بررسی تفاوت شدت درگیری ریه در سی تی اسکن قفسه سینه بیماران دیابتی و غیردیابتی مبتلا به کووید-19

زمینه و هدف: دیابت یکی از بیماری‌های شایع در ایران و جهان می‌باشد. این  بیماری به عنوان یک عامل خطر در بیماران مبتلا به covid-19 می‌باشد. ریسک علائم شدید و مرگ میر در بیماران دیابتی مبتلا به covid-19 بیشتر از سایرین می‌باشد. این مطالعه با هدف بررسی تفاوت شدت درگیری ریه در سی تی اسکن قفسه سینه بیماران دیابتی  و غیردیابتی مبتلا به کووید - 19 انجام شد. روش کار: مطالعه حاضر یک مطالعه توصیفی تحلیلی است که به صورت مقطعی بر روی  148 بیمار مبتلا به کووید  شامل 74 بیمار دیابتی و 74 بیمار غیر دیابتی در در سال 1399 انجام شد. ابتدا مشخصات دموگرافیک و اولیه بیماران ثبت شد. سپس اولین سی تی اسکن آنها توسط یک نفر رادیولوژیست ماهر و با تجربه بررسی و نمره‌دهی شد. یافته‌ها:  تفاوت آماری معناداری بین سن بیماران مبتلا به کرونا در دو گروه  بیماران دیابتی و غیر دیابتی مشاهده شد (0.002=p).  ولی بین جنسیت بیماران مبتلا به کرونا در دو گروه بیماران دیابتی و غیر دیابتی تفاوتی مشاهده نشد. میانگین معیار نمره سی تی اسکن قفسه سینه در بیماران دیابتی و غیر دیابتی مبتلا به کووید 19 به ترتیب برابر 21.2 و .20.04 بوده است. تفاوت آماری معناداری بین نمره سی تی اسکن قفسه سینه در دو گروه بیماران دیابتی و غیر دیابتی مشاهده نشد.هم چنین تفاوت آماری معناداری بین نمره سی تی اسکن قفسه سینه بیماران مبتلا به کووید 19 به تفکیک جنس و سن در دو گروه دیابتی و غیر دیابتی مشاهده نشد.  نتیجه گیری: اگر چه درگیری ریوی بیماران دیابتی مبتلا به کووید 19 بیشتر از بیماران غیردیابتی میباشد ،ولی این تفاوت از نظر آماری معنی دار نیست.  

evaluation of the difference in severity of lung involvement in chest ct scan of diabetic and non-diabetic patients with covid-19

background & aims: the new coronavirus, known as severe coronavirus syndrome (sarscov2), is a viral pneumonia caused by an emerging virus that causes coronavirus disease 2019 (covid19) (1). the etiology and pathology of the disease are not known exactly, but it has been reported to enter host cells by the angiotensinconverting enzyme (ace2). (2) the range of clinical symptoms of the disease varies from asymptomatic to respiratory failure, which requires mechanical ventilation. these symptoms have been more severe in patients with diabetes and hypertension (1). detection of covid19 is based on rtpcr (realtime reverse transcription polymerase chain reaction) test of the pharyngeal sample. it has been found that chest ct scans can be useful in diagnosing interstitial pneumonia in patients with suspected covid19 (7, 8). bilateral peripheral ggo involvement is the most common finding on chest ct scan in covid19 patients. the appearance of ggo alone or with consolidative opacities was also a common finding in chest ct. chest ct scan and pathological changes are more severe in patients with diabetes. diabetes is one of the most common diseases in iran and the world. this disease is considered as a risk factor in patients with 19covid. the risk of severe symptoms and death in diabetic patients with covid19 is higher than others. this study aimed to evaluate the differences in the severity of lung involvement in chest ct scan of diabetic and nondiabetic patients with covid19.methods: the present study is a retrospective crosssectional study that was performed on 148 patients with covid19 including 74 diabetic patients and 74 nondiabetic patients admitted to kosar hospital in semnan and firoozabadi hospital in tehran in 2016. inclusion criteria were confirmation of coronary heart disease, confirmation of diagnosis of diabetes from 5 years ago and use of diabetic drugs in the case group. demographic information, signs and symptoms, chest ct scan findings and rtpcr were extracted from patients’ medical records. statistical analysis was performed using spss software and the significance level of p was less than 0.05. results: there was a statistically significant difference between the age of patients with covid19 in the two groups of diabetic and nondiabetic patients (p = 0.002). chest ct scan in diabetic and nondiabetic patients with covid19 was 21.44 and 20.04, respectively. there was no statistically significant difference between the chest ct scores of patients with diabetic and nondiabetic groups by sex and age. conclusion: in the present study, the rate of lung involvement by chest ct scan in 74 diabetic patients with covid19 was compared with 74 nondiabetic patients. there was a statistically significant difference between the ages of patients with covid19 in both diabetic and nondiabetic patients, so that the mean age of diabetic patients was higher than nondiabetic patients. there was no statistically significant difference between the sex and chest ct scan score of patients with covid19 in the two groups of diabetic and nondiabetic patients. the results of the present study showed that the mean age of diabetic patients was higher than nondiabetic patients. the rate of pulmonary involvement in diabetic and nondiabetic patients with covid19 was not different and the score of lung ct scan was similar in both groups; in addition, age and gender had no effect on ct scan score. this finding is the most important result of the present study. pulmonary infiltration may be due to the body’s immune response to the virus, and overproduction of inflammatory cytokines, known as cytokine storms, can cause lung damage (15). people with diabetes are affected by lowgrade chronic inflammation that may facilitate the cytokine storm, which in turn appears to be the cause of severe cases of covid19 (19). il6 is the most common marker of inflammation in diabetes mellitus with covid19. (20). from these cases, it can be concluded that in diabetic patients, due to the higher level of inflammatory cytokines, lung damage is also expected to increase. another cause of severe covid19 9 and more lung involvement in diabetic patients can be a disorder in the innate immune system of these patients, which increases the risk of infection. another mechanism in the disorder of the immune system in diabetic patients is the increased adhesion of microorganisms to the cells of diabetic patients; in addition, some firoozabadi hospital clinical research development unit(fhcrdu),patients with covid19 is higher than nondiabetic patients, this difference is not statistically significant.