【作者】 孙琳；

【导师】 胡迎芬； 马爱国；

【作者基本信息】 青岛大学 ， 营养与食品卫生学， 2014， 硕士

【摘要】 目的肺结核合并糖尿病(PTB-DM)患者在营养状况及临床治疗等方面有别于单纯肺结核(PTB)患者。本文旨在通过了解住院PTB-DM患者膳食特点及短期临床疗效,为PTB-DM患者的饮食指导及临床诊疗提供参考依据和可行性建议。方法选取某市胸科医院2011年12月至2013年6月间住院的]88例肺结核合并糖尿病患者为PTB-DM组,另选取该院同期住院的188例单纯肺结核患者为PTB组,比较两组膳食多样化评分(DDS)、膳食结构、营养指标及营养相关疾病等方面的差异；比较两组住院治疗2个月间,在临床表现、痰涂片结果、胸部CT表现等方面的差异。结果膳食调查结果显示,PTB-DM组与PTB组DDS得分均大于3分,分布差异无统计学意义(P>0.05)。PTB-DM组蔬菜、禽畜肉类、奶及奶制品的摄入量分别为471.45g、103.76g、126.78g,均高于PTB组的414.75g、89.92g、87.83g(P均<0.05)；两组禽畜肉类摄入量均高于膳食宝塔推荐摄入量(50g-70g)。营养状况分析显示,偏瘦人群在PTB组(18.62%)较PTB-DM组(10.64%)高(χ2=4.792,P<0.05),超重人群在PTB-DM组(29.26%)较PTB组(16.49%)高(χ2=8.684,P<0.05)。TC和TG水平PTB-DM组分别为4.39mmol/L和1.38mmol/L,高于PTB组的3.98mmol/L和1.00mmol/L(t值分别为-3.86、-4.13,P值均<0.05)。高脂血症、高胆固醇血症和高血压患病率PTB-DM组分别为23.4%、19.7%和31.7%,均显著高于PTB组的5.9%、8.5%和19.1%(χ2值分别为23.19、9.69、7.80,P值均<0.05)。入院治疗前,PTB-DM患者痰血比例达32.5%、痰涂片阳性率为76.1%、肺部空洞率为56.4%,均分别高于单纯PTB组的18.6%、68.60%和45.7%(P值均<0.05)。治疗2个月后,PTB-DM组患者咳痰、胸闷症状改善率和痰菌转阴率达到20.9%、56.3%和52.4%,均显著低于PTB组36.8%、74.1%和69.8%(P值均<0.05)。PTB-DM组肺部病变广泛,累及肺叶个数显著高于PTB组(P<0.05),且下肺野结核的发生率高于PTB组(P<0.05)。结论与单纯肺结核相比,PTB-DM患者膳食结构不够合理,在较为普遍的营养状况不良情况下,部分超重人群又存在营养过剩的问题,同时临床表现较重,强化期治疗2个月后疗效较差,故临床上应加强饮食指导,及时调整和强化PTB-DM治疗并适当延长治疗时间。更多还原

【Abstract】 Objective The pulmonary tuberculosis patients with diabetes mellitus (PTB-DM) is different from the pulmonary tuberculosis (PTB) patients in nutritional status and clinical treatment. The objective was to study the characteristics of dietary structure and find out the clinical characteristics of the PTB-DM and provide the diet guidance and the reference basis for their clinical treatment.Methods188inpatients with pulmonary tuberculosis complicated with diabetes mellitus in a Chest Hospital from December2011to June2013were recruited as objects in the study. And188pulmonary tuberculosis inpatients without diabetes mellitus in the same period were selected as the control group. Between the two groups, analyzed and compared the dietary characteristics and the treatment effectiveness in short-term of two months.Results The dietary survey showed that DDS of the two groups are all higher than3. There was no significant statistic difference between the two groups (P>0.05). It was showed that the consumption of vegetables, meat and milk in PTB-DM patients were471.45g,103.76g and126.78g, which were obviously higher than414.75g,89.92g and87.83g in PTB group (P>0.05). The intakes of meat in both two groups were higher than the suggested value (50g-70g) in Dietary Guideline and Balance Diet Pagoda for Chinese Residents. The analyses of Body Mass Index showed that the underweight people is18.62%of PTB group which is higher than10.64%of PTB-DM.(χ2=4.792, P＜0.05). Overweight people had a29.26percentage of PTB-DM group which is higher than10.64%of PTB.(P<0.05).The analyses of nutrition status showed that TC and TG in PTB-DM group were4.39mmol/L and1.67mmol/L which is higher than3.97mmol/L and1.01mmol/L in PTB group (all P<0.05).The incidences of hyperlipidaemia, hypercholesterolemia and hypertension in PTB-DM group were23.4%,19.7%and31.7%respectively, which were all higher than5.9%,8.5%and19.1%in PTB group with significant statistic differences (all P<0.05).The incidences of hemoptysis, positive sputum smear and pulmonary cavity in PTB-DM patients with admitted to hospitals for treatment before were32.5%,76.1%and56.4%, which were significantly higher than18.6%,68.6%and45.7%in the control group (all P＜0.05). After two months, the incidences of expectoration, improvement of chest tightness and sputum smear negative conversion in PTB-DM patients were20.9%,56.3%and52.4%, which were significantly lower than36.8%,74.1%and69.8%(all P＜0.05). The lung lesion in PTB-DM patients were extensive, the number of involved lobe and the incidence of lower lung field tuberculosis were higher than the PTB group (all P<0.05).Conclusion Compared with PTB group, the dietary structure in PTB-DM patients was irrational. Under the circumstances that malnutrition is common; part of the overweight people had an overnutrition problem. The PTB-DM patients’ clinical manifestation are more serious and have less effect after2months intensive treatment. So we should direct rational diet, adjust and enhance the treatment for the PTB-DM patients and extend the treatment time suitably.更多还原