肺结核并发糖尿病患者临床特征及淋巴细胞亚群检测结果分析

目的 探讨肺结核并发糖尿病(pulmonary tuberculosis complicated with diabetes mellitus, PTB-DM)患者临床特征及淋巴细胞亚群特点。方法 回顾性收集2018年4月1日至2019年5月31日在解放军总医院第八医学中心结核二科住院的符合纳入标准的肺结核患者。根据是否并发糖尿病将其分为两组:PTB-DM组85例,单纯肺结核组(PTB组)96例。对两组患者临床特征包括性别、年龄、治疗史和胸部CT检查结果进行比较分析;对两组患者淋巴细胞亚群和结核分枝杆菌特异性反应T细胞检测结果分别进行比较分析。结果 PTB-DM组男性和女性分别占76.4%(65/85)和23.6%(20/85),PTB组分别占57.3%(55/96)和42.7%(41/96),差异有统计学意义(χ²=7.42,P=0.006)。PTB-DM组<25岁、25~60岁和>60岁的患者分别占2.4%(2/85)、68.2%(58/85)和29.4%(25/85); PTB组则分别占25.0%(24/96)、63.5%(61/96)和11.5%(11/96),差异有统计学意义(χ²=23.55,P=0.000)。PTB-DM组初治和复治患者分别占74.1%(63/85)和25.9%(22/85),PTB组分别占84.4%(81/96)和15.6%(15/96),差异无统计学意义(χ²=2.92,P=0.088)。PTB-DM组胸部CT扫描显示无空洞、有空洞、病变范围<3个肺叶和≥3个肺叶者分别占23.5%(20/85)、76.5%(65/85)、31.8%(27/85)和68.2%(58/85);PTB组分别为53.1%(51/96)、46.9%(45/96)、54.2%(52/96)和45.8%(44/96);PTB-DM组胸部CT有空洞和病变范围≥3个肺叶的患者明显多于PTB组,差异有统计学意义(χ²=16.56,P=0.000和χ²=9.20,P=0.002)。PTB-DM组结核分枝杆菌特异性反应T细胞阳性率为81.3%(65/80),PTB组阳性率为74.2%(66/89),差异无统计学意义(χ²=1.22,P=0.270)。PTB-DM组总T淋巴细胞绝对计数、CD4⁺T淋巴细胞绝对计数、CD8⁺T淋巴细胞绝对计数、自然杀伤细胞(NK细胞)绝对计数、NK样T淋巴细胞绝对计数和总B淋巴细胞绝对计数的中位数(四分位数)值分别为1069.00(753.50,2372.50)、548.00(381.00,787.50)、380.00(270.50,574.50)、184.00(111.00,294.50)、60.00(36.00,120.50)和162.00(80.50,244.00)个/μl,PTB组则分别为1161.50(858.50,1601.00)、628.00(472.75,860.50)、457.50(286.00,614.75)、191.50(115.75,315.75)、65.50(34.50,119.50)和184.50(112.25,301.00)个/μl,两组间6项指标差异无统计学意义(Z=-1.80,P=0.073;Z=-1.47,P=0.142;Z=-1.46,P=0.144;Z=-0.57,P=0.568;Z=-0.09,P=0.931;Z=-1.93,P=0.053)。结论 PTB-DM中老年男性较多,病灶范围广泛、严重; PTB是否并发DM对淋巴细胞亚群6项指标检测结果无明显影响。

Analyses of clinical features and lymphocyte subsets in patients with pulmonary tuberculosis complicated with diabetes mellitus

Objective To investigate the clinical features and lymphocyte subsets in patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM). Methods A total of 85 PTB-DM patients who were hospitalized from April 1, 2018 to May 31, 2019 were enrolled as the PTB-DM group, and 96 PTB patients hospitalized at the same time were selected as the PTB group. Clinical features including gender, age, treatment history, chest CT examination, and lymphocyte subsets absolute counts and Mycobacterium tuberculosis-specific T cells response were compared between the two groups. Results Males and females were 76.4% (65/85) and 23.6% (20/85) respectively in PTB-DM group, while those were 57.3% (55/96) and 42.7% (41/96) respectively in PTB group (χ ²=7.42, P=0.006).2.4% (2/85), 68.2%(58/85) and 29.4% (25/85) of the patients were <25, 25-60 and >60 years old in PTB-DM group, respectively, while 25.0% (24/96), 63.5%(61/96) and 11.5% (11/96) were in PTB group, respectively, with significant difference (χ ²=23.55, P=0.000). The rate of initial- and retreatment patients were 74.1% (63/85) and 25.9% (22/85) in PTB-DM group, and those were 84.4% (81/96) and 15.6% (15/96) in PTB group, respectively, with no significant statistical difference (χ ²=2.92, P=0.088). In PTB-DM group, the rate of no cavity, cavity, lesion area <3 lobes and ≥3 lobes in chest CT were 23.5% (20/85), 76.5% (65/85), 31.8% (27/85) and 68.2% (58/85), respectively, while those were 53.1% (51/96), 46.9% (45/96), 54.2% (52/96) and 45.8% (44/96) respectively in PTB group. The patients with cavity and lesions ≥3 lobes in chest CT in PTB-DM group was significantly higher than those in PTB group (χ ²=16.56, P=0.000 and χ ²=9.20, P=0.002). The positive rate of Mycobacterium tuberculosis-specific T cell reaction was 81.3% (65/80) in PTB-DM group, and that was 74.2%(66/89)in PTB group, with no significant difference (χ ²=1.22,P=0.270).The median of absolute counts of total T lymphocytes, CD4⁺, CD8⁺, NK-like T lymphocytes, natural killer cells (NK cells) and total B lymphocytes in the PTB-DM group were 1069.00(753.50,2372.50), 548.00(381.00,787.50), 380.00(270.50,574.50), 60.00(36.00,120.50), 184.00(111.00,294.50) and 162.00(80.50,244.00)/μl, respectively, while those in PTB group were 1161.50(858.50,1601.00), 628.00(472.75,860.50), 457.50(286.00,614.75), 65.50(34.50,119.50), 191.50(115.75,315.75)and 184.50(112.25,301.00)/μl, respectively. There were no significantly statistical difference in the six indexes between the two groups(Z=-1.80,P=0.073;Z=-1.47,P=0.142;Z=-1.46,P=0.144;Z=-0.09,P=0.931;Z=-0.57,P=0.568;Z=-1.93,P=0.053). Conclusion There were more middle-aged and elderly men, and extensive, serious lesions in PTB-DM group. PTB with or without DM had no significant effect on the detection results of lymphocyte subsets.