伴或不伴糖尿病的耐药肺结核患者肺部CT特征比较研究

郭金龙; 闵旭红; 宋彪; 李源; 王华

doi:10.16766/j.cnki.issn.1674-4152.003365

伴或不伴糖尿病的耐药肺结核患者肺部CT特征比较研究

doi: 10.16766/j.cnki.issn.1674-4152.003365

郭金龙¹,
闵旭红^1, ,,
宋彪¹,
李源¹,
王华²

1.
安徽省胸科医院医学影像中心，安徽合肥 230022
2.
安徽省胸科医院耐药结核病科

基金项目:

中央财政省级临床重点专科建设项目 Z155080000004

详细信息

通讯作者:
闵旭红，E-mail：1320722827@qq.com

中图分类号: R521 R587.1 R814.42
计量
- 文章访问数: 58
- HTML全文浏览量: 17
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-08-02
- 网络出版日期: 2024-03-27

Comparative study of CT features in patients with drug-resistant pulmonary tuberculosis with or without diabetes mellitus

1.
Comparative study of CT features in patients with drug-resistant pulmonary tuberculosis with or without diabetes mellitus

摘要

摘要: 目的探讨耐药肺结核并发糖尿病患者的胸部CT特征，以提高对其影像学表现的认识。方法回顾性研究安徽省胸科医院2022年6月—2023年5月诊治的伴有糖尿病的耐药肺结核患者55例(伴有糖尿病组)和同时期符合纳入标准的不伴有糖尿病的耐药肺结核患者80例(不伴有糖尿病组)，对比分析2组患者胸部CT征象。结果伴有糖尿病组毁损肺、叶段实变或干酪性肺炎、结核性胸膜炎检出率分别为32.73%(18/55)、36.36%(20/55)、41.82%(23/55)，不伴有糖尿病组分别为13.75%(11/80)、20.00%(16/80)、23.75%(19/80)，2组比较差异均有统计学意义(χ²=6.959、4.463、4.965，P<0.05)。伴有糖尿病组空洞例数、无壁空洞检出率分别为89.09%(49/55)、54.82%(108/197)，不伴有糖尿病组分别为67.50%(54/80)、44.09%(82/186)，2组比较差异均有统计学意义(χ²=8.401、4.411，P<0.05)。结论耐药肺结核并发糖尿病患者的胸部CT具有一定的特征性，更多表现为毁损肺、叶段实变或干酪性肺炎、多发无壁空洞，有效掌握其影像学特点能为临床早期诊治提供帮助。
- 糖尿病 /
- 结核，肺 /
- 抗药物性 /
- 体层摄影术，X线计算机 /
- 诊断显像
Abstract: Objective To explore the chest CT features of drug-resistant pulmonary tuberculosis complicated with diabetic patients, in order to improve the understanding of its imaging findings. Methods A retrospective study was performed between 55 cases of drug-resistant pulmonary tuberculosis with diabetes mellitus (referred to as "concurrent DM group") admitted to Anhui Chest Hospital from June 2022 to May 2023 and 80 cases of drug-resistant pulmonary tuberculosis without diabetes mellitus (referred to as "non-concurrent DM group") who met the inclusion criteria during the same period, and the chest CT features of the two groups were compared and analyzed. Results In the concurrent DM group, the detection rates of destroyed lung, lobar and segmental consolidation or caseous pneumonia and tuberculous pleurisy were 32.73% (18/55), 36.36% (20/55) and 41.82% (23/55), respectively, and the non-concurrent DM group were 13.75% (11/80), 20.00% (16/80) and 23.75% (19/80), respectively. The differences between the two groups were statistically significant (χ²=6.959, 4.463, 4.965, P<0.05). In the concurrent DM group, the detection rates of case of cavities and cavities without wall were 89.09%(49/55), 54.82%(108/197), respectively, and the non-concurrent DM group were 67.50% (54/80), 44.09% (82/186), respectively. The differences between the two groups were statistically significant (χ²=8.401, 4.411, P<0.05). Conclusion The chest CT features of drug-resistant pulmonary tuberculosis with diabetes mellitus has certain characteristics, which are more manifested as destroyed lung, lobar and segmental consolidation or caseous pneumonia, and multiple cavities without wall. Effective understanding of the imaging characteristics can provide help for early clinical diagnosis and treatment.
- Diabetes mellitus /
- Tuberculosis, Pulmonary /
- Drug-resistant /
- Tomography, X-ray and computer /
- Diagnostic imaging

HTML全文

图 1 异烟肼、利福平、氟喹诺酮耐药肺结核并发2型糖尿病患者影像

注：患者女性，57岁。A示右肺毁损，B示左肺上叶干酪性肺炎；两肺多发无壁空洞，肺叶分布≥3叶，空洞数≥3个。

Figure 1. Imaging of a patient with isoniazid, rifampin, and fluoroquinolone-resistant pulmonary tuberculosis complicated by type 2 diabetes mellitus

下载: 全尺寸图片幻灯片

图 2 利福平耐药肺结核并发2型糖尿病患者影像

注：患者男性，52岁。A、B示左肺上叶干酪性肺炎；左肺上叶无壁空洞、右肺上叶厚壁空洞，空洞数≥3个。

Figure 2. Imaging of patients with rifampicin-resistant pulmonary tuberculosis complicated with type 2 diabetes

下载: 全尺寸图片幻灯片

图 3 异烟肼、利福平耐药肺结核并发2型糖尿病患者影像

注：患者男性，43岁。A、B示两侧结核性胸膜炎；左肺上叶厚壁空洞、右肺上叶无壁空洞，空洞数≥3个。

Figure 3. Imaging of patients with isoniazid and rifampicin resistant pulmonary tuberculosis complicated with type 2 diabetes mellitus

下载: 全尺寸图片幻灯片

表 1 2组DR-PTB患者胸部CT不同征象比较[例(%)]

Table 1. Comparison of chest CT features in two groups of DR-PTB patients [cases (%)]

组别	例数	病灶分布≥ 3个肺叶	毁损肺	支气管扩张	叶段实变或干酪性肺炎	结节影	团块影	纵隔淋巴结肿大/钙化	结核性胸膜炎	气管/支气管结核
伴有糖尿病组	55	48(87.27)	18(32.73)	24(43.64)	20(36.36)	39(70.91)	10(18.18)	30(54.55)	23(41.82)	5(9.09)
不伴有糖尿病组	80	68(85.00)	11(13.75)	39(48.75)	16(20.00)	56(70.00)	9(11.25)	32(40.00)	19(23.75)	7(8.75)
χ²值		0.139	6.959	0.342	4.463	0.013	1.295	2.777	4.965	<0.001
P值		0.709	0.008	0.558	0.035	0.910	0.255	0.096	0.026	0.999

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表 2 2组DR-PTB患者空洞例数、分布及空洞数比较[例(%)]

Table 2. Comparison of the case, distribution and number of cavities in two groups of DR-PTB patients [cases (%)]

组别	例数	空洞例数	空洞分布范围			空洞数
组别	例数	空洞例数	1叶	2叶	≥3叶	1个	2个	≥3个
伴有糖尿病组	55	49(89.09)	22(40.00)	10(18.18)	17(30.91)	13(23.63)	5(9.09)	31(56.36)
不伴有糖尿病组	80	54(67.50)	29(36.25)	12(15.00)	13(16.25)	17(21.25)	15(18.75)	22(27.50)
统计量		8.401^a	-1.013^b			-1.759^b
P值		0.004	0.270			0.079
注：^a为χ²值，^b为Z值。

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表 3 2组DR-PTB患者不同类型空洞个数比较[例(%)]

Table 3. Comparison of the composition ratio and number of different types of cavities in two groups of DR-PTB patients [cases (%)]

组别	空洞个数	空洞类型
组别	空洞个数	厚壁空洞(＞3 mm)	薄壁空洞(≤3 mm)	无壁空洞
伴有糖尿病组	197	81(41.12)	8(4.06)	108(54.82)
不伴有糖尿病组	186	92(49.46)	12(6.45)	82(44.09)^a
χ²值		4.745
P值		0.093
注：与伴有糖尿病组比较，^aP<0.05。

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参考文献(20)

[1]	邓国防, 成诗明. 浅谈我国结核病与糖尿病共病治疗管理现状[J]. 中国防痨杂志, 2021, 43(1): 23-25. doi: 10.3969/j.issn.1000-6621.2021.01.005 DENG G F, CHENG S M. The challenge of clinical management and treatment of tuberculosis and diabietes in China[J]. Chinese Journal of Antituberculosis, 2021, 43(1): 23-25. doi: 10.3969/j.issn.1000-6621.2021.01.005
[2]	胡卫华, 金龙, 初乃惠. 耐多药/广泛耐药肺结核并发2型糖尿病患者耐药特征分析[J]. 中国防痨杂志, 2021, 43(1): 26-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202101007.htm HU W H, JIN L, CHU N H. Analysis of drug resistance characteristics of MDR/XDR-TB patients complicated with type 2 diabetes mellitus[J]. Chinese Journal of Antituberculosis, 2021, 43(1): 26-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202101007.htm
[3]	WU Q, WANG M, ZHANG Y, et al. Epidemiological characteristics and their influencing factors among pulmonary tuberculosis patients with and without diabetes mellitus: a survey study from drug resistance surveillance in east China[J]. Front Public Health, 2022, 9: 777000. DOI: 10.3389/fpubh.2021.777000.
[4]	PAN Y P, YU Y Y, YI Y H, et al. The differences in drug resistance between drug-resistant tuberculosis patients with and without diabetes mellitus in northeast China: a retrospective study[J]. BMC Infect Dis, 2023, 23(1): 162. doi: 10.1186/s12879-023-08130-1
[5]	杨子龙, 袁园, 汪敏, 等. 糖尿病与肺结核共病结核分枝杆菌耐药情况分析[J]. 实用医学杂志, 2023, 39(11): 1359-1363. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202311007.htm YANG Z L, YUAN Y, WANG M, et al. Drug resistance of Mycobacterium tuberculosis co-occurring with diabetes and tuberculosis[J]. The Journal of Practical Medicine, 2023, 39(11): 1359-1363. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202311007.htm
[6]	张幽蕾, 周笑, 吴灵君, 等. 肺结核患者结核分枝杆菌利福平基因突变特征及耐药情况[J]. 中华全科医学, 2020, 18(12): 2029-2031, 2139. doi: 10.16766/j.cnki.issn.1674-4152.001680 ZHANG Y L, ZHOU X, WU L J, et al. Mutation characteristics and drug resistance of rifampicin gene of Mycobacterium tuberculosis in patients with pulmonary tuberculosis[J]. Chinese Journal of General Practice, 2020, 18(12): 2029-2031, 2139. doi: 10.16766/j.cnki.issn.1674-4152.001680
[7]	中国防痨协会. 耐药结核病化学治疗指南(2019年简版)[J]. 中国防痨杂志, 2019, 41(10): 1025-1073. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202103018.htm Chinese Antituberculosis Association. Guidelines on chemotherapy of drug-resistant tuberculosis (2019 abbreviated version)[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1025-1073. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202103018.htm
[8]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202112018.htm Diabetes Society of Chinese Medical Association. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202112018.htm
[9]	张雅婷, 郝晓刚, 王炜, 等. 衢州市肺结核合并糖尿病病例特征分析[J]. 预防医学, 2023, 35(1): 57-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX202301013.htm ZHANG Y T, HAO X G, WANG W, et al. Characteristics of pulmonary tuberculosis patients complicated by diabetes mellitus in Quzhou City[J]. Preventive Medicine, 2023, 35(1): 57-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX202301013.htm
[10]	李雪, 李楠楠, 任斐, 等. 耐多药肺结核合并糖尿病的临床特点及治疗结局[J]. 中国热带医学, 2021, 21(10): 990-995. https://www.cnki.com.cn/Article/CJFDTOTAL-RDYX202110016.htm LI X, LI N N, REN F, et al. Clinical characteristics and treatment outcome of multidrug-resistant pulmonary tuberculosis complicated with diabetes mellitus[J]. China Tropical Medicine, 2021, 21(10): 990-995. https://www.cnki.com.cn/Article/CJFDTOTAL-RDYX202110016.htm
[11]	李硕兰, 李明武, 李光妹, 等. 中国耐多药肺结核不良治疗转归影响因素的Meta分析[J]. 中国防痨杂志, 2022, 44(12): 1303-1313. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202212010.htm LI S L, LI M W, LI G M, et al. Influencing factors of getting unfavorable treatment outcomes of patients with multidrug-resistant pulmonary tuberculosis in China: a Meta-analysis[J]. Chinese Journal of Antituberculosis, 2022, 44(12): 1303-1313. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202212010.htm
[12]	何萍, 姚华彦, 崔斌, 等. 2013—2020年上海2型糖尿病临床大数据人群结构分析报告[J]. 中国医药科学, 2022, 12(16): 5-7, 12. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202216002.htm HE P, YAO H Y, CUI B, et al. Population structure analysis of clinical big data of type 2 diabetes mellitus in Shanghai from 2013 to 2020[J]. China Medicine And Pharmacy, 2022, 12(16): 5-7, 12. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202216002.htm
[13]	陈建飞, 郭丽丽. 肺结核合并糖尿病继发肺部真菌感染的临床特征与耐药性分析[J]. 北京医学, 2021, 43(9): 927-929. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202109022.htm CHEN J F, GUO L L. Clinical characteristics and drug resistance analysis of pulmonary mycosis secondary to pulmonary tuberculosis and diabetes mellitus[J]. Beijing Medical Journal, 2021, 43(9): 927-929. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202109022.htm
[14]	李朝俊, 孙诚鸿, 金文宇. 非结核分枝杆菌肺病与耐多药肺结核的胸部CT征象对照分析[J]. 临床荟萃, 2021, 36(6): 530-534. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC202106010.htm LI Z J, SUN C H, JIN W Y. Comparation of CT imaging characteristics between non-tuberculous mycobacterium tuberculosis and multi-drug resistant tuberculosis[J]. Clinical Focus, 2021, 36(6): 530-534. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC202106010.htm
[15]	梁瑞云, 方伟军, 任会丽, 等. 耐药肺结核伴空洞患者的CT表现特征分析[J]. 中国防痨杂志, 2021, 43(4): 341-345. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202104008.htm LIANG R Y, FANG W J, REN H L, et al. Analysis of CT features of drug-resistant pulmonary tuberculosis with cavity[J]. Chinese Journal of Antituberculosis, 2021, 43(4): 341-345. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202104008.htm
[16]	汪敏, 袁园, 谭守勇, 等. 2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶和空洞发生的危险因素分析[J]. 中国防痨杂志, 2023, 45(8): 761-767. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202308013.htm WANG M, YUAN Y, TAN S Y, et al. Analysis of risk factors for extensive lung focus and cavities in type 2 diabetes mellitus patients complicated with newly treated pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(8): 761-767. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ202308013.htm
[17]	舒伟强, 李春华, 王惠秋, 等. 2型糖尿病并发肺结核患者血糖水平与CT特征的相关性分析[J]. 中国防痨杂志, 2017, 39(6): 565-569. SHU W Q, LI C H, WANG H Q, et al. The study on the relationship between blood glucose level's and chest CT features in diabetic patients complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2017, 39(6): 565-569.
[18]	SONG Q S, ZHANG G Q, JIANG H B, et al. Imaging features of pulmonary CT in type 2 diabetic patients with multidrug-resistant tuberculosis[J]. PLoS One, 2016, 11(3): e0152507. DOI: 10.1371/journal.pone.0152507.
[19]	黄倩, 刘德亮, 李惠林. 白细胞分化抗原36与2型糖尿病相关性的研究进展[J]. 中华全科医学, 2023, 21(7): 1206-1210. doi: 10.16766/j.cnki.issn.1674-4152.003085 HUANG Q, LIU D L, LI H L. Research progress on correlations between CD36 and type 2 diabetes mellitus[J]. Chinese Journal of General Practice, 2023, 21(7): 1206-1210. doi: 10.16766/j.cnki.issn.1674-4152.003085
[20]	陈秋景, 覃勇民, 罗文昭. 2型糖尿病合并活动性肺结核患者糖化血红蛋白与结核分枝杆菌及利福平耐药检测的相关性分析[J]. 临床内科杂志, 2022, 39(11): 767-768. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202211014.htm CHEN Q J, QIN Y M, LUO W Z. Analysis of correlation between glycosylated hemoglobin and resistance to mycobacterium tuberculosis and rifampicin in type 2 diabetes patients with active pulmonary tuberculosis[J]. Journal of Clinical Internal Medicine, 2022, 39(11): 767-768. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202211014.htm