0.001）。仅在有空洞的患者中观察到更高的糖化血红蛋白和空腹血糖（<0.001）。无论有无肺空洞，各组之间的ELISPOT.TB阳性率和降钙素原水平均无差异（分别>0.9和=0.1）。肺部浸润累及更多肺段的患者血红蛋白、白蛋白水平较低，降钙素原较高。
外周血高炎症反应与空洞及肺部病变数量显著相关。高血糖与肺空洞的形成显著相关。血糖控制和炎症影响结核 - 糖尿病患者的影像学表现。
