2型糖尿病合并肺结核老年患者CT征象特点分析
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摘要
目的研究2型糖尿病(T2DM)合并肺结核(PTB)老年患者CT征象特点,为提高临床诊断和治疗水平提供参考依据。方法选取2016年8月至2018年8月我院T2DM合并PTB患者(观察组)和单纯PTB患者(对照组)各80例为研究对象分别进行CT检查,比较两组病变位置、累及范围、病灶形态和性质等图像特点。结果两组病灶位置分布情况无明显差异(P>0.05),观察组双肺受累率及平均受累肺段数量高于对照组,差异有统计学意义(P﹤0.05);观察组结节状病灶比例少于对照组,空洞、斑片状影、胸腔积液及淋巴结肿大发生率及空洞数量均高于对照组,差异有统计学意义(P﹤0.05)。结论 T2DM合并PTB老年患者CT征象与单纯PTB患者相比较存在明显差异,除累及范围更广外,病灶形态也存在较多变化,主要表现为多肺叶或肺段大面积实变,伴渗出、干酪样变、空洞形成和树芽征,且结节病灶大量减少。
Objective To study the CT signs features in elderly patients with type 2 diabetes mellitus(T2 DM) complicated with pulmonary tuberculosis(PTB) so as to provide reference for improving clinical diagnosis and treatment. Methods Each 80 cases of patients with T2 DM and PTB(observation group) and patients with simple PTB(control group)from August 2016 to August 2018 in our hospital were selected for the study and they were given CT examination. The image features of lesion location, involvement range and lesion morphology and nature were compared between the two groups. Results There was no significant difference in the lesion location between the two groups(P>0.05),and the double lung involvement rate and average number of affected lung segments in observation group were higher than those in control group(P<0.05). The proportion of nodular lesions in observation group was less than that in control group, and the incidence rates of cavitation, patchy shadows, pleural effusion and lymphadenopathy and the cavitation quantity were higher than those in control group(P<0.05). Conclusion CT signs of elderly patients with T2 DM complicated with PTB are significantly different from those of patients with PTB. Except for a wider involvement range, there are more changes in the lesions morphology whose main manifestations are multi-lobes or large consolidation of lung segments, accompanied by exudation, caseation, cavitation formation and tree-inbud sign and greatly reduced nodular lesions.
Objective To study the CT signs features in elderly patients with type 2 diabetes mellitus(T2 DM) complicated with pulmonary tuberculosis(PTB) so as to provide reference for improving clinical diagnosis and treatment. Methods Each 80 cases of patients with T2 DM and PTB(observation group) and patients with simple PTB(control group)from August 2016 to August 2018 in our hospital were selected for the study and they were given CT examination. The image features of lesion location, involvement range and lesion morphology and nature were compared between the two groups. Results There was no significant difference in the lesion location between the two groups(P>0.05),and the double lung involvement rate and average number of affected lung segments in observation group were higher than those in control group(P<0.05). The proportion of nodular lesions in observation group was less than that in control group, and the incidence rates of cavitation, patchy shadows, pleural effusion and lymphadenopathy and the cavitation quantity were higher than those in control group(P<0.05). Conclusion CT signs of elderly patients with T2 DM complicated with PTB are significantly different from those of patients with PTB. Except for a wider involvement range, there are more changes in the lesions morphology whose main manifestations are multi-lobes or large consolidation of lung segments, accompanied by exudation, caseation, cavitation formation and tree-inbud sign and greatly reduced nodular lesions.
引文
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[12]张砚,朱凌云,左维泽,等.2型糖尿病患者结核分枝杆菌感染糖化血红蛋白与T淋巴细胞亚群的水平变化相关性研究[J].中华医院感染学杂志,2015,25(18):4119-4121.
[13]汪敏,邝浩斌,李艳,等.2型糖尿病合并肺结核患者抗结核化疗2个月末痰菌阴转影响因素分析[J].实用医学杂志,2013,29(23):3808-3811.
[14]Song Q,Zhang G,Jiang H,et a l.Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with Multidrug Resistant Tuberculosis[J].Plos One,2016,11(3):e0152507.
[15]王青乐,张志勇,施裕新.活动性肺结核的HRCT诊断[J].放射学实践,2013,28(12):1294-1295.
[2]王黎霞,成诗明,陈明亭,等.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[3]XuY,WangL,HeJ,etal.Prevalence and control of diabetes in Chinese adults[J].Jama the Journal of the American Medical Association,2013,310(9):948-958.
[4]Guariguata L.Contribute data to the 6th edition of the IDFDiabetes Atlas[J].Diabetes Res Clin Pract,2013,100(2):280-281.
[5]Ahmed M,Omer I,Osman SM,et a l.Association between pulmonarytuberculosis and Type 2 diabetes in Sudanese patients[J].International Journal of Mycobacteriology,2017,6(1):97-101.
[6]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中国实用乡村医生杂志,2013,20(2):70-74.
[7]田勍,洪天配.美国糖尿病学会2 0 1 7年版糖尿病医学诊疗标准的解读[J].中国糖尿病杂志,2017,25(7):577-581.
[8]孔忠顺,黄麦玲,刘荣梅,等.糖尿病合并初治肺结核患者临床特点[J].中国糖尿病杂志,2014,6(5):329-331.
[9]曾令延,陈根铭,黄福城,等.肺结核抗痨过程中病灶进展的影像学表现及误诊分析[J].实用放射学杂志,2016,32(11):1688-1691,1716.
[10]Nachiappan AC,Rahbar K,Shi X,et al.Pulmonary Tuberculosis:Role of Radiology in Diagnosis and Management[J].Radiographics,2017,37(1):52-72.
[11]张鑫,林吉征,李峰,等.尿病并发肺结核CT表现分析[J].中国CT和MRI杂志,2015,13(09):62-64+71.
[12]张砚,朱凌云,左维泽,等.2型糖尿病患者结核分枝杆菌感染糖化血红蛋白与T淋巴细胞亚群的水平变化相关性研究[J].中华医院感染学杂志,2015,25(18):4119-4121.
[13]汪敏,邝浩斌,李艳,等.2型糖尿病合并肺结核患者抗结核化疗2个月末痰菌阴转影响因素分析[J].实用医学杂志,2013,29(23):3808-3811.
[14]Song Q,Zhang G,Jiang H,et a l.Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with Multidrug Resistant Tuberculosis[J].Plos One,2016,11(3):e0152507.
[15]王青乐,张志勇,施裕新.活动性肺结核的HRCT诊断[J].放射学实践,2013,28(12):1294-1295.
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