| Background and Objects:Type2diabetes mellitus (T2DM) patients have a higher risk of acquiring pulmonary tuberculosis (TB), and T2DM may also impair TB treatment.TB and T2DM can cause metabolism disorder. T2DM occurred in hyperglycemia and lipid metabolism, free fatty acid concentrations may increase in blood circulation, resulting in pancreatic β cell apoptosis and dysfunction of insulin secretion. Mycobacterium tuberculosis use the energy of the patients for growth and reproduction, so TB patients may increase energy consumption, the energy demand and loss of protein is higher than normal. Mycobacterium tuberculosis can stimulate the secretion of inflammatory cytokines, which may direct effect feeding center in the central nervous system, cause poor appetite. Poor appetite reduce nutrient intake, lead to reduce anabolic reduction and prone to malnutrition. When TB combined T2DM, the nutritional status of patients is more complex. Leptin is an appetite suppressor, ghrelin is an appetite-stimulating factor. Leptin/ghrelin are two complementary factors in the energy balance of feeding center, which regulate appetite, and may participate in regulating the expression levels of inflammatory cytokines. Leptin/ghrelin imbalances may reduce the patient’s appetite. Changes in metabolic enzyme activities has important effects on energy metabolism, but whether there are differences between TB combined T2DM and TB or T2DM only of metabolic enzyme activities remains unknown. B vitamins are cofactors of a variety of metabolic enzymes, involved in energy balance and have beneficial in TB and T2DM treatment. Because of decreased appetite, lead to reduce intakes of B vitamins in TB patients, and can not meet the needs of the metabolic enzyme synthesis, also exacerbate metabolic disorders. In this study, we selected pulmonary tuberculosis with type2diabetes patients, and TB, T2DM, obese patients and the normal population as study subjects, contrast to systematic understanding of leptin/ghrelin levels and energy metabolism characteristics in pulmonary tuberculosis with diabetes patients, also their related factors and relations with the disease, inorder to provide new ideas for clinical treatment and nutritional support.Methods:Used epidemiological cross-sectional survey method to choose40patients in an area of TB dispensaries and hospitals from July2011to July2013, who diagnosed as tuberculosis (TB), and40patients as pulmonary tuberculosis with type2diabetes (TB+T2DM),40type2diabetes (T2DM) patients, selected40obese patients (body mass index BMI≥28)(OB) and76normal control subjects (C) in a medical center. BMI, biochemical parameters and plasma levels of leptin, ghrelin, inflammatory cytokines and urine specimens levels of B vitamins were measured. Results:Fasting blood glucose levels of TB+T2DM group was higher than T2DM (9.51mM versus7.75mM, P<0.05). Levels of serum lipid and protein of TB+T2DM group were lower than C group. The levels of leptin were significantly lower in TB+T2DM than TB groups (11.47ng/ml versus72.61ng/ml, P<0.05). TB+T2DM group had the highest levels of plasma TNF-a and IFN-y. Leptin showed a negative correlation with BMI in TB+T2DM and TB groups (P<0.05), but a positive correlation with BMI in other groups. Contrary ghrelin showed a positive correlation with BMI in TB+T2DM group (r=0.478, P<0.05). Triglycerides, leptin, ghrelin, TNF-a were the predictive factors of BMI in TB+T2DM group.The riskratio of TB+T2DM was2.587fold (OR2.587,95%CI1.0-6.68) in low weight (BMI<18.5) compared with normal weight,1.5fold (OR0.525,95%CI0.08-0.88) in highest levels of leptin compared with lowest levels of leptin,10.605fold (OR10.605,95%CI2.15-52.24) in lowest levels of ghrelin compared with highest levels of ghrein.Erythrocyte transketolase activity coefficient (ETKac) and erythrocyte glutathione reductase activity coefficient (EGRac) in TB+T2DM group was significantly higher than the C group (38.12versus8.00, and1.23versus0.86, P<0.05), erythrocyte Na+-K+-ATPase, plasma pyruvate kinase (PK), succinate dehydrogenase (SDH) activities were lower than C group. Levels of vitamin B1and vitamin B2in TB+T2DM group were significantly lower than C group (636.05versus976.56and425.24versus705.74, P<0.05).ETKac and ETKac showed a negative correlation with BMI, while PK and SDH showed a positive correlation with BMI in TB+T2DM group. ETKac, EGRac, vitamin B1and vitamin B2were the predictive factors of BMI in TB+T2DM group. ETKac showed a positive correlation with serum protein levels in TB+T2DM group (r=-0.363and r=-0.314, P<0.05), indicated that TK activites may relate to protein levels. ETKac and ETKac showed a positive correlation with leptin (r=0.304and r=0.209, P<0.05), while other metabolic enzymes and B vitamins were negative correlation with leptin, indicated high levels of leptin may reduce the patient’s appetite, had an effect on enzyme activities and levels of B vitamins. Higher levels of enzyme activities and B vitamins may be beneficial to disease prevention.Conclusions:Imbalance of leptin/ghrelin may affect the expression levels of inflammatory cytokines. TB+T2DM group had lower levels of enzyme activities and B vitamins, which related to the risk of TB+T2DM. Poor nutrition of of TB+T2DM (low BMI, lower levels of serum lipids and proteins) may cause by poor appetite, which reduce nutrient intake and lead to reduce anabolic reduction. |
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