The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis

Infection and Drug Resistance, Jan 2018

The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis Li-Li Xia,1,* Su-Fen Li,2,* Kan Shao,1 Xin Zhang,3 Shan Huang1 1Department of Endocrinology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Neurology, Huai’an Second People’s Hospital and The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, People’s Republic of China; 3Department of Radiology, The Fourth People’s Hospital of Huai’an, Huai’an, People’s Republic of China *These authors contributed equally to this work Abstract: To investigate the correlation between computed tomography (CT) features and glycosylated hemoglobin (HbAlc) levels in patients with type 2 diabetes mellitus (T2DM) complicated with primary pulmonary tuberculosis (PTB). One hundred and eighty untreated PTB patients complicated with T2DM were selected. Based on the HbAlc level, the patients were divided into three groups: HbAlc level <7% (Group I: 32 patients), 7%–9% (Group II: 48 patients), and >9% (Group III: 100 patients). The changes of CT manifestations and HbAlc were analyzed after TB and T2DM treatment. In the three groups, the detection rate of large segmented leafy shadow was 50%, 56.2%, and 87%; the air bronchogram sign detection rate was 40.6%, 47.9%, and 77%; the discovery rate of mouth-eaten cavity was 31.2%, 45.8%, and 65%; thick wall cavity detection rate was 25%, 31.2%, and 52%; the rate of multiple cavities was 34.3%, 50%, and 73%; and bronchial TB was found in 33.3%, 21.8%, and 46%, respectively. The detection rates of lesions in Group III were significantly higher than in Group II and Group I (p<0.05), and this increase was significant (p<0.05). After treatment, the HbAlc level reached control target (<7%) among all three groups and CT absorption improvement rates were 100%, 72.9%, and 56% respectively. The therapeutic efficacy of group I was better than group II (p<0.01), and the treatment efficacy of group II was better than group III (p<0.05). CT manifestations of T2DM complicated with PTB were closely related to HbAlc level. The effect is better when HbAlc level <7%. HbAlc level effectively reflects the severity and therapeutic effect to a certain extent. CT scan can provide some important information for clinical imaging. The above two examinations can guide clinicians to formulate the appropriate diagnosis and treatment in a timely manner. Keywords: T2DM, primary pulmonary tuberculosis, CT, HbAlc

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The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis

Infection and Drug Resistance The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis Kan Shao 2 3 Xin Zhang 0 2 Shan Huang 2 3 0 Department of Radiology, The Fourth People's Hospital of Huai'an , Huai'an , People's Republic of China 1 Department of Neurology, Huai'an Second People's Hospital and The Affiliated Huai'an Hospital of Xuzhou Medical University , Huai'an , People's Republic of China 2 Shan Huang Department of Gastroenterology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine , No. 1111 Xianxia Road, Changning District, Shanghai 200336 , People's Republic of China 3 Department of Endocrinology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , People's Republic of China To investigate the correlation between computed tomography (CT) features and glycosylated hemoglobin (HbAlc) levels in patients with type 2 diabetes mellitus (T2DM) complicated with primary pulmonary tuberculosis (PTB). One hundred and eighty untreated PTB patients complicated with T2DM were selected. Based on the HbAlc level, the patients were divided into three groups: HbAlc level <7% (Group I: 32 patients), 7%-9% (Group II: 48 patients), and >9% (Group III: 100 patients). The changes of CT manifestations and HbAlc were analyzed after TB and T2DM treatment. In the three groups, the detection rate of large segmented leafy shadow was 50%, 56.2%, and 87%; the air bronchogram sign detection rate was 40.6%, 47.9%, and 77%; the discovery rate of mouth-eaten cavity was 31.2%, 45.8%, and 65%; thick wall cavity detection rate was 25%, 31.2%, and 52%; the rate of multiple cavities was 34.3%, 50%, and 73%; and bronchial TB was found in 33.3%, 21.8%, and 46%, respectively. The detection rates of lesions in Group III were significantly higher than in Group II and Group I (p<0.05), and this increase was significant (p<0.05). After treatment, the HbAlc level reached control target (<7%) among all three groups and CT absorption improvement rates were 100%, 72.9%, and 56% respectively. The therapeutic efficacy of group I was better than group II (p<0.01), and the treatment efficacy of group II was better than group III (p<0.05). CT manifestations of T2DM complicated with PTB were closely related to HbAlc level. The effect is better when HbAlc level <7%. HbAlc level effectively reflects the severity and therapeutic effect to a certain extent. CT scan can provide some important information for clinical imaging. The above two examinations can guide clinicians to formulate the appropriate diagnosis and treatment in a timely manner. T2DM; primary pulmonary tuberculosis; CT; HbAlc - d e d a o l n w o d e c n a t s i s e R g u r D d n a n o it c e f n I open access to scientific and medical research Introduction Primary pulmonary tuberculosis (PTB) is a serious threat to human health. According to the “Global Tuberculosis Report 2016” of the World Health Organization, in 2015, there were an estimated 10.4 million new (incident) TB cases worldwide.1 The rapid increase in TB morbidity where diabetes mellitus (DM) is epidemic indicates that DM may be a risk factor.2 Recent studies have also shown that TB in patients with DM compared to those without DM displays a different clinical manifestation and clinical outcome.3,4 However, there are still some studies showing that DB does not affect TB.5–9 Although the association between TB and DM has been described and researched for centuries, the correlation between computed tomography (CT) imaging features and glycosylated hemoglobin (HbAlc) levels in type 2 diabetic patients (T2DM) with PTB has not been thoroughly studied. Song et al10 conducted a study to investigate the CT imaging features for T2DM patients with multidrug-resistant TB, (defined as TB strains resistant to at least isoniazid and rifampin). They found consolidation in or above multiple pulmonary segments with multiple moutheaten cavities and bronchial damage on CT images in T2DM patients with TB, suggesting the possibility of multidrug 81 resistance. Also, Kim et al11 aimed to assess CT features of l-2u0 PTB and TB pleurisy in DM patients and to evaluate the effect -J21 of duration of DM on CT imaging findings of PTB and TB on pleurisy. The study from Kim suggested that involvement of .315 all lobes, bilateral pulmonary involvement, and lymph node .524 enlargement are significantly more common CT features in .315 TB patients with DM than in those without DM. It is well /yb5m bknetowwenenthtahteTsBetawnoddDisMeacsaens bisencootnptraorltliecdu,laanrldytchleearer.laHtiuoannsghiept .cso al12 evaluated the impact of glycemic status on CT findings se of PTB in DM patients as well. They suggested that glycemic .rvdoepw l.syeon status influenced radiological manifestations of PTB with DM as there was an increased risk of atypical radiological /:ww luan presentations of PTB in DM patients. In orde (...truncated)


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Li-Li Xia, Su-Fen Li, Kan Shao, Xin Zhang, Shan Huang. The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis, Infection and Drug Resistance, 2018, pp. 187-193, DOI: 10.2147/IDR.S146741