The relationship between nutritional and immune status and severity of drug-resistant pulmonary tuberculosis

doi:10.19871/j.cnki.xfcrbzz.2025.03.003

Abstract

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

CLC Number:

R521

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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