| ObjectiveTo investigate the relationship between cellular immunity and insulin resistance in patients with type 2 diabetes mellitus(T2DM),tuberculosis(TB),and T2DM with TB(T2DM-TB).To provide a possible basis for the enhancement of immunotherapy for those patients.MethodsPatients who were hospitalized in the First Affiliated Hospital of Xi’an Medical College and Shaanxi Tuberculosis Prevention and Treatment Hospital from March 2019 to October 2020 were collected.After screening in strict accordance with the inclusion and exclusion criteria,216 cases were enrolled,with 127 cases in the T2DM-TB group,62cases in the TB group and 27 cases in the T2DM group;gender,age,height,weight and five categories of blood routine,liver and kidney function,glycosylated hemoglobin(Hb A1c),fasting blood glucose(FPG),fasting insulin(FPG),T lymphocyte subsets,videography,bacteriology and immunology and other related data of the three groups collected.The Homeostasis model assessment of-β(HOMA-β),HOMA-Insulin Resistance Index(HOMA-IR)of candidate’s were caculated and SPSS 25.0 software was used to analyze the data.Results1.Comparison of the basic data of the three groups of research subjects in the T2DM group,T2DM-TB group and TB group:(1)The basic data of the three groups of research subjects:gender,age,height,weight,body mass index comparison,no statistical significance(P>0.05);(2)Comparison of biochemical data:the comparison of red blood cells(RBC),hemoglobin(HB),calcium ion(Ca),total protein(TP),albumin(ALB),and blood urea nitrogen(BUN)among the three groups of T2DM,T2DM-TB,and TB groups was statistically significant(P<0.05);The comparison of white blood cells(WBC),platelets(PLT),indirect bilirubin(IBIL),aspartate transaminase(AST),alanine transferase(ALT),serum creatinin(Scr)and uric acid(UA)was not statistically significant(P>0.05);(3)Comparison of glucose metabolism indicators:FPG,Hb A1c,T2DM-TB group>T2DM group>TB group,there were statistically significant of the three groups(P<0.05);FINS,HOMA-IR,T2DM group>T2DM-TB group>TB group,there were statistically significant of the three groups(P<0.05);HOMA-β,T2DM-TB group<T2DM group<TB group,there were statistically significant of the three groups(P<0.05);(4)Comparison of T cell subsets:1)CD4~+T%and CD4~+T/CD8~+T in T2DM-TB group were lower than T2DM group and TB group,which was statistically significant compared with TB group(P<0.05);2)CD3~+T%and CD8~+T%in T2DM-TB group were higher than T2DM group and TB group,which was statistically significant compared with TB group(P<0.05);The comparison of CD3~+T%in T2DM-TB group and T2DM group was statistically significant(P<0.05).2.Comparison of immunology,bacteriology and imaging data between T2DM-TB group and TB group:(1)The positive rate of tuberculosis antibody Ig G in the T2DM-TB group was higher than that of TB group(P<0.05);There was no significancant difference of tuberculosis protein antibody 16KD,38KD,LAM,tuberculosis antibody Ig M,γ-interferon release test,T-sport(P>0.05);(2)The positive rate of sputum tuberculosis RNA in the T2DM-TB group was higher than that in the TB group(P<0.05);there was no statistically significant comparison between the residual sputum and the alveolar lavage fluid tuberculosis bacteriological examination results(P>0.05);(3)Comparison of imaging data between the two groups of subjects:the incidence of cavitation in the T2DM-TB group was higher than that in the TB group(P<0.05);there was no significancant difference of lung lesions<3 lung lobes,lung lesions≥3 lung lobes and incidence of lesions involving the pleura(P>0.05).3.Comparison of T cell subgroups between T2DM-TB group and TB group:(1)CD3~+T%,CD4~+T%,CD4~+T/CD8~+T,T2DM-TB group(bacteria negative)were higher than T2DM-TB group(bacteria positive),CD8~+T%,T2DM-TB group(bacterial negative)was lower than T2DM-TB group(bacterial positive),which was not statistically significant(P>0.05);(2)CD3~+T%,T2DM-TB group(initial treatment)was higher than T2DM-TB group(retreatment),CD4~+T%,CD8~+T%,CD4~+T/CD8~+T were lower than T2DM-TB group(retreatment),the comparison was not statistically significant(P>0.05);(3)CD3~+T%,CD8~+T%,TB group(bacterial negative)was lower than TB group(bacterial positive),CD4~+T%,CD4~+T/CD8~+T,TB group(bacterial negative)was higher than TB group(bacterial positive),the comparison was not statistically significant(P>0.05);(4)CD4~+T%,CD4~+T/CD8~+T,TB group(initial treatment)was lower than TB group(retreatment),CD3~+T%,CD8~+T%TB group(initial treatment)was higher than TB group(retreatment),the comparison between the two groups was not statistically significant(P>0.05).4.Correlation analysis of T lymphocyte subsets:(1)CD3~+T%was positively correlated with PLT(r_s=0.181)and Hb A1c(r_s=0.174)(P<0.05),and negatively correlated with BUN(r_s=-0.147)and Scr(r_s=-0.134)(P<0.05);(2)CD8~+T%was positively correlated with PLT(r_s=0.278),Hb A1c(r_s=0.142)(P<0.05),CD8~+T%was negatively correlated with TBIL(r_s=-0.145),AST(r_s=-0.146)(P<0.05);(3)CD4~+T/CD8~+T was negatively correlated with platelets(r_s=-0.248)(P<0.05).Conclusion(1)Type 2 diabetes and tuberculosis can cause cellular immune damage,and cellular immune damage is more serious when the two diseases are combined;(2)Pulmonary lesions in patients with diabetes and tuberculosis are more serious than those in people with simple tuberculosis;(3)In patients with type 2 diabetes mellitus complicated with tuberculosis,there is positive correlation between Hb A1c and CD3~+T%and CD8~+T%in T cell subsets. |
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