2型糖尿病合并肺结核患者空腹血糖水平与痰涂片、T-SPOT.TB结果的关系及结核分枝杆菌rpoB基因检测临床意义

The relationship between fasting blood glucose level and sputum smear,T-SPOT.TB results in patients with T2DM complicated with tuberculosis,and the clinical significance of detecting the rpoB gene of Mycobacterium tuberculosis

目的探究2型糖尿病(type 2 diabetes nephropathys,T2DM)合并肺结核患者空腹血糖(fasting plasma glucose,FPG)水平与痰涂片、结核分枝杆菌T细胞斑点实验(T-cell spot test for tuberculosis infection,T-SPOT.TB)结果的关系及结核分枝杆菌rpoB基因检测的临床意义。方法选取2022年1月—2023年1月昆明市第三人民医院收治102例T2DM合并肺结核患者作为研究组,另选同期在我院治疗的102例单纯肺结核患者作为对照组。比较2组临床资料、痰涂片和T-SPOT.TB检查结果,并对研究组不同FPG水平患者痰涂片阳性率、T-SPOT.TB阳性率进行比较,分析痰涂片阳性率、T-SPOT.TB阳性率与患者FPG水平的相关性。对2组进行结核分枝杆菌培养,分离利福平(rifampicin,RFP)耐药菌株和敏感菌株,比较2组2种菌株rpoB基因检测结果。结果研究组咳嗽、呼吸困难、厌食、盗汗、胸痛、咯血、发热发生率、痰涂片阳性率、T-SPOT.TB阳性率均高于对照组(P均<0.05)。不同FPG水平患者痰涂片阳性率比较,差异具有统计学意义(P=0.003);T-SPOT.TB阳性率比较,差异无统计学意义(P=0.262);痰涂片阳性率与T2DM合并肺结核患者FPG水平呈正相关(rs=0.386,P=0.015),T-SPOT.TB阳性率与FPG水平无明显相关性(rs=0.127,P=0.326)。研究组RFP耐药菌株多于对照组,研究组RFP耐药菌株rpoB基因突变率高于RFP敏感菌株(P均<0.05)。结论T2DM合并肺结核患者FPG水平与痰涂片结果呈正相关,但与T-SPOT.TB结果无相关性。与单纯肺结核患者相比,T2DM合并肺结核患者更易感染耐药株。通过检测耐药基因rpoB,可快速识别检测结核分枝杆菌对RFP耐药性,为临床治疗提供科学指导。

Objective To explore the relationship between fasting plasma glucose(FPG)levels and sputum smear results,T-cell spot test for tuberculosis infection(T-SPOT.TB)in patients with pulmonary tuberculosis and type 2 diabetes mellitus(T2DM),as well as the clinical significance of rpoB gene detection in Mycobacterium tuberculosis.Methods A total of 102 patients by pulmonary tuberculosis,who were admitted to the Kunming Third People’s Hospital from January 2022 to January 2023,were selected as the study group.Another 102 patients with only pulmonary tuberculosis treated in our hospital during the same period were selected as the control group.And compare the clinical data,sputum smears,and T-SPOT test results between the 2 groups.Analyze the correlation between the positive rates of sputum smears and T-SPOT.TB tests with different fasting plasma glucose(FPG)levels in the study group.Furthermore,culture Mycobacterium tuberculosis from both groups,isolate rifampicin-resistant and sensitive strains,and compare the rpoB gene detection results between these strains in the 2 groups.Results The incidence of cough,dyspnea,anorexia,night sweating,chest pain,hemoptysis,fever,sputum smear positive rate,and T-SPOT.TB positive rate in the study group were higher than those in the control group(P<0.05).Comparison of sputum smear positive rates among patients with different FPG levels showed statistically significant differences(P=0.003),while the comparison of T-SPOT.TB positive rates showed no statistically significant difference(P=0.262).The positive rate of sputum smear is positively correlated with the FPG level in patients with T2DM complicated with pulmonary tuberculosis(rs=0.386,P=0.015),while the positive rate of T-SPOT.TB was not significantly correlated with FPG levels(rs=0.127,P=0.326).The research group had more RFP-resistant strains than the control group,and the mutation rate of rpoB gene in RFP-resistant strains was higher than that in RFP-sensitive strains(P<0.05).Conclusion The FPG levels in patients with T2DM and pulmonary tuberculosis are closely related to the results of sputum smears,but there is no significant correlation with T-SPOT.TB results.In addition,the detection of the drug-resistance gene rpoB can quickly identify and detect resistance of Mycobacterium tuberculosis to RFP,providing scientific guidance for clinical treatment.