CAJ | 학술논문

目的：对胰岛素泵、胰岛素皮下注射与口服降糖药三种方法治疗糖尿病合并肺结核进行近期疗效观察,为患者选择经济、方便、有效的控制血糖方法提供依据。方法92例糖尿病合并初治肺结核患者被随机分为胰岛素泵组、胰岛素注射组和口服降糖药组。胰岛素泵组采用胰岛素泵入治疗,胰岛素皮下注射治疗组每日早、晚餐前2次皮下注射治疗；口服降糖药组采用阿卡波糖联合二甲双胍缓释片治疗。结核病治疗方案均为HREZ。观察3组控制血糖达标时间、临床症状、痰菌阴转及肺部病灶吸收好转情况。结果使用胰岛素泵组血糖达标(平均4d),胰岛素注射组血糖达标(平均7．5d),口服降糖药组血糖达标(平均15d),其中有20例未达标,第一组与第二组、第二组与第三组比较差异有统计学意义(P<0．05)。胰岛素泵组痰菌转阴快,治疗4周时达83．3%,胰岛素注射组转阴率为42．1%,2组差异有统计学意义(=6．68,P<0．05)。胰岛素注射组与口服降糖药痰菌阴转率(22．2%)比较,差异有统计学意义(=8．3,P<0．05)。前两组患者治疗后临床症状好转,胸CT显示肺部病灶吸收情况(治疗4周后)差异无统计学意义(=0．097,P>0．05)；但与口服降糖药比较,差异有统计学意义(=6．67,P<0．05)。结论糖尿病合并肺结核使用胰岛素泵治疗时,血糖控制达标快,肺结核痰菌阴转快,但胰岛素泵价格、耗材昂贵；而口服降糖药无论是血糖达标、临床症状好转、病灶吸收等情况均与胰岛素泵组和胰岛素皮下注射组比较相差甚远,而胰岛素皮下注射,经济、方便、能较快控制血糖,肺结核痰菌阴转、临床症状好转、肺部病灶吸收均较快。建议糖尿病合并肺结核首选外源胰岛素皮下注射治疗控制血糖。
목적：대이도소빙、이도소피하주사여구복강당약삼충방법치료당뇨병합병폐결핵진행근기료효관찰,위환자선택경제、방편、유효적공제혈당방법제공의거。방법92례당뇨병합병초치폐결핵환자피수궤분위이도소빙조、이도소주사조화구복강당약조。이도소빙조채용이도소빙입치료,이도소피하주사치료조매일조、만찬전2차피하주사치료；구복강당약조채용아잡파당연합이갑쌍고완석편치료。결핵병치료방안균위HREZ。관찰3조공제혈당체표시간、림상증상、담균음전급폐부병조흡수호전정황。결과사용이도소빙조혈당체표(평균4d),이도소주사조혈당체표(평균7．5d),구복강당약조혈당체표(평균15d),기중유20례미체표,제일조여제이조、제이조여제삼조비교차이유통계학의의(P<0．05)。이도소빙조담균전음쾌,치료4주시체83．3%,이도소주사조전음솔위42．1%,2조차이유통계학의의(=6．68,P<0．05)。이도소주사조여구복강당약담균음전솔(22．2%)비교,차이유통계학의의(=8．3,P<0．05)。전량조환자치료후림상증상호전,흉CT현시폐부병조흡수정황(치료4주후)차이무통계학의의(=0．097,P>0．05)；단여구복강당약비교,차이유통계학의의(=6．67,P<0．05)。결론당뇨병합병폐결핵사용이도소빙치료시,혈당공제체표쾌,폐결핵담균음전쾌,단이도소빙개격、모재앙귀；이구복강당약무론시혈당체표、림상증상호전、병조흡수등정황균여이도소빙조화이도소피하주사조비교상차심원,이이도소피하주사,경제、방편、능교쾌공제혈당,폐결핵담균음전、림상증상호전、폐부병조흡수균교쾌。건의당뇨병합병폐결핵수선외원이도소피하주사치료공제혈당。
Objective Observe the efficacy of Diabetes Mellitus patients complicated with pulmonary tuberculosis treated by insulin pump, insulin subcutaneous injection and oral hypoglycemic respectively, giving patients and clinic economical, convenient and effective reference views. Methods A short-term(4 weeks), randomized, controlled study was conducted. 92 cases of DM complicated with PTB patients were divided randomly into insulin pump group,treated by insulin pump, insulin subcutaneous injec-tion group, treated by insulin subcutaneous injection twice a day before breakfast and supper,and oral hypoglycemic group, treated by having acarbose combined with metformin release tablets. Observe the time of achieving normal blood glucose, clinical symptoms, the rates of sputum native conversion and the shrink of lung focus. Results In the insulin pump group, the blood glucose achieved to normal in an average of 4 days. In insulin subcutaneous injection group, the blood glucose achieved to normal in an average of 7. 5 days. And the oral hypoglycemic group achieved normal blood glucose in an average of 15 days, among this group,20 cases didn't a-chieve the normal level. The difference was statistically significant(P<0. 05;P<0. 05). The time of sputum negative conversion is fast in the insulin pump group, up to 33. 3% at the fourth week of treatment. There were 42. 1% of patients in the insulin subcutane-ous injection group who achieved sputum negative conversion. There was significant difference between two groups which has statisti-cally significance( =6. 68, P<0. 05). And the rates of sputum negative conversion in insulin subcutaneous injection and oral hy-poglycemic group(22. 2%)have statistically significance( =8. 3, P<0. 05). After the treatment,the clinical symptoms of former two groups is improved, and the lung focus shrinking on chest CT( after 4 weeks of treatment) have no statistically significance( =0. 097,P>0. 05). However compared with the oral hypoglycemic group,the difference was statistically significant( =6. 67, P<0. 05 ) . Conclusion When using insulin pump to cure Diabetes Mellitus patients complicated with pulmonary tuberculosis, the speed of achieving normal blood glucose and sputum negative conversion is very fast, however, the price of insulin pump and consumables is high. And from blood glucose, clinical symptoms improved, focus absorption, and etc. , the efficacy of oral hypoglycemic group is far cry from the previous two groups. The insulin subcutaneous injection is not only convenient and affordable but also can it achieve normal blood glucose and sputum negative conversion, improve clinical symptoms and make the lung focus shrink. So when treat the Diabetes Mellitus patients complicated with pulmonary tuberculosis, the insulin subcutaneous injection can become the first choice.