代谢相关脂肪性肝病对初治肺结核患者抗结核治疗短期疗效影响因素

doi:10.19982/j.issn.1000-6621.20250422

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (5): 631-640.doi: 10.19982/j.issn.1000-6621.20250422

代谢相关脂肪性肝病对初治肺结核患者抗结核治疗短期疗效影响因素

黄俊¹, 杜志祥², 胡春梅³()

¹南京市第二医院/南京中医药大学医学院, 南京 210023
²南京市第二医院/南京中医药大学附属南京医院/南京市肝病重点实验室, 南京 210003
³南京市第二医院/南京中医药大学附属南京医院结核科, 南京 210003

收稿日期:2025-11-03 出版日期:2026-05-10 发布日期:2026-04-27
通信作者: 胡春梅 E-mail:njyy003@njucm.edu.cn
基金资助:
江苏省传染病医学创新中心(CXZX202232);江苏省 “333 高层次人才培养工程”(2022-3-1-272)

Influence factors of metabolic dysfunction-associated fatty liver disease on short-term effectiveness of anti-tuberculosis therapy in primary pulmonary tuberculosis patients

Huang Jun¹, Du Zhixiang², Hu Chunmei³()

¹Nanjing Second Hospital/Nanjing University of Chinese Medicine, Nanjing 210023, China
²Nanjing Second Hospital/Nanjing University of Chinese Medicine Affiliated Nanjing Hospital Nanjing Municipal Key Laboratory of Hepatology, Nanjing 210003, China
³Tuberculosis Department, Nanjing Second Hospital/Nanjing University of Chinese Medicine Affiliated Nanjing Hospital, Nanjing 210003, China

Received:2025-11-03 Online:2026-05-10 Published:2026-04-27
Contact: Hu Chunmei E-mail:njyy003@njucm.edu.cn
Supported by:
Jiangsu Provincial Center for Innovation in Infectious Disease Medicine(CXZX202232);Jiangsu Province ‘333 High-Level Talent Cultivation Program’(2022-3-1-272)

摘要/Abstract

摘要：

目的: 探讨代谢相关脂肪性肝病(metabolic dysfunction-associated fatty liver disease,MAFLD)对初治肺结核患者抗结核治疗短期疗效的影响因素,为肺结核患者的治疗提供理论依据。方法: 采用病例-对照研究设计,纳入2023年1—12月江苏省南京市第二医院收治的320例初治肺结核患者,根据抗结核治疗2个月末的治疗效果分为良好组(146例)和不佳组(174例)。收集患者人口学特征、代谢相关指标(包括血脂、血糖、肝脂肪变性等)及临床资料,通过单因素分析筛选与治疗效果相关的代谢指标,并采用多因素logistic回归分析影响治疗效果的因素。结果: 单因素分析显示,疗效不佳组体质量指数(body mass index,BMI)>24kg/m²的患者占42.0%(73/174)、并发糖尿病的患者占54.0%(94/174)、并发高血压者占29.9%(52/174)及并发肝脂肪变性者占59.2%(103/174),均显著高于良好组的24.7%(36/146)、17.1%(25/146)、15.1%(22/146)、12.3%(18/146),差异均有统计学意义(χ² 值分别为 17.739、46.276、9.803、74.155,P值均<0.05)。多因素分析显示治疗效果不佳组甘油三酯异常(OR=6.179,95%CI:3.159~12.312)、高密度脂蛋白胆固醇异常(OR=2.134,95%CI:1.233~3.586)和并发糖尿病(OR=4.412,95%CI:2.464~7.666)是抗结核治疗效果不佳的独立危险因素。符合MAFLD诊断标准的患者,其治疗效果不佳的风险显著增高(OR=11.15,95%CI:6.04~20.57)。结论: 甘油三酯异常、高密度脂蛋白胆固醇异常及并发糖尿病是抗结核治疗效果不良的独立危险因素。MAFLD是影响肺结核预后的重要因素,临床应加强对MAFLD肺结核患者的监测和管理。

关键词: 结核,肺, 脂肪肝, 代谢综合征X, 危险因素

Abstract:

Objective: To explore the impact and influencing factors of metabolic dysfunction-associated fatty liver disease (MAFLD) on short-term effectiveness of anti-tuberculosis treatment in patients with newly diagnosed pulmonary tuberculosis (PTB), to provide a theoretical basis for individualized treatment of PTB patients. Methods: A case-control study was conducted, enrolling 320 newly diagnosed PTB patients admitted to Nanjing Second Hospital, Jiangsu Province from January to December 2023. According to the effectiveness at the end of the 2nd month of anti-tuberculosis treatment, the patients were divided into a favorable effectiveness group (146 cases) and a poor effectiveness group (174 cases). Demographic characteristics, metabolic indicators (including blood lipids, blood glucose, hepatic steatosis, etc.) and clinical data of the patients were collected. Univariable analysis was used to screen metabolic indicators related to treatment effectiveness, and multivariable logistic regression analysis was performed to identify factors influencing treatment effectiveness. Results: Univariable analysis revealed that in the poor-response group, 42.0% (73/174) of patients had a body mass index (BMI) >24 kg/m², 54.0% (94/174) had concomitant diabetes, hypertension (52/174, 29.9%), and hepatic steatosis (103/174, 59.2%). These proportions all were significantly higher than those in the good response group (24.7% (36/146), 17.1% (25/146), 15.1% (22/146), and 12.3% (18/146), respectively; χ² values: 17.739, 46.276, 9.803, 74.155; P<0.05 for all). Multivariable analysis indicated that abnormal triglycerides (OR=6.179, 95%CI: 3.159-12.312), abnormal high-density lipoprotein cholesterol (OR=2.134, 95%CI: 1.233-3.586), and complicated diabetes mellitus (OR=4.412, 95%CI: 2.464-7.666) were independent risk factors for poor anti-tuberculosis treatment effectiveness. Patients who met the diagnostic criteria for MAFLD had a significantly increased risk of poor treatment effectiveness (OR=11.15, 95%CI: 6.04-20.57). Conclusion: Abnormal triglycerides, abnormal high-density lipoprotein cholesterol, and concomitant diabetes mellitus are independent risk factors for poor anti-tuberculosis treatment effectiveness. MAFLD is an important factor affecting the prognosis of PTB. Clinically, enhanced monitoring and management should be implemented for PTB patients complicated with MAFLD.

Key words: Tuberculosis, pulmonary, Fatty liver, Metabolic syndrome X, Risk factors

中图分类号:

R521
R575.5

黄俊, 杜志祥, 胡春梅. 代谢相关脂肪性肝病对初治肺结核患者抗结核治疗短期疗效影响因素[J]. 中国防痨杂志, 2026, 48(5): 631-640. doi: 10.19982/j.issn.1000-6621.20250422

Huang Jun, Du Zhixiang, Hu Chunmei. Influence factors of metabolic dysfunction-associated fatty liver disease on short-term effectiveness of anti-tuberculosis therapy in primary pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2026, 48(5): 631-640. doi: 10.19982/j.issn.1000-6621.20250422

图/表 10

图1

表1

表2

两组患者的实验室检查资料比较

实验室检查资料	治疗效果良好组 (146例)	治疗效果不佳组 (174例)	t值	P值
甘油三酯(mmol/L,$\overline{x}$±s)	1.15±0.41	1.54±0.72	5.843	<0.001
高密度脂蛋白(mmol/L,$\overline{x}$±s)	1.25±0.28	1.17±0.28	2.596	0.010
总胆固醇(mmol/L,$\overline{x}$±s)	3.95±0.83	4.27±0.99	3.108	0.002
低密度脂蛋白(mmol/L,$\overline{x}$±s)	2.54±0.86	2.59±0.66	1.256	0.211
谷丙转氨酶(U/L,$\overline{x}$±s)	21.66±19.62	27.89±38.98	1.752	0.081
谷草转氨酶(U/L,$\overline{x}$±ss)	21.14±10.14	23.07±12.13	1.532	0.127
谷氨酰转肽酶(U/L,$\overline{x}$±s)	40.70±34.11	51.60±63.38	1.863	0.063
乳酸脱氢酶(U/L,$\overline{x}$±s)	188.05±55.47	187.65±51.29	0.066	0.947
碱性磷酸酶(U/L,$\overline{x}$±s)	74.71±28.09	80.20±45.62	1.265	0.207
总胆红素(μmol/L,$\overline{x}$±s)	17.82±12.24	16.98±9.05	0.689	0.491
直接胆红素(μmol/L,$\overline{x}$±s)	6.00±4.74	5.39±3.39	1.310	0.191
间接胆红素(μmol/L,$\overline{x}$±s)	11.75±8.25	11.14±6.50	0.721	0.471
总蛋白(g/L,$\overline{x}$±s)	65.90±6.30	65.57±5.62	0.499	0.618
白蛋白(g/L,$\overline{x}$±s)	38.03±6.00	38.90±5.10	1.385	0.167
球蛋白(g/L,$\overline{x}$±s)	27.38±5.52	26.66±4.85	1.235	0.218
白球比($\overline{x}$±s)	1.44±0.41	1.51±0.36	1.778	0.076
总胆汁酸(μmol/L,$\overline{x}$±s)	3.70±2.49	3.75±2.60	0.181	0.857
尿素氮(mmol/L,$\overline{x}$±s)	5.10±2.28	6.15±2.47	3.980	0.000
肌酐(μmol/L,$\overline{x}$±s)	64.63±21.91	66.68±16.08	0.962	0.337
估算肾小球滤过率[mL/(min·1.73m²),$\overline{x}$±s]	121.67±19.49	115.83±14.15	3.015	0.003
尿酸(μmol/L,$\overline{x}$±s)	337.36±132.74	351.90±123.39	1.014	0.311
β2微球蛋白(mg/L,$\overline{x}$±s)	2.08±0.92	2.19±0.93	1.018	0.309
乳酸(mmol/L,$\overline{x}$±s)	2.41±0.83	2.44±0.71	0.268	0.789
视黄醇结合蛋白(mg/L,$\overline{x}$±s)	39.68±16.10	47.40±15.82	4.312	<0.001
白细胞计数(×10⁹/L,$\overline{x}$±s)	6.89±3.30	6.89±2.81	0.004	0.997
中性粒细胞计数(×10⁹/L,$\overline{x}$±s)	4.34±2.16	4.35±2.00	0.047	0.963
淋巴细胞计数(×10⁹/L,$\overline{x}$±s)	1.56±0.63	1.59±0.62	0.421	0.674
嗜酸性粒细胞计数(×10⁹/L,$\overline{x}$±s)	0.17±0.15	0.16±0.13	1.358	0.175
单核细胞计数(×10⁹/L,$\overline{x}$±s)	0.63±0.27	0.59±0.27	1.265	0.207
嗜碱性粒细胞计数(×10⁹/L,$\overline{x}$±s)	0.03±0.02	0.03±0.02	1.338	0.182
血红细胞沉降率(mm/1h,$\overline{x}$±s)	20.10±21.85	16.69±18.53	1.488	0.138
CD3⁺总T细胞(个/μl,$\overline{x}$±s)	1166.01±435.88	1244.47±559.03	1.380	0.169
CD4⁺T细胞(个/μl,$\overline{x}$±s)	684.15±315.51	738.65±340.43	1.474	0.141
CD8⁺T细胞(个/μl,$\overline{x}$±s)	416.68±241.30	443.05±241.30	1.127	0.261
CD19⁺B细胞(个/μl,$\overline{x}$±s)	232.60±120.60	243.90±146.95	0.743	0.458
白细胞介素6(pg/ml,$\overline{x}$±s)	20.32±42.85	19.83±49.89	0.091	0.927

表2

表3

表4

表5

表6

表7

表8

表9

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临床资料	治疗效果良好组(146例)	治疗效果不佳组(174例)	统计检验值	P值
年龄(岁,$\overline{x}$±s)	43.3±21.9	45.9±22.6	t=1.073	0.284
性别[例,构成比(%)]			χ²=0.360	0.549
男性	103(70.5)	128(73.6)
女性	43(29.5)	46(26.4)
体质量指数[例,构成比(%)]			χ²=17.739	<0.001
>24kg/m²	36(24.7)	73(42.0)
18.5~23.9kg/m²	94(64.3)	93(53.4)
<18.5kg/m²	16(11.0)	5(2.9)
并发症[例,发生率(%)]
糖尿病	25(17.1)	94(54.0)	χ²=46.276	<0.001
高血压	22(15.1)	52(29.9)	χ²=9.803	0.002
肝脂肪变性	18(12.3)	103(59.2)	χ²=74.155	<0.001
病灶范围[例,构成比(%)]			χ²=2.081	0.149
累及一侧肺	53(36.3)	77(44.3)
累及两侧肺	93(63.7)	97(55.7)
病灶出现空洞[例,发生率(%)]	31(21.2)	37(21.3)	χ²=0.001	0.995

因素	赋值	因素	赋值
甘油三酯	<1.7mmol/L=0,≥1.7mmol/L=1	高密度脂蛋白
甘油三酯	<1.7mmol/L=0,≥1.7mmol/L=1	男性	≥1.0mmol/L=0,<1.0mmol/L=1
总胆固醇	<5.2mmol/L=0,≥5.2mmol/L=1	男性	≥1.0mmol/L=0,<1.0mmol/L=1
总胆固醇	<5.2mmol/L=0,≥5.2mmol/L=1	女性	≥1.3mmol/L=0,<1.3mmol/L=1

代谢相关指标	治疗效果良好组(146例)	治疗效果不佳组(174例)	χ²值	P值
甘油三酯异常[例,发生率(%)]	13^a(8.9)	73^a(42.0)	44.124	<0.001
总胆固醇异常[例,发生率(%)]	11^a(7.5)	27^a(15.6)	4.834	0.028
高密度脂蛋白异常[例,发生率(%)]	41^a(28.0)	81^a(46.6)	11.480	<0.001

因素	赋值	因素	赋值
性别	男=1,女=0	高密度脂蛋白
性别	男=1,女=0	男性	≥1.0mmol/L=0,<1.0mmol/L=1
年龄	<37岁=1;37~47岁=2;47~57岁=3;>57岁=4	男性	≥1.0mmol/L=0,<1.0mmol/L=1
年龄	<37岁=1;37~47岁=2;47~57岁=3;>57岁=4	女性	≥1.3mmol/L=0,<1.3mmol/L=1
甘油三酯	<1.7mmol/L=0,≥1.7mmol/L=1	女性	≥1.3mmol/L=0,<1.3mmol/L=1
甘油三酯	<1.7mmol/L=0,≥1.7mmol/L=1	并发糖尿病	是=1,否=0
总胆固醇	<5.2mmol/L=0,≥5.2mmol/L=1	并发糖尿病	是=1,否=0
总胆固醇	<5.2mmol/L=0,≥5.2mmol/L=1	并发高血压	是=1,否=0

变量	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
年龄^a	0.151	0.006	1.572	0.171	0.986	0.974~1.121
性别^b	0.242	0.294	0.677	0.411	0.785	0.442~1.396
甘油三酯异常^b	1.830	0.351	27.201	<0.001	6.179	3.159~12.312
高密度脂蛋白异常^b	0.801	0.279	8.257	0.004	2.134	1.233~3.586
并发糖尿病^c	1.444	0.292	24.483	<0.001	4.412	2.464~7.666
并发高血压^c	0.581	0.334	3.029	0.082	1.791	0.963~3.480

代谢相关脂肪性肝病对初治肺结核患者抗结核治疗短期疗效影响因素

Influence factors of metabolic dysfunction-associated fatty liver disease on short-term effectiveness of anti-tuberculosis therapy in primary pulmonary tuberculosis patients

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因素	治疗效果良好组(146例)	治疗效果不佳组(174例)	χ²值	P值
MAFLD[例,发生率(%)]	15(10.3)	97(55.70)	74.155	<0.001
亚组分类[例,发生率(%)]
糖尿病并发肝脂肪变性	4(2.74)	63(36.20)	68.392	<0.001
高血压并发肝脂肪变性	5(3.42)	38(21.84)	32.675	<0.001
脂质代谢异常并发肝脂肪变性	8(5.48)	72(41.38)	65.128	<0.001

变量		β值		s${}_{\overline{x}}$值		Wald χ²值		P值	OR值	95%CI值
性别^a		0.214		0.289		0.547		0.459	0.807	0.458~1.423
年龄^b		0.010		0.006		2.914		0.088	1.010	0.999~1.022
MAFLD^a		2.411		0.313		59.436		<0.001	11.146	6.039~20.573
亚组1
性别^a		0.231		0.291		0.551		0.461	0.809	0.453~1.425
年龄^b		0.012		0.007		2.919		0.090	1.012	0.998~1.012
糖尿病并发肝脂肪变性^a	2.083		0.580		12.878		<0.001		8.026	2.573~25.031
亚组2
性别^a	0.236		0.288		0.548		0.457		0.814	0.459~1.421
年龄^b	0.010		0.005		2.912		0.094		1.009	0.996~1.009
高血压并发肝脂肪变性^a	0.670		0.577		1.350		0.245		1.954	0.631~6.050
亚组3
性别^a	0.227		0.294		0.556		0.465		0.803	0.449~1.429
年龄^b	0.015		0.010		2.924		0.087		1.017	0.993~1.016
脂质代谢异常并发肝脂肪变性^a	1.738		0.428		12.712		<0.001		5.688	2.460~13.155

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因素	赋值
性别	男=1,女=0
年龄	<37岁=1;37~47岁=2;47~57岁=3;>57岁=4
MAFLD(主分析)	是=1,否=0
糖尿病并发肝脂肪变性(亚组1)	是=1, 否(包括无此情况及其他MAFLD亚型)=0
高血压并发肝脂肪变性(亚组2)	是=1, 否(包括无此情况及其他MAFLD亚型)=0
脂质代谢异常并发肝脂肪变性(亚组3)	是=1, 否(包括无此情况及其他MAFLD亚型)=0