摘要
肺结核(PTB)和糖尿病(DM)临床常见且发病率高,二者存在双向关联。DM患者葡萄糖代谢异常,免疫系统改变,增加PTB发病风险;PTB感染又加重机体代谢紊乱,形成恶性循环,这增加了治疗和管理难度,也提升了病死率。T淋巴细胞亚群在PTB和DM患者免疫反应中至关重要,其数量和功能变化影响疾病发展与治疗效果。DM状态下,机体先天性和适应性免疫受损,辅助性T细胞(Th)1型细胞因子产生减少,T细胞介导的适应性免疫反应启动延迟,机体对结核分枝杆菌感染防御能力下降,PTB易感性增加。PTB-DM共病患者中,Th1、Th17细胞与调节T细胞(Treg)细胞平衡被打破,引发过度促炎反应,破坏免疫平衡稳态。高血糖促使Treg细胞增多、效应T细胞减少,降低机体免疫力,加速病情恶化。检测T淋巴细胞亚群对评估PTB-DM共病患者免疫状态意义重大,在抗结核治疗效果评估、感染风险预测、预后判断及长期健康管理等方面不可或缺。深入研究其作用机制,可为优化临床治疗方案、开发新疗法提供理论依据,改善患者预后。
Pulmonary tuberculosis(PTB)and diabetes mellitus(DM)were common and highly prevalent in hospitals,and there was biodirectional association between the two types of diseases.The DM patients had the abnormal glucose metabolism and alteration of immune system,which may lead to the increase of risk of PTB;PTB may again exacerbate the metabolic disorders to form a vicious circle,which increased the difficuties of treatment and manatgment and also raised the mortality rate.T lymphocyte subsets were crucial to the immune response of the patients with PTB and DM,and the changes of their number and function affected the progression of disease and therapeutic effect.Under the state of DM,the damaged congenital and adaptive immunity,the decreased helper T cell(Th)type 1cytokines,the delayed start of T cell-mediated adaptive immune response and the declined defense capability to Mycobacterium tuberculosis infection may lead to the increase of susceptibility to PTB.The broken balance of Th1,Th17and Regulatory T cells(Treg)may induce the excessive proinflammatory reactions and destroy the immune homeostasis of the patients with PTB-DM comorbidity.High blood glucose level increases the number of Treg cells,decreses the number of effector T cells,reduces the immunity and accelerates the deterioration of diseases.The T lymphocytes subsets have great significance in assessment of the immune state of the patients with PTB-DM comorbidity and are essential for assessment of anti-tuberculosis effect,prediction of risk for infections,judgment of prognosis and long-term health management.Further study on the mechanisms may provide theoretical bases for optimizing clinical treatment programs and developing new therapies so as to improve the prognosis of the patients.
作者
古丽斯坦·艾力
沃拉孜汗·玛德尼亚提
阿吉姑丽·库来西
拜合提尼沙·吐尔地
Gulisitan·AILI;Wolazihan·MADENIYATI;Ajiguli·KULAIXI;Baihetinisha·TUERDI(The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830000,China)
出处
《中华医院感染学杂志》
北大核心
2025年第14期2230-2234,共5页
Chinese Journal of Nosocomiology
基金
新疆地区高发疾病研究教育部重点实验室开放课题基金资助项目(2024A03)。
关键词
肺结核
糖尿病
T细胞亚群
免疫机制
病程管理
共病演变
Pulmonary tuberculosis
Diabetes mellitus
T lymphocyte subset
Immune mechanism
Disease course management
Comorbidity evolution
