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目的探讨HLA-DRB1基因多态性与我国北方汉族糖尿病并发肺结核易感性的关系。方法采用1∶1配对的病例对照研究设计,以我国北方汉族124例糖尿病并发肺结核患者为研究对象,以与病例同民族、同性别、年龄相差不超过3岁,相同居住地(城市或农村),且经统一结核菌素试验(PPD)确认为有结核分支杆菌感染的2型糖尿病患者为对照组;采用聚合酶链反应-特异性序列引物(PCR-SSP)的方法检测HLA-DRB1基因DR15、DR16、DR1、DR11位点多态性,对与肺结核相关的危险因素进行问卷调查,应用SPSS软件进行单因素和多因素条件Logistic回归分析。结果在病例组中,携带DR15基因突变型患肺结核的风险增高(OR=2.461,95%CI:1.363-4.444,P=0.002);DR15位点突变与DR16位点突变同时存在时风险更大(OR=4.904,95%CI:1.554-15.476)。对17个环境危险因素进行单因素分析,在多因素分析中调整卡痕、体质量指数、家族史3个因素后,DR15突变基因型仍与糖尿病并发肺结核显著相关(OR=2.996,95%CI:1.51-5.945)。结论 HLA-DR15基因突变型可能为2型糖尿病并发肺结核的易感基因型。
Objective To investigate the relationship between HLA-DRB1 gene polymorphism and susceptibility to pulmonary tuberculosis in Han nationality in northern China. Methods The case-control study design with 1: 1 pairing was used to study 124 cases of diabetic patients with pulmonary tuberculosis in Han nationality in northern China. The patients with the same nationality, same sex and age less than 3 years old, the same place of residence (urban or rural) , And the type 2 diabetes mellitus patients confirmed as having mycobacterium tuberculosis infection by the unified tuberculin test (PPD) as the control group; PCR-SSP was used to detect the HLA-DRB1 DR15 , DR16, DR1 and DR11 polymorphisms. The risk factors related to pulmonary tuberculosis were investigated by questionnaire. SPSS software was used to analyze single-factor and multi-factor conditional Logistic regression. Results In the case group, the risk of TB patients carrying DR15 mutation was higher (OR = 2.461, 95% CI: 1.363-4.444, P = 0.002); the risk of DR15 locus mutation was greater than that of DR16 locus OR = 4.904, 95% CI: 1.554-15.476). After univariate analysis of 17 environmental risk factors, the DR15 genotype was still significantly associated with pulmonary tuberculosis (OR = 2.996, 95% CI) after adjusting for three factors: card marks, body mass index and family history in multivariate analysis : 1.51-5.945). Conclusion The mutation of HLA-DR15 gene may be the susceptible genotype of type 2 diabetes complicated with pulmonary tuberculosis.