2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析

doi:10.3969/j.issn.1000-6621.2017.12.007

中国防痨杂志 ›› 2017, Vol. 39 ›› Issue (12): 1286-1290.doi: 10.3969/j.issn.1000-6621.2017.12.007

2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析

王孝微, 骆宝建, 张楠, 刘秋月, 康万里, 李琦, 陈效友

101149 首都医科大学附属北京胸科医院重症医学科(王孝微、骆宝建、张楠、刘秋月),流行病研究室(康万里),结核三科(李琦、陈效友)

收稿日期:2017-11-16 修回日期:2018-01-10 出版日期:2017-12-10 发布日期:2018-01-11
通信作者: 骆宝建,Email: lbjttgf@sina.com
基金资助:
北京市医院管理局“登峰”计划(DFL20151501)

Risk factors of respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis

WANG Xiao-wei, LUO Bao-jian, ZHANG Nan, LIU Qiu-yue, KANG Wan-li, LI Qi, CHEN Xiao-you

Department of Intensive Care Unit,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China

Received:2017-11-16 Revised:2018-01-10 Online:2017-12-10 Published:2018-01-11
Contact: LUO Bao-jian, Email: lbjttgf@sina.com

摘要/Abstract

摘要： 目的分析2型糖尿病并发肺结核(type 2 diabetes mellitus complicated with pulmonary tuberculosis,T2DM-PTB)患者发生呼吸衰竭的危险因素,为临床治疗提供参考依据。方法回顾性分析2012年1月至2015年12月期间北京胸科医院住院的200例T2DM-PTB患者,其中100例发生呼吸衰竭者为A组;100例未发生呼吸衰竭者为B组。收集两组患者的临床资料;采用logistic回归分析筛选危险因素。结果对A、B两组患者的临床资料进行单因素分析发现,年龄(χ²=18.588,P=0.000)、病灶所占肺野个数(χ²=11.808,P=0.001)、肺结核空洞(χ²=16.330,P=0.000)、咯血(χ²=8.753,P=0.003)、使用糖皮质激素(χ²=10.485,P=0.001)、长期应用抗生素(χ²=4.750,P=0.029)、结核病病程(χ²=9.469,P=0.009)、酮症酸中毒(χ²=8.414,P=0.004)和体质量指数(χ²=14.474,P=0.001)差异有统计学意义。对这些因素进一步行多因素分析显示,年龄[Wald χ²=15.527,P=0.000,OR=4.055(95%CI:2.021～8.136)]、病灶所占肺野个数[Wald χ²=11.938,P=0.001,OR=3.689(95%CI:1.759～7.735)]、肺结核空洞[Wald χ²=4.844,P=0.028,OR=0.463(95%CI:0.233～0.919)]、使用糖皮质激素[Wald χ²=7.374,P=0.007,OR=4.765(95%CI:1.544～14.707)]和酮症酸中毒[Wald χ²=6.077,P=0.014,OR=4.859(95%CI:1.383～17.079)]为T2DM-PTB患者发生呼吸衰竭的危险因素。结论本研究发现年龄、病灶所占肺野个数、结核空洞、使用糖皮质激素和酮症酸中毒为T2DM-PTB患者发生呼吸衰竭的重要危险因素。

关键词: 糖尿病,2型, 结核,肺, 共病现象, 呼吸功能不全, 危险因素

Abstract: Objective To analyze the risk factors of respiratory failure in patients with type 2 diabetes mellitus complicated with pulmonary tuberculosis, so as to provide reference for clinical treatment. Methods A total of 200 cases of pulmonary tuberculosis cases in Beijing Chest Hospital from January 2012 to December 2015 were retrospectively investigated and divided into two groups. Group A: 100 cases of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis, with respiratory failure; group B: 100 cases of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis, without respiratory failure. The clinical data of all patients was collected. Logistic regression analysis was used to screen risk factors. Results The clinical data of group A and group B was analyzed by single factor analysis. Significant statistical difference was found in age (χ²=18.588,P=0.000),number of affected lung fields (χ²=11.808,P=0.001),tuberculous cavity (χ²=16.330,P=0.000), hemoptysis (χ²=8.753,P=0.003), glucocorticoids (χ²=10.485,P=0.001), long-term use of antibiotics (χ²=4.750,P=0.029),tuberculosis course (χ²=9.469,P=0.009), ketoacidosis (χ²=8.414,P=0.004), and body mass index (χ²=14.474,P=0.001). Multivariable analysis of these factors further revealed that age (Wald χ²=15.527,P=0.000,OR=4.055 (95%CI:2.021-8.136)), number of affected lung fields (Wald χ²=11.938,P=0.001,OR=3.689 (95%CI:1.759-7.735)), tuberculous cavity (Wald χ²=4.844,P=0.028,OR=0.463 (95%CI:0.233-0.919)), glucocorticoids (Wald χ²=7.374,P=0.007,OR=4.765 (95%CI:1.544-14.707)),and ketoacidosis (Wald χ²=6.077,P=0.014,OR=4.859 (95%CI:1.383-17.079)), the Results had a significant statistical difference. Conclusion The results indicated that age, number of affected lung fields, tuberculous cavity, glucocorticoids application and ketoacidosis were important risk factors that led to respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis.

Key words: Diabetes mellitus, type 2, Tuberculosis, pulmonary, Comorbidity, Respiratory insufficiency, Risk factors

王孝微, 骆宝建, 张楠, 刘秋月, 康万里, 李琦, 陈效友. 2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析[J]. 中国防痨杂志, 2017, 39(12): 1286-1290. doi: 10.3969/j.issn.1000-6621.2017.12.007

WANG Xiao-wei, LUO Bao-jian, ZHANG Nan, LIU Qiu-yue, KANG Wan-li, LI Qi, CHEN Xiao-you. Risk factors of respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2017, 39(12): 1286-1290. doi: 10.3969/j.issn.1000-6621.2017.12.007

参考文献

[1] World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization,2017.

[2] International Diabetes Federation. Diabetes Atlas, 7th ed. Brussels: International Diabetes Federation, 2015.

[3] Lin Y,Innes A,Xu L, et al.Screening of patients with Diabetes Mellitus for Tuberculosis in Community Health Settings in China. Trop Med Int Health, 2015, 20(8): 1073-1080.

[4] 王倪,马艳,杜建,等. 涂阳肺结核患者并发糖尿病对疗效和治疗转归的影响因素研究. 中国防痨杂志, 2016, 38(10): 843-849.

[5] 王燕森, 赵延吉, 万康林, 等. 糖尿病合并初治涂阳肺结核患者痰菌阴转的影响因素研究. 中国防痨杂志, 2015, 37(12): 1236-1239.

[6] Penner C, Roberts D, Kunimoto D, et al. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med, 1995, 151(3 Pt 1): 867-872.

[7] 张洁, 赵天佐, 康澍, 等. 糖尿病合并肺结核的CT影像分析. 中国辐射卫生, 2016, 25(2): 248-250.

[8] Dooley KE, Tang T, Golub JE, et al. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg, 2009, 80(4): 634-639.

[9] Viswanathan V, KumPatla S, Aravindalochanan V, et al. Prevalence of Diabetes and Pre-Diabetes and Associated Risk Factors among Tuberculosis patients in India. PLoS One, 2012, 7(7): e41367.

[10] Zhao W, Shi L, Fonseca VA, et al. Screening patients with Type 2 diabetes for active tuberculosis in communities of China. Diabetes Care, 2013, 36(9): e159-160.

[11] Jeon CY, Harries AD, Baker MA, et al. Bi-directional scree-ning for tuberculosis and diabetes: a systematic review. Trop Med Int Health, 2010, 15(11): 1300-1314.

[12] 胡东生, 顾东风. 我国成年人群2型糖尿病的流行病学研究. 北京:中国协和医科大学,2007.

[1]	梁瑞云, 方伟军, 任会丽, 黎惠如, 张晖. 非结核分枝杆菌肺病并发与未并发糖尿病患者的CT征象研究[J]. 中国防痨杂志, 2020, 42(9): 962-967.
[2]	鲍锐, 刘晓阳, 任鹏, 张峰, 梁海燕, 王茹, 付玲, 甘地守. 脊柱结核并发HIV感染患者手术治疗特点分析[J]. 中国防痨杂志, 2020, 42(6): 645-648.
[3]	李邦银, 蒲育, 何敏, 何磊, 环明苍, 蔡玉郭, 刘林, 蒋曦. HIV检测阳性脊柱结核患者的临床特征及强化围手术期管理的效果分析[J]. 中国防痨杂志, 2020, 42(5): 449-453.
[4]	何敏, 蒲育, 蔡玉郭, 李邦银, 何磊, 环明苍. 23例脊柱结核并发艾滋病患者的手术疗效观察[J]. 中国防痨杂志, 2020, 42(5): 454-458.
[5]	秦楠,徐春泽,关颖,路丽苹,王伟炳,姜永根. 上海市松江城区结核病登记死亡患者特征及影响因素分析[J]. 中国防痨杂志, 2020, 42(4): 345-352.
[6]	张兴,王凤鸣,吕旭峰,华天齐,张学军,蒋靖怡,丁陈丽,朱伟,夏国栋,吉俊敏,赵飞. HIV感染/AIDS者结核感染的影响因素分析[J]. 中国防痨杂志, 2020, 42(4): 360-365.
[7]	尤媛媛,张国龙,陈裕. 120例初治耐多药肺结核患者治疗依从性的影响因素分析[J]. 中国防痨杂志, 2020, 42(3): 249-254.
[8]	李志明,俞珊,王涛. 柴竹石膏汤对29例反复发热结核病并发其他感染患者的疗效分析[J]. 中国防痨杂志, 2020, 42(2): 121-125.
[9]	马进宝, 马婷婷, 任斐, 杨翰, 谭淦纹. 涂阳肺结核患者γ-干扰素释放试验假阴性的影响因素分析[J]. 中国防痨杂志, 2020, 42(12): 1299-1304.
[10]	吕和, 王政, 王婷, 闫雅更, 董凤丽, 杨晓巍, 张琳, 郭晓微, 王红梅, 徐欢. 非活动性肺结核并发慢性阻塞性肺疾病患者营养状况及营养风险分析[J]. 中国防痨杂志, 2020, 42(12): 1310-1312.
[11]	梁建琴, 白雪娟, 王金河, 陈志, 郭东霖, 吴雪琼. 肺结核并发糖尿病患者临床特征及淋巴细胞亚群检测结果分析[J]. 中国防痨杂志, 2020, 42(10): 1075-1079.
[12]	石倩, 陈志. 风湿性疾病并发肺结核患者的三种免疫学指标检测结果分析[J]. 中国防痨杂志, 2020, 42(10): 1087-1091.
[13]	卢亦波,周静如,莫移美,宋树林. 艾滋病并发颈部淋巴结结核的临床特征及CT表现[J]. 中国防痨杂志, 2020, 42(1): 31-37.
[14]	高颖,王琳,陈丽娜. 颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的影响因素分析[J]. 中国防痨杂志, 2019, 41(8): 857-862.
[15]	吴青青,宋丽君,章琳. 每日唤醒执行量表在机械通气镇静肺结核患者中的临床应用[J]. 中国防痨杂志, 2019, 41(8): 863-868.

2型糖尿病并发肺结核患者发生呼吸衰竭的危险因素分析

Risk factors of respiratory failure in type 2 diabetes mellitus patients complicated with pulmonary tuberculosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

友情链接