Changes of the pro-hormone levels of vitamin D 25(OH)D in patients with newly diagnosed pulmonary tuberculosis treatment failure
DOI:
https://doi.org/10.14739/2310-1237.2020.1.203743Keywords:
tuberculosis, treatment failure, vitamin DAbstract
In Ukraine the number of patients with newly diagnosed tuberculosis (NDTB) who successfully complete the course of treatment reaches 60–65 % today. This is while the World Health Organization (WHO) criteria for successful treatment of this category of patients is 85 %. Scientists around the world are studying the possible pathogenetic factors of treatment failure of antimycobacterial therapy in patients with tuberculosis. Nowadays, the impact of vitamin D has been widely studied in this area. Studying of the dynamics of this indicator in patients with NDTB with widespread destructive tuberculosis in the lungs and bacterial excretion with the purpose of finding new markers of progression of a specific process and failure of treatment, as well as finding possible ways of additional pathogenetic therapy to accompany patients is actual. This approach will prevent treatment failure and, as a consequence, improve treatment efficiency.
Purpose. To determine changes in the pro-hormone levels of vitamin D 25(OH)D in patients with NDTB treatment failure during the intensive phase of antimycobacterial therapy.
Materials and methods. A prospective study involving 58 patients with NDTB lungs was performed. The patients were divided into 2 groups: 28 patients with pulmonary NDTB treatment failure were included in the 1st group (the main group), 30 patients, who subsequently successfully completed the course of treatment were included in the 2nd group (comparison group). The control group consisted of 29 healthy volunteer-donors. All the patients had been in inpatient treatment in Communal Institution “Zaporizhzhia Regional TB Clinical dispensary” during 2017–2019 years. Scientific medical-laboratory center of Zaporizhzhia State Medical University researched changes of the level of 25(OH)D in the blood serum by method of enzyme linked immunosorbent assay using immunoassay analyser Sirio S with “DIAsource ImmunoAssays S.A.” kit (Belgium) (ng/ml). Blood sampling was made after an overnight fast. Blood was collected uniformly throughout the year in all patients and volunteers to avoid the effect of seasonal variability in vitamin D in the blood.
Results. While healthy volunteers have a reduction in the level of pro-hormone 25(OH)D only in 51.7 % of cases (deficiency in 13.8 % and insufficiency in 37.9 %), patients with NDTB with generalized specific process in the lungs, the presence of destruction of over 3 cm in diameter and bacterial excretion at the beginning of intensive phase of antimycobacterial therapy (0 doses), have its decrease in 96.5 % (81 % deficiency and 15.5 % insufficiency). 1/3 of patients (35.7 % at the 0th dose and 32.1 % at the 90th dose) with tuberculosis treatment failure have pro-hormone levels 25(OH)D less than 7 ng/ml, whereas in patients who successfully completed the course of treatment, this concentration of pro-hormone 25(OH)D was not even diagnosed. In the dynamics, after 3 months of intensive phase of antimycobacterial therapy (90 doses) in patients with NDTB treatment failure the levels of pro-hormone 25(OH)D continue to decrease significantly by 1.3 times relative to the initial values, which is 1.4 times lower than in patients who successfully completed the course of treatment.
Conclusions. In the vast majority of patients with NDTB of lungs with a risk of ineffective treatment, a pronounced deficiency of vitamin D (1/3 patients with pro-hormone levels 25(OH)D less than 7 ng/ml) is determined at the beginning of treatment, and after 3 months of the intensive phase of antimycobacterial chemotherapy exacerbates vitamin D deficiency. Therefore, this indicator can be used as a prognostic for the tuberculosis treatment failure and reducing the level of pro-hormone 25(OH)D in the dynamics require consideration of the problem of methods of its correction by the addition of vitamin D.
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