2型糖尿病并发肺结核患者PCT、HMGB1、CD4+/CD8+比值与继发肺部感染的关系

摘要 目的：探讨2型糖尿病并发肺结核患者降钙素原（PCT）、高迁移率族蛋白1（HMGB1）、CD4⁺/CD8⁺比值与继发肺部感染的关系。方法：选择2019年1月至2022年6月四川大学华西医院呼吸与危重症医学科收治的97例2型糖尿病并发肺结核患者，根据入院治疗时是否继发肺部感染分为肺部感染组（53例）及非肺部感染组（44例）。检测两组血清PCT、HMGB1水平以及外周血CD4⁺/CD8⁺比值。单因素和多因素Logistic回归分析2型糖尿病并发肺结核患者继发肺部感染的因素。受试者工作特征（ROC）曲线分析PCT、HMGB1和CD4⁺/CD8⁺比值预测2型糖尿病并发肺结核患者继发肺部感染的价值。结果：肺部感染组血清PCT、HMGB1水平高于非肺部感染组（P＜0.05），外周血CD4⁺/CD8⁺比值低于非肺部感染组（P＜0.05）。糖化血红蛋白及血清PCT、HMGB1水平升高是2型糖尿病并发肺结核患者继发肺部感染的危险因素（P＜0.05），高CD4⁺/CD8⁺比值是保护因素（P＜0.05）。PCT、HMGB1、CD4⁺/CD8⁺比值预测2型糖尿病并发肺结核患者继发肺部感染的曲线下面积为0.719、0.761、0.738，联合PCT、HMGB1和CD4⁺/CD8⁺比值预测的曲线下面积为0.878，高于各指标单独预测。结论：2型糖尿病并发肺结核患者血清PCT、HMGB1水平增高，外周血CD4⁺/CD8⁺比值降低，均与继发肺部感染有关，PCT、HMGB1联合CD4⁺/CD8⁺比值可辅助预测2型糖尿病并发肺结核患者继发肺部感染的风险。

Relationship between the PCT, HMGB1, CD4+/CD8+ Ratio and Secondary Pulmonary Infection in Patients with Type 2 Diabetes Complicated with Pulmonary Tuberculosis

ABSTRACT Objective: To investigate the relationship between procalcitonin (PCT), high mobility group protein 1 (HMGB1), CD4⁺/CD8⁺ ratio and secondary pulmonary infection in patients with type 2 diabetes complicated with pulmonary tuberculosis. Methods: 97 patients with type 2 diabetes complicated with pulmonary tuberculosis who were admitted to the Respiratory and Critical Care Department of West China Hospital of Sichuan University from January 2019 to June 2022 were selected, and they were divided into pulmonary infection group (53 cases) and non-pulmonary infection group (44 cases) according to whether they had secondary pulmonary infection during treatment after admission. Serum PCT, HMGB1 levels and peripheral blood CD4⁺/CD8⁺ ratio in the two were detected. Univariate and multivariate Logistic regression analysis was used to analyze the factors of secondary pulmonary infection in type 2 diabetes patients complicated with pulmonary tuberculosis. The value of PCT, HMGB1 and CD4⁺/CD8⁺ ratio in predicting secondary pulmonary infection in type 2 diabetes patients complicated with pulmonary tuberculosis was analyzed by receiver operating characteristic (ROC) curve. Results: The levels of serum PCT and HMGB1 in pulmonary infection group were higher than those in non-pulmonary infection group(P<0.05), and the peripheral blood CD4⁺/CD8⁺ ratio was lower than that in non-pulmonary infection group (P<0.05). The elevated levels of glycosylated hemoglobin, serum PCT and HMGB1 were the risk factors of secondary pulmonary infection in type 2 diabetes patients complicated with pulmonary tuberculosis(P<0.05), and the high CD4⁺/CD8⁺ ratio was the protective factor(P<0.05). PCT, HMGB1, CD4⁺/CD8⁺ ratio predicted the area under the curve of secondary pulmonary infection in type 2 diabetes patients complicated with pulmonary tuberculosis was 0.719, 0.761, 0.738, and the area under curve predicted by PCT, HMGB1, and CD4⁺/CD8⁺ ratio was 0.878, which were higher than that predicted by each indicator alone. Conclusion: The increase of serum PCT and HMGB1 levels and the decrease of peripheral blood CD4⁺/CD8⁺ ratio in type 2 diabetes patients complicated with pulmonary tuberculosis are all related to secondary pulmonary infection. The combination of PCT and HMGB1 with CD4⁺/CD8⁺ ratio can help predict the risk of secondary pulmonary infection in type 2 diabetes patients complicated with pulmonary tuberculosis.