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初治肺结核患者治疗期间体重指数改善模式及相关临床因素:新诊断肺结核患者的前瞻性分析

Patterns of Quetelet Index (Body Mass Index) Improvement and Associated Clinical Factors During Initial Tuberculosis Treatment: A Prospective Analysis of Newly Diagnosed Tuberculosis Patients.

作者信息

Dharmaraj Rock B, Mohan Madhan, George Neethu, Hariharan Vellaiappan P, Swarna C Brilly, Muniyapillai Tamilarasan, Mohandas Neeraj V, Anand V Vijay, Kulothungan Karthikeyan

机构信息

Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND.

Respiratory Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND.

出版信息

Cureus. 2025 Mar 12;17(3):e80446. doi: 10.7759/cureus.80446. eCollection 2025 Mar.

Abstract

Introduction Tuberculosis (TB) and malnutrition form a detrimental synergistic relationship, with malnutrition weakening the immune system and increasing susceptibility to TB, while TB, in turn, worsens the nutritional status through increased metabolic demands and decreased appetite. The nutritional recovery is expected during treatment, but the extent and rate of improvement may vary based on patient characteristics, disease severity, and presence of comorbidities. This study aimed to assess the nutritional status changes in newly diagnosed TB patients by evaluating and comparing their body mass index (BMI) at treatment initiation and after the completion of intensive phase (two months) while also analysing the influence of various factors (age, gender, bacterial load, drug sensitivity, and comorbidities) on BMI variations during this period. Methods A prospective longitudinal study was conducted among 116 newly diagnosed pulmonary TB patients at a tertiary medical college hospital in Tamil Nadu between August and October 2021. Baseline assessments included demographic data, sputum microscopy for bacterial load, drug sensitivity testing via the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)/TrueNat, and screening for diabetes mellitus and chronic kidney disease (CKD). Anthropometric measurements (weight and BMI) were recorded at treatment initiation and after the completion of a two-month intensive phase treatment using standardized protocols. Data analysis was performed using IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY, USA), with descriptive statistics for demographic and clinical characteristics, comparative analyses using independent t-test and one-way ANOVA for subgroup BMI improvements, and McNemar's test and paired t-test for assessing changes in BMI from baseline to post-two-month treatment (p < 0.05 considered significant). Results Among 116 pulmonary TB patients, mean (SD) BMI significantly increased from 16.17 (4.15) to 16.96 (4.01) kg/m² during the intensive phase treatment (p < 0.001). Of 89 initially malnourished patients, 9% achieved normal BMI status. Younger patients (<30 years) showed higher BMI improvement (1.12 ± 0.51 kg/m²) compared to the elderly (>70 years: 0.56 ± 0.49 kg/m²). Lower BMI improvements were observed in rifampicin-resistant cases (0.48 ± 0.22 vs 0.80 ± 0.50 kg/m²) and patients with comorbidities (diabetes: 0.74 ± 0.53 vs 0.85 ± 0.46 kg/m²; CKD: 0.65 ± 0.51 vs 0.83 ± 0.49 kg/m²), though these differences were not statistically significant. Conclusion Significant improvements in nutritional status were observed during the intensive phase treatment, with younger age associated with better BMI gains. Though not statistically significant, drug resistance and the presence of comorbidities appeared to negatively influence nutritional recovery, suggesting the need for enhanced nutritional monitoring and support in these vulnerable subgroups.

摘要

引言

结核病(TB)与营养不良形成了一种有害的协同关系,营养不良会削弱免疫系统并增加患结核病的易感性,而结核病反过来又会通过增加代谢需求和降低食欲来恶化营养状况。预计在治疗期间营养状况会有所恢复,但改善的程度和速度可能因患者特征、疾病严重程度和合并症的存在而有所不同。本研究旨在通过评估和比较新诊断的结核病患者在治疗开始时和强化期(两个月)结束后的体重指数(BMI),来评估其营养状况的变化,同时分析各种因素(年龄、性别、细菌载量、药物敏感性和合并症)在此期间对BMI变化的影响。

方法

2021年8月至10月,在泰米尔纳德邦的一所三级医学院医院对116例新诊断的肺结核患者进行了一项前瞻性纵向研究。基线评估包括人口统计学数据、用于细菌载量检测的痰涂片显微镜检查、通过基于 cartridge 的核酸扩增试验(CBNAAT)/TrueNat 进行的药物敏感性检测,以及糖尿病和慢性肾脏病(CKD)筛查。使用标准化方案在治疗开始时和为期两个月的强化期治疗结束后记录人体测量数据(体重和BMI)。使用IBM SPSS Statistics for Windows,V. 23.0(IBM公司,美国纽约州阿蒙克)进行数据分析,对人口统计学和临床特征进行描述性统计,使用独立t检验和单因素方差分析对亚组BMI改善情况进行比较分析,使用McNemar检验和配对t检验评估从基线到治疗两个月后BMI的变化(p < 0.05被视为具有统计学意义)。

结果

在116例肺结核患者中,强化期治疗期间平均(标准差)BMI从16.17(4.15)显著增加至16.96(4.01)kg/m²(p < 0.001)。在89例最初营养不良的患者中,9%达到了正常BMI状态。较年轻患者(<30岁)的BMI改善程度(1.12±0.51 kg/m²)高于老年患者(>70岁:0.56±0.49 kg/m²)。耐利福平病例(0.48±0.22 vs 0.80±0.50 kg/m²)和合并症患者(糖尿病:0.74±0.53 vs 0.85±0.46 kg/m²;CKD:0.65±0.51 vs 0.83±0.49 kg/m²)的BMI改善程度较低,尽管这些差异无统计学意义。

结论

在强化期治疗期间观察到营养状况有显著改善,年龄较小与BMI增加更好相关。尽管无统计学意义,但耐药性和合并症的存在似乎对营养恢复有负面影响,这表明需要对这些脆弱亚组加强营养监测和支持。

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