耐药肺结核患者营养和免疫状态与结核病严重程度的关系

doi:10.19871/j.cnki.xfcrbzz.2025.03.003

摘要/Abstract

摘要： 目的探讨营养和免疫指标与耐药肺结核（drug-resistant pulmonary tuberculosis,DR-TB）严重程度的关系,为构建基于营养和免疫调节的精准干预策略提供依据。方法本研究为横断面研究,研究对象为2023年1月至12月广州市胸科医院住院部收治的336例确诊为DR-TB的患者,根据肺部影像学特征分为严重DR-TB组（感染肺野数≥3个,n=183）和一般DR-TB组（感染肺野数<3个,n=153）。营养状况评估指标包括体重指数（body mass index,BMI）、营养风险筛查2002（nutritional risk screening 2002,NRS 2002）、总蛋白（total protein,TP）、前白蛋白（prealbumin,PA）、转铁蛋白（transferrin,TRF）、血清白蛋白（albumin,ALB）水平和预后营养指标（prognostic nutritional indicators,PNI）。免疫状况评估指标包括CD3+T淋巴细胞、CD4+T淋巴细胞、CD8⁺T淋巴细胞、白细胞（white blood cell,WBC）、中性粒细胞（neutrophils,Neu）、血小板（platelets,PLT）、淋巴细胞（lymphocyte,LYM）、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）等。采用多因素Logistic回归分析营养和免疫状况与DR-TB严重程度的关联。结果与一般DR-TB组相比,严重DR-TB组以中老年男性为主,且病程更长（P<0.05）。严重DR-TB组的BMI、PNI、ALB、PA和TRF水平较低（均P<0.05）。严重DR-TB组中CD3⁺T淋巴细胞、CD4⁺T淋巴细胞、LYM计数水平较低,而WBC、Neu、PLT、NLR和PLR水平较高,且WBC、LYM、NLR和PLR结果异常的比例显著增多（均P<0.05）。多因素Logistic回归分析结果显示,在调整了年龄、性别、BMI、糖尿病和疾病病程后,BMI、PNI、ALB、PA水平升高是严重DR-TB的独立保护因素,而WBC、Neu、PLT、NLR和PLR水平升高是严重DR-TB的独立危险因素。结论营养和免疫状况与DR-TB的严重程度显著相关,控制感染、维持较好的营养状况和免疫功能有助于降低严重DR-TB的风险,从而有助改善患者预后。

关键词: 耐药肺结核, 营养状况, 免疫功能, 严重程度, 预后营养指数

Abstract: Objective To investigate the relationship between nutritional and immune indicators and the severity of drug-resistant pulmonary tuberculosis (DR-TB), and to provide a basis for developing precision intervention strategies based on nutritional and immunomodulatory approaches. Method This cross-sectional study enrolled 336 patients diagnosed with DR-TB and admitted to Guangzhou Chest Hospital from January to December 2023. Based on pulmonary imaging features, patients were divided into a severe DR-TB group (≥3 infected lung fields, n=183) and a general DR-TB group (<3 infected lung fields, n=153). Nutritional status was assessed using body mass index (BMI), nutritional risk screening score (NRS-2002), total protein (TP), prealbumin (PA), trans iron protein (TRF), serum albumin (ALB) levels and prognostic nutritional indicator (PNI), immune status was evaluated via CD4+T, CD8+T, CD3+T, as well as white blood cells (WBC), neutrophil(Neu), lymphocyte (LYM) count, platelets (PLT), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR). Multivariate logistic regression was used to assess the relationship between nutrition, immune status and DR-TB severity. Result Compared with patients in the general DR-TB group, patients in the severe DR-TB group were more likely to be middle-aged and older men with a longer course of disease (P<0.05). In nutritional index, BMI, PNI, ALB, PA and TRF levels were significantly lower in the severe DR-TB group (all P<0.05). In terms of immune indexes, severe DR-TB patients exhibited reduced CD4+T, CD3+T and LYM levels but elevated WBC, PLT, NLR and PLR levels, with higher proportions of abnormal WBC, LYM, and NLR results, P<0.05. Multivariate logistic regression analysis showed that BMI, PNI, ALB and PA were protective factors against severe DR-TB, while WBC, Neu, PLT, NLR, and PLR were independent risk factors, after adjusting for age, gender, BMI, diabetes mellitus and disease duration. Conclusion Nutrition and immune status are significantly associated with the severity of DR-TB. Effective infection control, improved nutritional status, and enhanced immune function may help reduce the risk of severe DR-TB and thus improve patient prognosis.

Key words: Drug-resistant pulmonary tuberculosis, Nutritional status, Immune function, Severity, Prognostic nutritional indicators

中图分类号:

R521

卢春丽, 李艳, 汪敏, 袁园, 黄亚玲, 范佳画. 耐药肺结核患者营养和免疫状态与结核病严重程度的关系[J]. 新发传染病电子杂志, 2025, 10(3): 12-17.

Lu Chunli, Li Yan, Wang Min, Yuan Yuan, Huang Yaling, Fan Jiahua. The relationship between nutritional and immune status and severity of drug-resistant pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(3): 12-17.

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