Barot Anuj, Vora Asmi, Dobariya Om, Parikh Vraj, Rahumath S Loolu, Shah Nalin, Borisagar Ghanshyam
Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
Respiratory Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
Cureus. 2024 Apr 23;16(4):e58810. doi: 10.7759/cureus.58810. eCollection 2024 Apr.
Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, the hematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.
有报道称糖尿病（DM）对结核病（TB）的临床和放射学特征有显著影响。然而，也有相互矛盾的结果报道。因此，尚未得出结论。本研究旨在分析和比较有DM和无DM的药物敏感型肺结核的临床和放射学特征。
于2023年8月至10月进行了一项比较性观察研究。本研究排除了耐药结核病患者、肺外结核病患者、服用免疫抑制药物的患者以及人类免疫缺陷病毒阳性个体。患有DM的肺结核患者被分类为病例组，无DM的患者被分类为对照组。记录人口统计学细节、临床症状、合并症的详细既往史和家族史、实验室检查、痰抗酸杆菌结果以及胸部X线检查结果。结核病的诊断和痰涂片结果的分级按照国家结核病消除计划指南进行。
本研究共纳入40例患者，其中20例（50%）为病例组，20例（50%）为对照组。除呼吸困难（80%对40%）和咯血（75%对35%）外，两组的临床症状几乎相似，病例组中这些症状明显更常见。病例组胸部X线检查下叶受累（75%）明显多于对照组（40%）（p = 0.0079）。DM合并TB组的空洞性病变也明显更多（p = 0.031）。双侧病变和多区域受累在病例组中也更常见，尽管未观察到统计学显著差异。此外，两组的血液学参数不同；然而，结果无统计学意义。
根据我们的研究结果，我们建议对所有结核病患者进行DM筛查。同样，所有高危DM患者都应进行TB筛查，以便早期诊断和管理，从而降低发病率和死亡率。医生应意识到DM患者可能以非典型方式出现肺结核。
