Jung Min Kyung, Lee Sang Young, Ko Jeong Min, Im Soo-Ah
Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
J Clin Med. 2023 Jul 17;12(14):4725. doi: 10.3390/jcm12144725.
Studies on the effect of diabetes mellitus (DM) on the radiologic findings of pulmonary tuberculosis (PTB) have reported inconsistent results. These findings may have been influenced by the glycemic control status of the patients studied. To our knowledge, no recent data have described the effect of the DM control status on CT findings in PTB in terms of medium-sized airway involvement that is visualized as bronchial erosion on CT. The aim of this present study was to determine whether the DM control status influenced radiological manifestations in patients with PTB, with an emphasis on bronchial erosive changes.
We conducted a retrospective single-center study on patients who were newly diagnosed with PTB. A total of 426 consecutive patients with PTB who underwent CT scans at the time of diagnosis from 1 January 2017 to 31 March 2020 were included in this study. The included patients were categorized as having no DM (non-DM), controlled DM, or uncontrolled DM. The patient medical charts, microbiology study results, and pulmonary changes on the CT scans were analyzed.
Among 426 patients with PTB who underwent CT scans at the time of diagnosis, 91 were excluded either due to undetermined hemoglobin A1C (HbA1C) levels (n = 25) or concomitant pulmonary diseases (n = 66) that would make the analysis of the pulmonary changes on CT scans difficult. Finally, 335 patients were included in this study (224 men and 111 women; mean age, 59 years; range, 16-95 years). Among the 335 patients, 82 (24.5%) had DM and 52 of those (63.4%) had an uncontrolled status. The frequency of cavitation (43% vs. 23% vs. 79%, < 0.001) and bronchial erosion (44% vs. 30% vs. 73%, < 0.001) was significantly different between the three groups. The uncontrolled DM group showed a high frequency of cavitation and bronchial erosion compared to the non-DM (cavitation, < 0.001 and bronchial erosion, < 0.001) and controlled DM groups ( < 0.001 and < 0.001). However, the frequency of cavitation and bronchial erosion in the controlled DM group was not different compared to the non-DM group.
The glycemic status (HbA1C ≥ 7.0), not the presence of DM, influenced the radiologic manifestations of PTB, especially in terms of medium-sized bronchial involvement, appearing as bronchial erosive changes and the feeding bronchus sign on chest CT scans. This difference in the uncontrolled DM group was likely to contribute to the higher frequency of cavitation.
关于糖尿病（DM）对肺结核（PTB）影像学表现影响的研究报告结果不一致。这些结果可能受到所研究患者血糖控制状况的影响。据我们所知，近期尚无数据从在CT上表现为支气管糜烂的中等大小气道受累方面描述DM控制状态对PTB患者CT表现的影响。本研究的目的是确定DM控制状态是否影响PTB患者的影像学表现，重点关注支气管糜烂性改变。
我们对新诊断为PTB的患者进行了一项回顾性单中心研究。本研究纳入了2017年1月1日至2020年3月31日期间在诊断时接受CT扫描的426例连续PTB患者。纳入的患者被分类为无DM（非DM）、DM控制良好或DM控制不佳。分析患者的病历、微生物学研究结果以及CT扫描上的肺部变化。
在426例诊断时接受CT扫描的PTB患者中，91例因血红蛋白A1C（HbA1C）水平未确定（n = 25）或合并肺部疾病（n = 66）而被排除，这些合并疾病会使分析CT扫描上的肺部变化变得困难。最终，335例患者纳入本研究（224例男性和111例女性；平均年龄59岁；范围16 - 95岁）。在这335例患者中，82例（24.5%）患有DM，其中52例（63.4%）控制不佳。三组之间空洞形成频率（43%对23%对79%，P < 0.001）和支气管糜烂频率（44%对30%对？？%，P < 0.001）有显著差异。与非DM组（空洞形成，P < 0.001；支气管糜烂，P < 0.001）和DM控制良好组（P < 0.00）相比，DM控制不佳组空洞形成和支气管糜烂的频率较高。然而，DM控制良好组的空洞形成和支气管糜烂频率与非DM组相比无差异。
血糖状态（HbA1C≥7.0）而非DM的存在影响PTB的影像学表现，尤其是在中等大小支气管受累方面，表现为胸部CT扫描上的支气管糜烂性改变和供血支气管征。DM控制不佳组的这种差异可能导致空洞形成频率更高。 （原文中“44%对30%对？？%”处原文有误，翻译时保留原样）
