目的分析老年肺结核合并糖尿病患者在强化治疗末期痰菌未转阴的危险因素,为临床最优化治疗提供指导。方法选取我院于2010年3月至2012年8月收治的54例肺结核合并糖尿病老年患者,所有患者均给予标准化的抗结核治疗和降糖治疗。在治疗前,需记录患者的痰涂片情况、糖尿病病程、胸片、空腹血糖值及血清白蛋白;待患者进入强化治疗末期,再记录患者的空腹血糖、治疗前后血糖差值及复查痰菌情况,并进行单因素和多因素logistic回归分析。结果 54例患者经标准的抗结核化疗方案治疗后,31例(57.4%)痰菌转阴,23例(42.6%)未转阴。经单因素logistic回归分析发现,治疗前血清白蛋白水平、结核病灶范围、是否合并空洞及数量、抗结核治疗前空腹血糖、糖尿病病程、强化期末空腹血糖及治疗前后空腹血糖差值与强化治疗末期痰菌是否转阴有显著相关性。经多因素logistic回归分析发现,抗结核治疗前空腹血糖、糖尿病病程、结核病灶范围是痰菌未阴转的危险因素,而治疗前血清白蛋白含量是痰菌转阴的保护因素。结论老年肺结核合并糖尿病患者应重视糖尿病的早期治疗,在实施抗结核治疗前应有效控制血糖,并需要重视自身营养状况,提高血清白蛋白水平。 Objective To analyze the risk factors of sputum negative conversion in elderly patients with pulmonary tuberculosis complicated with diabetes at the end of intensive treatment and provide guidance for the optimal clinical treatment. Methods A total of 54 elderly patients with tuberculosis and diabetes mellitus admitted to our hospital from March 2010 to August 2012 were selected. All patients were given standardized anti-TB and anti-diabetic therapy. Before treatment, need to record the patient’s sputum smear, diabetes course, chest X-ray, fasting blood glucose and serum albumin; until the patient into the end of intensive treatment, and then record the patient’s fasting blood glucose, blood glucose before and after treatment and review of sputum Cases, and univariate and multivariate logistic regression analysis. Results After 54 patients were treated with standard anti-tuberculosis chemotherapy, 31 (57.4%) sputum negative and 23 (42.6%) negative. The results of univariate logistic regression analysis showed that the serum albumin level, the range of tuberculosis, the cavity and quantity of tuberculosis, the fasting blood glucose and the course of diabetes before TB treatment, the fasting fasting blood glucose before and after treatment, the difference of fasting blood glucose before and after treatment and the end of intensive treatment Whether sputum is negative or not is significant correlation. Multivariate logistic regression analysis showed that fasting blood glucose, diabetes duration and tuberculosis range before TB treatment were risk factors of sputum negative conversion, while serum albumin level before treatment was the protective factor of sputum negative conversion. Conclusion Elderly patients with pulmonary tuberculosis and diabetes mellitus should pay more attention to the early treatment of diabetes mellitus, and should control their blood sugar effectively before antituberculous therapy. They should pay attention to their own nutritional status and raise serum albumin level.