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Abstract：
UNASSIGNED: The coexistence of diabetes mellitus (DM) and pulmonary tuberculosis (PTB) poses a significant health concern globally, with their convergence presenting a considerable challenge to healthcare systems. Previous research has highlighted that comorbidities can mutually influence and exacerbate immune disorders. However, there is a paucity of data on the impact of DM on immunological features and treatment responses in the TB population in China.
UNASSIGNED: From January 2020 to June 2022, 264 cases of pulmonary tuberculosis patients (82 DM patients and 182 non-DM patients) hospitalized in our center were selected. 80 patients with TB with DM (TB-DM) and 80 patients with TB without DM (TB-NDM) were enrolled into the final analysis by propensity score matching for age, gender and involved lung field at a ratio of 1:1. The clinical characteristics, immunological features and treatment response were compared between the two groups.
UNASSIGNED: After propensity score matching, no differences in the general features such as age gender, involved lung field, the incidence of retreatment and WBC count were found between the two groups. Compared to TB-NDM group, the TB-DM group exhibited a higher positive rate of sputum smear and incidence of cavitary lesions. Immunological features analysis revealed that the TB-DM patients had higher levels of TNF-α [pg/ml; 8.56 (7.08-13.35) vs. 7.64 (6.38-10.14) p = 0.033] and IL-8 [pg/ml; 25.85 (11.63-58.40) vs. 17.56 (6.44-39.08) p = 0.003] but lower CD8+ T lymphocyte count [cells/mm3; 334.02 (249.35-420.71) VS 380.95 (291.73-471.25) p = 0.038]. However, there was no significant difference in serum IL-6 concentration and CD4+ T lymphocyte count between the two groups. After 2 months of anti-tuberculosis treatment, 39 (24.4%) cases had suboptimal treatment response, including 23 (28.7%) TB-DM patients and 16 (20%) TB-NDM patients. There was no difference in suboptimal response rate (SRR) was found between the two groups (p = 0.269). The multivariate logistic regression analysis indicated that retreatment for TB [AOR: 5.68 (95%CI: 2.01-16.08), p = 0.001], sputum smear positivity [AOR: 8.01 (95%CI: 2.62-24.50), p = 0.001] were associated with SRR in all participants, and in TB-DM group, only sputum smear positivity [AOR: 16.47 (1.75-155.12), p = 0.014] was positive with SRR.
UNASSIGNED: DM is a risk factor for pulmonary cavity formation and sputum smear positivity in TB population. Additionally, TB-DM patients is characterized by enhanced cytokine responses and decreased CD8+ T lymphocytes. The retreatment for TB and sputum smear positivity were associated with the occurrence of suboptimal treatment response.
UNASSIGNED: From January 2020 to June 2022, 264 cases of pulmonary tuberculosis patients (82 DM patients and 182 non-DM patients) hospitalized in our center were selected. 80 patients with TB with DM (TB-DM) and 80 patients with TB without DM (TB-NDM) were enrolled into the final analysis by propensity score matching for age, gender and involved lung field at a ratio of 1:1. The clinical characteristics, immunological features and treatment response were compared between the two groups.
UNASSIGNED: After propensity score matching, no differences in the general features such as age gender, involved lung field, the incidence of retreatment and WBC count were found between the two groups. Compared to TB-NDM group, the TB-DM group exhibited a higher positive rate of sputum smear and incidence of cavitary lesions. Immunological features analysis revealed that the TB-DM patients had higher levels of TNF-α [pg/ml; 8.56 (7.08-13.35) vs. 7.64 (6.38-10.14) p = 0.033] and IL-8 [pg/ml; 25.85 (11.63-58.40) vs. 17.56 (6.44-39.08) p = 0.003] but lower CD8+ T lymphocyte count [cells/mm3; 334.02 (249.35-420.71) VS 380.95 (291.73-471.25) p = 0.038]. However, there was no significant difference in serum IL-6 concentration and CD4+ T lymphocyte count between the two groups. After 2 months of anti-tuberculosis treatment, 39 (24.4%) cases had suboptimal treatment response, including 23 (28.7%) TB-DM patients and 16 (20%) TB-NDM patients. There was no difference in suboptimal response rate (SRR) was found between the two groups (p = 0.269). The multivariate logistic regression analysis indicated that retreatment for TB [AOR: 5.68 (95%CI: 2.01-16.08), p = 0.001], sputum smear positivity [AOR: 8.01 (95%CI: 2.62-24.50), p = 0.001] were associated with SRR in all participants, and in TB-DM group, only sputum smear positivity [AOR: 16.47 (1.75-155.12), p = 0.014] was positive with SRR.
UNASSIGNED: DM is a risk factor for pulmonary cavity formation and sputum smear positivity in TB population. Additionally, TB-DM patients is characterized by enhanced cytokine responses and decreased CD8+ T lymphocytes. The retreatment for TB and sputum smear positivity were associated with the occurrence of suboptimal treatment response.
摘要：
■糖尿病（DM）和肺结核（PTB）的共存在全球范围内引起了重大的健康问题，它们的融合给医疗保健系统带来了相当大的挑战。先前的研究强调，合并症可以相互影响并加剧免疫疾病。然而,关于DM对中国结核病人群的免疫学特征和治疗反应的影响的数据很少。
■选择2020年1月至2022年6月在本中心住院的肺结核患者264例（DM患者82例，非DM患者182例）。80例TB合并DM（TB-DM）和80例TB无DM（TB-NDM）患者通过年龄倾向评分匹配纳入最终分析，性别和累及肺野的比例为1:1。临床特点,比较两组患者的免疫学特征和治疗反应。
■倾向得分匹配后，一般特征没有差异，如年龄性别，受累肺野,发现两组之间的再治疗发生率和白细胞计数。与TB-NDM组相比，TB-DM组的痰涂片阳性率和空洞性病变发生率较高.免疫学特征分析显示，TB-DM患者的TNF-α水平[pg/ml;8.56（7.08-13.35）与7.64（6.38-10.14）p=0.033]和IL-8[pg/ml;25.85（11.63-58.40）vs.17.56（6.44-39.08）p=0.003]，但较低的CD8+T淋巴细胞计数[细胞/mm3;334.02（249.35-420.71）VS380.95（291.73-471.25）p=0.038]。然而,两组患者血清IL-6浓度和CD4+T淋巴细胞计数差异无统计学意义。抗结核治疗2个月后,39例(24.4%)治疗反应欠佳，包括23例(28.7%)TB-DM患者和16例(20%)TB-NDM患者。两组之间的次优反应率（SRR）没有差异（p=0.269）。多因素logistic回归分析显示结核病复治[AOR:5.68(95CI:2.01-16.08),p=0.001],痰涂片阳性[AOR：8.01（95CI：2.62-24.50），p=0.001]与所有参与者的SRR相关，在TB-DM组中，仅痰涂片阳性[AOR：16.47（1.75-155.12），p=0.014]对SRR呈阳性。
■DM是结核病人群肺腔形成和痰涂片阳性的危险因素。此外,TB-DM患者的特征在于增强的细胞因子应答和减少的CD8+T淋巴细胞。结核病的再治疗和痰涂片阳性与次优治疗反应的发生有关。
■选择2020年1月至2022年6月在本中心住院的肺结核患者264例（DM患者82例，非DM患者182例）。80例TB合并DM（TB-DM）和80例TB无DM（TB-NDM）患者通过年龄倾向评分匹配纳入最终分析，性别和累及肺野的比例为1:1。临床特点,比较两组患者的免疫学特征和治疗反应。
■倾向得分匹配后，一般特征没有差异，如年龄性别，受累肺野,发现两组之间的再治疗发生率和白细胞计数。与TB-NDM组相比，TB-DM组的痰涂片阳性率和空洞性病变发生率较高.免疫学特征分析显示，TB-DM患者的TNF-α水平[pg/ml;8.56（7.08-13.35）与7.64（6.38-10.14）p=0.033]和IL-8[pg/ml;25.85（11.63-58.40）vs.17.56（6.44-39.08）p=0.003]，但较低的CD8+T淋巴细胞计数[细胞/mm3;334.02（249.35-420.71）VS380.95（291.73-471.25）p=0.038]。然而,两组患者血清IL-6浓度和CD4+T淋巴细胞计数差异无统计学意义。抗结核治疗2个月后,39例(24.4%)治疗反应欠佳，包括23例(28.7%)TB-DM患者和16例(20%)TB-NDM患者。两组之间的次优反应率（SRR）没有差异（p=0.269）。多因素logistic回归分析显示结核病复治[AOR:5.68(95CI:2.01-16.08),p=0.001],痰涂片阳性[AOR：8.01（95CI：2.62-24.50），p=0.001]与所有参与者的SRR相关，在TB-DM组中，仅痰涂片阳性[AOR：16.47（1.75-155.12），p=0.014]对SRR呈阳性。
■DM是结核病人群肺腔形成和痰涂片阳性的危险因素。此外,TB-DM患者的特征在于增强的细胞因子应答和减少的CD8+T淋巴细胞。结核病的再治疗和痰涂片阳性与次优治疗反应的发生有关。
