Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Role of Diabetes Mellitus on Treatment Effects in Drug-susceptible Initial Pulmonary Tuberculosis Patients in China

We assessed the role of diabetes mellitus（DM） on treatment effects in drug‐susceptible initial pulmonary tuberculosis（PTB） patients. A prospective study was conducted in eight provinces of China from October 2008 to December 2010. We enrolled 1,313 confirmed drug‐susceptible initial PTB patients, and all subjects received the treatment regimen（2 H3 R3 E3 Z3/4 H3 R3） as recommended by the national guidelines. Of the 1,313 PTB patients, 157（11.9%） had DM; these patients had more sputum smear‐positive rates at the end of the second month [adjusted odds ratios（aO R） 2.829, 95% confidence intervals（CI） 1.783‐4.490], and higher treatment failure（aO R 2.120, 95% CI 1.565‐3.477） and death rates（aO R 1.536, 95% CI 1.011‐2.628）. DM was a contributing factor for culture‐positive rates at the end of the second month and treatment failure and death of PTB patients, thus playing an unfavorable role in treatment effects of PTB.

Computed tomography imaging and clinical significance of bacterium-positive pulmonary tuberculosis complicated with diabetes

BACKGROUND The increasing prevalence of tuberculosis(TB)and diabetes on a global scale poses a significant health challenge,particularly due to their co-occurrence,which amplifies the severity,recurrence and mortality rates associated with both conditions.This highlights the need for further investigation into their interrelationship.AIM To explore the computed tomography(CT)imaging and clinical significance of bacterium-positive pulmonary TB(PTB)combined with diabetes.METHODS There were 50 patients with bacterium-positive PTB and diabetes,and 50 with only bacterium-positive PTB.The latter were designated as the control group.The CT imaging of the two groups of patients was compared,including lesion range,shape,density and calcification.RESULTS No significant differences were observed in age,gender,smoking and drinking history,high blood pressure,hyperlipidemia and family genetic factors between the groups.However,compared to the patients diagnosed solely with simple bacterium-positive PTB,those with concurrent diabetes showed a wider range of lesions and more complex and diverse morphology on CT images.Among them,intrapulmonary tuberculosis lesions were often accompanied by manifestations of pulmonary infection,such as cavity formation and bronchiectasis.At the same time,diabetes-related signs were often seen on CT images,such as pulmonary infection combined with diabetic pulmonary lesions.Logistic regression analysis identified age and medical history as significant factors influencing the degree of pulmonary infection and CT imaging outcomes in patients with both TB and diabetes.This suggests that older age and specific medical histories may increase the risk or severity of pulmonary damage in these patients.CONCLUSION CT imaging reveals more complex lesions in PTB patients with diabetes,emphasizing the need for careful evaluation and comprehensive analysis to enhance diagnostic accuracy.

The Effect of Tuberculosis Infection on Pancreatic Beta-Cell Function in Patients with Type 2 Diabetes Mellitus

Objective: The aim of this study is to investigate how individuals with type 2 diabetes mellitus’ pancreatic β-cell function index and insulin resistance index are affected by tuberculosis infection. Methods: The study group consisted of 89 patients with type 2 diabetes mellitus and tuberculosis infection who were admitted to Jingzhou Chest Hospital between March 2019 and March 2021. Gender and duration of diabetes were matching conditions. The control group was made up of 89 patients with type 2 diabetes who were admitted to Jingzhou Central Hospital’s endocrinology department during the same period. The two patient groups provided general information such as gender, age, length of diabetes, and blood biochemical indexes such as glycosylated hemoglobin (HbA1c), fasting glucose (FPG), and fasting C-peptide (FC-P). The HOMA calculator was used to calculate the HOMA-β and the HOMA-IR, and intergroup comparisons and correlation analyses were carried out. Results: Regarding gender, age, disease duration, FC-P, and HbA1c, the differences between the two groups were not statistically significant (P > 0.05). However, BMI, FPG, HOMA-β, and HOMA-IR showed statistically significant differences (P < 0.05). In comparison to the control group, the study group’s HOMA-β was lower and its HOMA-IR was greater. According to Spearman’s correlation analysis, HOMA-β had a negative association (P th FPG, HbA1c, and the length of the disease, and a positive correlation with BMI and FC-P. A positive correlation was found between HOMA-IR and BMI, FPG, and FC-P (P < 0.01), as well as a correlation with the length of the disease (P > 0.05) and HbA1c. Conclusions: In type 2 diabetes mellitus combined with tuberculosis infection, the patients had higher FPG levels and lower FC-P levels, the secretory function of pancreatic β-cells was more severely impaired, and insulin resistance was more obvious.

Mutual Impact of Diabetes Mellitus and Tuberculosis in China

China has a double burden of diabetes mellitus and tuberculosis, and many studies have been carried out on the mutual impact of these two diseases. This paper systematically reviewed studies conducted in China covering the mutual impact of epidemics of diabetes and tuberculosis, the impact of diabetes on multi-drug resistant tuberculosis and on the tuberculosis clinical manifestation and treatment outcome, the yields of bi-directional screening, and economic evaluation for tuberculosis screening among diabetes patients.

The relationship between chemokine ligand 1 gene polymorphism and type 2 diabetes mellitus with pulmonary tuberculosis

Objective To explore the relationship between chemokine(CC motif)ligand1(CCL1)gene polymorphisms(rs159291,rs159294 and rs210837)and the susceptibility of type 2 diabetes mellitus with pulmonary tuberculosis(T2DM-PTB).Methods 124 T2DM cases,124T2DM-PTB cases and 130 healthy controls(NC)were collected in this case-control study.The genotypes

Diabetes and tuberculosis:An emerging dual threat to healthcare

Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.

Association of chronic obstructive pulmonary disease with type 2 diabetes mellitus

Chronic obstructive pulmonary disease （COPD） is a complex disorder, characterized by an irreversible airflow limitation during breathing. This may lead to various extrapulmoanry comorbidities, such as cardiovascular disease, osteoporosis, and diabetes mellitus （DM）. Type 2 （T2DM） accounts for a large proportion of DM, and is also showing a rising prevalence in developed and developing countries. In addition to the known factors for T2DM, several studies have demonstrated that COPD is also an important risk factor for T2DM. In this study, we aimed to determine the prevalence of COPD in patients with T2DM, and to analyze the clinical characteristics of COPD accompanied by T2DM.

Effects on type 2 diabetes complicated with pulmonary tuberculosis:regiment of insulin,isoniazid,rifampicin,pyrazinamide and ethambutol versus the regiment plus Qi-boosting and Yin-nourishing decoction of Traditional Chinese Medicine

OBjECTIVE:To observe the clinical effect on type 2diabetes mellitus(T2DM) complicated with pulmonary tuberculosis(TB) of insulin,isoniazid,rifampicin,pyrazinamide and ethambutol(conventional medication) administered together with Qi-boosting and Yin-nourishing decoction derived from Traditional Chinese Medicine(TCM).METHODS:A total of 60 patients with T2 DM complicated with pulmonary TB were randomly and equally divided into positive control group and treatment group.The control group was treated with Western conventional regiment(WCR):insulin,isoniazid,rifampicin,pyrazinamide,and ethambutol,whereas the treatment group was given both WCR and Qi-boosting and V/n-nourishing decoction prepared from TCM.RESULTS:After the treatment,20(66.7%) and 11(36.7%) cases showed sputum bacteria negative conversion in the WCR plus TCM group and WCM group respectively(P < 0.05).A total of 25(83.3%)and 18(60%) cases showed improvement in lung lesion in the WCR plus TCM group and WCM group respectively(P < 0.05).Compared with WCR group,fasting plasma glucose and 2-hour postprandial blood glucose levels in the WCR plus TCM group significantly decreased(P < 0.05 and P < 0.01,respectively).CONCLUSION:Qi-boosting and Yin-nourishing decoction combined with the Western medication showed better curative effect in treating T2 DM complicated with pulmonary TB compared with the group using the conventional Western Medicine alone.

Diabetes mellitus is associated with increased mortality during tuberculosis treatment:a prospective cohort study among tuberculosis patients in SouthEastern Amahra Region,Ethiopia

Background:There is growing evidence suggesting that diabetes mellitus(DM)affects disease presentation and treatment outcome in tuberculosis(TB)patients.This study aimed at investigating the role of DM on clinical presentations and treatment outcomes among newly diagnosed TB patients.Methods:A prospective cohort study was conducted in South-Eastern Amhara Region,Ethiopia from September 2013 till March 2015.Study subjects were consecutively recruited from 44 randomly selected health facilities in the study area.Participants were categorized into two patient groups,namely,patients with TB and DM(TBDM)and TB patients without DM(TBNDM).Findings on clinical presentations and treatment outcomes were compared between the two patient groups.Cox proportional hazard regression analysis was applied to identify factors associated with death.Results:Out of 1314 TB patients enrolled in the study,109(8.3%)had coexisting DM.TBDM comorbidity[adjusted hazard ratio(AHR)3.96;95%confidence interval(C.I.)(1.76–8.89)],and TB coinfection with human immunodeficiency virus(HIV)[AHR 2.59;95%C.I.(1.21–5.59)]were associated with increased death.TBDM and TBNDM patients did not show significant difference in clinical symptoms at baseline and during anti-TB treatment period.However,at the 2nd month of treatment,TBDM patients were more symptomatic compared to patients in the TBNDM group.Conclusions:The study showed that DM is associated with increased death during TB treatment.DM has no association with clinical presentation of TB except at the end of the intensive phase treatment.Routine screening of TB patients for DM is recommended for early diagnosis and treatment of patients with TBDM comorbidity.

Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors

In this editorial,we comment on the article by Liu et al.Based on our analysis of a case report,we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor(TNFi).While TNFi therapy increases the risk of reactivating latent tuberculosis,primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa.Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery,diabetes,and human immunodefi ciency virus.Patients with early symptoms such as nasal congestion,rhinorrhea,altered olfaction,epistaxis,or ulceration,and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy,possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary.When diagnosis is challenging,it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic antituberculosis treatment.The preferred method for tuberculosis screening is the Interferon Gamma Release Assay,with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months.However,the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.

Association between restrictive pulmonary disease and type 2 diabetes in Koreans:A cross-sectional study

BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood.While studies have shown that patients with pulmonary disease(both obstructive and restrictive pulmonary disease)have a higher prevalence of type 2 diabetes mellitus(T2DM),there have been more studies on restrictive patterns than chronic obstructive pulmonary disease.AIM To assess whether restrictive and obstructive pulmonary diseases are associated with T2DM in Koreans.METHODS For our analysis,we used data from the Korea National Health and Nutrition Examination Survey.A total of 2830 subjects were included in this study.Spirometry results were categorized into three patterns:Normal,restrictive pulmonary disease(RPD),and obstructive pulmonary disease(OPD).RESULTS The factors used as diabetic indicators(i.e.homeostatic model assessment of insulin resistance,homeostatic model assessment of beta-cell function,glycated hemoglobin,and fasting insulin)were among the highest in RPD but not in OPD.Based on multivariate logistic regression analysis,subjects with RPD were found with an increased odds ratio[OR:1.907,95%confidence interval(CI):1.110-3.277]for T2DM compared with subjects with normal pulmonary function,whereas in patients with OPD,the OR had not increased.Model 4,which adjusted for the variables that could affect diabetes and pulmonary disease,showed a significant increase in the T2DM OR to RPD(OR:2.025,95%CI:1.264-3.244).On the other hand,no statistically significant difference was shown in OPD(OR:0.982,95%CI:0.634-1.519).CONCLUSION RPD,not OPD,is highly associated with T2DM regardless of the risk factors of various T2DMs that can be confounds.

Managing spondylitis tuberculosis in a patient with underlying diabetes and hypothyroidism:A case report

BACKGROUND Tuberculosis(TB)remains one of the highest Asia’s health problems.Spondylitis TB in diabetes mellitus(DM)and hypothyroidism patients is a rare case of extrapulmonary tuberculosis.However,there is a lack of therapeutic guidelines to treat spondylitis TB,particularly with type 2 DM(T2DM)and hypothyroidism as comorbidities.Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure.CASE SUMMARY We report the case of a 35-year-old male patient from Surabaya,Indonesia.Based on anamnesis,physical examination,and magnetic resonance imaging,the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia.Surprisingly,the patient also had a high HbA1c level,high thyroid stimulating hormone,and low free T_(4)(FT_(4)),which indicated T2DM and hypothyroidism.A granulomatous process was observed in the histopathological section.The antituberculosis drugs isoniazid and rifampicin were given.In addition,insulin,empagliflozin,and linagliptin were given to control hyperglycemia conditions,and also levothyroxine to control hypothyroidism.CONCLUSION The outcome was satisfactory.The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels.For such cases,we recommend the treatment of spondylitis TB by spinal surgery,together with T2DM and hypothyroidism therapies,to improve the patients’condition.Prompt early and non-invasive diagnoses and therapy are necessary.

Smear positive pulmonary tuberculosis among diabetic patients at the Dessie referral hospital, Northeast Ethiopia

Background:Tuberculosis(TB)is an infectious disease which is still a major cause of morbidity and mortality throughout the world.People with diabetes mellitus(DM)have a three times higher risk of developing active TB than people without diabetes.However,there is not enough credible information on the burden of pulmonary tuberculosis(PTB)among DM patients in Ethiopia,in general,and in the city of Dessie,in particular.Therefore,this study aims to determine the prevalence and associated risk factors of smear positive PTB among diabetic patients at a referral hospital in Dessie.Methods:A cross-sectional study was conducted from February 2012 to April 2012.Patient demographic characteristics were collected using a pre-tested standard questionnaire format.Spot-morning-spot sputum specimens were collected from the study participants and examined for acid-fast bacilli using direct microscopy by the Ziehl-Neelsen staining technique.Data was entered and analyzed using the SPSS version 16 statistical software and p-value<0.05 was considered as statistically significant.Results:Out of 225 TB suspected diabetic patients,52%were males and 48%were females.Their ages ranged from 12 to 82 years,with a mean age of 47.2 years.Urban residence(AOR:5.5;95%CI:1.07-28.20),history of TB(AOR:13.4;95%CI:2.74-65.73),contact with TB patients in the family(AOR:9.4;95%CI:1.822-48.50),and long duration of DM(AOR:8.89;95%CI:1.88-58.12)were independently associated with the development of active TB in people living with DM.Conclusions:The prevalence of smear positive PTB was 6.2%in TB suspected diabetic patients,which is higher compared with the general population(0.39%).Patients with a previous history of contact with TB patients,as well as those who had prolonged diabetes,were more prone to have PTB.Therefore,screening of diabetic patients for PTB infection during follow-up is necessary.

2017—2021年云南省肺结核与糖尿病共病患者抗结核治疗效果及影响因素分析

目的:分析云南省利福平敏感肺结核与糖尿病共病患者(简称“共病患者”)抗结核治疗效果及影响治疗效果的危险因素,为改善共病患者抗结核治疗效果提供依据。方法:通过“中国疾病预防控制信息系统”子系统“监测报告管理系统”获取2017年1月1日至2021年12月31日云南省登记的共病患者病案信息,包括社会人口学信息、结核病诊断信息、抗结核治疗信息和抗结核治疗结局判定信息等,最终纳入3984例。分析共病患者抗结核治疗效果,并运用Cox回归模型分析影响共病患者治疗结局的危险因素。结果:3984例共病患者抗结核成功治疗率为89.36%(3560/3984),不良治疗结局发生率为10.64%(424/3984),死亡占4.27%(170/3984),治疗过程中丢失占2.46%(98/3984),失败占2.31%(92/3984),因药物不良反应中断治疗占1.61%(64/3984)。44.22%(179/424)的不良结局发生在治疗的前2个月。Cox回归模型分析显示,≥65岁者出现不良治疗结局的风险较<35岁者高(HR=2.612,95%CI:1.483~4.601),复治患者出现不良治疗结局的风险是初治患者的1.405倍(95%CI:1.072~1.843),病原学阳性者出现不良治疗结局的风险是阴性或未查患者的1.473倍(95%CI:1.183~1.834)。结论:云南省共病患者抗结核治疗效果不佳,应重视共病患者,尤其是≥65岁老年人、复治、病原学阳性患者,抗结核治疗过程中治疗效果监测及健康管理,及时给予干预。

关于完善我国糖尿病患者肺结核筛查政策的思考

糖尿病不仅增加结核病的发病风险,还会增加结核病患者治疗的失败、复发和死亡风险。基于现有的研究发现,在我国糖尿病患者中大规模开展结核病筛查总体收益不高,在高负担地区或存在高危因素的糖尿病患者中开展结核病筛查或许是一个更佳的选择,具有较高的成本-效益。本文中,笔者指出了目前我国糖尿病患者结核病筛查存在的问题,并介绍了相应的对策与建议。

活动性肺结核合并糖尿病患者血糖水平与树突状细胞亚群及T细胞亚群的相关性研究

目的研究活动性肺结核合并糖尿病患者血糖水平与树突状细胞(DCs)亚群及T细胞亚群的相关性。方法选取2020年1月至2022年1月惠州市中心人民医院接受诊治的200例患者为研究对象,按照病情分为单纯活动性肺结核患者(对照组)和活动性肺结核合并糖尿病患者(研究组),每组各100例。按照患者糖化血红蛋白(HbA1c)水平将研究组患者分为轻度高血糖组(10 mmol/L≤HbA1c<13.9 mmol/L)45例、中度高血糖组(13.9 mmol/L≤HbA1c<22 mmol/L)33例、重度高血糖组(HbA1c≥22 mmol/L)22例。比较每组患者血糖指标、DCs亚群、T细胞亚群、细胞因子水平,并分析不同血糖程度与DCs、T细胞亚群的相关性。结果四组患者各血糖指标比较为对照组<轻度高血糖组<中度高血糖组<重度高血糖组(P<0.05);DCs亚群(cDC1、cDC2、pDC)及T细胞亚群(CD4^(+)、CD8^(+)、CD3^(+))分布值比较为对照组>轻度高血糖组>中度高血糖组>重度高血糖组(P<0.05);四组患者各炎性细胞因子水平比较为对照组<轻度高血糖组<中度高血糖组<重度高血糖组(P<0.05);外周血DCs亚群、T细胞亚群分布情况与血糖水平呈负相关(P<0.05)。结论针对活动性肺结核合并糖尿病患者,不同血糖程度患者炎性细胞因子水平、DCs亚群及T细胞亚群分布情况不同,且DCs亚群及T细胞亚群分布情况与患者血糖水平呈负相关。

肺结核合并糖尿病患者营养不良预测模型的构建与验证

目的:探究肺结核合并糖尿病患者发生营养不良的影响因素,构建并验证列线图预测模型。方法:采用便利抽样法收集2021年10月至2023年9月入住南京市第二医院结核科的401例肺结核合并糖尿病患者的临床资料,按照7∶3的比例将患者分为建模组(281例)和验证组(120例)。采用logistic回归分析构建列线图预测模型,使用受试者工作特征曲线(ROC)曲线下面积(AUC)和Hosmer-Lemeshow拟合优度检验评价模型的预测效能和校准度。结果:年龄(OR=3.796,95%CI:1.159~12.627)、病程>1个月(OR=5.711,95%CI:1.879~17.274)、糖化血红蛋白(OR=5.951,95%CI:1.517~23.269)、查尔森并发症指数(OR=8.079,95%CI:2.345~27.681)、衰弱状况≥3分(OR=9.145,95%CI:2.404~34.172)是发生营养不良的独立危险因素。将上述变量构建列线图预测模型,预测模型的Hosmer-Lemeshow检验结果显示,P=0.625,AUC为0.897,约登指数为0.584,最佳临界值为0.615。验证组的敏感度为67.5%,特异度为93.8%,预测正确率为85.0%。结论:本研究构建的列线图模型具有一定的预测价值及临床适用性,为临床工作早期识别营养不良并给予针对性的营养干预措施提供参考。

氧化型低密度脂蛋白对2型糖尿病合并肺结核患者的风险评估价值

目的探讨氧化型低密度脂蛋白(oxLDL)对2型糖尿病(T2DM)合并肺结核(PTB)患者的风险评估潜力。方法前瞻性纳入2022年6月至2023年6月门诊就诊的单纯高脂血症组病例60例、PTB组病例100例、T2DM组病例100例和T2DM合并PTB组病例100例,其中PTB组、T2DM组和T2DM合并PTB组再二次分组为血脂正常亚组40例和高脂血症亚组60例,共计360例为病例组;健康人群60例为对照组;入组年龄段为35~70岁。各组均采集静脉血,检测血液中的HbA1C、INS、FSG、TC、TG、HDL、LDL、ApoA I和Apo B,并采用ELISA法检测oxLDL,比较各组间的水平差异。应用多元logistic回归分析oxLDL水平与PTB和T2DM合并PTB的关联。结果T2DM高脂血症亚组的BMI、血糖、血脂和胰岛素抵抗等情况与T2DM合并PTB高脂血症亚组对比差异均无统计学意义(P>0.05);T2DM高脂血症亚组oxLDL水平高于对照组2倍以上,其血脂正常亚组的oxLDL水平显著高于对照组(P<0.05);T2DM合并PTB高脂血症亚组和单纯高脂血症组的oxLDL水平均显著高于对照组2倍以上,但与PTB高脂血症亚组相比,差异均无统计学意义(P>0.05)。相关性分析显示,T2DM高脂血症亚组和T2DM合并PTB高脂血症亚组的TG和LDL均与oxLDL呈显著正线性相关(R=0.352,P<0.05),PTB高脂血症亚组人群的CHOL和LDL均与oxLDL呈显著正线性相关(R=0.441,P<0.05);多元logistic回归分析显示oxLDL高于对照组2倍以上水平均是PTB和T2DM合并PTB的独立危险因素(均P<0.05)。结论显著升高的oxLDL水平可能是T2DM和PTB共病的危险因素,建议对oxLDL高于对照组2倍以上水平作为一个有临床意义的病理水平去进一步评估。