Objective To investigate serum vitamin D levels in tuberculosis (TB) patients with different blood glucose status.Methods Two hundred and forty seven TB patients were recruited from tuberculosis clinics in Jilin province and 80 normal subjects who underwent health check up in Beijing Hospital served as controls.Blood samples were collected,fasting blood glucose (FBG) and serum vitamin D [25 (OH)D] levels were measured.Results FBG results showed that there were 95 patients with normal FBG,69 with pre-diabetes (pre-DM) and 83 with diabetes mellitus (DM).Vitamin D measurement showed that 25(OH) D level in TB patients with normal FBG,pre-DM and DM was 16.1 (10.7,26.2) μg/L,12.9 (9.6,20.1) μg/L and 12.4 (10.4,16.9) μg/L,respectively,(x2 =19.608,P ＜ 0.001) and were much lower than that in the normal controls (20.5 μg/L) (x2 =21.701,P ＜ 0.001).Proportion of TB patients with 25 (OH)D sever deficiency(＜ 10.0 μg/L)in patients with normal FBG,pre-DM and DM was 20.0％ (19/95),31.9％ (22/69),and 24.1％ (20/83) respectively (x2 =6.376,P ＜ 0.05);proportion of 25 (OH) D deficiency (10.0-19.9 ng/ml) in three groups was 41.1％ (39/95),40.6％ (28/69),and 57.8 ％ (48/83),respectively (x2 =15.141,P ＜ 0.05);sufficient 25 (OH) D (≥ 30.0 μg/L) was 14.7％ (14/95),7.2％ (5/69),and 1.2％ (1/83),respectively (x2 =19.118;P ＜0.05).While the proportion of TB patient with 25 (OH) D insufficiency (20.0-29.9 ng/ml) was 24.2％ (23/95),20.3％ (14/69),and 16.9％ (14/48) respectively (x2 =0.933,P =0.627).In TB patients with normal FBG,risk factors for 25 (OH) D deficiency were smoking (OR =5.619,95％ CI:1.293-24.424,P =0.021),cold season (OR =14.402,95％CI:4.070-50.965,P ＜ 0.001) and smear negative TB (OR =6.194,95 ％ CI:1.873-20.481,P =0.003).Living in rural area (OR =3.429,95％ CI:1.040-11.299,P =0.043) was the risk factor for 25 (OH) D deficiency in TB patients with pre-DM and age ≥ 60 years (OR =2.474,95％CI:1.086-5.623,P =0.031) was risk factor for 25 (OH) D deficiency in those with DM.Conclusions Vitamin D level is lower in TB patients than that in normal controls.The diabetic TB patients have the lowest 25 (OH) D level and have highest proportion of vitamin D deficiency and sever deficiency,particularly for elderly patients.

Objective:To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis.Methods:A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival.Results:The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8 +absolute T lymphocyte count≤177 cells/μl, CD28 +CD8 +T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95 %CI 0.749-0.833, P<0.000 1;AUC=0.892,95 %CI 0.856-0.921, P<0.000 1;AUC=0.761, 95 %CI 0.715-0.803, P<0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8 +T-cell count≤139 cells/μl ( OR=7.463, 95 %CI 1.300-42.831, P=0.024) and CD28 +CD8 +T-cell counts≤52 cells/μl ( OR=57.494, 95 %CI 3.986-829.359, P=0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8 +T-cell count ≤139 cells/μl ( P=0.0159) and CD28 +CD8 +T-cell count≤52 cells/μl ( P=0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Conclusions:Low CD28 +CD8 +T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.