The Risk Factors For The Development Of Hypertension And The Level Of Antioxidant Capacity And Antimicrobial Peptides In Patients With Active Pulmonary Tuberculosis Complicating With And Without Diabetes

Objective:Pulmonary tuberculosis(PTB)is a kind of chronic infectious diseases and hypertension(HBP)is a kind of chronic non-communicable diseases,which have significant public health implications.When patients suffered from both tuberculosis and hypertension,these two diseases may have interactions.Patients suffered from HBP can promotes the release of inflammatory factors and the occurrence of oxidative stress,which may aggravate the development of tuberculosis.Complicated with hypertension also increase the risk of adverse outcomes of tuberculosis treatment and increase the contagious risk of tuberculosis.Tuberculosis can cause the vascular structure destruction and vasculitis in lungs,which make the condition of hypertension worse.There were no study determining the risk factors for hypertension in tuberculosis patients up to now.The antioxidant capacity and anti-tuberculosis ability play important roles on the development and prognosis of tuberculosis,and antimicrobial peptides are the important antituberculosis substances.Recently,the double burden of diabetes mellitus(DM)and tuberculosis has attracted more and more attention.Therefore,we explored and compared the characteristics and risk factors for the prevalence of hypertension among simple pulmonary tuberculosis patients(PTB)and pulmonary tuberculosis complicating with diabetes patients(PTB-DM)and compared the level of antioxidant capacity and antimicrobial peptides in two groups to provide an important scientific basis for prevention and control of pulmonary tuberculosis.Methods:This study is divided into two parts.In the first part,we conducted a cross-sectional study method,the PTB patients and PTB-DM patients were from a chest hospital from January 2017 to October 2018.All patients were subjected to questionnaire survey,physical radiological examination and laboratory investigations.The dietary model was established using principal component analysis and maximum rotation of variance.The measurement of height and weight were used uniform instruments and methods.Using automatic biochemical analyzer to detect biochemical indicators such as serum protein and serum lipid.Univariate and multivariable logistic regression analysis was run to examine the risk factors for HBP in pulmonary tuberculosis.Crude and adjusted odds ratios(OR)and 95 % confidence intervals(CIs)are presented.In the second part,a matched case-control study were conducted in the same hospital from June 2017 to May 2018.The case group included newly detected pulmonary tuberculosis who had already diagnosed DM in the chest hospital and PTB alone in the same hospital as the control group.we randomly chose up to two population control subjects for each case subject,individually matched on age and gender.All patients were subjected to questionnaire survey and collected 5 mL fasting peripheral venous blood and plasma was separated.The total antioxidant capacity(T-AOC)was measured by colorimetric method and oxidized low-density lipoprotein(ox-LDL),human cathelicidin peptide LL-37(LL-37),human beta defensin-2(HBD-2)and human neutrophil peptides 1-3(HNP1-3)were measured by ELISA.Results:In the first study,815 participants with pulmonary tuberculosis(481 PTB patients and 332 PTB-DM patients)were recruited,158 of them were suffered from hypertension,the prevalence of hypertension was 19.3%.The prevalence of hypertension in PTB patients was 11.0% and the prevalence of hypertension in PTB-DM patients was 31.6%.Among PTB patients,Age and the proportion of male,married,smoking,drinking and overweight/obesity in HBP group were significantly higher than in non-HBP group while the education level was significantly lower in HBP group than in non-HBP group.Among PTB-DM patients,Age and the proportion of male,married,smoking index3400 and overweight/obesity in HBP group were significantly higher than in non-HBP group.According to the multivariate regression analysis,overweight/obesity(OR=3.15,95%CI: 1.54-6.45),heavy smoking(OR=2.85,95%CI: 1.38-5.87)may be the risk factors for HBP while higher education levels(senior high school: OR=0.29,95%CI: 0.12-0.72;college:OR=0.36,95%CI: 0.12-0.98;beyond university: OR=0.25,95%CI: 0.06-0.97)may be the protective factor in PTB patients.In PTB-DM patients,age350(OR=2.15,95%CI: 1.22-3.80)and overweight/obesity(OR=1.82,95%CI: 1.08-3.09)may be the risk factors for HBP.We found that compared with PTB patients,the level of T-AOC(12.84 vs 20.32 per mL,P<0.05)decreased significantly while ox-LDL(326.32 vs 292.69 ng/mL,P<0.05)increased significantly in plasma of PTB-DM patients.the plasma level of HBD-2 and HNP1-3 in PTB-DM patients were significantly higher than in PTB patients.Conclusion:The prevalence of hypertension in PTB-DM patients is significantly higher than in PTB patients.Pulmonary tuberculosis patients complicating with diabetes are more likely to have hypertension.Overweight/obesity and heavy smoking may be the risk factors for hypertension in PTB patients,while higher education levels may be the protective factors.Aging and overweight/obese may be the risk factors for hypertension in PTB-DM patients.When complicating with DM,the antioxidant capacity and antimicrobial peptides levels in tuberculosis patients were decreased.