糖尿病合并肺结核63例临床分析.docVIP

糖尿病合并肺结核63例临床分析 【关键词】 ,糖尿病 　　摘 要：目的：探讨糖尿病合并肺结核的临床特点、诊断和治疗方法。方法：对本科1991年以来收治的糖尿病合并肺结核患者诊治情况进行回顾性分析。结果：63例中血糖控制理想者34例，病灶不同程度吸收、空洞缩小或关闭。血糖控制尚理想者19例，15例吸收好转，2例无好转，2例死亡。血糖控制不理想者 10例 3例吸收好转，4例无好转，死亡3例。结论：糖尿病合并肺结核应积极控制血糖，早期抗结核治疗，预防并发症的发生，能较好的控制结核，改善预后。 　　关键词： 糖尿病； 肺结核； 血 糖 　　Clinical Analysis of 63 cases Diabetes Complicated with Pulmonary Tuberculosis 　　Abstract：Objective: To investigate the clinical features, diagnosis and treatment of diabetes complicating pulmonary tuberculosis. Method: The data of diagnosis and treatment for patients of diabetes complicating pulmonary tuberculosis admitted in our department since 1991 was analyzed retrospectively. Result: In all 63 cases, there were 34 cases with well-controlled serum glucose. Their focuses of pulmonary tuberculosis were more or less absorbed, and cavities reduced or disappeared. 19 cases had comparatively well-controlled serum glucose, 15of whom had absorbed focuses and improved, 2 didn抰 improve and 2 died. There were 10 patients whose serum glucose was not controlled well. Of the 10 patients, 3 gained absorbed focuses and improved, 4 didn抰 improve and 3 died. Conclusion: In diabetes complicating pulmonary tuberculosis, controlling serum glucose positively, giving early anti-tuberculosis treatment and preventing complication can control tuberculosis well and improve prognosis. 　　Key words： Diabetes； Pulmonary； Serum glucose 　　糖尿病患者容易合并感染，糖尿病合并肺结核的发病率为非糖尿病合并肺结核的2～4倍［1］，其临床特点较单纯肺结核有所不同，预后较差［2］。本文就我科自1990年至2004年住院糖尿病合并肺结核病历进行分析。 　　1 资料与方法 　　1.1 一般资料：63例均是住院病例，其中男42例，女21例，年龄21～85岁，其小于40岁8人，41～50岁9人，51～60岁15人，61～70岁20人，71～80岁7人，81岁以上5人。先诊断糖尿病后发现并发肺结核39例，先发现肺结核后诊断糖尿病15例，同时诊断肺结核和糖尿病者9列。 　　1.2 糖尿病情况：糖尿病的诊断标准采用1997年ADA/WHO糖尿病诊断标准。Ⅰ型糖尿病5例，Ⅱ型糖尿病58例，入院时查空腹血糖6.1～10mmol/L40例，10.1～26.4mmol/L23例。有典型的“三多一少”23例，糖尿病视网膜病变18例，糖尿病肾病9例，糖尿病神经病变15例。 　　1.3 肺结核情况：肺结核的诊断标准按照2000年中华医学会结核学分会制定的《肺结核诊断和治疗指南》［3］63例肺结核患者中，初次病人43例，复治病人20例，临床表现为咳嗽57例、咳痰40例、发热24例、盗汗17例、消瘦18例，咯血13例，气促9例乏力15例，纳差17例，胸痛8例。查痰找