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2009, Número 1

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Rev Inst Nal Enf Resp Mex 2009; 22 (1)


Asociación de tuberculosis y diabetes mellitus: mecanismos inmunológicos involucrados en la susceptibilidad

González-Hernández Y, Sada DE, Escobar-Gutiérrez A, Muños TM, Torres RM

Idioma: Español
Referencias bibliográficas: 57
Paginas: 48-55
Archivo PDF: 82.57 Kb.


RESUMEN

La tuberculosis (TB) es una de las enfermedades infecciosas que más muertes causa en el mundo. Entre los principales factores de riesgo para el desarrollo de TB está la diabetes mellitus (DM), y en la población mexicana su papel como factor de riesgo parece ser aún mayor que el de la infección por el VIH. Los estudios en pacientes con DM tipo 2 (DM2) han demostrado que el riesgo de desarrollar TB es de 1.8 a 8 veces mayor con respecto a la población no diabética. También se ha observado que la DM2 incrementa el número de fracasos al tratamiento anti-TB y la susceptibilidad a la infección con cepas farmacorresistentes de M. tuberculosis. Por otra parte, estudios inmunológicos en pacientes con TB-DM han puesto en evidencia que hay defectos en las funciones de los leucocitos polimorfonucleares (fagocitosis, opsonización por complemento y actividad bactericida intracelular), así como la liberación de IL-1 y la producción de IL-6, TNF-a e IFN-g por células mononucleares. En modelos animales se demostró que la baja producción de IL-12, IL-6 e IL-10 se asocia a las altas concentraciones de glucosa, sugiriendo el posible papel de la hiperglucemia en la alteración de la respuesta inmune causante del incremento de la susceptibilidad a infecciones. Macrófagos alveolares de pacientes con DM2 complicados con TB activa mostraron un estado de menor activación con disminución en la producción de IFN-g. Estos datos sugieren que alteraciones en la respuesta inmune innata y adaptativa en los pacientes con DM son factores que influyen en la mayor susceptibilidad a la infección y al desarrollo de TB activa.


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