切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (05) : 899 -904. doi: 10.3877/cma.j.issn.1674-6902.2026.05.028

综述

糖尿病与肺结核双向关系的病理机制及综合管理研究进展
何亚弦, 林思雨, 熊娟†()   
  1. 430060 武汉,武汉大学人民医院胸外Ⅰ科
  • 收稿日期:2025-05-26 出版日期:2026-10-25
  • 通信作者: 熊娟

Research progress on the pathological mechanisms and comprehensive management of the bidirectional relationship between diabetes and pulmonary tuberculosis

Yaxian He, Siyu Lin, Juan Xiong†()   

  • Received:2025-05-26 Published:2026-10-25
  • Corresponding author: Juan Xiong
引用本文:

何亚弦, 林思雨, 熊娟. 糖尿病与肺结核双向关系的病理机制及综合管理研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(05): 899-904.

Yaxian He, Siyu Lin, Juan Xiong. Research progress on the pathological mechanisms and comprehensive management of the bidirectional relationship between diabetes and pulmonary tuberculosis[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(05): 899-904.

糖尿病(diabetes mellitus)与肺结核(pulmonary tuberculosis)的双重疾病负担是一项重大的公共卫生挑战。2021年全球糖尿病患者达5.37亿,预计2045年将增至7.83亿,其中中国是糖尿病患者最多的国家,亟需采取紧急且综合的应对措施。在糖尿病与肺结核双向关系方面,糖尿病不仅通过削弱宿主免疫应答显著增加结核病易感性,其具体机制涉及巨噬细胞极化异常(如M2型极化增强)及T细胞亚群失衡(如Th1/Th17反应减弱),从而促进结核分枝杆菌的免疫逃逸与增殖;同时,糖尿病也使耐药结核病风险倍增。结核病引发的炎症反应与代谢紊乱加剧胰岛素抵抗,形成恶性循环。这两种慢性疾病的相互作用在临床与公共卫生管理、社会及经济影响方面均呈现出独特的复杂性。糖尿病与肺结核的共病问题与双向关系是不可避免的医学挑战,本文旨在总结近年来对糖尿病与肺结核双向关系的病理机制的研究进展,本文系统综述了糖尿病与肺结核双向关系的病理机制研究进展,并对共病患者的综合管理提出展望,包括二甲双胍的宿主导向治疗潜力、卡介苗在免疫调节中的应用等新型干预策略,以期为临床实践与公共卫生防控提供参考。

1
左晓飞,范华菊,吴倩盈,等. 硼化镁纳米颗粒通过上调BDNF减轻海马神经元及突触损伤改善糖尿病并发抑郁症小鼠行为和脑结构异常[J]. 陆军军医大学学报,2026, 48(17): 2440-2452.
2
Xu Y, Lu J, Li M, et al. Diabetes in China part 1: Epidemiology and risk factors[J]. Lancet Public Health, 2024, 9(12): e1089-e1097.
3
Jia W, Chan JC, Wong TY, et al. Diabetes in China: epidemiology, pathophysiology and multi-omics[J]. Nat Metab, 2025, 7(1): 16-34.
4
Diagnosis and classification of diabetes: standards of care in diabetes-2025[J]. Diabetes Care, 2025, 48(Supplement_1): S27-S49.
5
Holt RIG, Cockram CS, Ma RCW, et al. Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment[J]. Diabetologia, 2024, 67(7): 1168-1180.
6
Kontsevaya I, Cabibbe AM, Cirillo DM, et al. Update on the diagnosis of tuberculosis[J]. Clin Microbiol Infect, 2024, 30(9): 1115-1122.
7
Litvinjenko S, Magwood O, Wu S, et al. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews[J]. Lancet Infect Dis, 2023, 23(12): 1395-1407.
8
Franco JV, Bongaerts B, Metzendorf MI, et al. Diabetes as a risk factor for tuberculosis disease[J]. Cochrane Database Syst Rev, 2024, 8(8): CD016013.
9
Li M, Chen T, Hua Z, et al. Global, regional, and national prevalence of diabetes mellitus in patients with pulmonary tuberculosis: a systematic review and meta-analysis[J]. Diabetol Metab Syndr, 2021, 13(1): 127.
10
周勇,闫世春,韩雪,等. 2017-2021年黑龙江省肺结核合并糖尿病登记率及变化趋势[J]. 疾病监测,2023, 38(04): 426-431.
11
黄涛,菅辉勇,王新旗,等. 新疆维吾尔自治区肺结核合并糖尿病患者治疗转归影响因素分析[J] 中国防痨杂志,2024, 46(9): 1083-1088.
12
杨蕊,李玲,陈金瓯,等. 2017-2021年云南省肺结核与糖尿病共病患者抗结核治疗效果及影响因素分析[J].中国防痨杂志,2024, 46(5): 519-524.
13
Huangfu P, Ugarte-Gil C, Golub J, et al. The effects of diabetes on tuberculosis treatment outcomes: an updated systematic review and meta-analysis[J]. Int J Tuberc Lung Dis, 2019, 23(7): 783-796.
14
郭晶,庞加磊,高卫卫,等. 2019-2021年南京地区成人活动性肺结核合并糖尿病患者表型耐药特征分析[J]中国防痨杂志,2024, 46(1): 62-69.
15
Tegegne BS, Mengesha MM, Teferra AA, et al. Association between diabetes mellitus and multi-drug-resistant tuberculosis: evidence from a systematic review and meta-analysis[J]. Syst Rev, 2018, 7(1): 161.
16
Cheng P, Wang L, Gong W. Cellular Immunity of patients with tuberculosis combined with diabetes[J]. J Immunol Res, 2022, 2022: 6837745.
17
Scriba TJ, Maseeme M, Young C, et al. Immunopathology in human tuberculosis[J]. Sci Immunol, 2024, 9(102): eado5951.
18
Flynn JL, Chan J. Immune cell interactions in tuberculosis[J]. Cell, 2022, 185(25): 4682-4702.
19
Chandra P, Grigsby SJ, Philips JA. Immune evasion and provocation by Mycobacterium tuberculosis[J]. Nat Rev Microbiol, 2022, 20(12): 750-766.
20
Ayelign B, Negash M, Genetu M, et al. Immunological impacts of diabetes on the susceptibility of Mycobacterium tuberculosis[J]. J Immunol Res, 2019, 2019: 6196532.
21
Kumar NP, Babu S. Impact of diabetes mellitus on immunity to latent tuberculosis infection[J]. Front Clin Diabetes Healthc, 2023, 4: 1095467.
22
Hair PS, Echague CG, Rohn RD, et al. Hyperglycemic conditions inhibit C3-mediated immunologic control of Staphylococcus aureus[J]. J Transl Med, 2012, 10: 35.
23
Dowey R, Iqbal A, Heller SR, et al. A bittersweet response to infection in diabetes; targeting neutrophils to modify inflammation and improve host immunity[J]. Front Immunol, 2021, 12: 678771.
24
Usero L, Sánchez A, Pizarro E, et al. Interleukin-13 pathway alterations impair invariant natural killer t-cell-mediated regulation of effector t cells in type 1 diabetes[J]. Diabetes, 2016, 65(8): 2356-2366.
25
Ssekamatte P, Sande OJ, Van Crevel R, et al. Immunologic, metabolic and genetic impact of diabetes on tuberculosis susceptibility[J]. Front Immunol, 2023, 14: 1122255.
26
Clayton SM, Shafikhani SH, Soulika AM. Macrophage and neutrophil dysfunction in diabetic wounds[J]. Adv Wound Care (New Rochelle), 2024, 13(9): 463-484.
27
Nobs SP, Kolodziejczyk AA, Adler L, et al. Lung dendritic-cell metabolism underlies susceptibility to viral infection in diabetes[J]. Nature, 2023, 624(7992): 645-652.
28
Kumar NP, Sridhar R, Banurekha VV, et al. Expansion of pathogen-specific T-helper 1 and T-helper 17 cells in pulmonary tuberculosis with coincident type 2 diabetes mellitus[J]. J Infect Dis, 2013, 208(5): 739-748.
29
Rajamanickam A, Kothandaraman SP, Kumar NP, et al. Cytokine and chemokine profiles in pulmonary tuberculosis with pre-diabetes[J]. Front Immunol, 2024, 15: 1447161.
30
Buasroung P, Petnak T, Liwtanakitpipat P, et al. Prevalence of diabetes mellitus in patients with tuberculosis: a prospective cohort study[J]. Int J Infect Dis, 2022, 116: 374-379.
31
Daryabor G, Atashzar M R, Kabelitz D, et al. The effects of type 2 diabetes mellitus on organ metabolism and the immune system[J]. Front Immunol, 2020, 11: 1582.
32
Martinez N, Smulan LJ, Jameson ML, et al. Glycerol contributes to tuberculosis susceptibility in male mice with type 2 diabetes[J]. Nat Commun, 2023, 14(1): 5840.
33
Cordeiro Da Costa J, Oliveira O, Baía L, et al. Prevalence and factors associated with diabetes mellitus among tuberculosis patients: a nationwide cohort[J]. Eur Respir J, 2016, 48(1): 264-268.
34
Segura-Cerda CA, López-Romero W, Flores-Valdez MA. Changes in host response to Mycobacterium tuberculosis infection associated with type 2 diabetes: beyond hyperglycemia[J]. Front Cell Infect Microbiol, 2019, 9: 342.
35
Kumar NP, Moideen K, Nancy A, et al. Systemic RAGE ligands are upregulated in tuberculosis individuals with diabetes co-morbidity and modulated by anti-tuberculosis treatment and metformin therapy[J]. BMC Infect Dis, 2019, 19(1): 1039.
36
Lagman M, Ly J, Saing T, et al. Investigating the causes for decreased levels of glutathione in individuals with type Ⅱ diabetes[J]. PLoS One, 2015, 10(3): e0118436.
37
Vankayalapati A, Durojaye O, Mukherjee T, et al. Metabolic changes enhance necroptosis of type 2 diabetes mellitus mice infected with Mycobacterium tuberculosis[J]. PLoS Pathog, 2024, 20(5): e1012148.
38
Donath MY, Dinarello CA, Mandrup-Poulsen T. Targeting innate immune mediators in type 1 and type 2 diabetes[J]. Nat Rev Immunol, 2019, 19(12): 734-746.
39
Chen HG, Liu M, Jiang SW, et al. Impact of diabetes on diagnostic delay for pulmonary tuberculosis in Beijing[J]. Int J Tuberc Lung Dis, 2014, 18(3): 267-271.
40
Martinez N, Kornfeld H. Tuberculosis and diabetes: from bench to bedside and back[J]. Int J Tuberc Lung Dis, 2019, 23(6): 669-677.
41
Yew WW, Chang KC, Chan DP. Oxidative Stress and first-line antituberculosis drug-induced hepatotoxicity[J]. Antimicrob Agents Chemother, 2018, 62(8).DOI:10.1128/AAC.02637-17
42
Medellín-Garibay SE, Cortez-Espinosa N, Milán-Segovia RC, et al. Clinical pharmacokinetics of rifampin in patients with tuberculosis and Type 2 diabetes mellitus: Association with biochemical and Immunological parameters[J]. Antimicrob Agents Chemother, 2015, 59(12): 7707-7714.
43
Kornfeld H, Sahukar SB, Procter-Gray E, et al. Impact of diabetes and low body mass index on tuberculosis treatment outcomes[J]. Clin Infect Dis, 2020, 71(9): e392-e398.
44
Ren Y, Ren H, Tian Q, et al. The relationship between computed tomography appearance of pulmonary tuberculosis and blood glucose levels in 763 diabetes mellitus patients with pulmonary tuberculosis: a comparative study[J]. Endocrine, 2022, 76(3): 584-592.
45
Panic N, Maetzel H, Bulajic M, et al. Pancreatic tuberculosis: A systematic review of symptoms, diagnosis and treatment[J]. United European Gastroenterol J, 2020, 8(4): 396-402.
46
Kelestimur F. The endocrinology of adrenal tuberculosis: the effects of tuberculosis on the hypothalamo-pituitary-adrenal axis and adrenocortical function[J]. J Endocrinol Invest, 2004, 27(4): 380-386.
47
Magee MJ, Salindri AD, Kyaw NTT, et al. Stress hyperglycemia in patients with tuberculosis disease: epidemiology and clinical implications[J]. Curr Diab Rep, 2018, 18(9): 71.
48
Trajman A, Campbell JR, Kunor T, et al. Tuberculosis[J]. Lancet, 2025, 405(10481): 850-866.
49
Pérez-Martínez DE, Bermúdez-Hernández GA, Madrazo-Moya CF, et al. SNPs in genes related to DNA damage repair in Mycobacterium tuberculosis: their association with type 2 diabetes mellitus and drug resistance[J]. Genes (Basel), 2022, 13(4).DOI:10.3390/genes13040609.
50
Pradipta IS, Forsman LD, Bruchfeld J, et al. Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis[J]. J Infect, 2018, 77(6): 469-478.
51
Metwally AS, El-Sheikh SMA, Galal AA. The impact of diabetes mellitus on the pharmacokinetics of rifampicin among tuberculosis patients: A systematic review and meta-analysis study[J]. Diabetes Metab Syndr, 2022, 16(2): 102410.
52
Wattanapokayakit S, Mushiroda T, Yanai H, et al. NAT2 slow acetylator associated with anti-tuberculosis drug-induced liver injury in Thai patients[J]. Int J Tuberc Lung Dis, 2016, 20(10): 1364-1369.
53
Kumar AKH, Kadam A, Karunaianantham R, et al. Effect of metformin on plasma exposure of rifampicin, isoniazid, and pyrazinamide in patients on treatment for pulmonary tuberculosis[J]. Ther Drug Monit, 2023, 46(3): 370-375.
54
Huang LK, Wang HH, Lai YC, et al. The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients[J]. PLoS One, 2017, 12(6): e0179750.
55
Ramappa V, Aithal GP. Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management[J]. J Clin Exp Hepatol, 2012, 3(1): 37-49.
56
Te Brake LHM, Yunivita V, Livia R, et al. Rifampicin alters metformin plasma exposure but not blood glucose levels in diabetic tuberculosis patients[J]. Clin Pharmacol Ther, 2018, 105(3): 730-737.
57
Sutter A, Landis D, Nugent K. The potential role for metformin in the prevention and treatment of tuberculosis[J]. J Thorac Dis, 2022, 14(6): 1758-1765.
58
Zhou J, Massey S, Story D, et al. Metformin: an old drug with new applications[J]. Int J Mol Sci, 2018, 19(10).DOI:10.3390/ijms19102863
59
Lee YJ, Han SK, Park JH, et al. The effect of metformin on culture conversion in tuberculosis patients with diabetes mellitus[J]. Korean J Intern Med, 2018, 33(5): 933-940.
60
Lee MC, Lee CH, Lee MR, et al. Impact of metformin use among tuberculosis close contacts with diabetes mellitus in a nationwide cohort study[J]. BMC Infect Dis, 2019, 19(1): 936.
61
Kumar AKH, Kadam A, Karunaianantham R, et al. Effect of metformin on plasma exposure of rifampicin, isoniazid, and pyrazinamide in patients on treatment for pulmonary tuberculosis[J]. Ther Drug Monit, 2024, 46(3): 370-375.
62
Radhakrishnan RK, Thandi RS, Tripathi D, et al. BCG vaccination reduces the mortality of Mycobacterium tuberculosis-infected type 2 diabetes mellitus mice[J]. JCI Insight, 2020, 5(5).DOI:10.1172/jci.insight.133788.
63
Zhen J, Zhang C, Huang T, et al. Drug repurposing: an antidiabetic drug Ipragliflozin as Mycobacterium tuberculosis sirtuin-like protein inhibitor that synergizes with anti-tuberculosis drug isoniazid[J]. Int J Biol Macromol, 2024, 282(Pt 3): 137003.
[1] 赵海珠, 袁慧颖, 冯倩倩, 韩彪. 个性化截骨导板在全膝关节置换术后功能锻炼中的应用[J/OL]. 中华关节外科杂志(电子版), 2026, 20(03): 299-306.
[2] 曾艺平, 刁雪山, 宁天华, 梁金莲, 谢举临, 胡志成, 唐锦明, 谢肖霞, 李延甫. 抗生素骨水泥填充治疗糖尿病足骨髓炎的临床疗效分析[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(04): 271-276.
[3] 冯颖, 祝红娟, 王倩, 高猛猛, 郭佳宁, 马妍. 负压伤口疗法联合生物活性敷料在糖尿病足溃疡中的应用研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(04): 309-314.
[4] 梁寒婷, 李想, 孔晶, 张喆楠, 高孟涵, 李一涵, 郑超, 王鸣. 钠-葡萄糖共转运蛋白2抑制剂在肾移植合并糖尿病受者中的应用[J/OL]. 中华移植杂志(电子版), 2026, 20(04): 306-312.
[5] 林英立, 靳孟丽, 胡建东, 颜廷晖. 2型糖尿病患者前列腺增生组织中HIF-1α/VEGF的表达及意义[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(04): 407-412.
[6] 成津, 郭建明. 间充质干细胞治疗糖尿病足溃疡的研究现状与进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(05): 278-284.
[7] 谢乐静, 顾新新, 郝秀雪. 干细胞治疗老年糖尿病的作用机制及临床研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(05): 314-320.
[8] 王裕康, 周洁, 付爽, 刘语菲, 周振宇, 王淑芳. 肝脏脱细胞支架的制备及其对胰岛细胞活性的作用[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(04): 209-217.
[9] 刘欣贤, 陈柏煜, 魏玲玲. 细胞治疗糖尿病的临床突破与进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(04): 246-254.
[10] 季恒源, 关思涵, 李纳琦. 补体系统凝集素途径在糖尿病肾脏疾病中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 220-223.
[11] 石雨申, 王旭, 张艳霞, 张静洁, 苏静克, 胡海娇, 陈怡洁, 王聪慧, 耿燕秋. 基于GEO数据挖掘探讨大黄-丹参药对干预糖尿病肾脏疾病的作用机制[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 181-187.
[12] 徐莹, 吴逸璐, 金畅, 金毅, 陈萍, 汤月秋, 杨蓉, 任连升, 朱丹. 度拉糖肽联合达格列净对2型糖尿病肾脏疾病患者肾脏功能及纤维化的影响[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 188-194.
[13] 张紫玥, 王晓晨, 付章宁, 邓蔚竹, 迟坤, 孙冠南, 洪权. Nrf2调控糖尿病肾脏疾病巨噬细胞代谢重编程和极化的分子机制[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 195-201.
[14] 王春茂, 王隽, 王子彤. Thopaz数字化胸腔引流系统在肺结核术后持续性漏气治疗中的应用价值[J/OL]. 中华临床医师杂志(电子版), 2026, 20(05): 341-345.
[15] 唐海燕, 李星宇, 彭超, 朱妍, 张玉, 秦玥, 唐新玉, 杨晓. 二维超声联合剪切波弹性成像评估2型糖尿病及糖尿病周围神经病变患者下肢肌肉形态及力学特性[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 275-284.
阅读次数
全文


摘要


AI
小
编
AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?