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

摘要

目的 分析2型糖尿病并发肺结核(type 2 diabetes mellitus complicated with pulmonary tuberculo-sis,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(x2=18.588,P=0.000)、病灶所占肺野个数(x2=11.808,P=0.001)、肺结核空洞(x2 =16.330,P=0.000)、咯血(x2=8.753,P=0.003)、使用糖皮质激素(x2=10.485,P=0.001)、长期应用抗生素(x2 =4.750,P=0.029)、结核病病程(x2=9.469,P=0.009)、酮症酸中毒(x2=8.414,P=0.004)和体质量指数(x2=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 x2=15.527,P=0.000,OR=4.055 (95％CI:2.021～8.136)]、病灶所占肺野个数[Wald x2=11.938,P=0.001,OR=3.689(95 ％CI:1.759～7.735)]、肺结核空洞[Wald x2 =4.844,P=0.028,OR=0.463(95％CI:0.233～0.919)]、使用糖皮质激素[Wald x2 =7.374,P=0.007,OR=4.765 (95％CI:1.544～14.707)]和酮症酸中毒[Wald x2=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.%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 (x2 =18.588,P=0.000),number of affected lung fields (x2 =11.808,P=0.001),tuberculous cavity (x2 =16.330,P=0.000),hemoptysis (x2 =8.753,P=0.003),glucocorticoids (x2 =10.485,P=0.001),long-term use of antibiotics (x2 =4.750,P=0.029),tuberculosis course (x2 =9.469,P =0.009),ketoacidosis (x2 =8.414,P =0.004),and body mass index (x2 =14.474,P=0.001).Muhivariable analysis of these factors further revealed that age (Wald x2 =15.527,P=0.000,OR=4.055 (95％CI:2.021-8.136)),number of affected lung fields (Wald x2 =11.938,P=0.001,OR=3.689 (95％CI:1.759-7.735)),tuberculous cavity (Waldx2 =4.844,P =0.028,OR =0.463 (95％ CI:0.233-0.919)),glucocorticoids (Wald x2 =7.374,P =0.007,OR =4.765 (95 ％ CI:1.544-14.707)),and ketoacidosis (Wald x2 =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.