| Background and Objects:Diabetes mellitus type II (T2DM) patients have a higher risk of acquiring pulmonary tuberculosis (PTB) and DM in PTB patients may also impair TB treatment. Data on DM and pre-DM prevalence among TB patients from the community are inadequate. There exists vitamin A and D deficiency in PTB and DM patients. After combined with Toll-like receptor on the membrane of macrophage, VD can induce the production of cathelicidin, an important anti-MTB peptide, inhibiting and killing MTB inside the cell. VA can improve the immune function and modify energetic metabolism through its influence on cell metabolism and function. Leptin, IL-6and TNF-a have aroused concern to a large extent. Leptin can inhibit appetite, decrease energy intake, increase energy expenditure, which is closely related to obesity, insulin resistance (IR) and type II diabetes. However, the report on the level of these cytokine and their correlation with PTB-DM is quite few. Therefore we investigated the prevalence of DM and pre-DM among newly detected TB patients and non-TB controls in rural areas in China, evaluated risk factors for the presence of DM, observed the correlation between cytokines and the disease, analyzed the risk factors of PTB-DM. Also, we carried out VA and/or VD supplementation intervention in PTB-DM and PTB patients to discover the effect on the symptoms related to PTB and to investigate the possible mechanisms.Methods:This is a prospective community based study. From2009-2012, a representative sample of6382newly detected active PTB patients from7TB clinics were tested for DM, together with6674non-TB controls from the same community. Four groups subjects were selected randomly from the above population, including PTB (n=295), DM (n=102), PTB-DM (n=139) and control (n=295). RIA was used to detect serum VD concentration and HPLC to vitamin A, enzyme immunoassay used to detect serum leptin, IL-6and TNF-a. The risk correlation of these indexes with PTB-DM and IR was estimated. Furthermore, PTB (with or without DM) patients in a TB hospital from December of2011and August of2012were selected and divided into four groups randomly including VA(2000IU/d), VD (400IU/d), VAD (VA2000IU/d+VD400IU/d) and placebo control. The blood glucose and lipid indexes after two months were detected together with the symptoms including hemoptysis, cough and cavity. Multivariable logistic analysis was used to evaluate the risk factors.Results:The prevalence of DM in TB patients (6.3%) was higher than that in non-TB controls (4.7%)(P<0.05). PTB patients had a3.17fold higher adjusted risk of having DM than non-TB (risk ratio3.17,95%CI1.14-8.84). Serum vitamin D level of PTB-DM patients was decreased, the patients in the lowest quartile(<8.6ng/ml) had three fold higher risk ratio of PTB-DM compared with the highest quartile (≥26.6ng/ml), also the risk of IR increased4fold in this group (OR3.85,95%CI1.34-11.02). Serum leptin and IL-6were the predictive factors of HOMA-IR, leptin with negative correlation and IL-6with positive correlation. The incidence of hemoptysis and expectoration increased in PTB-DM patients, also the positive sputum rate and cavity incidence increased. The risk ratio of4+positive sputum was3fold (OR3.04,95%CI1.98-4.68) in PTB-DM group compared with PTB. VA, VD can improve the glucose and lipid metabolism to some extent after two months clinical treatment. VA can help the amelioration of TB symptom and the recovery of cavity in the lower lobe.Conclusions:The prevalence of diabetes in PTB patients was higher than in non-TB controls with a3.17fold higher adjusted risk of having DM. Hemoptysis, expectoration and lesion were more common in PTB-DM with increased positive sputum smear rate and cavity. Low serum vitamin D was the risk factor of PTB-DM and insulin resistance. Supplementation of VA and/or VD can improve the glucose and lipid metabolism, ameliorating the clinical symptoms. |
PDF Full Text Request