Association between nutritional risk, inflammatory indicators, and glycemic control in patients with tuberculosis complicated by diabetes mellitus

doi:10.19982/j.issn.1000-6621.20250503

Abstract

Abstract:

Objective: To investigate the relationship between nutritional risk, inflammatory markers, and glycemic control in patients with tuberculosis and diabetes comorbidity (TB-DM), providing evidence for optimizing the integrated management of TB-DM patients. Methods: A cross-sectional study was conducted, enrolling 264 TB-DM patients admitted to the Guangzhou Chest Hospital from January to December 2023. Patients were grouped and compared based on their Nutritional Risk Screening 2002 (NRS-2002) scores and glycated hemoglobin (HbA1c) levels. Data collected included nutritional indicators such as body mass index (BMI), albumin (ALB), prognostic nutritional index (PNI), immuno-inflammatory indicators such as CD cell subsets, white blood cell count (WBC), neutrophil count (Neu), lymphocyte count (LYM), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and glycemic indicators (random blood glucose and HbA1c). Multivariable logistic regression was used to analyze the association between nutritional risk and poor glycemic control. Mediation analysis was further employed to examine the mediating role of inflammatory markers in the relationship between nutritional risk and glycemic control. Results: Patients with nutritional risk (NRS-2002 ≥3) accounted for 50.4% (133/264). Compared to the no-nutritional-risk group, the nutritional-risk group had significantly lower nutritional and immune indicators: BMI (20.20 (18.73, 22.95) kg/m² vs. 22.14 (20.55, 24.22) kg/m², Z=-4.759, P<0.001), ALB ((30.93±7.02) g/L vs. (36.48±7.08) g/L, t=6.393, P<0.001), CD4⁺ T-cell count (392 (260, 560) cells/μl vs. 564 (394, 756) cells/μl, Z=-5.108, P<0.001), and a higher sputum smear-positive rate (60.90% (81/133) vs. 39.69% (52/131), χ²=11.874, P<0.001). Notably, this group had significantly higher inflammatory levels: NLR (5.20 (3.54, 10.14) vs. 3.64 (2.61, 5.48), Z=-4.510, P<0.001), C-reactive protein (22.54 (6.36, 58.32) mg/L vs. 5.23 (1.36, 22.12) mg/L, Z=-4.852, P<0.001), but lower HbA1c levels (7.50% (6.60%, 10.00%) vs. 8.60% (7.35%, 10.20%), Z=-2.711, P=0.007). Multivariable logistic regression analysis indicated that, after adjusting for confounders, nutritional risk was independently inversely association with poor glycemic control (OR=0.357, 95%CI: 0.194-0.656). Mediation analysis revealed that inflammatory markers (WBC, Neu, NLR) were significant mediators in the effect of nutritional risk on HbA1c levels, accounting for 31.29%, 50.44%, and 53.16% of the total effect, respectively. Conclusion: In TB-DM patients, those with nutritional risk often present with more severe inflammatory status and immunosuppression, but their blood glucose levels may be relatively lower, potentially due to severe bodily catabolism. Inflammation is a key pathway linking nutritional risk to glycemic control. In the clinical management of TB-DM patients, while actively controlling blood glucose, we should attach high importance to nutritional assessment, and regulating inflammation should be considered a crucial component of comprehensive treatment.

Key words: Tuberculosis, Diabetes mellitus, Comorbidity, Nutritional status, Inflammation, Blood glucose

CLC Number:

Fan Jiahua, Yan Liang, Chen Hua, Lu Chunli, Wang Min, Huang Yaling, Li Yan. Association between nutritional risk, inflammatory indicators, and glycemic control in patients with tuberculosis complicated by diabetes mellitus[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 769-778. doi: 10.19982/j.issn.1000-6621.20250503

Figures/Tables 7

指标	合计 (264例)	无营养风险组 (131例)	有营养风险组 (133例)	统计检验值	P值
年龄(岁,$\overline{x}$±s)	59.30±12.80	57.30±10.80	61.30±14.20	t=-2.593	0.010
TP(g/L,$\overline{x}$±s)	68.94±7.76	70.72±6.37	67.18±8.59	t=3.801	<0.001
ALB(g/L,$\overline{x}$±s)	33.69±7.57	36.48±7.08	30.93±7.02	t=6.393	<0.001
PNI(g/L,$\overline{x}$±s)	40.09±9.02	43.57±8.12	36.66±8.57	t=6.728	<0.001
BMI[kg/m²,M(Q₁,Q₃)]	21.47(19.29,23.72)	22.14(20.55,24.22)	20.20(18.73,22.95)	Z=-4.759	<0.001
随机血糖[mmol/L,M(Q₁,Q₃)]	11.57(7.57,16.26)	11.77(8.52,16.93)	11.07(7.06,15.39)	Z=-2.154	0.031
HbA1c[%,M(Q₁,Q₃)]	8.15(6.80,10.12)	8.60(7.35,10.20)	7.50(6.60,10.00)	Z=-2.711	0.007
CD4⁺ T细胞[个/μl,M(Q₁,Q₃)]	468(314,689)	564(394,756)	392(260,560)	Z=-5.108	<0.001
CD8⁺ T细胞[个/μl,M(Q₁,Q₃)]	259.9(183.8,396.6)	312.1(219.8,469.9)	212.4(143.7,340.1)	Z=-4.866	<0.001
CD3⁺ T细胞[个/μl,M(Q₁,Q₃)]	794(534,1167)	912(702,1290)	640(448,896)	Z=-5.311	<0.001
CD4/CD8 T细胞比值[M(Q₁,Q₃)]	1.78(1.32,2.34)	1.74(1.40,2.37)	1.78(1.26,2.33)	Z=-0.434	0.664
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	7.37(5.87,9.52)	7.18(5.84,9.03)	7.73(5.98,9.95)	Z=-1.399	0.162
淋巴细胞计数[×10⁹/L,M(Q₁,Q₃)]	1.23(0.80,1.64)	1.34(1.10,1.72)	1.01(0.64,1.53)	Z=-4.114	<0.001
中性粒细胞计数[×10⁹/L,M(Q₁,Q₃)]	5.36(3.94,7.33)	5.00(3.71,6.48)	5.70(4.22,7.64)	Z=-2.452	0.014
血小板计数[×10⁹/L,M(Q₁,Q₃)]	260.5(200.8,335.3)	262.0(205.5,321.5)	257.0(197.0,352.0)	Z=-0.150	0.881
CRP[mg/L,M(Q₁,Q₃)]	11.31(2.17,38.79)	5.23(1.36,22.12)	22.54(6.36,58.32)	Z=-4.852	<0.001
NLR[M(Q₁,Q₃)]	4.35(2.85,7.18)	3.64(2.61,5.48)	5.20(3.54,10.14)	Z=-4.510	<0.001
PLR[M(Q₁,Q₃)]	217.9(146.7,349.7)	195.7(131.3,261.6)	257.7(168.0,390.7)	Z=-3.574	<0.001
感染肺野数[个,M(Q₁,Q₃)]	4(2,6)	2(2,6)	6(2,6)	Z=-2.310	0.021
结核病病程[月,M(Q₁,Q₃)]	6(2,21)	6(2,18)	7(3,24)	Z=-1.117	0.264
糖尿病病程[年,M(Q₁,Q₃)]	3.00(1.00,10.00)	3.00(1.00,10.00)	3.00(1.00,8.00)	Z=-0.778	0.440
性别[例(构成比,%)]				χ²=0.607	0.436
女性	43(16.29)	19(14.50)	24(18.05)
男性	221(83.71)	112(85.50)	109(81.95)
免疫功能低下[例(构成比,%)]				χ²=20.860	<0.001
否	118(44.70)	77(58.78)	41(30.83)
是	146(55.30)	54(41.22)	92(69.17)
患者类型[例(构成比,%)]^a				χ²=0.684	0.408
初治	173(69.76)	86(72.27)	87(67.44)
复治	75(30.24)	33(27.73)	42(32.56)
痰涂片情况[例(构成比,%)]				χ²=11.874	<0.001
阳性	133(50.38)	52(39.69)	81(60.90)
阴性	131(49.62)	79(60.31)	52(39.10)
耐药情况[例(构成比,%)]				χ²=0.047	0.829
耐药	85(32.20)	43(32.82)	42(31.58)
敏感	179(67.80)	88(67.18)	91(68.42)
HbA1c≥7.0%[例(构成比,%)]				χ²=14.572	<0.001
否	79(29.92)	25(19.08)	54(40.60)
是	185(70.08)	106(80.92)	79(59.40)

指标	合计 (264例)	血糖控制良好组 (79例)	血糖控制不佳组 (185例)	统计检验值	P值
年龄(岁,$\overline{x}$±s)	59.34±12.75	61.28±14.24	58.51±12.00	t=1.515	0.132
TP(g/L,$\overline{x}$±s)	68.94±7.76	68.63±8.16	69.06±7.61	t=-0.411	0.681
ALB(g/L,$\overline{x}$±s)	33.69±7.57	33.97±7.59	33.57±7.58	t=0.394	0.694
PNI(g/L,$\overline{x}$±s)	40.09±9.02	40.10±8.78	40.08±9.15	t=0.017	0.986
BMI[kg/m²,M(Q₁,Q₃)]	21.50(19.30,23.70)	20.80(19.00,23.60)	21.50(19.60,23.70)	Z=-1.425	0.149
随机血糖[mmol/L,M(Q₁,Q₃)]	11.57(7.57,16.26)	7.96(6.14,10.75)	13.01(9.30,17.34)	Z=-6.786	<0.001
HbA1c[%,M(Q₁,Q₃)]	8.15(6.80,10.12)	6.40(6.00,6.70)	9.30(8.00,11.20)	Z=-12.864	<0.001
CD4⁺ T细胞[个/μl,M(Q₁,Q₃)]	468(314,689)	420(294,592)	500(316,748)	Z=-2.214	0.027
CD8⁺ T细胞[个/μl,M(Q₁,Q₃)]	260(184,396)	251(180,358)	264(192,444)	Z=-1.108	0.265
CD3⁺ T细胞[个/μl,M(Q₁,Q₃)]	794(534,1167)	692(524,910)	844(536,1224)	Z=-1.993	0.046
CD4/CD8 T细胞比值[M(Q₁,Q₃)]	1.78(1.32,2.34)	1.73(1.29,2.23)	1.80(1.34,2.39)	Z=-1.151	0.250
白细胞计数[10⁹/L,M(Q₁,Q₃)]	7.37(5.87,9.52)	6.94(5.53,8.71)	7.73(6.05,9.60)	Z=-2.117	0.034
淋巴细胞计数[10⁹/L,M(Q₁,Q₃)]	1.23(0.80,1.64)	1.12(0.76,1.58)	1.27(0.85,1.68)	Z=-1.281	0.200
中性粒细胞[10⁹/L,M(Q₁,Q₃)]	5.36(3.94,7.33)	5.11(3.63,6.65)	5.50(4.09,7.52)	Z=-2.017	0.044
血小板[10⁹/L,M(Q₁,Q₃)]	261(201,335)	228(181,305)	273(213,349)	Z=-2.549	0.011
CRP[mg/L,M(Q₁,Q₃)]	11.31(2.17,38.79)	16.91(1.83,31.55)	9.93(2.21,42.10)	Z=-0.185	0.853
NLR[M(Q₁,Q₃)]	4.35(2.85,7.17)	4.25(2.72,6.88)	4.50(2.88,7.28)	Z=-0.578	0.567
PLR[M(Q₁,Q₃)]	217.9(146.7,349.7)	214.0(144.3,320.6)	219.7(146.9,373.8)	Z=-0.447	0.654
感染肺野数[个,M(Q₁,Q₃)]	4(2,6)	6(2,6)	3(2,6)	Z=-1.438	0.151
结核病病程[月,M(Q₁,Q₃)]	6(2,21)	7(3,12)	6(2,24)	Z=-0.701	0.485
糖尿病病程[年,M(Q₁,Q₃)]	3.00(1.00,10.00)	2.00(0.75,4.00)	3.00(1.00,10.00)	Z=-2.684	<0.001
性别[例(构成比,%)]				χ²=4.982	0.026
女性	43(16.29)	19(24.05)	24(12.97)
男性	221(83.71)	60(75.95)	161(87.03)
免疫功能低下[例(构成比,%)]				χ²=3.906	0.048
否	118(44.70)	28(35.44)	90(48.65)
是	146(55.30)	51(64.56)	95(51.35)
患者类型[例(构成比,%)]^a				χ²=0.262	0.609
初治	173(69.76)	52(67.53)	121(70.76)
复治	75(30.24)	25(32.47)	50(29.24)
痰涂片情况[例(构成比,%)]				χ²=0.566	0.452
阳性	133(50.38)	37(46.84)	96(51.89)
阴性	131(49.62)	42(53.16)	89(48.11)
耐药情况[例(构成比,%)]				χ²=0.544	0.461
耐药	85(32.20)	28(35.44)	57(30.81)
敏感	179(67.80)	51(64.56)	128(69.19)
营养风险[例(构成比,%)]				χ²=14.572	<0.001
无	131(49.62)	25(31.65)	106(57.30)
有	133(50.38)	54(68.35)	79(42.70)

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变量	赋值
男性	否=0,是=1
免疫功能低下	否=0,是=1
营养风险	否=0,是=1
糖尿病病程	原值输入
白细胞计数	原值输入
血小板计数	原值输入

指标	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
模型1
营养风险	-0.928	0.302	9.456	0.002	0.395	0.219~0.714
男性	0.834	0.368	5.121	0.024	2.302	1.118~4.740
免疫功能低下	-0.354	0.304	1.357	0.244	0.702	0.387~1.273
糖尿病病程	0.086	0.031	4.000	0.006	1.090	1.025~1.159
模型2
营养风险	-1.031	0.311	10.976	<0.001	0.357	0.194~0.656
男性	0.780	0.379	4.248	0.039	2.182	1.039~4.585
免疫功能低下	-0.251	0.311	0.653	0.419	0.778	0.423~1.431
糖尿病病程	0.083	0.032	6.518	0.011	1.086	1.019~1.157
白细胞计数	0.069	0.057	1.471	0.225	1.072	0.958~1.198
血小板计数	0.002	0.002	1.946	0.163	1.002	0.999~1.005