活动性肺结核患者微量营养素变化及其相关营养治疗的研究进展

doi:10.3969/j.issn.2096-8493.2020.03.015

摘要/Abstract

摘要：

活动性肺结核(PTB)患者不仅存在蛋白质-能量型营养不良,也存在必需微量元素和维生素缺乏,二者缺乏不仅是结核病发病的高危因素,也是结核病病情加重的因素之一,与活动性PTB之间存在明显的双向因果关系。针对目前结核病营养相关问题(尤其是对微量元素和维生素的缺乏)仍未受到临床应有的重视,作者通过查阅最新文献,对活动性PTB患者营养不良的类型和特征、营养不良对活动性PTB患者的损害,以及补充微量元素和维生素对PTB患者的益处进行综述,以提高临床医师对PTB营养相关问题的认识水平和重视程度。

关键词: 结核,肺, 营养不良, 健康状况指标, 营养支持, 营养评价, 综述文献(主题)

Abstract:

Patients with active pulmonary tuberculosis (PTB) exist protein-energy malnutrition, essential microelements and vitamins deficiency, and all of them are high risk factors of pathogenesis and progression of disease. There is an obvious two-way causal relationship between malnutrition and active PTB. But the proper attention is not yet paid to nutritional problems of tuberculosis, especially for deficiency of microelements and vitamins. Having referred to a lot of documents, the authors have done a deep review about the type, characteristics, the damage of malnutrition, and the benefits of nutrient supplement to the active PTB patients, in order to improve the level of awareness in clinical treatment of clinicians.

Key words: Tuberculosis,pulmonary, Malnutrition, Health status indicators, Nutritional support, Nutrition assessment, Review literature as topic

王乐乐, 杨松, 唐神结. 活动性肺结核患者微量营养素变化及其相关营养治疗的研究进展[J]. 结核与肺部疾病杂志, 2020, 1(3): 281-284. doi: 10.3969/j.issn.2096-8493.2020.03.015

WANG Le-le, YANG Song, TANG Shen-jie. Progress on changes of micronutrients and nutritional therapy of active pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(3): 281-284. doi: 10.3969/j.issn.2096-8493.2020.03.015

参考文献 36

[1]	中华医学会结核病学分会重症委员会. 结核病营养治疗专家共识. 中华结核和呼吸杂志, 2020,43(1):17-26. doi: 10.3760/cma.j.issn.1001-0939.2020.01.006.
[2]	石汉平, 许红霞, 李苏宜, 等. 营养不良的五阶梯治疗. 肿瘤代谢与营养电子杂志, 2015,2(1):29-32.
[3]	全国科学技术名词审定委员会. 肠外肠内营养学. 北京: 科学出版社, 2019: 6.
[4]	Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulm Med, 2019,19(1):182. doi: 10.1186/s12890-019-0953-0. doi: 10.1186/s12890-019-0953-0 URL pmid: 31638950
[5]	Ren Z, Zhao F, Chen H, et al. Nutritional intakes and associated factors among tuberculosis patients: a cross-sectional study in China. BMC Infect Dis, 2019,19(1):907. doi: 10.1186/s12879-019-4481-6. doi: 10.1186/s12879-019-4481-6 URL pmid: 31664922
[6]	Koethe JR, von Reyn CF. Protein-calorie malnutrition, macronutrient supplements, and tuberculosis. Int J Tuberc Lung Dis, 2016,20(7):857-863. doi: 10.5588/ijtld.15.0936. URL pmid: 27287634
[7]	Islam QS, Ahmed SM, Islam MA, et al. Beyond drugs: tuberculosis patients in Bangladesh need nutritional support during convalescence. Public Health Action, 2013,3(2):136-140. doi: 10.5588/pha.13.0005. doi: 10.5588/pha.13.0005 URL pmid: 26393016
[8]	柯学, 李国保, 沈生荣. 结核病的营养治疗. 中华结核和呼吸杂志, 2020,43(1):8-10. doi: 10.3760/cma.j.issn.1001-0939.2020.01.003.
[9]	唐神结, 高文. 临床结核病学. 2版. 北京: 人民卫生出版社, 2019: 253-269.
[10]	Wang Q, Ma A, Bygbjerg IC, et al. Rationale and design of a randomized controlled trial of the effect of retinol and vitamin D supplementation on treatment in active pulmonary tuberculosis patients with diabetes. BMC Infect Dis, 2013,13:104. doi: 10.1186/1471-2334-13-104. doi: 10.1186/1471-2334-13-104 URL pmid: 23442225
[11]	Wang Q, Ma A, Schouten EG, et al. A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency. Clin Nutr, 2020:S0261-5614(20) 30456-8. doi: 10.1016/j.clnu.2020.08.040.
[12]	Syal K, Chatterji D. Vitamin C: A Natural Inhibitor of Cell Wall Functions and Stress Response in Mycobacteria. Adv Exp Med Biol, 2018,1112:321-332. doi: 10.1007/978-981-13-3065-0_22. doi: 10.1007/978-981-13-3065-0_22 URL pmid: 30637707
[13]	Yamshchikov AV, Oladele A, Leonard MK Jr, et al. Vitamin D as adjunctive therapy in refractory pulmonary tuberculosis: a case report. South Med J, 2009,102(6):649-652. doi: 10.1097/SMJ.0b013e3181a5d37e. doi: 10.1097/SMJ.0b013e3181a5d37e URL pmid: 19434014
[14]	Cernat RI, Mihaescu T, Vornicu M, et al. Serum trace metal and ceruloplasmin variability in individuals treated for pulmonary tuberculosis. Int J Tuberc Lung Dis, 2011,15(9):1239-1245. doi: 10.5588/ijtld.10.0445. URL pmid: 21943852
[15]	Baeke F, Takiishi T, Korf H, et al. Vitamin D: modulator of the immune system. Curr Opin Pharmacol, 2010,10(4):482-496. doi: 10.1016/j.coph.2010.04.001. URL pmid: 20427238
[16]	Thomas L, Sekhar Miraj S, Surulivelrajan M, et al. Influence of Single Nucleotide Polymorphisms on Rifampin Pharmacokinetics in Tuberculosis Patients. Antibiotics(Basel), 2020,9(6):307. doi: 10.3390/antibiotics9060307.
[17]	Allegra S, Fatiguso G, Calcagno A, et al. Role of vitamin D pathway gene polymorphisms on rifampicin plasma and intracellular pharmacokinetics. Pharmacogenomics, 2017,18(9):865-880. doi: 10.2217/pgs-2017-0176. URL pmid: 28594304
[18]	Rekha RS, Mily A, Sultana T, et al. Immune responses in the treatment of drug-sensitive pulmonary tuberculosis with phenylbutyrate and vitamin D as host directed therapy. BMC Infect Dis, 2018,18(1):303. doi: 10.1186/s12879-018-3203-9. URL pmid: 29973153
[19]	Reeme AE, Robinson RT. Dietary Vitamin D3 Suppresses Pulmonary Immunopathology Associated With Late-Stage Tuberculosis in C3HeB/FeJ Mice. J Immunol, 2016,196(3):1293-1304. doi: 10.4049/jimmunol.1500931. doi: 10.4049/jimmunol.1500931 URL pmid: 26729807
[20]	Dalvi SM, Ramraje NN, Patil VW, et al. Study of IL-6 and vitamin D3 in patients of pulmonary tuberculosis. Indian J Tuberc, 2019,66(3):337-345. doi: 10.1016/j.ijtb. 2018. 05.018. URL pmid: 31439177
[21]	王乐, 钱毅骏. 活性维生素D3联合IFN-α对肝纤维化小鼠肝纤维化程度、IL-6、TNF-α、TGF-β及Smad3表达的影响. 肝脏, 2019,24(8):944-947.
[22]	Periyasamy KM, Ranganathan UD, Tripathy SP, et al. Vitamin D—A host directed autophagy mediated therapy for tuberculosis. Mol Immunol, 2020,127:238-244. doi: 10.1016/j.molimm.2020.08.007. doi: 10.1016/j.molimm.2020.08.007 URL pmid: 33039674
[23]	Bahi GA, Boyvin L, Méité S, et al. Assessments of serum copper and zinc concentration, and the Cu/Zn ratio determination in patients with multidrug resistant pulmonary tuberculosis (MDR-TB) in Côte d’Ivoire. BMC Infect Dis, 2017,17(1):257. doi: 10.1186/s12879-017-2343-7. doi: 10.1186/s12879-017-2343-7 URL pmid: 28399817
[24]	Mazumder MK, Rahim MA, Ahmed S, et al. Serum Zinc Concentrations in Patients With Pulmonary Tuberculosis. Mymensingh Med J, 2018,27(3):536-543. URL pmid: 30141443
[25]	Sepehri Z, Mirzaei N, Sargazi A, et al. Essential and toxic metals in serum of individuals with active pulmonary tuberculosis in an endemic region. J Clin Tuberc Other Mycobact Dis, 2017,6:8-13. doi: 10.1016/j.jctube.2017.01.001. doi: 10.1016/j.jctube.2017.01.001 URL pmid: 31723693
[26]	Choi R, Kim HT, Lim Y, et al. Serum Concentrations of Trace Elements in Patients With Tuberculosis and Its Association With Treatment Outcome. Nutrients, 2015,7(7):5969-5981. doi: 10.3390/nu7075263. URL pmid: 26197334
[27]	Minchella PA, Donkor S, McDermid JM, et al. Iron homeostasis and progression to pulmonary tuberculosis disease among household contacts. Tuberculosis (Edinb), 2015,95(3):288-293. doi: 10.1016/j.tube.2015.02.042. doi: 10.1016/j.tube.2015.02.042 URL
[28]	Prasad R, Ahmad I, Kushwaha RAS, et al. Vitamin A and Zinc Alter the Immune Function in Tuberculosis. J Kuwait Med Assoc, 2012,44(3):183-189.
[29]	Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr, 1998,68(2 Suppl):447S-463S. doi: 10.1093./ajcn/68.2.447S. doi: 10.1093/ajcn/68.2.447S URL pmid: 9701160
[30]	Prasad AS. Zinc: role in immunity, oxidative stress and chronic inflammation. Curr Opin Clin Nutr Metab Care, 2009,12(6):646-652. doi: 10.1097/MCO. 0b013e3283312956. doi: 10.1097/MCO.0b013e3283312956 URL pmid: 19710611
[31]	Hussain MI, Ahmed W, Nasir M, et al. Immune modulatory and anti-oxidative effect of selenium against pulmonary tuberculosis. Pak J Pharm Sci, 2019,32(2 (Supplementary)): 779-784.
[32]	Ward SK, Heintz JA, Albrecht RM, et al. Single-cell elemental analysis of bacteria: quantitative analysis of polyphosphates in Mycobacterium tuberculosis. Front Cell Infect Microbiol, 2012,2:63. doi: 10.3389/fcimb.2012.00063. doi: 10.3389/fcimb.2012.00063 URL pmid: 22919654
[33]	Hood MI, Skaar EP. Nutritional immunity: transition metals at the pathogen-host interface. Nat Rev Microbiol, 2012,10(8):525-537. doi: 10.1038/nrmicro2836. URL pmid: 22796883
[34]	Darwin KH. Mycobacterium tuberculosis and Copper: A Newly Appreciated Defense against an Old Foe? J Biol Chem, 2015,290(31):18962-18966. doi: 10.1074/jbc.R115. 640193. URL pmid: 26055711
[35]	Wolschendorf F, Ackart D, Shrestha TB, et al. Copper resis-tance is essential for virulence of Mycobacterium tuberculosis. Proc Natl Acad Sci U S A, 2011,108(4):1621-1626. doi: 10.1073/pnas.1009261108. URL pmid: 21205886
[36]	Amaral EP, Costa DL, Namasivayam S, et al. A Major role for ferroptosis in Mycobacterium tuberculosis-induced cell death and tissue necrosis. J Exp Med, 2019,216(3):556-570. doi: 10.1084/jem.20181776. URL pmid: 30787033