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

doi:10.19982/j.issn.1000-6621.20230147

摘要/Abstract

摘要：

目的: 探讨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,为慢性病的治疗管理提供参考。方法: 采用回顾性研究方法,收集2013年1月至2018年1月在广州市胸科医院首次住院的2型糖尿病合并初治菌阳肺结核患者,筛选出符合研究条件的955例患者,通过电子病历和医院信息管理系统采集患者的年龄、性别、糖尿病病程、肺部病灶范围、肺部空洞、糖化血红蛋白、淋巴细胞、中性粒细胞/淋巴细胞比值(NLR)、二甲双胍是否在近3个月连续稳定使用等。分别以肺部广泛病灶(影像学检查证实肺部病灶≥3个肺野)和肺部空洞为因变量,上述其他因素为自变量进行单因素和多因素logistic回归分析。结果: 955例患者中,病灶广泛者753例(78.8%),出现空洞者659例(69.0%)。多因素logistic回归分析结果显示,二甲双胍使用史(OR=0.656,95%CI:0.449~0.957)及淋巴细胞水平高(OR=0.608,95%CI:0.404~0.915)为两病合并时肺部病灶广泛的保护因素,出现空洞(OR=2.094,95%CI:1.498~2.926)、NLR水平高(OR=2.681,95%CI:1.860~3.864)为肺部广泛病灶的危险因素;肺部病灶广泛(OR=1.945,95%CI:1.390~2.719)、糖化血红蛋白水平高(OR=1.206,95%CI:1.078~1.350)及NLR水平高(OR=1.390,95%CI:1.012~1.991)为发生空洞的危险因素。结论: 2型糖尿病合并初治菌阳肺结核患者肺部常出现广泛病灶和空洞,两者互为危险因素。对于2型糖尿病患者,可首选含二甲双胍降糖干预的方案,并积极进行糖化血红蛋白、淋巴细胞及NLR指标的监测和管理,以减轻并发肺结核时的病情。

关键词: 糖尿病, 2型, 结核, 肺, 病灶感染, 因素分析, 统计学

Abstract:

Objective: To explored the risk factors of extensive lung focus and cavities in type 2 diabetes mellitus (T2DM) patients complicated with newly treated pulmonary tuberculosis (PTB), to provide reference for clinical treatment strategies. Methods: Through electronic medical records and hospital information system, 955 T2DM patients complicated with newly diagnosed positive PTB who were hospitalized in Guangzhou Chest Hospital for the first time from January 2013 to January 2018 were collected for a conducted retrospective study. Univariate and multivariate logistic regression analysis was conducted with extensive lung focus (imaging lung lesions ≥3 lung fields) and cavity as dependent variables, and age, gender, diabetes course, glycosylated hemoglobin, lymphocyte (LY), neutrophil ratio (NLR), and whether metformin was used in recent three months as independent variables. Results: Among the 955 patients, 753 (78.8%) had extensive focus and 659 (69.0%) had cavities. The multivariate logistic regression analysis showed that the history of usage of metformin (OR=0.656, 95%CI: 0.449-0.957) and the high level of LY (OR=0.608,95%CI: 0.404-0.915) were protective factors for the extensive focus of both diseases. The occurrence of cavities (OR=2.094, 95%CI: 1.498-2.926) and the high level of NLR (OR=2.681, 95%CI: 1.860-3.864) were risk factors for the extensive focus of both diseases. The extensive focus (OR=1.945, 95%CI: 1.390-2.719) and high level of glycosylated hemoglobin (OR=1.206, 95%CI: 1.078-1.350), the high level of NLR (OR=1.390, 95%CI: 1.012-1.991) were the risk factors for cavitation. Conclusion: When T2DM complicated with PTB, the extensive focus and cavities were common, and both were risk factors for each other. Treatment that includes metformin should be the first choice for T2DM patients, and active monitoring and management of glycated hemoglobin, lymphocyte and NLR indicators should be carried out to alleviate the disease condition when complicated with tuberculosis.

Key words: Diabetes mellitus, type 2, Tuberculosis, pulmonary, Focal infection, Factor analysis, statistical

中图分类号:

R521
R587.1

汪敏, 袁园, 谭守勇, 杨子龙, 冯治宇, 张宏, 吴迪, 陈泽莹, 黄显林, 邝浩斌. 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. doi: 10.19982/j.issn.1000-6621.20230147

Wang Min, Yuan Yuan, Tan Shouyong, Yang Zilong, Feng Zhiyu, Zhang Hong, Wu Di, Chen Zeying, Huang Xianlin, Kuang Haobin. 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. doi: 10.19982/j.issn.1000-6621.20230147

图/表 4

表1

955例2型糖尿病合并初治菌阳肺结核患者临床特征基线的比较

临床特征	肺部病灶					统计检验值	P值		空洞					统计检验值		P值
临床特征	≥3个(753例)		<3个(202例)			统计检验值	P值		有(659例)			无(296例)		统计检验值		P值
年龄(岁, $x ˉ$ ±s)	55.88±12.63		55.52±11.68			t=0.362	0.717		54.98±11.91			57.63±13.36		t=-3.063		0.002
年龄组[例(构成比,%)]
0~29岁	18(2.4)		1(0.5)			χ²=2.043^a	0.153		13(2.0)			6(2.0)		χ²=0.003		0.956
30~49岁	209(27.7)		61(30.2)			χ²=0.469	0.494		198(30.0)			72(24.3)		χ²=3.297		0.069
50~64岁	353(46.9)		97(48.0)			χ²=0.083	0.773		314(47.7)			136(46.0)		χ²=0.237		0.626
≥65岁	173(23.0)		43(21.3)			χ²=0.259	0.611		134(20.3)			82(27.7)		χ²=6.337		0.012
性别[例(构成比,%)]						χ²=0.051	0.821							χ²=1.390		0.238
男性	606(80.5)		164(81.2)						538(81.6)			232(78.4)
女性	147(19.5)		38(18.8)						121(18.4)			64(21.6)
糖尿病病程[年,M(Q₁,Q₃)]	1.00(0.00,6.00)		1.00(0.00,6.00)			Z=-0.463	0.643		1.00(0.00,6.00)			1.00(0.00,6.00)		Z=-1.707		0.088
糖尿病病程分组[例(构成比,%)]
<2年	384(51.0)		106(52.5)			χ²=0.139	0.709		350(53.1)			140(47.3)		χ²=2.763		0.096
2~3年	87(11.5)		27(13.4)			χ²=0.498	0.480		76(11.5)			38(12.8)		χ²=0.331		0.565
4~5年	78(10.4)		15(7.4)			χ²=1.559	0.212		62(9.4)			31(10.5)		χ²=0.263		0.608
≥6年	204(27.1)		54(26.7)			χ²=0.010	0.919		171(26.0)			87(29.4)		χ²=1.228		0.268
淋巴细胞计数[×10⁹个/L,M(Q₁,Q₃)]	1.26(0.89,1.63)		1.56(1.14,1.95)			Z=-5.928	0.000		1.35(0.93,1.70)			1.26(0.93,1.75)		Z=-0.204		0.838
淋巴细胞水平[例(构成比,%)]						χ²=21.588	0.000							χ²=1.625		0.202
<1.1×10⁹个/L	301(40.0)		45(22.3)						230(34.9)			116(39.2)
≥1.1×10⁹个/L	452(60.0)		157(77.7)						429(65.1)			180(60.8)
NLR值[M(Q₁,Q₃)]	4.98(3.36,7.84)		3.19(2.30,4.94)			Z=-8.251	0.000		4.7(3.13,7.04)			4.46(2.67,7.44)		Z=-1.060		0.289
NLR水平[例(构成比,%)]						χ²=55.219	0.000							χ²=7.211		0.007
≥3.13	589(78.2)		105(52.0)						496(75.3)			198(66.9)
<3.13	164(21.8)		97(48.0)						163(24.7)			98(33.1)
糖化血红蛋白值[%,M(Q₁,Q₃)]	9.38(7.6,11.82)		8.94(7.43,11.23)			Z=-1.734	0.083		9.52(7.98,11.84)			8.61(7.06,11.00)		Z=-4.506		0.000
糖化血红蛋白水平[例(构成比,%)]
<7%	118(15.7)		36(17.8)			χ²=0.545	0.460		85(12.9)			69(23.3)		χ²=16.373		0.000
7%~<9%	215(28.5)		67(33.2)			χ²=1.631	0.202		190(28.8)			92(31.1)		χ²=0.497		0.481
9%~<11%	171(22.7)		47(23.2)			χ²=0.028	0.867		157(23.8)			61(20.6)		χ²=1.199		0.274
11%~<13%	127(16.9)		24(11.9)			χ²=2.973	0.085		118(17.9)			33(11.1)		χ²=7.006		0.008
≥13%	122(16.2)		28(13.9)			χ²=0.659	0.417		109(16.6)			41(13.9)		χ²=1.115		0.291
二甲双胍方案[例(构成比,%)]						χ²=4.035	0.045							χ²=4.273		0.039
是	152(20.2)		54(26.7)						130(19.7)			76(25.7)
否	601(79.8)		148(73.3)						529(80.3)			220(74.3)
病灶所占肺野数[例(构成比,%)]													χ²=23.661		0.000
<3个		-		-	-			-		111(16.8)	91(30.7)
≥3个		-		-	-			-		548(83.2)	205(69.3)
空洞[例(构成比,%)]					χ²=23.661			0.000
有		548(72.8)		111(55.0)						-	-		-		-
无		205(27.2)		91(45.0)						-	-		-		-

表1

表2

表3

影响2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
使用二甲双胍	-0.422	0.193	4.795	0.029	0.656(0.449~0.957)
出现空洞	0.739	0.171	18.725	0.000	2.094(1.498~2.926)
淋巴细胞水平高	-0.497	0.208	5.705	0.017	0.608(0.404~0.915)
NLR水平高	0.986	0.186	27.975	0.000	2.681(1.860~3.864)

表3

表4

影响2型糖尿病合并初治菌阳肺结核患者发生空洞的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
肺部病灶广泛	0.665	0.171	15.134	0.000	1.945(1.390~2.719)
NLR水平高	0.330	0.162	4.126	0.042	1.390(1.012~1.991)
糖化血红蛋白水平高	0.188	0.057	10.662	0.001	1.206(1.078~1.350)

表4

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