Khandelwal Deepchand, Gupta Nandita, Mukherjee Aparna, Lodha Rakesh, Singh Varinder, Grewal Harleen M S, Bhatnagar Shinjini, Singh Sarman, Kabra S K
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2014 Oct;140(4):531-7.
BACKGROUND & OBJECTIVES: Deficiency of vitamin D, an immunomodulator agent, is associated with increased susceptibility to tuberculosis in adults, but only limited studies are available in the paediatric age group, especially regarding association of vitamin D with type and outcome of tuberculosis. We conducted this study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis.
Children with intrathoracic tuberculosis, diagnosed on the basis of clinico-radiological criteria, were enrolled as part of a randomized controlled trial on micronutrient supplementation in paediatric tuberculosis patients. Levels of 25-hydroxy vitamin D were measured in serum samples collected prior to starting antitubercular therapy by chemiluminescent immunoassay technology.
Two hundred sixty six children (mean age of 106.9 ± 43.7 months; 57.1% girls) were enrolled. Chest X-ray was suggestive of primary pulmonary complex, progressive disease and pleural effusion in 81 (30.5%), 149 (56%) and 36 (13.5%) subjects, respectively. Median serum 25-hydroxy vitamin D level was 8 ng/ml (IQR 5, 12). One hundred and eighty six (69.9%) children were vitamin D deficient (serum 25-hydroxy vitamin D <12 ng/ml), 55 (20.7%) were insufficient (12 to <20 ng/ml) and 25 (9.4%) were vitamin D sufficient (≥ 20 ng/ml). Levels of 25-hydroxy vitamin D were similar in all three types of intrathoracic tuberculosis, and in microbiologically confirmed and probable cases. Levels of 25-hydroxy vitamin D did not significantly affect outcome of the disease. Children who were deficient or insufficient were less likely to convert (become smear/culture negative) at two months as compared to those who were 25-hydroxy vitamin D sufficient ( p <0.05).
INTERPRETATION & CONCLUSIONS: Majority of Indian children with newly diagnosed intrathoracic tuberculosis were deficient in vitamin D. Type of disease or outcome was not affected by 25-hydroxy vitamin D levels in these children. However, children who did not demonstrate sputum conversion after intensive phase of antitubercular therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did.
维生素D作为一种免疫调节剂，其缺乏与成人肺结核易感性增加有关，但关于儿童年龄组的研究有限，尤其是维生素D与肺结核类型及转归的关联。我们开展本研究以确定患胸内结核儿童的基线25-羟维生素D水平及其与肺结核类型和转归的关系。
根据临床-放射学标准诊断为胸内结核的儿童，作为儿童肺结核患者微量营养素补充随机对照试验的一部分被纳入研究。采用化学发光免疫分析技术，在开始抗结核治疗前采集的血清样本中检测25-羟维生素D水平。
共纳入266名儿童（平均年龄106.9±43.7个月；57.1%为女孩）。胸部X线检查提示原发性肺复合征、进展期疾病和胸腔积液的分别有81名（30.5%）、149名（56%）和36名（13.5%）受试者。血清25-羟维生素D水平中位数为8 ng/ml（四分位间距5，12）。186名（69.9%）儿童维生素D缺乏（血清25-羟维生素D<12 ng/ml），55名（20.7%）不足（12至<20 ng/ml），25名（9.4%）维生素D充足（≥20 ng/ml）。三种类型的胸内结核以及微生物学确诊和疑似病例中，25-羟维生素D水平相似。25-羟维生素D水平对疾病转归无显著影响。与25-羟维生素D充足的儿童相比，缺乏或不足的儿童在两个月时痰菌转阴（涂片/培养阴性）的可能性较小（p<0.05）。
大多数新诊断为胸内结核的印度儿童维生素D缺乏。这些儿童的疾病类型或转归不受25-羟维生素D水平影响。然而，与痰菌转阴的儿童相比，抗结核治疗强化期后未实现痰菌转阴的儿童基线25-羟维生素D水平较低。
