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

doi:10.19982/j.issn.1000-6621.20250422

Abstract

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

CLC Number:

R521
R575.5

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

Figures/Tables 10

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

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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