University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, TB Centre Beatrixoord, Haren, The Netherlands.
Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
Int J Infect Dis. 2020 Mar;92S:S10-S14. doi: 10.1016/j.ijid.2020.01.029. Epub 2020 Jan 23.
The holistic management of tuberculosis (TB) patients can improve life expectancy and lost organ function.
Chronic sequelae are very common among patients who survive TB, which can lead to a further decline in lung function. There is still no guidance for 'cured' patients with impaired lung function who need pulmonary rehabilitation. Additional tests for evaluation should be given after the end of treatment, as recent studies have shown the good effect of pulmonary rehabilitation for TB patients.
Malnutrition is very common among TB patients and is related to malabsorption. The latter can cause lower drug exposure, which may result in treatment failure, increasing the risk of death, and can lead to acquired drug resistance. Malnutrition should be assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the diagnosis should lead to an individualized treatment plan, including sufficient proteins and preferably in combination with adequate training.
Under normal circumstances, most immune cells use a glucose-based mechanism to generate energy. Therefore the patient's nutritional status is a key factor in shaping immune responses. Disease-related malnutrition leads to proteolysis and lipolysis. In the end, the identification of individuals who will benefit from immune-modulatory strategies may lead to clinically relevant markers.
结核病（TB）患者的整体管理可以提高预期寿命并恢复丧失的器官功能。
在幸存的结核病患者中，慢性后遗症非常常见，这可能导致肺功能进一步下降。对于肺功能受损需要肺康复的“治愈”患者，仍然没有指导。治疗结束后应进行额外的评估测试，因为最近的研究表明肺康复对结核病患者有良好的效果。
营养不良在结核病患者中非常常见，并且与吸收不良有关。后者可能导致药物暴露降低，这可能导致治疗失败，增加死亡风险，并可能导致获得性耐药性。应根据全球营养倡议（GLIM）标准评估营养不良，并应根据诊断制定个体化治疗计划，包括充足的蛋白质，最好与适当的训练相结合。
在正常情况下，大多数免疫细胞使用基于葡萄糖的机制来产生能量。因此，患者的营养状况是塑造免疫反应的关键因素。与疾病相关的营养不良会导致蛋白水解和脂肪分解。最终，确定将从免疫调节策略中受益的个体可能会产生具有临床相关性的标志物。
