血糖血脂异常对肺结核合并2型糖尿病的影响分析

doi:10.19871/j.cnki.xfcrbzz.2022.04.009

摘要/Abstract

摘要： 目的探讨血糖血脂异常与肺结核（PTB）合并2型糖尿病（PTB-T2DM）的相关性,为降低PTB患病率提供新思路。方法收集2020年9月至2021年8月于深圳市慢性病防治中心就诊的PTB病例90例（PTB组）、2型糖尿病（T2DM）病例90例（T2DM组）和PTB-T2DM病例90例（PTB-T2DM组）,三组合并为试验组,本中心体检门诊就诊的健康人群60例为对照组。收集试验组和对照组全血和血清标本,采用HPLC法检测抗凝全血以测定HbA1c的百分含量,酶比色法检测血清空腹血糖（FBG）、总胆固醇（CHOL）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平,分析血糖血脂控制水平与PTB患病的关联。结果 T2DM组年龄最大,平均（57.34±9.52）岁,T2DM组和PTB-T2DM组HbA1c和FBG控制不理想的人数比例均显著高于对照组和PTB组（均P<0.05）;PTB组、T2DM组和PTB-T2DM组的CHOL和LDL-C升高的人数比例均显著高于对照组（均P<0.05）,T2DM组和PTB-T2DM组的TG升高的人数比例显著高于对照组和PTB组（均P<0.05）。二元Logistic回归显示TG升高（OR=2.43,95%CI：1.117~5.289,P<0.05）是PTB患病率的独立危险因素。结论 TG升高可能是PTB患病的独立危险因素;建议对中老年人群采取生活方式指导和干预,控制TG的异常水平。

关键词: 肺结核, 2型糖尿病, 血糖, 血脂

Abstract: Objective To address the correlation between dysglycemic dyslipidemia and pulmonary TB combined with T2DM (pulmonary TB-T2DM) was investigated to provide new ideas for reducing the prevalence of pulmonary TB. Method A total of 330 cases, including 270 cases in the experimental group—90 patients of pulmonary TB(PTB group)、90 patients of T2DM(T2DM group) and 90 patients of pulmonary TB-T2DM(TB-T2DM group), and 60 cases of healthy subjects from outpatient physical examination in the control group, were collected from September 2020 to August 2021 in Shenzhen Center for Chronic Disease Control. After the whole blood and serum specimens were collected from the experimental and control group, the anticoagulated whole blood was tested by high performance liquid chromatography (HPLC) to determine the percentage of hemoglobin A1c (HbA1c), and serum fasting blood glucose (FBG), total cholesterol (CHOL), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) levels were measured by enzyme colorimetric method. To analyze the prediction of the level of glycemic lipid control on the prevalence of pulmonary TB. Result The T2DM group has the highest average age (57.34 ± 9.52 ), the proportion of people with poorly controlled HbA1c and FBG in both T2DM and pulmonary TB-T2DM groups was significantly higher than that in the healthy control and pulmonary TB groups (all P<0.05); pulmonary TB, T2DM and pulmonary TB-T2DM groups all had significantly higher proportions of elevated CHOL and LDL-C than controls (all P<0.05), while T2DM and pulmonary TB-T2DM groups had significantly higher proportions of elevated TG than healthy control and pulmonary TB groups (all P<0.05). Binary logistic regression shows that elevated TG（OR=2.43,95% CI：1.117~5.289,P<0.05）was independent risk factors for the prevalence of pulmonary TB. Conclusion Elevated TG is possible independent risk factor for pulmonary TB disease; Lifestyle guidance and interventions aimed to contain abnormal fluctuations in lipid profiles are recommended for middle-aged and elderly populations.

Key words: Pulmonary tuberculosis, Type 2 diabetes mellitus, Blood glucose, Blood lipid

桂静, 杨慧, 傅钰, 刘涛. 血糖血脂异常对肺结核合并2型糖尿病的影响分析[J]. 新发传染病电子杂志, 2022, 7(4): 37-41.

Gui Jing, Yang Hui, Fu Yu, Liu Ta. Analysis of the correlation between dysglycemic dyslipidemia and pulmonary tuberculosis combined with type 2 diabetes[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(4): 37-41.

参考文献

[1] 卢春容, 房宏霞, 陆普选, 等. 2021 WHO全球结核病报告:全球与中国关键数据分析[J/CD]. 新发传染病电子杂志, 2021, 6(4): 368-372.
[2] INTERNATIONAL DIABETES FEDERATION. IDF Diabetes Atlas. 8th edn[EB/OL]. [2017-07-11]. http://diabetesatlas.org/resources/2017-atlas.html.
[3] PEREZ-NAVARRO LM, RESTREPO BI, FUENTES-DOMINGUEZ FJ et al. The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes[J]. Tuberculosis, 2017, 103: 83-91.
[4] 杨松,严晓峰. 结核病与糖尿病:相互关系和诊治的研究新进展[J/CD]. 新发传染病电子杂志,2018,3(4):234-238.
[5] WORLD HEALTH ORGANIZATION.Latent TB Infection: Updated and Consolidated Guidelines for Programmatic Management [EB/OL]. Geneva, Switzerland: World Health Organization, 2018.
[6] HAIDER M, AL-RASHED F, ALBAQSUMI Z, et al.Candida albicans induces foaming and inflammation in macrophages through FABP4: its implication for atherosclerosis[J]. Biomedicines, 2021, 9(11): 1567.
[7] SHIM D, KIM H, SHIN SJ.Mycobacterium tuberculosis infection-driven foamy macrophages and their implications in tuberculosis control as targets for host-directed therapy[J]. Front immunol, 2020, 5(11): 910.
[8] GUERRINI V, PRIDEAUX B, BLANC I, et al.Storage lipid studies in tuberculosis reveal that foam cell biogenesis is disease-specific[J]. PLoS Pathog, 2018, 14(8): e1007223.
[9] CAMWRON AM, CASTOLDI A, SANIN DE, et al.Inflammatory macrophage dependence on NAD(+) salvage is a consequence of reactive oxygen species-mediated DNA damage[J]. Nat Immunol. 2019, 20(4): 420-432.
[10] 中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288—2017)[J/CD]. 新发传染病电子杂志, 2018, 3(1): 59-61.
[11] AMERICAN DIABETES ASSOCIATION.Introduction: Standards of medical care in diabetes 2021[S]. Diabetes Care, 2021.
[12] 中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南 (2017 年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67.
[13] 诸骏仁,高润霖,赵水平,等. 中国成人血脂异常防治指南(2016年修订版)[J],中国循环杂志,2016, 16(10): 15-35.
[14] 谭运彩,袁媛,杨双喜,等. 二甲双胍与2型糖尿病患者肺结核感染风险的倾向性评分匹配分析 [J/CD]. 新发传染病电子杂志, 2021, 6(3): 202-205.
[15] 方燕龄,魏裕涛,肖新怀,等. 老年2型糖尿病伴冠状动脉硬化患者的生存质量影响因素分析[J]. 实用医学杂志, 2020, 36(23): 3250-3255.
[16] VRIELING F, RONACHER K, KLEYNHANS L, et al.Patients with Concurrent Tuberculosis and Diabetes Have a Pro-Atherogenic Plasma Lipid Profile[J]. EBioMedicine, 2018, 6(32): 192-200.
[17] DUTTA NK, BRUINERS N, PINN ML, et al.Statin adjunctive therapy shortens the duration of TB treatment in mice[J]. J Antimicrob Chemother 2016, 71(6): 1570-1577.
[18] VRIELING F, WILSON L, RENSEN PCN, et al.Oxidized low-density lipoprotein (oxLDL) supports Mycobacterium tuberculosis survival in macrophages by inducing lysosomal dysfunction[J]. PLoS Pathog, 2019, 15(4): e1007724.
[19] DONG Z, SHI J, DORHOI A, et al.Hemostasis and lipoprotein indices signify exarbated lung injury in tuberculosis with diabetes coorbidity[J]. Chest, 2018, 153(5): 118.