营养不良影响结核病患者治疗转归的相关研究进展

doi:10.19982/j.issn.1000-6621.20250287

摘要/Abstract

摘要：

结核病是一种与营养不良紧密相关的慢性消耗性传染病。结核病患者可通过慢性炎症反应、胃肠道吸收障碍和多器官受累等途径导致营养不良,后者可通过多种机制削弱患者的免疫防御能力,从而影响其治疗转归。因此,营养不良在影响结核病患者治疗转归及预后的基础上进一步增加结核病的发病风险。个体化的营养干预,特别是高蛋白、高热量饮食和微量营养素补充,能够显著改善结核病患者的预后。本文系统综述了营养不良与结核病的双向恶性循环关系、结核病导致营养不良的病理生理机制,以及营养不良通过降低细胞免疫功能、扰乱代谢平衡和加剧慢性炎症影响结核病治疗结局的分子机制;进一步分析高蛋白高热量饮食、维生素D与微量元素补充,以及脂肪酸干预等营养支持策略在改善结核病患者体质量、免疫功能及治疗转归方面的临床研究证据,旨在为结核病患者的营养支持治疗提供理论依据,并为优化临床实践和公共卫生策略提供科学参考。

关键词: 结核, 营养不良, 治疗结果, 预后

Abstract:

Tuberculosis is a chronic consumptive infectious disease intrinsically associated with malnutrition. In patients with tuberculosis, malnutrition can result from multiple pathways including chronic inflammatory responses, gastrointestinal malabsorption, and multi-organ involvement. Such nutritional impairment further compromises host immune defenses through various mechanisms, thereby adversely affecting treatment outcomes. Thus, malnutrition not only worsens tuberculosis prognosis but also elevates the risk of disease development. Individualized nutritional interventions-particularly high-protein, high-calorie diets and micronutrient supplementation-have been shown to significantly improve clinical outcomes in tuberculosis patients. This review systematically summarizes the bidirectional vicious cycle between malnutrition and tuberculosis, detailing the pathophysiological processes by which tuberculosis induces malnutrition, and elucidates the molecular mechanisms through which malnutrition impairs treatment outcomes via diminished cellular immunity, disrupted metabolic homeostasis, and exacerbated chronic inflammation. It further evaluates clinical evidence supporting nutritional strategies-such as high-protein, high-calorie diets, vitamin D and trace element supplementation, and specific fatty acid interventions-in improving body weight, immune function, and treatment outcomes in tuberculosis patients. The overarching aim of this article is to provide a scientific rationale for nutritional support in tuberculosis management and to inform evidence-based clinical practice and public health strategies.

Key words: Tuberculosis, Malnutrition, Treatment outcome, Prognosis

中图分类号:

热依汗古丽·阿肯, 范琳. 营养不良影响结核病患者治疗转归的相关研究进展[J]. 中国防痨杂志, 2026, 48(1): 153-159. doi: 10.19982/j.issn.1000-6621.20250287

Reyihanguli Aken, Fan Lin. Research progress on the impact of malnutrition on the treatment outcomes of tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 153-159. doi: 10.19982/j.issn.1000-6621.20250287

图/表 1

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表型标准		病因标准
低体质量指数	肌肉减少	摄食减少或消化吸收障碍	炎症或疾病负担
欧美人群:70岁以下<20kg/m²,或70岁以上<22kg/m² 亚洲人群:70岁以下<18.5kg/m²,或70岁以上<20kg/m²	人体成分分析提示肌肉减少,目前缺乏统一的切点值	摄入量≤50%的能量需求超过1周,或任何摄入量减少超过2周,或存在任何影响消化吸收的慢性胃肠状况	急性疾病或创伤,或慢性疾病如恶性肿瘤、慢性阻塞性肺疾病、充血性心力衰竭、慢性肾衰竭或任何伴随慢性或复发性炎症的慢性疾病