| BackgroundPulmonary tuberculosis is a pulmonary infection caused by Mycobacterium tuberculosis(MTB).According to epidemiological reports released in recent years,the amount of new pulmonary tuberculosis patients and the mortality both increased,and the issue severely threatens health of people all over the world.The 2015 World Health Organization(WHO)reported,which around 9.6 million new patients diagnosed pulmonary tuberculosis cases world wide in 2014,nearly 500,000 cases higher than that of 2013;at the same time,the death toll reached 1.5 million,while 940,000 new cases of pulmonary tuberculosis patients in China,and the issue severely threatens health of people all over the world.With economic development,growth in the living standard and dietary structure changed,the occurrence rate of diabetes in China increased year by year and tops the list in Asia.Therefore,the prevalence rate of patients with pulmonary tuberculosis and diabetes mellitus is significantly higher,and these patients discovered keeps increasing.However,the clinical symptoms and imaging findings of pulmonary tuberculosis patients with diabetes mellitus are atypical,and the prognosis of patients is poorer than those with simple pulmonary tuberculosis.Tuberculosis infected T-cells spot test(T-SPOT.TB)presents favorable specificity and sensitivity for diagnosis of pulmonary tuberculosis.However,findings about the diagnostic value for pulmonary tuberculosis with diabetes mellitus patients are different.Under these background,it is necessary to find out the early diagnosis of mycobacterium tuberculosis infection with the clinical symptoms and imaging findings of pulmonary tuberculosis with diabetes mellitus.ObjectiveThe study aims at discussing differences of clinical manifestations,imaging findings,lab findings between pulmonary tuberculosis with diabetes mellitus patients and pure pulmonary tuberculosis patients,exploring the diagnostic value of T-SPOT.TB for pulmonary tuberculosis with diabetes mellitus patients,and providing clinical basis for the diagnosis and differential diagnosis of these patients.MaterialsA total of 205 pure PTB patients and 304 PTB-DM patients,who were admitted to the Henan Provincial Chest Hospital from February 2016 to January 2018,were enrolled as the control group(104 males and 65 females;average age of 56.22±9.55)and the experimental group(196 males and 108 females;average age of 56.60±9.02)respectively.Detailed records of all patients'clinical data:1.clinical symptoms of the patient upon admission,including cough,fever,chest distress,hemoptysis,night sweats,wasting and so on,and the history of tobacco and alcohol,nutritional status,old history of tuberculosis,et al;2.lab test indexes,such as white blood count(WBC),platelet count(PLT),hemoglobin(HGB),erythrocyte sedimentation rate(ESR)and serum albumin(ALB)and other indexes;3.bacteriological test(mycobacterium tuberculosis culture and drug sensitivity)results and routine phlegm culture results;4.main imaging findings of all patients.All patients collected 5ml peripheral venous blood at early morning fasting to take the T-SPOT.TB within 24 hours after admission.All experimental data were analyzed with SPSS 22.0 software.Chi-square test was used for analysis of clinical symptoms,lab test results,bacteriological test results,and imaging findings between the two groups;dual logistic regression analysis was adopted for analysis of smoking factors,alcohol consumption history,tuberculosis history and nutritional status between the two groups;and chi-square test was applied for analysis of peripheral blood T-SPOT.TB results.When P<0.05,the difference is statistically significant.Results1.For comparison of clinical symptoms,the experiment group had significantly higher occurrences of night sweat(?~2=8.528,P=0.014),hemoptysis(?~2=6.093,P=0.048)and emaciation(?~2=6.930,P=0.031)than the control group.The two groups had no statistically significant difference of cough,expectoration,chest distress,fever,chest pain and asymptomatic condition(P>0.05).2.With respect to imaging finding results,the experiment group has a statistically higher rate of cavity shadow than the control group(62.8%vs.36.1%;?~2=37.999,P<0.001).3.Comparing the lab test results,the ALB reduction rate was significantly higher in the experiment group(51.3%)than in the control group(38.5%)(?~2=8.517,P=0.014),while there was no statistically significant difference of WBC,HGB,PLT and ESR results between the experiment group and the control group(P>0.05).4.Regarding phlegm mycobacterium tuberculosis culture and drug sensitivity test results,the probability of multi-drug resistant tuberculosis(MDR-TB)in the experiment(9.2%)was statistically higher than that of the control group(4.4%)(?~2=4.220,P=0.040).Based on routine phlegm culture results,the probability of accompanied fungal infection was significantly higher in the experiment group than in the control group(4.3%vs.0.0%;?~2=8.996,P=0.001).5.It was suggested by multiple-factor analysis that smoking history and alcohol consumption history were both independent risk factors for PTB-DM(P<0.05).6.In view of T-SPOT.TB result analysis,the positive rate was significantly lower in the experiment group and in the control group(64.5%vs.76.6%;?~2=8.450,P=0.004).Conclusion1.Comparing with pure PTB patients,PTB-DM patients are more inclined to hemoptysis,night sweat,emaciation and hypoproteinemia,have pulmonary foci with higher severity,and have higher rates of MDR-TB and fungal infection.2.Smoking and alcohol consumption are risk factors for PTB-DM.The history of alcohol and tobacco patients with diabetes,should pay attention to the occurrence of PTB-DM.3.The positive rate at T-SPOT.TB of pulmonary tuberculosis with diabetes mellitus was lower than that of simple tuberculosis.Relying on T-SPOT.TB test result,pulmonary tuberculosis with diabetes mellitus patients might be misdiagnosed. |
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