关键词: 结核, 肺, 糖尿病, 共病现象, 淋巴细胞亚群, 结果评价(卫生保健), 对比研究

Abstract:

Objective To investigate the clinical features and lymphocyte subsets in patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM). Methods A total of 85 PTB-DM patients who were hospitalized from April 1, 2018 to May 31, 2019 were enrolled as the PTB-DM group, and 96 PTB patients hospitalized at the same time were selected as the PTB group. Clinical features including gender, age, treatment history, chest CT examination, and lymphocyte subsets absolute counts and Mycobacterium tuberculosis-specific T cells response were compared between the two groups. Results Males and females were 76.4% (65/85) and 23.6% (20/85) respectively in PTB-DM group, while those were 57.3% (55/96) and 42.7% (41/96) respectively in PTB group (χ ²=7.42, P=0.006).2.4% (2/85), 68.2%(58/85) and 29.4% (25/85) of the patients were <25, 25-60 and >60 years old in PTB-DM group, respectively, while 25.0% (24/96), 63.5%(61/96) and 11.5% (11/96) were in PTB group, respectively, with significant difference (χ ²=23.55, P=0.000). The rate of initial- and retreatment patients were 74.1% (63/85) and 25.9% (22/85) in PTB-DM group, and those were 84.4% (81/96) and 15.6% (15/96) in PTB group, respectively, with no significant statistical difference (χ ²=2.92, P=0.088). In PTB-DM group, the rate of no cavity, cavity, lesion area <3 lobes and ≥3 lobes in chest CT were 23.5% (20/85), 76.5% (65/85), 31.8% (27/85) and 68.2% (58/85), respectively, while those were 53.1% (51/96), 46.9% (45/96), 54.2% (52/96) and 45.8% (44/96) respectively in PTB group. The patients with cavity and lesions ≥3 lobes in chest CT in PTB-DM group was significantly higher than those in PTB group (χ ²=16.56, P=0.000 and χ ²=9.20, P=0.002). The positive rate of Mycobacterium tuberculosis-specific T cell reaction was 81.3% (65/80) in PTB-DM group, and that was 74.2%(66/89)in PTB group, with no significant difference (χ ²=1.22,P=0.270).The median of absolute counts of total T lymphocytes, CD4⁺, CD8⁺, NK-like T lymphocytes, natural killer cells (NK cells) and total B lymphocytes in the PTB-DM group were 1069.00(753.50,2372.50), 548.00(381.00,787.50), 380.00(270.50,574.50), 60.00(36.00,120.50), 184.00(111.00,294.50) and 162.00(80.50,244.00)/μl, respectively, while those in PTB group were 1161.50(858.50,1601.00), 628.00(472.75,860.50), 457.50(286.00,614.75), 65.50(34.50,119.50), 191.50(115.75,315.75)and 184.50(112.25,301.00)/μl, respectively. There were no significantly statistical difference in the six indexes between the two groups(Z=-1.80,P=0.073;Z=-1.47,P=0.142;Z=-1.46,P=0.144;Z=-0.09,P=0.931;Z=-0.57,P=0.568;Z=-1.93,P=0.053). Conclusion There were more middle-aged and elderly men, and extensive, serious lesions in PTB-DM group. PTB with or without DM had no significant effect on the detection results of lymphocyte subsets.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Comorbidity, Lymphocyte subsets, Outcome assessment (health care), Comparative study