| Tuberculosis is a chronic consumptive,infectious disease,and seriouslyharms human health.The number of tuberculosis(TB)in our country ranks to the second in the world,and only next to India.The fourth tuberculosis epidemiological survey showed that the number of people infected with TB bacteria is about 550 million in our country.There are about 1.5 million of contagious tuberculosis patients,in which there are about 140000 multi-drug resistant patients,and accounts for one-third of the total global resistance.The fifth tuberculosis epidemiological survey showed that the number of tuberculosis in our country is about 1.3 million every year,and accounts for 14.3% of the global disease.With the increasing of global human immunodeficiency virus(HIV)infection,The number of cases of HIV with pulmonary tuberculosis is significantly increasing;The WHO data shows that there is 12% of HIV infected people died due to pulmonary tuberculosis every year in the world.The number of newly infected patients with both HIV and TB is about 63 million every year.Diabetes is a group of metabolic diseases characterized by hyperglycemia.According to the survey of the international diabetes federation in 2013,the total number of diabetes patients in the world reached 382 million.However,the number of the prevalence of diabetes in China ranked to first,and about 98.4 million diabetic patients.It is supposed that the number of diabetes will reach 143 million in 2035.Because the sugar metabolic disorders affect protein and fat metabolism which leads to decline in immune function of organism,and easily complicated by a variety of infections.Foreign research data shows that the pulmonary morbidity of patients with diabetes is 4~8 times higher than ones without diabetes.Diabetes is independent risk factors for pulmonary tuberculosis.In our country the morbidity of pulmonary tuberculosis in patients with diabetes is 3-10 times higher than ones without diabetes.To sum up,the number of pulmonarytuberculosis patients still ranks among the world in our country,HIV infection can induce Mycobacterium tuberculosis activity,which can easily merge with tuberculosis.Diabetes,asa non-infectious disease,is an independent risk factor for TB infection.However,most of the studies on the clinical features,imaging manifestations and auxiliary examination features of type 2 diabetes mellitus with pulmonary tuberculosis and HIV with pulmonary tuberculosis come from abroad,especially in Africa,and most of the studies lack information about the population in China,especially about the double infection of HIV and tuberculosis.Purpose:The purpose of this article is to investigate the difference between type 2 diabetes mellitus with pulmonary tuberculosis or HIV with pulmonary tuberculosis and pure tuberculosis patients on clinical manifestations,imaging characteristics and the related auxiliary examinations of the similarities,and research their features to obtain the regularities.It is helpful to early diagnosis and timely accurate treatment.The innovation of the article is to compare HIV with pulmonary tuberculosis and type 2 diabetes mellitus with pulmonary tuberculosis and pure tuberculosis.It also discusses the clinical application value of the early rapid detection method of GeneXpert MTB,especially for the role and significance of HIV or type 2 diabetes mellitus complicated with pulmonary tuberculosis.Materials and Methods:22 HIV patients with pulmonary tuberculosis retrospectively are selected sequentially in Dalian tuberculosis hospital from June 2013 to August 2015.Meanwhile,22 type 2 diabetes mellituspatients with pulmonary tuberculosis are selected randomly,and 22 pulmonarytuberculosis patients.The patients' clinical manifestation,physical examination and auxiliary examination information are collected to analysis.The object of study is accordance with diagnostic criteria of pulmonary tuberculosis,type 2 diabetes mellitus and HIV diagnostic criteria,without other underlying diseases such as coronary heart disease,high blood pressure,heart failure and other lung diseases,and so on.Results:1.Basic features: Pure pulmonary tuberculosis group includes 13 male patients and 9 female patients.The average age of patients is 40.27 years old(18 years old-62 years old);Type 2 diabetes mellitus with pulmonary tuberculosis group includes 18 male patients and 4 female patients.The average age of patients is 54.14 years old(25years old-77 years old);HIV with pulmonary tuberculosis group is all males patients,The average age of patients is 38.41 years old(24 years old – 61 years old).Diabetes mellitus amalgamative pulmonary tuberculosis patients' average age is higher than pure pulmonary tuberculosis group(p=0.01,p is probability),and HIV with pulmonary tuberculosis group(p=0.00).There is no statistical difference about the average age of patients in pulmonary tuberculosis group and HIV with pulmonary tuberculosis group(p=0.615),Three groups of gender exist significant difference(p = 0.001).2.Clinical features: The ratio of pure pulmonary tuberculosis group with haemoptysis,chest pain and lung rale is higher than that of diabetes mellitus with pulmonary tuberculosis group(p<0.05).The positive rate of Sputum smear acid bacillus and GeneXpert MTB on Auxiliary examination of diabetes mellitus with pulmonary tuberculosis group is significantly higher than that of the pure pulmonary tuberculosis group(p<0.05).The research shows that it is no difference between the two groups of lung CT features(p<0.05).The prevalence of fatigue aspect in pure pulmonary tuberculosis group is higher than that of the HIV amalgamative pulmonary tuberculosis group(p<0.05),the rate of fever in HIV amalgamative pulmonary tuberculosis is higher than that of pure pulmonary tuberculosis group(p<0.05).the ratio of ymph node enlargement in imaging of HIV amalgamative pulmonary tuberculosis group is that of higher than pure pulmonary tuberculosis group(p<0.05).The prevalence of fatigue in diabetes mellitus amalgamative pulmonary tuberculosis group is higher than HIV amalgamative pulmonary tuberculosis group(p<0.05).The rate of fever in HIV amalgamative pulmonary tuberculosis is higher than that of diabetes mellitus with pulmonary tuberculosis group(p<0.05).The ratio of empty shadow in imaging of diabetes mellitus amalgamative pulmonary tuberculosis groups is higher than that of HIV amalgamative pulmonary tuberculosis group(p<0.05).The rate of lymph node enlargement in HIV amalgamative pulmonary tuberculosis group is higher than that of diabetes mellitus amalgamative pulmonary tuberculosis group(p<0.05).Positive rate of LAM – Ab in auxiliary examination of diabetes mellitus amalgamative pulmonary tuberculosis group is higher than that of HIV amalgamative pulmonary tuberculosis group(p<0.05).PaCO2 in HIV amalgamative pulmonary tuberculosis group is lower than that of diabetes mellitus with pulmonary tuberculosis group(p<0.05).erythrocyte number and Hemoglobin values in HIV with pulmonary tuberculosis group are lower than those ofdiabetes mellituswith pulmonary tuberculosis group(p<0.05).Conclusion:1.The rate of fever and the lymph node enlargement of CT imaging in HIV amalgamative pulmonary tuberculosis group are higher than those in between pure pulmonary tuberculosis group and diabetes mellitus with pulmonary tuberculosis group;The red blood cells and hemoglobin value in HIV amalgamative pulmonary tuberculosis group are lower than those of diabetes mellitus with pulmonary tuberculosis group.2.The positive rate of Sputum smear acid bacillus and GeneXpert MTB on auxiliary examination of diabetes mellitus with pulmonary tuberculosis group is higher than that of the pure pulmonary tuberculosis group;The ratio of empty shadow in CT imaging and positive rate of LAM-Ab in auxiliaryexamination in diabetes mellitus amalgamative pulmonary tuberculosis groups arehigher than those of HIV amalgamative pulmonary tuberculosis group.3.The positive rate of sputum GeneXpert MTB examinationis significantly higher thanthat ofSputum smear acid bacillus in diabetes mellitus with pulmonary tuberculosis group and HIV with pulmonary tuberculosisgroup.Therefore,patients with diabetes or HIV should be screened for sputum GeneXpert MTB in time. |
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