Evaluation Of CT Application In Prognosis And Follow-up Studies Of TB In Diabetics And Non-diabetic Patients With Positive Smear

Objective:(1)Compare the CT manifestations of smear-positive pulmonary tuberculosis before and after treatment,investigate the progress of CT signs of smear-positive tuberculosis during treatment.(2)Compare the CT manifestations of pulmonary tuberculosis and pulmonary tuberculosis with diabetes mellitus,find the CT characteristics of pulmonary tuberculosis with diabetes mellitus,to improve the diagnosing capability.(3)Compare the CT manifestations of pulmonary tuberculosis with diabetes mellitus before and after treatment,investigate the relationship between blood glucose level and smear negative conversion rates and lesion prognosis.Methods :51patients with pulmonary tuberculosis complicated with diabetes mellitus were collected as TBDM group,and 55 patients with pulmonary tuberculosis only were collected as TB group,patients in both groups were registered to receive treatment at our hospital during the period from July 2013 to September 2015 and had complete clinical materials.Patients in TB group performed CT scan and sputum smear examination before treatment,after 2 months treatment as well as after 6 months treatment;Patients in TBDM group performed CT scan,sputum smear examination and Hb A1 c examination before treatment and after 6 months treatment.The results of CT and sputum smear examination before and after treatment were analyzed and compared between each other.Results:In TB group,before treatment occurrences of tree-in-bud sign,lobular nodules,consolidation shadow with blurred margin,ground-glass opacity,thickened bronchial wall,thickened-wall cavity were 41.8%,89.0%,74.5%,69.0%,41.8% and 50.9% respectively.While after treatment,occurrences of the above signs were 0,12.7%,9.0%,0,21.8% and 5.4% respectively,occurrences of the above signs between before and after treatment were statistically difference.There is no statistically different with lesion locations in two groups.88.2% patients were multiple lobes involved in TBDM group,83.6% patients were multiple lobes involved in TB group,there is no statistically difference in two groups.the frequency of large-scale caseous pneumonia and multiple cavities in consolidation were higher in TBDM group with statistically difference.After glucose control and anti-tuberculous treatment,there were37 patients controlled their glucose well(groupⅠ)while 14 patients controlled their glucose not well(group Ⅱ).The sputum negative conversion rate in group Ⅰ was no statistically different from TB group,while was higher than group Ⅱ with statistically difference.After treatment,observably lesion and cavity absorption in group Ⅰ was higher than group Ⅱ with statistically difference.Conclusion:(1)The changes of CT signs before and after treatment can be used as a criteria to evaluate the curative effect of pulmonary tuberculosis with positive smear,and provide reference for medication choice and subsequent processing.(2)In terms of lesion locations there is no significant different between pulmonary tuberculosis and pulmonary tuberculosis with diabetes mellitus,while large-scale caseous pneumonia and multiple cavities in consolidation were more likely to be observed in patients with pulmonary tuberculosis and diabetes mellitus.(3)The state of glucose control is a vital factor in the process of anti-tuberculous therapy,and the changes of CT signs can be used as a criteria to evaluate the curative effect of patients with pulmonary tuberculosis and diabetes mellitus.