Indumati V, Vijay V, Krishnaswamy D, Rajeshwari V, Ramesh A, Shantala D, Shilpa A
Department of Biochemistry, Vijayanagar Institute Medical Sciences, Bellary, Karnataka, India.
Department of Biochemistry, Vijayanagar Institute Medical Sciences, Bellary, Karnataka, India.
Indian J Tuberc. 2017 Jul;64(3):206-211. doi: 10.1016/j.ijtb.2017.01.012. Epub 2017 Feb 22.
Upon diagnosis, Pulmonary Tuberculosis patients are treated for TB for a period of 6-9 months. At present, there exists very little indication of the efficacy of the particular treatment. A few previous studies have shown that soluble urokinase plasminogen activator receptor (SuPAR) may be used as treatment efficacy marker. SuPAR is a cellular receptor for serine protease urokinase plasminogen activator (uPA). Bacterial endotoxins and cytokines of the innate immune system stimulate the secretion of uPA in monocytes & neutrophils. Serum SuPAR levels are elevated when TB is active and decrease when the patient responds positively to therapy.
To investigate if SuPAR levels decline upon treatment and whether serum SuPAR levels may be used as a biomarker to monitor Tuberculosis treatment efficacy.
The study was conducted in the department of Biochemistry at VIMS, Ballari, Karnataka. The study subjects were randomly selected from RNTCP centre of VIMS.
Twelve tuberculin skin test positive healthy controls from the community.
A total of 60 cases were enrolled for the study and were divided into 3 groups with 20 in each, based on the duration of TB treatment. Group I (n=20): Newly diagnosed pulmonary TB patients before initiation of DOTS. Group II (n=20): TB patients, 2-3 months after initiation of DOTS. Group III (n=20): TB patients who had completed 6 months of DOTS.
Hb%, TC, DC(P)%, DC(L)% & ESR were measured by standard procedures. Serum suPAR was measured by the quantitative sandwich enzyme immunoassay technique using the R & D systems Human uPAR Quantikine ELISA Kit.
The suPAR levels were elevated before treatment (3.27+2.08ng/ml) and dropped significantly in groups after 2 months of initiation of therapy (2.18+1.17ng/ml) and after completion of 6 months of treatment (1.50+0.93ng/ml).
The decrease in suPAR levels in PTB patients with treatment is a manifestation of treatment efficacy. Hence suPAR levels can be used to guide clinical decisions in TB management.
肺结核患者确诊后需接受6至9个月的抗结核治疗。目前，关于特定治疗方法疗效的指征非常少。先前的一些研究表明，可溶性尿激酶型纤溶酶原激活物受体（SuPAR）可用作治疗疗效标志物。SuPAR是丝氨酸蛋白酶尿激酶型纤溶酶原激活物（uPA）的细胞受体。先天性免疫系统的细菌内毒素和细胞因子会刺激单核细胞和中性粒细胞分泌uPA。肺结核活动期时血清SuPAR水平升高，患者对治疗产生积极反应时该水平下降。
研究治疗后SuPAR水平是否下降，以及血清SuPAR水平是否可用作监测肺结核治疗疗效的生物标志物。
该研究在卡纳塔克邦巴拉里市VIMS的生物化学系进行。研究对象从VIMS的RNTCP中心随机选取。
12名社区结核菌素皮肤试验阳性的健康对照者。
共60例患者纳入研究，根据肺结核治疗时长分为3组，每组20例。第一组（n = 20）：开始直接观察短程治疗（DOTS）前新诊断的肺结核患者。第二组（n = 20）：开始DOTS治疗2至3个月后的肺结核患者。第三组（n = 20）：完成6个月DOTS治疗的肺结核患者。
通过标准程序测量血红蛋白百分比（Hb%）、总胆固醇（TC）、中性粒细胞百分比（DC(P)%）、淋巴细胞百分比（DC(L)%）和红细胞沉降率（ESR）。使用R&D系统的人uPAR Quantikine ELISA试剂盒，通过定量夹心酶免疫测定技术测量血清suPAR。
治疗前suPAR水平升高（3.27 + 2.08ng/ml），治疗开始2个月后（2.18 + 1.17ng/ml）和完成6个月治疗后（1.50 + 0.93ng/ml），各组水平显著下降。
肺结核患者治疗过程中suPAR水平下降是治疗疗效的一种表现。因此，suPAR水平可用于指导肺结核管理中的临床决策。
