| Objective:Recently,the rapidly rising prevalence of diabetes mellitus and serious burden of tuberculosis in developing countries become the major challenges for tuberculosis prevention and control.Patients with diabetes mellitus(DM)have high risk(2.4 to 8.3folds)for developing pulmonary tuberculosis(PTB).Compared with the normal people,the levels of serum zinc(Zn)and selenium(Se)are decreased in PTB and DM patients,and the serum copper(Cu)increased.The changes in the types and contents of fatty acids in the body may have significantly association with disease.The fatty acids on the erythrocyte membrane are relatively stable and unsusceptible to fatty acid intake in short terms,therefore,it can reflect the level of fatty acid intake in recent 2 to 3 months.Some studies found that the levels of saturated fatty acids on erythrocyte membranes were elevated while the levels of unsaturated fatty acids were reduced.Therefore,the patients with diabetes mellitus complicated with pulmonary tuberculosis(DM-PTB),patients with simple DM,patients with simple PTB,and normal controls were enrolled in this study.We analyzed the differences in serum mineral elements and erythrocyte membrane fatty acid content between different disease groups and between disease groups and healthy people to explore the relationship between serum mineral element and erythrocyte membrane fatty acid content and the risk of DM-PTB,and provide scientific basis for prevention and control of tuberculosis.Methods:We conducted a cross-sectional study method,patients with DM-PTB and simple PTB were a city chest hospital while DM and healthy people were come from the general hospital in the certain city from January 2018 to December 2018.The basic data such as age and gender were collected through questionnaires and their height,weight and blood pressure were measured in the same time.Fasting blood glucose,cholesterol and triglycerides were measured by Hitachi 7180 automatic biochemical analyzer.The serum mineral element levels were determined by Inductively coupled Plasma Mass Spectrometry(ICP-MS)method;the erythrocyte membrane fatty acid composition wasdetermined by Gas Chromatography-Mass Spectrometry(GC-MS).We analyzed the content of serum mineral elements such as calcium,magnesium,copper and zinc and the fatty acid on erythrocyte membrane in DM-PTB,DM,PTB patients and control people.Univariate and multivariate logistic regression were used.Odds ratio(OR)and its 95%confidence interval(95% CI)were presented.Results:Our study was divided into two parts.In the first part,a total of 300 subjects were enrolled(average age: 50.44 years old),including DM-PTB,DM,PTB and control groups,each group had 75 people.The level of serum triglyceride(TG)in DM-PTB group were significantly higher than in the control group and the level of serum total cholesterol(TC)and TG were significantly lower than in DM group.The systolic blood pressure(SBP)in the DM-PTB group was significantly higher than that of the PTB group.Compared with the control group,serum K,Cu and Ni levels in the DM-PTB group were significantly increased while serum Ca,Mg,Fe,Zn,Se and Mn levels were significantly decreased;The PTB group have the same change;There was no increase in Cu and decrease in Fe and Mn in DM group.The results of multivariate logistic regression showed that in serum,high K(OR=36.67,95% CI: 14.42-93.20),high Cu(OR=8.67,95)% CI: 4.04-18.59)and low Mg(OR = 12.61,95% CI: 5.46-29.11),low Ca(OR = 6.12,95% CI: 2.90-12.91),low Zn(OR = 5.97,95%)CI: 2.84-12.55),low Mn(OR=4.97,95% CI: 2.43-10.14)may have association with DM-PTB and PTB(P<0.05).There was no correlation between high K,high Cu,high Ni and low Mn in serum and the risk of diabetes.In the second part,a total of 200 subjects were enrolled(average age: 45.13 years old),each group had 50 people.The levels of BMI and serum TG in DM-PTB group were significantly higher than in control group and PTB group,and BMI and DBP were significantly lower than in DM group(P<0.05).The levels of BMI,DBP and serum TG in DM group were significantly higher than in control group.the levels of C16:0 and C18:0in erythrocyte membrane in DM-PTB group were significantly higher while the levels of C18:1,C18:2,C20:4,C20:3n3,C20:5 and C22:6 were significantly lower than in the control group(P<0.05);The level of C18:0 in erythrocyte membrane in DM-PTB group was significantly higher than in PTB group(P<0.05);The level of C20:4 in erythrocyte membrane was significantly lower than in DM group(P<0.05);Compared with control group,there was no change of the level of C20:4 the erythrocyte membrane in PTB and DM groups.Multivariate logistic regression results showed that the high levels of C16:0(OR=6.81,95% CI: 2.63-17.64)and C18:0(OR=16.81,95% CI: 5.76-49.00)inerythrocyte membranes may have association with the higher prevalence of DM-PTB(P<0.05)while the high levels of C18:1(OR=0.19,95% CI: 0.08-0.46),high C18:2(OR=0.32,95% CI: 0.14-0.76),high C20:4(OR =0.18,95% CI: 0.07-0.43),high C20:3n3(OR=0.14,95% CI: 0.05-0.35)and high C22:6(OR=0.14,95% CI: 0.05-0.35)may have association with the lower prevalence of DM-PTB(P<0.05).The high levels of C20:3n6(OR=0.31,95% CI: 0.13-0.77)may have association with the lower prevalence of DM.There was no association between the levels of C18:2 and C20:4 and DM.The high level of C20:5(OR=0.31,95% CI: 0.14-0.70)may have association with the lower prevalence of PTB.There was no association between the levels of C20:4 and PTB.Conclusions:The levels of serum mineral elements and erythrocyte membrane fatty acid composition were disorder in Patients suffered from the diabetes complicated with pulmonary tuberculosis,high K,high Cu,high Ni and low Ca,low Mg,low Fe,low Zn,low Se,low Mn may be the risk factor of DM-PTB.The level of saturated fatty acid was elevated and monounsaturated fatty acid and polyunsaturated fatty acid were decreased.The high level of C16:0 and C18:0 may be the risk factors for diabetes complicated with tuberculosis and the high levels of C18:1,C18:2,C20:4,C20:3n3 and C22:6 may be the protective factor of DM-PTB. |
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