糖尿病与肺结核的相关性研究
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摘要
糖尿病(diabetes mellitus)和肺结核(tuberculosis, TB)是临床上的常见病和多发病。相关资料表明,糖尿病患者合并肺结核的机率是普通人群肺结核患病率的4-8倍。随着糖尿病发病率在全球范围的不断上升,糖尿病合并肺结核的情况仍有增长趋势,尤其在发展中国家如中国、印度等,两病的并存给临床诊断,尤其是治疗造成一定的困难。糖尿病合并肺结核的临床表现不典型,可能无典型“三多一少”的症状,肺结核的结核中毒症状也不典型,容易出现误诊。或者因为糖尿病导致患者逐渐消瘦,从而忽视了肺结核所致机体消耗状态的可能,延误了结核的诊断和治疗。在两病并存的情况下,对于糖尿病血糖控制节点问题面前尚有不同看法,仍需要大量的临床研究。肺结核与糖尿病并存,病情进展快,治疗效果差,容易产生耐药,二者相互影响从而加重病情,减弱抗结核治疗效果。
Diabetes and Tuberculosis are common and frequently-occurring disease in clinical.The relevant data indicate that the probability of diabetic patients with tuberculosis is4-8times the general population prevalence of Tuberculosis.With the incidence of Diabetes worldwide rise,especially in the developing countries such as India and China,Diabetes secondary to pulmonary Tuberculosis are still growth trend.The treatment appears considerable difficulties since the merger of the two diseases present to the clinical diagnosis.The patients without the typical diabetic manifestations such as "polydipsia, polyphagia, polyuria, weight loss",Tuberculosis symptoms of poisoning, is prone to misdiagnosis.Or because Diabetes can cause patients with progressive weight loss, thus ignoring the possibility of Tuberculosis caused by the body consumes state, leading to delays in TB diagnosis and treatment.There are different views on glycemic control node in the case of the coexistence of two diseases, still requires a lot of clinical research,we still need clinical large number of studies.The coexistence of Tuberculosis and Diabetes,the incidence of progress is rapid and treatment is poor, prone to drug resistance,both interaction and thus aggravate the condition, weakening the effect of anti-TB treatment.
Diabetes and Tuberculosis are common and frequently-occurring disease in clinical.The relevant data indicate that the probability of diabetic patients with tuberculosis is4-8times the general population prevalence of Tuberculosis.With the incidence of Diabetes worldwide rise,especially in the developing countries such as India and China,Diabetes secondary to pulmonary Tuberculosis are still growth trend.The treatment appears considerable difficulties since the merger of the two diseases present to the clinical diagnosis.The patients without the typical diabetic manifestations such as "polydipsia, polyphagia, polyuria, weight loss",Tuberculosis symptoms of poisoning, is prone to misdiagnosis.Or because Diabetes can cause patients with progressive weight loss, thus ignoring the possibility of Tuberculosis caused by the body consumes state, leading to delays in TB diagnosis and treatment.There are different views on glycemic control node in the case of the coexistence of two diseases, still requires a lot of clinical research,we still need clinical large number of studies.The coexistence of Tuberculosis and Diabetes,the incidence of progress is rapid and treatment is poor, prone to drug resistance,both interaction and thus aggravate the condition, weakening the effect of anti-TB treatment.
引文
1.陈明卫,王长江,杨明功等.2型糖尿病发病年龄对遗传表型影响的研究[J].中国慢性病预防与控制,2006,14：230 2。
2.霍丽梅,叶蔚,宋光耀,脂联素与2型糖尿病发生发展的研究进展[J].临床汇萃2005：20：54—6。
3. Alisjahbana B. Diabetes mellitus is strongly associated with tuberculosis in Indonesia[J]. International Journal of Tuberculosis and Lung Disease,2006,10:696-700.
4. stevenson(:R. Diabetes alld tuberculosis:the impact ofthe di8bete §p. idemic on tuberculosis incidellce[J]. BMC Public Health,2007,7:234.
5.朱红,王建华等,2型糖尿病并发肺结核病危险因素探讨[J].中华流行病学杂志,2006,27(1)：58—62。
6. Kim SJ,Hong YP,Lew WJ et all Incidence of pulmonary tuberculo2sis among diabeticsl Tuber Lung Dis,2005,76 (6):529.
7. Bloomgarden zt.inflammation and insulin resistance [J].diabetes care,2003,26:1619.
8. Complications of Type 1 Diabetes:New Molecular Findings Alin Stirban MD,1 Peter Rosen, MD, "2and Diethelm Tschoepe, MD11, Diabetes Clinic, Heart and Diabetes Center North Rhine-Westphalia, Ruhr UniversiBochum, Bad Oeynhausen, Germany 2, German Diabetes Center, Heinrich Heine University, Duesseldorf, GermanyMOUNT SINAI JOURNAL OF MEDICINE 75:328-351,2008 9.
9. Volishin IM, Suslov Ⅱ, Chepel PI, et al. The pulmonary microangiopathy in patients with tuherculosis coexisting with diabetes mellitus[J]. Klin K.hir.2000.11(10):37-39.
10. Perea G C,Torres C A,Vilarreal V H,et al.Progressive agerelated changes in pulmonary tuberculosis images and the effect of diabetes[J].Am J Res Crit Med,2000,162:1738-1740.
11.曹思哲等.含司帕沙星化疗方案治疗39例耐多药肺结核的临床分析[J].临床肺科杂志,2009,14(4)：477—478。
12.朱慧敏等.糖尿病合并肺结核降糖治疗现状调查[J].临床肺科杂志,2009,14(4)：477—478。
13. Jawad F, Shera AS, Memon R et all Glucose intolerance in pul2monary tuberculosis lJ Pak Med Assoc,1995,45(9):237.
14. Resende CT, Hirsch CS, Toossi Z, et al. Intestinal helminth coinfection has a negative impact on both anti-Myeobaeterium tuberculosis, immunity and clinical response to tuberculosis therapy [J]. ClinExp Immunol,2007,147(1):45-52.
15. Maria DA, Xue ID, Hai Z. Urea-induced ROS generation causes insulin resistance in mice with chronic renal failure [J]. J Clin Invest,2010,120(1):203-213.
16. Vadde R, Rama J. Oxidative stress in Non-insulin-dependent diabetes mellitus(NIDDM) patients [J]. Acta Diabetologica,2008,45(1):41-46.
17. Sung JK. Leptin potentiates Prevotella intermedia lipopolysaccha-ride induced production of TNF-α in monocyte-derived macropha-ges[J]. J Periodontal Implant Sci,2010,40(2): 119-124.
18. Bacakoglu F. Pulmonary tuberculosis in patients with diabetes mellitus[J]. Respiration, 2001,68:595-600.
19. Shaikh MA, Does diabetes alter the radiological presntation of pulmonary tuberculosis[J]. Saudi Medical Journal,2003,24:278-281.
20. Perez-Guzman C.Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes[J]. American Journal of Respiratory and Critical Care Medicine,2000,162:1738-1740.
21. Morris JT, Seaworth BJ, McAllister CK. Pulmonary Tuberculosis Diabetics. Chest,2002, 102(2):539-541.
22.罗道宝,刘岩,扬芳玲等.32例合并糖尿病的肺结核x线表现[J].中国防痨杂志。2007,29(5)：445-446。
23.杨连军等人.20例糖尿病合并肺结核初诊影像表现[J],中国防痨杂志,2009,89-90,31(2)。
24. Van Dyck P.Vanhoenacker FM.Van den Brande P, et al.Imaging of pulmonary tuberculosis [J].Eur Radiol.2003.13:1771-17851.
25. Lam KY.Autopsy findings in diabetic patients:a 27-yr clinicopathologic study with emphasis on oppotunistic infections and cancers.Endoctpatho,2002,13:39-45.
26.王小群,杨惠,李小平.糖尿病合并肺结核65例x线、CT表现及临床分析[J]中国民康医学,2009,21(16)：1914-1915。
27.丁桂华等.肺结核合并糖尿病的162例临床观察[J].新医学学刊,2008.5(6)：889—890。
28. El-Masry S,Lotfy M,Nasif WA,et al.Elevated serum level of interleukin(IL)-18, interferon(IFN)-gamma and 9 soluble Fas in patients with pulmonary complications in tuberculosis [J],Acta Microbiol Immunol Hung,2007,54:65-77.
29. Nijland HM. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes[J],Clinical Infectious Diseases,2006.43:848-854.
30. Resende Co T, Hirsch CS,Toossi Z,et al.Intestinal helminth co-infection has a negative impact on both anti-Mycobacterium tuberculosis immunity and clinical response to tuberculosis therapy [J],Clin Exp Immunol,2007,147:45-52.
31.赵风德,孙伟,韩明锋等,肺结核合并糖尿病的诊疗探讨[J].安徽医学,2007,28(1)：54—55。
32. Subhash H S.Ashwin I, Mukundan U,et al. Drug resistant tuberculosis in diabetes mellitus: a retrospective study from south India[J],Trop Doct,2003,33(3):154.
33. Alisjahbana B. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis[J]. Clinical Infectious Diseases,2007.45:428-435.
34.郎松梅等人,糖尿病合并肺结核120例临床分析[J],临床合理用药,2(15)：38-39。2009。
35.符鸿俊,林琴,何泽宝等,糖尿病合并肺结核50例临床的分析[J].临床医学,2008,28(7)：1112。
36. Wada M. The effectiveness of pyrazinamide-containing six-month short course Chemotherapy. Kekkaku.2000 Nov;75(11):665-73.
37.刘智,蔡雄茂,罗瑞玲等.263例肺结核合并糖尿病临床分析.临床肺科杂志,2007 12 940-941。
38.连建军等.肺结核合并糖尿病126例的临床分析[J].中国社区医师·医学专业.2008,10(15)：46。
1 Alisjahbana B Diabetes mellitus is strongly associated with tuberculosis in Indonesia[J],International Journal of Tuberculosis and Lung DiseaSe,2006,10:696-700.
2 Stevenson CR,Diabetes and the risk of tuberculosis:a neglected threat to public health[J],Chronic Illness,2007.3:228-245.
3赵海涛,王欢援,白晓军,糖尿病合并肺结核影像表现及分析[J].中国医药指南：124-125,2010,8(18)。
4 Bloomgarden ZT.Inflammation and insulin resistance [J].Diabetes Care,2003,26:1619
5 Volishin IM,Suslov Ⅱ,Chepel PI,et al.The pulmonary microangiopathy in patients with tuherculosis coexisting with diabetes mellitus[J],Klin Khir.2000.11(10):37-39.
6 Sugawara I,Mizuno S.Higher susceptibility of type 1 diabetic rats to Mycobacterium tuberculosis infection [J]. Tohoku J Exp Med,2008,216 (4):363-370.
7 Broxmeyer L,Sosnowska D,Miltner E,et al. Killing of My-cobacterium avium and Mycobacterium tuberculosis by a my-cobacteriophage delivered by a nonvirulent mycobacterium:a model for phage therapy of intracellular bacterial pathogens [J].J Infect Dis,2002,186(8):1155-1160.
8 Sugawara I,Yamada H,Mizuno S. Pulmonary tuberculosis inspontaneously diabetic goto kakizaki rats [J].Tohoku J ExpMed,2004,204 (2):135-145.
9王建军,李兰,郭述良等,ManLAM对树突状细胞的成熟及下游免疫的影响[J],中国免疫学杂志,2010,26(7)：587-590。
10 Vallerskog T,Martens GW,Kornfeld H.Diabetic mice display a delayed adaptive immune response to Mycobacterium tuberculosis [J]. J Immunol,2010,184(11):6275-6282.
11 Restrepo BI,Type 2 diabetes and tuberculosis in adynamic binational border population[J],Epidemiology and lnfection,2007,135 483-491.
12杜娟,张先明,肺结核合并糖尿病42例中的临床分析[J],贵州医药,2010.34(9)：810—811。
13王小群,杨惠,李小平,糖尿病合并肺结核65例x线、CT表现及临床分析[J],中国民康医学,2009,21(16)：1914-1915。
14符鸿俊,林琴,何泽宝等人,糖尿病合并肺结核的50例临床分析[J],临床医学,2008,28(7)：11-12.。
15 Jawad F,Shera AS,Memon R,et al Glucose intolerance in pulmonary tuberculosis[J] pak Med Assoc,2005,54(9):237.
16 Subhash H S.Ashwin I,Mukundan U,et al. Drug resistant tuberculosis in diabetes mellitus:a retrospective study from south India[J],Trop Doct,2003,33(3):154.
17 Jawad F,Shera AS,Memon R,et al Glucose intolerance in pulmonary tuberculosis[J] pak Med Assoc,2005,54(9):237.
18连建军等.肺结核合并糖尿病126例的临床分析[J].中国社区医师·医学专业,200810(15)：46。
19周新凤.糖尿病合并肺结核护理特点[J],中国基础医药学,2001,4(2)：163。
20王爱华.糖尿病合并肺结核的营养及饮食[J],食品与药品,2005,7(3)：67。
1陈明卫,杨明功,王长江,等.2型糖尿病先证者发病年龄对遗传表型影响的研究[J].中国慢性病预防与控制,2006,14：230—2。
2霍丽梅,宋光耀,叶蔚.脂联素与2型糖尿病发生发展的研究进展[J].临床汇萃,2005：20：54—6。
3宣丽萍.老年Ⅰ型糖尿病80例病例分析[J].中华现代内科学杂志,2007,4(8)：744。
4中华医学会编.临床诊疗指南(结核病分册)[J].北京：人民卫生出版社,2005：122。
5朱红,王建华.2型糖尿病并发肺结核病的危险因素探讨[J].中华流行病学杂志,2006,27(1)：58—59。
6王光亮,吴沛霞,雷涛.肺结核合并糖尿病82例临床分析[J].临床肺科杂志,2007,12(7)：683。
7 Resende Co T, Hirsch CS, Toossi Z, et al. Intestinal helminth co-infection has a negative impact on both anti-Mycobacterium tuberculosis immunity and clinical response to tuberculosis therapy [J]. Clin Exp Immunol,2007,147:45-52.
8 El-Masry S, Lotfy M, Nasif WA, et al. Elevated serum level of interleukin(IL)-18, interferon(IFN)-gamma and 9 soluble Fas in patients with pulmonary complications in tuberculosis [J]. Acta Microbiol Immunol Hung,2007,54:65-77.
9罗道宝,刘岩,扬芳玲,等.32例合并糖尿病肺结核的x线表现[J].中国防痨杂志,2007,29(5)：445—446。
10白锡山,等.司帕沙星治疗肺结核的临床研究[J].临床肺科杂志,2006,11(6)749。
11曹思哲,等.含司帕沙星化疗方案治疗39例耐多药肺结核的临床分析[J].临床肺科杂志,2009,14(4)：477—478。
12朱慧敏,等.糖尿病合并肺结核降糖治疗现状调查[J].临床肺科杂志,2009,14(4)：477—478。
2.霍丽梅,叶蔚,宋光耀,脂联素与2型糖尿病发生发展的研究进展[J].临床汇萃2005：20：54—6。
3. Alisjahbana B. Diabetes mellitus is strongly associated with tuberculosis in Indonesia[J]. International Journal of Tuberculosis and Lung Disease,2006,10:696-700.
4. stevenson(:R. Diabetes alld tuberculosis:the impact ofthe di8bete §p. idemic on tuberculosis incidellce[J]. BMC Public Health,2007,7:234.
5.朱红,王建华等,2型糖尿病并发肺结核病危险因素探讨[J].中华流行病学杂志,2006,27(1)：58—62。
6. Kim SJ,Hong YP,Lew WJ et all Incidence of pulmonary tuberculo2sis among diabeticsl Tuber Lung Dis,2005,76 (6):529.
7. Bloomgarden zt.inflammation and insulin resistance [J].diabetes care,2003,26:1619.
8. Complications of Type 1 Diabetes:New Molecular Findings Alin Stirban MD,1 Peter Rosen, MD, "2and Diethelm Tschoepe, MD11, Diabetes Clinic, Heart and Diabetes Center North Rhine-Westphalia, Ruhr UniversiBochum, Bad Oeynhausen, Germany 2, German Diabetes Center, Heinrich Heine University, Duesseldorf, GermanyMOUNT SINAI JOURNAL OF MEDICINE 75:328-351,2008 9.
9. Volishin IM, Suslov Ⅱ, Chepel PI, et al. The pulmonary microangiopathy in patients with tuherculosis coexisting with diabetes mellitus[J]. Klin K.hir.2000.11(10):37-39.
10. Perea G C,Torres C A,Vilarreal V H,et al.Progressive agerelated changes in pulmonary tuberculosis images and the effect of diabetes[J].Am J Res Crit Med,2000,162:1738-1740.
11.曹思哲等.含司帕沙星化疗方案治疗39例耐多药肺结核的临床分析[J].临床肺科杂志,2009,14(4)：477—478。
12.朱慧敏等.糖尿病合并肺结核降糖治疗现状调查[J].临床肺科杂志,2009,14(4)：477—478。
13. Jawad F, Shera AS, Memon R et all Glucose intolerance in pul2monary tuberculosis lJ Pak Med Assoc,1995,45(9):237.
14. Resende CT, Hirsch CS, Toossi Z, et al. Intestinal helminth coinfection has a negative impact on both anti-Myeobaeterium tuberculosis, immunity and clinical response to tuberculosis therapy [J]. ClinExp Immunol,2007,147(1):45-52.
15. Maria DA, Xue ID, Hai Z. Urea-induced ROS generation causes insulin resistance in mice with chronic renal failure [J]. J Clin Invest,2010,120(1):203-213.
16. Vadde R, Rama J. Oxidative stress in Non-insulin-dependent diabetes mellitus(NIDDM) patients [J]. Acta Diabetologica,2008,45(1):41-46.
17. Sung JK. Leptin potentiates Prevotella intermedia lipopolysaccha-ride induced production of TNF-α in monocyte-derived macropha-ges[J]. J Periodontal Implant Sci,2010,40(2): 119-124.
18. Bacakoglu F. Pulmonary tuberculosis in patients with diabetes mellitus[J]. Respiration, 2001,68:595-600.
19. Shaikh MA, Does diabetes alter the radiological presntation of pulmonary tuberculosis[J]. Saudi Medical Journal,2003,24:278-281.
20. Perez-Guzman C.Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes[J]. American Journal of Respiratory and Critical Care Medicine,2000,162:1738-1740.
21. Morris JT, Seaworth BJ, McAllister CK. Pulmonary Tuberculosis Diabetics. Chest,2002, 102(2):539-541.
22.罗道宝,刘岩,扬芳玲等.32例合并糖尿病的肺结核x线表现[J].中国防痨杂志。2007,29(5)：445-446。
23.杨连军等人.20例糖尿病合并肺结核初诊影像表现[J],中国防痨杂志,2009,89-90,31(2)。
24. Van Dyck P.Vanhoenacker FM.Van den Brande P, et al.Imaging of pulmonary tuberculosis [J].Eur Radiol.2003.13:1771-17851.
25. Lam KY.Autopsy findings in diabetic patients:a 27-yr clinicopathologic study with emphasis on oppotunistic infections and cancers.Endoctpatho,2002,13:39-45.
26.王小群,杨惠,李小平.糖尿病合并肺结核65例x线、CT表现及临床分析[J]中国民康医学,2009,21(16)：1914-1915。
27.丁桂华等.肺结核合并糖尿病的162例临床观察[J].新医学学刊,2008.5(6)：889—890。
28. El-Masry S,Lotfy M,Nasif WA,et al.Elevated serum level of interleukin(IL)-18, interferon(IFN)-gamma and 9 soluble Fas in patients with pulmonary complications in tuberculosis [J],Acta Microbiol Immunol Hung,2007,54:65-77.
29. Nijland HM. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes[J],Clinical Infectious Diseases,2006.43:848-854.
30. Resende Co T, Hirsch CS,Toossi Z,et al.Intestinal helminth co-infection has a negative impact on both anti-Mycobacterium tuberculosis immunity and clinical response to tuberculosis therapy [J],Clin Exp Immunol,2007,147:45-52.
31.赵风德,孙伟,韩明锋等,肺结核合并糖尿病的诊疗探讨[J].安徽医学,2007,28(1)：54—55。
32. Subhash H S.Ashwin I, Mukundan U,et al. Drug resistant tuberculosis in diabetes mellitus: a retrospective study from south India[J],Trop Doct,2003,33(3):154.
33. Alisjahbana B. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis[J]. Clinical Infectious Diseases,2007.45:428-435.
34.郎松梅等人,糖尿病合并肺结核120例临床分析[J],临床合理用药,2(15)：38-39。2009。
35.符鸿俊,林琴,何泽宝等,糖尿病合并肺结核50例临床的分析[J].临床医学,2008,28(7)：1112。
36. Wada M. The effectiveness of pyrazinamide-containing six-month short course Chemotherapy. Kekkaku.2000 Nov;75(11):665-73.
37.刘智,蔡雄茂,罗瑞玲等.263例肺结核合并糖尿病临床分析.临床肺科杂志,2007 12 940-941。
38.连建军等.肺结核合并糖尿病126例的临床分析[J].中国社区医师·医学专业.2008,10(15)：46。
1 Alisjahbana B Diabetes mellitus is strongly associated with tuberculosis in Indonesia[J],International Journal of Tuberculosis and Lung DiseaSe,2006,10:696-700.
2 Stevenson CR,Diabetes and the risk of tuberculosis:a neglected threat to public health[J],Chronic Illness,2007.3:228-245.
3赵海涛,王欢援,白晓军,糖尿病合并肺结核影像表现及分析[J].中国医药指南：124-125,2010,8(18)。
4 Bloomgarden ZT.Inflammation and insulin resistance [J].Diabetes Care,2003,26:1619
5 Volishin IM,Suslov Ⅱ,Chepel PI,et al.The pulmonary microangiopathy in patients with tuherculosis coexisting with diabetes mellitus[J],Klin Khir.2000.11(10):37-39.
6 Sugawara I,Mizuno S.Higher susceptibility of type 1 diabetic rats to Mycobacterium tuberculosis infection [J]. Tohoku J Exp Med,2008,216 (4):363-370.
7 Broxmeyer L,Sosnowska D,Miltner E,et al. Killing of My-cobacterium avium and Mycobacterium tuberculosis by a my-cobacteriophage delivered by a nonvirulent mycobacterium:a model for phage therapy of intracellular bacterial pathogens [J].J Infect Dis,2002,186(8):1155-1160.
8 Sugawara I,Yamada H,Mizuno S. Pulmonary tuberculosis inspontaneously diabetic goto kakizaki rats [J].Tohoku J ExpMed,2004,204 (2):135-145.
9王建军,李兰,郭述良等,ManLAM对树突状细胞的成熟及下游免疫的影响[J],中国免疫学杂志,2010,26(7)：587-590。
10 Vallerskog T,Martens GW,Kornfeld H.Diabetic mice display a delayed adaptive immune response to Mycobacterium tuberculosis [J]. J Immunol,2010,184(11):6275-6282.
11 Restrepo BI,Type 2 diabetes and tuberculosis in adynamic binational border population[J],Epidemiology and lnfection,2007,135 483-491.
12杜娟,张先明,肺结核合并糖尿病42例中的临床分析[J],贵州医药,2010.34(9)：810—811。
13王小群,杨惠,李小平,糖尿病合并肺结核65例x线、CT表现及临床分析[J],中国民康医学,2009,21(16)：1914-1915。
14符鸿俊,林琴,何泽宝等人,糖尿病合并肺结核的50例临床分析[J],临床医学,2008,28(7)：11-12.。
15 Jawad F,Shera AS,Memon R,et al Glucose intolerance in pulmonary tuberculosis[J] pak Med Assoc,2005,54(9):237.
16 Subhash H S.Ashwin I,Mukundan U,et al. Drug resistant tuberculosis in diabetes mellitus:a retrospective study from south India[J],Trop Doct,2003,33(3):154.
17 Jawad F,Shera AS,Memon R,et al Glucose intolerance in pulmonary tuberculosis[J] pak Med Assoc,2005,54(9):237.
18连建军等.肺结核合并糖尿病126例的临床分析[J].中国社区医师·医学专业,200810(15)：46。
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