目的 分析糖尿病与非糖尿病患者合并社区获得性肺炎的临床特点.方法 选取2008年1月-2011年5月在某院住院的社区获得性肺炎患者100例,其中糖尿病患者50例(A组),非糖尿病患者50例(B组),对其病历资料进行回顾性分析.结果 A组病程常迁延,平均住院时间为(18.52±4.32)d,较B组(12.64±4.18)d长,两组差异有统计学意义(χ2=6.92,P＜0.01);A组患者肝功能多受损:血清丙氨酸转氨酶(ALT)为(52.26± 15.18)U/L、天门冬氨酸转氨酶(AST)为(48.44±10.25) U/L,显著高于B组的ALT、AST[分别为(40.39± 15.42)U/L、(35.70±9.98)U/L](P＜0.05);A组患者肾功能减退,血尿素氮(BUN)和血清肌酐(SCr)分别为(8.02±2.12)mmol/L、(128.05±21.25)μmol/L,显著高于B组的BUN和SCr[分别为(5.35±1.99)mmol/L、(98.20±20.93)μmol/L](P＜0.05).A组混合感染发生率为26.00%,显著高于B组的10.00%;代谢综合征和大血管并发症发生率分别为28.00%、36.00%,明显高于B组的12.00%、10.00%,差异均有统计学意义(均P＜0.05).A组发展为重症肺炎的比率和病死率分别为 12.00%(6例)、6.00%(3例),B组分别为4.00%(2例)、2.00%(1例).A组痰培养阳性41例(82.00%,41/50),B组痰培养阳性44例(88.00%,44/50),两组检出病原体均以肺炎链球菌(A组16株,B组17株)、肺炎克雷伯菌(A组4株,B组5株)较多.结论 糖尿病合并社区获得性肺炎病程长,病情重,合并症多;控制血糖是治疗的基础,抗感染是关键,改善营养和器官功能状态是重要的环节.%Objective To analyze clinical characteristics of community-acquired pneumonia (CAP)in diabetic and non-diabetic patients. Methods From January 2008 to May 2011 ,100 CAP patients in a hospital were selected, 50 of whom had diabetes (group A) and 50 without diabetes (group B), their clinical data were analyzed. Results The average length of hospital stay in group A was significantly longer than that of group B ([18. 52 ± 4. 32] d vs [12. 64 ±4. 18] d, x2 = 6. 92,P＜0. 01); serum alanine aminotransferase (ALT) and aspartate transaminase (AST) in group A were significantly higher than group B ([52. 26 ± 15. 18] U/L vs [40. 39 ± 15. 42] U/L; [48. 44 ± 10. 25] U/L vs [35. 70 ± 9. 98] U/L, P＜0. 05, respectively); blood urea nitrogen (BUN) and serum creatinine (SCr) in group A were significantly higher than group B ([8. 02 ± 2. 12] mmol/L vs [5. 35 ± 1. 99] mmol/L; [128. 05 ± 21. 25] μmol/L vs [98. 20 ± 20. 93) μmol/L, P ＜0. 05, respectively). Mixed infection rate in group A was significantly higher than group B (26. 00% vs 10. 00%); metabolic syndrome and incidence of macrovascular complications were significantly higher than group B (28. 00% vs 12. 00%; 36. 00% vs 10. 00%, P＜0. 05, respectively). Rate of severe pneumonia and mortality in group A was 12. 00% (6 cases) and 6. 00% (3 cases) respectively,and group B was 4. 00% (2 cases) and 2. 00% (1 case) respectively, sputum culture positive rate in group A and B was 82. 00% (41/50) and 88. 00% (44/50) respectively, Streptococcus pneumoniae (16 isolates in group A and 17 in group B) and Klebsiella pneumoniae (4 isolates in group A and 5 in group B)were common in both groups. Conclusion Diabetic patients with CAP have long disease course, with severe illness and multiple complications, controlling blood glucose is the basis of treatment, anti-infection is the key, and improving nutritional state and organ function is important aspect.
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