Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity
Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity
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止血和脂蛋白指数表明伴有糖尿病合并症的结核病肺损伤加剧
DOI：
10.1016/j.chest.2017.11.029
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发表时间：
2018-05-01
期刊：
影响因子：
9.6
通讯作者：
Feng, Yonghong
中科院分区：
文献类型：
--
作者：
Dong, Zhengwei;Shi, Jingyun;Feng, Yonghong
背景技术背景：免疫病理学恶化是结核病并发糖尿病（DM）的常见后果;然而，其潜在机制仍不明确。方法：在两组年龄和性别匹配的结核病和糖尿病患者（DM-TB）和结核病和非糖尿病患者中，我们在显微镜下评估了干酪样坏死的面积，并对痰涂片阴性（SN）的肺活检中的坏死周围纤维化程度进行了分级。患者我们对痰涂片阳性（SP）患者的抗酸杆菌进行评分，并收集SN和SP患者的CT扫描数据。我们比较了炎症生物标志物和常规血液学和生化参数。应用二元Logistic回归分析来定义与肺损伤程度相关的指标。结果：DM-TB的SN患者的干酪样坏死区扩大，纤维化程度加重，与DM-TB的SP患者痰中厚壁空洞和杆菌的比例较高一致。与SN TB组中的女性相比，在男性中检测到更大的坏死灶。DM-TB合并SN患者的纤维蛋白原显著升高，高密度脂蛋白胆固醇（HDL-C）显著降低。回归分析显示，糖尿病，凝血途径的激活，（表现为血小板分布宽度增加、平均血小板体积减少和凝血酶原时间缩短）和血脂异常（表现为低密度脂蛋白胆固醇、HDL-C和载脂蛋白A的降低）是SN和SP结核患者严重肺部病变的危险因素。止血和血脂异常与肉芽肿坏死和纤维组织增生相关，导致TB患者（尤其是DM-TB患者）肺损伤加重。
BACKGROUND: Exacerbated immunopathology is a frequent consequence of TB that is complicated by diabetes mellitus (DM); however, the underlying mechanisms are still poorly defined.METHODS: In the two groups of age-and sex-matched patients with TB and DM (DM-TB) and with TB and without DM, we microscopically evaluated the areas of caseous necrosis and graded the extent of perinecrotic fibrosis in lung biopsies from the sputum smear-negative (SN) patients. We scored acid-fast bacilli in sputum smear-positive (SP) patients and compiled CT scan data from both the SN and SP patients. We compared inflammatory biomarkers and routine hematologic and biochemical parameters. Binary logistic regression analyses were applied to define the indices associated with the extent of lung injury.RESULTS: Enlarged caseous necrotic areas with exacerbated fibrotic encapsulations were found in SN patients with DM-TB, consistent with the higher ratio of thick-walled cavities and more bacilli in the sputum from SP patients with DM-TB. Larger necrotic foci were detected in men compared with women within the SN TB groups. Significantly higher fibrinogen and lower high-density lipoprotein cholesterol (HDL-C) were observed in SN patients with DM-TB. Regression analyses revealed that diabetes, activation ofu the coagulation pathway (shown by increased platelet distribution width, decreased mean platelet volume, and shortened prothrombin time), and dyslipidemia (shown by decreased low-density lipoprotein cholesterol, HDL-C, and apolipoprotein A) are risk factors for severe lung lesions in both SN and SP patients with TB.CONCLUSIONS: Hemostasis and dyslipidemia are associated with granuloma necrosis and fibroplasia leading to exacerbated lung damage in TB, especially in patients with DM-TB.