We read with great interest the recently published informative article by Kim等等。1粟粒肺结核营养缺陷的预后价值(TB)。使用营养风险评分,包括四个因素(低体重指数,低杀虫剂血症,次粒细胞症和严重淋巴细胞症),作者展示了急性呼吸衰竭和56例粟粒患者的急性呼吸衰竭和90天死亡率的独立和主要预后价值TB.1。However, with the observational nature and retrospective design of the study, it might be difficult to pinpoint the exact cause and effect relationship between nutrition status and TB severity/outcome.
Being underweight is a well known factor that predisposes patients to the development of TB2那3.。但是,结核病也可能导致显着的浪费和虚弱4.。在大规模的前瞻性结核病治疗试验中,在基线上不体重5.and the absence of an early gain in weight during chemotherapy have been associated with an increased risk of relapse6.。高达61%的复发患者在该试验中发生的诊断≥10%≥10%,而且在初始治疗阶段未能获得> 5%重量的人中发生62%5.那6.。然而,在没有针对营养状况的随机干预的情况下,问题仍然仍然是与结核化疗相关的体重增加,只反映了对疾病的成功控制,或进一步增加对分枝杆菌病原体的宿主防御。
粟粒疹的结核病有非常重大的程度的密苏里州rtality. If poor nutritional status does predispose patients to major complication(s) and death, specific intervention targeted at improving the nutritional status would be indicated to decrease the associated morbidity and mortality. Unfortunately, systematically collected data are notably scarce in this area. Notwithstanding that, a cholesterol-rich diet has been shown to accelerate bacteriological sterilisation in pulmonary TB7.。还证明了微量营养素在艾滋病毒感染和无感染患者的第一个月初始转化后降低痰培养物至阳性的风险,但对死亡率没有显着影响8.。总体而言,微量营养素受益于该试验中最多的艾滋病毒无感染的科目,而相反的是在同一地点的先前试验中的情况9.。虽然微量营养素缺陷通常在全球营养缺陷中发生,但这些试验都不包含有关总蛋白质 - 卡路里摄入或体重或体重指数的串行测量的特定信息,以允许推论的推论是整体营养状况的影响。
全身炎症反应也似乎在结核病严重并发症的发展中发挥着重要作用。在Kim的研究中等等。1那an elevated C-reactive protein level was also shown to be an independent predictor of acute respiratory failure1。Poor appetite and decreased food intake may also be associated with advanced tuberculosis disease. Adjunctive corticosteroid administration during tuberculosis treatment has been found to afford earlier and more significant body weight gain, albeit causes no differences in sputum bacteriological conversion and disease relapse rate10.。Such a form of treatment might also merit reappraisal in clinical situations associated with heightened inflammatory responses, especially when simple dietary manipulation does not appear to result in a significant improvement in nutrition status.
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None declared.
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