Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis
Background: Extrapulmonary tuberculosis (EPTB) complicates pulmonary tuberculosis (PTB) management. Diabetes mellitus impairs immune function, worsening tuberculosis (TB) outcomes. Methods: This retrospective study investigates the effect of glycemic control on immune function and TB dissemination i...
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Elsevier
2025-06-01
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| Series: | Infectious Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772431X2500022X |
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| author | Yujun Lin Xiaohong Chen Jiangwei Chen Di Wu |
| author_facet | Yujun Lin Xiaohong Chen Jiangwei Chen Di Wu |
| author_sort | Yujun Lin |
| collection | DOAJ |
| description | Background: Extrapulmonary tuberculosis (EPTB) complicates pulmonary tuberculosis (PTB) management. Diabetes mellitus impairs immune function, worsening tuberculosis (TB) outcomes. Methods: This retrospective study investigates the effect of glycemic control on immune function and TB dissemination in 1,768 TB patients (2022–2024). Patients were stratified by glycated hemoglobin (HbA1c) levels (≤ 6% vs. > 6%) and fasting blood glucose (FBG) concentrations (< 7 vs. ≥ 7 mmol/L). Lymphocyte subsets (CD3+, CD4+, CD8+ T cells, CD19+ B cells, and CD16+CD56+ natural killer cells) were compared between glycemic control and TB groups. Multiple regression and threshold effect analysis were conducted to assess the effects of HbA1c and CD3+ T cells on TB dissemination and their critical values. Results: Poor glycemic control was associated with lower cell counts of all lymphocyte subsets in patients with PTB (all p < 0.0001). Similar reductions were observed in patients with concurrent PTB and EPTB (PTB + EPTB) when HbA1c values > 6% (all p < 0.05). When HbA1c values ≤ 6% or FBG concentrations < 7 mmol/L, patients with PTB + EPTB showed lower immune cell counts than PTB (p < 0.05). Multiple regression indicated HbA1c increased TB dissemination risk (OR = 10.95), while CD3+ T cells showed protective effects. Threshold effect analysis identified an HbA1c values ≥ 7.4% for metabolic control and CD3+ T cell thresholds of 387/µL (immune deficiency) and 2,100/µL (immune overactivation). Conclusions: Poor glycemic control impairs immune cells, while EPTB further reduces immune cell numbers. Integrated glycemic management and immunological monitoring help optimize treatment strategies and improve clinical outcomes, particularly in patients at risk for EPTB. |
| format | Article |
| id | doaj-art-7113fc67aab24500a6120be08bf44220 |
| institution | Kabale University |
| issn | 2772-431X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Infectious Medicine |
| spelling | doaj-art-7113fc67aab24500a6120be08bf442202025-08-20T03:24:11ZengElsevierInfectious Medicine2772-431X2025-06-014210018310.1016/j.imj.2025.100183Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysisYujun Lin0Xiaohong Chen1Jiangwei Chen2Di Wu3Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian Province, Fuzhou 350008, Fujian Province, ChinaDepartment of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian Province, Fuzhou 350008, Fujian Province, ChinaThe Medical Services Section, Fuzhou Pulmonary Hospital of Fujian Province, Fuzhou 350008, Fujian Province, ChinaDepartment of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian Province, Fuzhou 350008, Fujian Province, China; Corresponding author.Background: Extrapulmonary tuberculosis (EPTB) complicates pulmonary tuberculosis (PTB) management. Diabetes mellitus impairs immune function, worsening tuberculosis (TB) outcomes. Methods: This retrospective study investigates the effect of glycemic control on immune function and TB dissemination in 1,768 TB patients (2022–2024). Patients were stratified by glycated hemoglobin (HbA1c) levels (≤ 6% vs. > 6%) and fasting blood glucose (FBG) concentrations (< 7 vs. ≥ 7 mmol/L). Lymphocyte subsets (CD3+, CD4+, CD8+ T cells, CD19+ B cells, and CD16+CD56+ natural killer cells) were compared between glycemic control and TB groups. Multiple regression and threshold effect analysis were conducted to assess the effects of HbA1c and CD3+ T cells on TB dissemination and their critical values. Results: Poor glycemic control was associated with lower cell counts of all lymphocyte subsets in patients with PTB (all p < 0.0001). Similar reductions were observed in patients with concurrent PTB and EPTB (PTB + EPTB) when HbA1c values > 6% (all p < 0.05). When HbA1c values ≤ 6% or FBG concentrations < 7 mmol/L, patients with PTB + EPTB showed lower immune cell counts than PTB (p < 0.05). Multiple regression indicated HbA1c increased TB dissemination risk (OR = 10.95), while CD3+ T cells showed protective effects. Threshold effect analysis identified an HbA1c values ≥ 7.4% for metabolic control and CD3+ T cell thresholds of 387/µL (immune deficiency) and 2,100/µL (immune overactivation). Conclusions: Poor glycemic control impairs immune cells, while EPTB further reduces immune cell numbers. Integrated glycemic management and immunological monitoring help optimize treatment strategies and improve clinical outcomes, particularly in patients at risk for EPTB.http://www.sciencedirect.com/science/article/pii/S2772431X2500022XPulmonary tuberculosisExtrapulmonary tuberculosisGlycated hemoglobinLymphocyte subpopulationImmunity |
| spellingShingle | Yujun Lin Xiaohong Chen Jiangwei Chen Di Wu Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis Infectious Medicine Pulmonary tuberculosis Extrapulmonary tuberculosis Glycated hemoglobin Lymphocyte subpopulation Immunity |
| title | Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis |
| title_full | Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis |
| title_fullStr | Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis |
| title_full_unstemmed | Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis |
| title_short | Effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis: A retrospective analysis |
| title_sort | effect of glycemic control on lymphocyte subsets in the dissemination of pulmonary tuberculosis a retrospective analysis |
| topic | Pulmonary tuberculosis Extrapulmonary tuberculosis Glycated hemoglobin Lymphocyte subpopulation Immunity |
| url | http://www.sciencedirect.com/science/article/pii/S2772431X2500022X |
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