57例糖尿病合并气管支气管结核患者的临床影像和支气管镜下表现

doi:10.19871/j.cnki.xfcrbzz.2023.01.005

摘要/Abstract

摘要： 目的探讨糖尿病合并气管支气管结核（TBTB）的临床影像和支气管镜下表现,为糖尿病合并TBTB的早期诊断提供依据。方法 2020年1月至2021年12月首次在南京市第二医院住院确诊的糖尿病合并初治肺结核患者824例,其中57例经支气管镜检查后确诊为TBTB,收集完整病例资料并对研究对象的人口学特征、临床症状、糖化血红蛋白、胸部CT表现、支气管镜下表现、TBTB病理分型和病原学检查结果进行分析。结果同期住院的糖尿病合并初治肺结核患者中,TBTB检出率6.92%（57/824）。57例糖尿病合并TBTB患者平均年龄（57.5±14.6）岁,男性多于女性（2.8∶1）,男性发病年龄小于女性[（54.9±14.5）岁比（64.7±12.3）岁],性别间年龄差异有统计学意义（P<0.05）。咳嗽（46例,80.7%）是糖尿病合并TBTB患者的主要症状,平均糖化血红蛋白水平（9.18±2.03）%。所有患者胸部CT均可见TBTB直接或间接征象,其中直接征象以管壁增厚（18例,31.6%）和管腔狭窄（20例,35.1%）为主,间接征象以多发结节影（40例,70.2%）和单发或多发空洞（27例,47.4%）为主。糖尿病合并TBTB主要病变部位为左上支气管（22例,38.6%）、右上支气管（23例,40.4%）和右下支气管（18例,31.6%）;侵犯部位≥2个叶段支气管者28例,占比49.1%。病理分型以Ⅳ型（40例,70.2%）为主,混合型38例,占比66.7%。痰液结核病原学阳性26例,支气管肺泡灌洗液结核病原学阳性45例,支气管肺泡灌洗液检查病原学阳性率明显高于痰液（78.9%比45.6%）。结论对于血糖控制不佳,反复咳嗽且胸部CT表现出TBTB直接或间接征象的糖尿病患者,应在早期完善支气管镜检查,并通过联合病原学及病理学检查明确诊断。

关键词: 糖尿病, 气管支气管结核, 支气管镜

Abstract: Objective To explore the clinical, imaging and electronic bronchoscopy manifestations of diabetes mellitus complicated with tracheobronchial tuberculosis, so as to provide clues for the early diagnosis of diabetic TBTB. Method From January 2020 to December 2021, 824 patients with diabetes and first-treat pulmonary tuberculosis were hospitalized in Nanjing Second Hospital, among which 57 were diagnosed with TBTB after electronic bronchoscopy. Demographic characteristics, clinical symptoms, glycosylated hemoglobin, chest CT scan, TBTB pathological typing and etiological examination results were analyzed. Result Among the patients with diabetes and first-treated pulmonary tuberculosis hospitalized during the same period, the detection rate of TBTB was 6.92% (57/824). The average age of the 57 diabetic patients with TBTB was (57.5±14.6) years old, more men than women (2.8:1), and the age of onset in men was lower than that of women [(54.9±14.5)years vs (64.7±12.3)years], and there was a statistically significant difference in age between genders(P<0.05). Cough (46 cases, 80.7%) was the main symptom of diabetic patients with TBTB, and the average glycated hemoglobin level was (9.18±2.03)%. All patients showed direct or indirect signs of TBTB in chest CT images. The direct signs were mainly wall thickening (18 cases, 31.6%) and lumen stenosis (20 cases, 35.1%), and the indirect signs were mainly multiple nodular shadows (40 cases, 70.2%) and cavity shadows (27 cases, 47.4%).The main lesions of diabetes mellitus complicated with TBTB were the left upper bronchus (22 cases, 38.6%), right upper bronchus (23 cases, 40.4%) and right lower bronchus (18 cases, 31.6%), and 28 cases had ≥2 lobe segmental bronchial invasion sites, accounted for 49.1%. The pathological type was mainly type Ⅳ (40 cases, 70.2%) and mixed type (38 cases, 66.7%). Sputum tuberculosis was positive in 26 cases, lavage fluid tuberculosis was positive in 45 cases. The positive rate of lavage fluid was significantly higher than that of sputum (78.9%: 45.6%). Conclusion For diabetic patients with poor blood glucose control, repeated cough and direct or indirect signs of TBTB on chest CT, bronchoscopy should be performed early, and the diagnosis should be confirmed by combined etiological and pathological examination.

Key words: Diabetes, Tracheobronchial tuberculosis, Electronic bronchoscopy

中图分类号:

R58
R523

吴志嵩, 马南兰, 曾谊, 张丞, 王文连. 57例糖尿病合并气管支气管结核患者的临床影像和支气管镜下表现[J]. 新发传染病电子杂志, 2023, 8(1): 26-30.

Wu Zhisong, Ma Nanlan, Zeng Yi, Zhang Cheng, Wang Wenlian. Clinical, imaging and bronchoscopy findings of 57 cases of diabetes mellitus complicated with tracheobronchial tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(1): 26-30.

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