Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis

Infectious Medicine Pub Date : 2025-06-01 DOI:10.1016/j.imj.2025.100183

Yujun Lin , Xiaohong Chen , Jiangwei Chen , Di Wu

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引用次数: 0

Abstract

Background

Extrapulmonary tuberculosis (EPTB) complicates pulmonary tuberculosis (PTB) management. Diabetes mellitus impairs immune function, worsening tuberculosis (TB) outcomes.

Methods

This retrospective study investigates the effect of glycemic control on immune function and TB dissemination in 1,768 TB patients (2022–2024). Patients were stratified by glycated hemoglobin (HbA1c) levels (≤ 6% vs. > 6%) and fasting blood glucose (FBG) concentrations (< 7 vs. ≥ 7 mmol/L). Lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺ T cells, CD19⁺ B cells, and CD16⁺CD56⁺ natural killer cells) were compared between glycemic control and TB groups. Multiple regression and threshold effect analysis were conducted to assess the effects of HbA1c and CD3⁺ T cells on TB dissemination and their critical values.

Results

Poor glycemic control was associated with lower cell counts of all lymphocyte subsets in patients with PTB (all p < 0.0001). Similar reductions were observed in patients with concurrent PTB and EPTB (PTB + EPTB) when HbA1c values > 6% (all p < 0.05). When HbA1c values ≤ 6% or FBG concentrations < 7 mmol/L, patients with PTB + EPTB showed lower immune cell counts than PTB (p < 0.05). Multiple regression indicated HbA1c increased TB dissemination risk (OR = 10.95), while CD3⁺ T cells showed protective effects. Threshold effect analysis identified an HbA1c values ≥ 7.4% for metabolic control and CD3⁺ T cell thresholds of 387/µL (immune deficiency) and 2,100/µL (immune overactivation).

Conclusions

Poor glycemic control impairs immune cells, while EPTB further reduces immune cell numbers. Integrated glycemic management and immunological monitoring help optimize treatment strategies and improve clinical outcomes, particularly in patients at risk for EPTB.

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血糖控制对肺结核传播中淋巴细胞亚群的影响：回顾性分析

背景：肺痨（EPTB）是肺结核（PTB）治疗的并发症。糖尿病损害免疫功能，恶化结核病（TB）结局。方法回顾性研究2022-2024年1768例结核病患者血糖控制对免疫功能和结核传播的影响。根据糖化血红蛋白（HbA1c）水平对患者进行分层(≤6% vs. >；6%)和空腹血糖（FBG）浓度(<；7 vs.≥7 mmol/L)。比较血糖控制组和TB组的淋巴细胞亚群（CD3+、CD4+、CD8+ T细胞、CD19+ B细胞和CD16+CD56+自然杀伤细胞）。采用多元回归和阈值效应分析评估HbA1c和CD3+ T细胞对TB传播的影响及其临界值。结果PTB患者血糖控制不佳与所有淋巴细胞亚群细胞计数降低相关(p <；0.0001)。当HbA1c值为>时，合并PTB和EPTB （PTB + EPTB）的患者也观察到类似的降低；6%(全部p <；0.05)。当HbA1c值≤6%或FBG浓度<；7 mmol/L， PTB + 患者的免疫细胞计数低于PTB (p <；0.05)。多元回归表明，HbA1c增加了TB传播风险（OR = 10.95），而CD3+ T细胞具有保护作用。阈值效应分析确定HbA1c值≥7.4%用于代谢控制，CD3+ T细胞阈值为387/µL（免疫缺陷）和2100 /µL（免疫过度激活）。结论血糖控制不良可损害免疫细胞，EPTB可进一步降低免疫细胞数量。综合血糖管理和免疫监测有助于优化治疗策略和改善临床结果，特别是对有EPTB风险的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Medicine

CiteScore

1.40

自引率

0.00%

发文量