结核病与糖尿病共病患者营养风险、炎症指标与血糖控制的相关性分析OA

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),x2=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.