肺结核合并糖尿病的临床特征、耐药机制及预后影响因素研究进展
Research Progress on Clinical Characteristics, Drug Resistance Mechanisms, and Prognostic Factors of Pulmonary Tuberculosis with Diabetes Mellitus
摘要: 肺结核与糖尿病共病是全球重大公共卫生挑战，两病存在双向协同加重效应，增加治疗难度与耐药风险。本文系统综述其核心研究进展：共病人群以中老年男性为主，临床症状重、空洞形成率及痰菌阳性率高，治疗成功率低；高血糖通过诱发先天免疫异常、适应性免疫失衡及免疫代谢紊乱，破坏结核肉芽肿完整性；糖尿病可通过多途径促进结核分枝杆菌耐药，rpoB、inhA等基因为特征性突变位点；血糖控制是核心可干预预后因素，二甲双胍及新型降糖药为共病管理提供新方向。未来需推进双向筛查、大样本前瞻性研究及精准预测模型转化。
Abstract: The comorbidity of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) poses a major global public health challenge, with bidirectional synergistic aggravation that increases treatment difficulty and the risk of drug resistance. This review systematically summarizes key research advances: the comorbid population is predominantly middle-aged and elderly males, presenting with severe clinical symptoms, high rates of cavity formation and positive sputum bacteriology, and low treatment success rates; hyperglycemia disrupts the integrity of tuberculous granulomas by inducing innate immune dysfunction, adaptive immune imbalance, and immunometabolic disorders; diabetes mellitus promotes drug resistance of Mycobacterium tuberculosis through multiple pathways, with rpoB, inhA and other genes as characteristic mutation sites; glycemic control is the core modifiable prognostic factor, and metformin along with novel antidiabetic agents offer new directions for comorbidity management. Future efforts should advance bidirectional screening, large‑scale prospective studies, and the translation of precision prediction models.
文章引用：朱茜茜, 黄富礼. 肺结核合并糖尿病的临床特征、耐药机制及预后影响因素研究进展[J]. 生物医学, 2026, 16(4): 711-720. https://doi.org/10.12677/hjbm.2026.164073

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