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中国防痨杂志 ›› 2025, Vol. 47 ›› Issue (10): 1358-1364.doi: 10.19982/j.issn.1000-6621.20250194

• 论著 • 上一篇    下一篇

肺结核合并肺外结核患者免疫功能和营养状况特征及其相关性研究

张帆1, 陈木兴1, 陈晓红1(), 聂文娟2, 初乃惠2   

  1. 1福建省福州肺科医院结核科,福州 350008
    2首都医科大学附属北京胸科医院结核一科,北京 101149
  • 收稿日期:2025-05-12 出版日期:2025-10-10 发布日期:2025-09-29
  • 通信作者: 陈晓红,Email:cxhong6886@126.com
  • 基金资助:
    福州市临床重点专科建设项目;福建省省级临床重点专科建设项目-福州肺科医院/福州结核病防治院结核病科(20230104)

Characteristics and correlation of immune function and nutritional status in patients with pulmonary tuberculosis combined with extrapulmonary tuberculosis

Zhang Fan1, Chen Muxing1, Chen Xiaohong1(), Nie Wenjuan2, Chu Naihui2   

  1. 1Department of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian, Fuzhou 350008, China
    2The First Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
  • Received:2025-05-12 Online:2025-10-10 Published:2025-09-29
  • Contact: Chen Xiaohong, Email:cxhong6886@126.com
  • Supported by:
    Fuzhou Clinical Key Specialty Construction Project, Fujian Province, China;Fujian Provincial Clinical Key Specialty Construction Project-Fuzhou Pulmonary Hospital/Fuzhou Tuberculosis Prevention and Control Hospital, Fujian Province(20230104)

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摘要：

目的: 探讨肺结核(pulmonary tuberculosis, PTB)合并肺外结核(extrapulmonary tuberculosis, EPTB)患者的免疫功能和营养状况特征及其相互关系。方法: 采用回顾性研究方法,参照入组标准、按照1∶1配比分别将2019年3月至2023年10月在福建省福州结核病防治院及首都医科大学附属北京胸科医院结核一科住院的PTB患者纳入单一PTB组和PTB合并EPTB组(PTB+EPTB组),两组各226例。比较两组患者的免疫功能指标(CD3+、CD4+、CD8+、CD45+ T细胞)及营养状态指标[体质量指数(BMI)、血清白蛋白、血红蛋白]的差异,并进行二者相关性分析;同时评估免疫营养状态与疾病播散程度(肺外感染部位数量)的关系。结果: PTB+EPTB组患者的BMI[19.35(17.65,21.59)kg/m2]、血清白蛋白[35.70(31.70,38.98)g/L]、血红蛋白水平[117.00(102.00,128.00)g/L]均明显低于单一PTB组[分别为20.30(19.02,22.05)kg/m2、41.05(38.50,44.10)g/L、128.00(119.00,139.00)g/L],差异均有统计学意义(W值分别为30593.500、40415.000、34752.500,P值均<0.001);免疫功能指标CD3+、CD4+、CD8+、CD45+ T细胞水平均明显低于PTB组,即使变化最小的CD4+ T细胞计数的差异也有统计学意义[303.50(172.25,459.75)个/μl和430.50(306.25,572.75)个/μl;W=34000.000,P<0.001],且单一部位肺外感染患者的血清白蛋白水平[36.20(32.50,39.20)g/L]明显高于多部位肺外感染患者[34.40(29.75,37.45)g/L],差异有统计学意义(W=6430.500,P=0.014)。相关性分析显示,PTB+EPTB组白蛋白和血红蛋白分别与CD3+、CD4+ T细胞达到中等强度相关(CD3+:r值分别为0.420和0.322,CD4+:r值分别为0.412和0.336),而单一PTB组均为弱相关(r值分别为0.192和0.177、0.100和0.102)。结论: 相较于单一PTB患者,PTB+EPTB患者存在细胞免疫功能抑制和营养不良状态更严重、免疫功能与营养状态相关性更为紧密、多部位感染患者营养状况更差的特点,建议临床应常规评估免疫营养状况,重视营养支持治疗的作用,同时动态监测单一PTB患者,以降低EPTB发生风险。

关键词: 结核,肺, 结核,肺外, T淋巴细胞, 营养状况

Abstract:

Objective: To analyze the characteristics of immune function and nutritional status and their relationship with pulmonary tuberculosis (PTB) patients combined with extrapulmonary tuberculosis (EPTB). Methods: In this retrospective study, 226 PTB-only patients and 226 patients combined with EPTB (PTB+EPTB group) from Fuzhou Tuberculosis Prevention and Control Hospital in Fujian Province and the Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University from March 2019 and October 2023 were enrolled according to inclusion criteria. The differences in immune function indicators (CD3+, CD4+, CD8+, and CD45+ T cells) and nutritional status indicators (body mass index (BMI), serum albumin, hemoglobin) were compared between the two groups, and their correlation was analyzed. The relationship between immunonutritional status and the extent of disease dissemination (number of extrapulmonary infection sites) was also evaluated. Results: The PTB+EPTB group demonstrated significantly lower BMI (19.35 (17.65, 21.59) kg/m2 vs. 20.30 (19.02, 22.05) kg/m2), serum albumin (35.70 (31.70, 38.98) g/L vs. 41.05 (38.50, 44.10) g/L), and hemoglobin levels (117.00 (102.00, 128.00) g/L vs. 128.00 (119.00, 139.00) g/L) compared with the PTB-only group (W=30593.500, 40415.000, 34752.500, respectively; all P<0.001). The levels of immune function indicators (CD3+, CD4+, CD8+, CD45+ T cells) in the PTB+EPTB group were significantly lower than those in the PTB-only group. The CD4+ T cell counts with the smallest change showed statistical significance (303.50 (172.25, 459.75) cells/μl vs. 430.50 (306.25, 572.75) cells/μl; W=34000.000, P<0.001). The serum albumin levels in patients with a single extrapulmonary infection site was significantly higher than that in patients with multiple infection sites (36.20 (32.50, 39.20) g/L vs. 34.40 (29.75, 37.45) g/L; W=6430.500, P=0.014). Correlation analysis revealed moderate correlations between albumin and hemoglobin and CD3+ T cells (r=0.420 and r=0.322, respectively) and CD4+ T cells (r=0.412 and r=0.336, respectively) in the PTB+EPTB group, whereas these correlations were weak in the PTB-only group (r=0.192 and r=0.177; r=0.100 and r=0.102, respectively). Conclusion: Compared to PTB-only patients, PTB+EPTB patients demonstrate more severe cellular immuno-suppression and malnutrition, a stronger correlation between immune function and nutritional status, and worse nutritional status in those with multiple infection sites. It is recommended to routinely assess immunonutritional status, emphasized the role of nutritional support therapy, and dynamically monitor PTB-only patients to reduce the risk of EPTB development.

Key words: Tuberculosis, pulmonary, Extrapulmonary tuberculosis, T lymphocytes, Nutritional status

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