Agrawal Yuthika, Goyal Vipin, Singh Abhishek, Lal Sandhya
Senior Resident, Department of Biochemistry, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India.
Assistant Professor, Department of Chest and TB, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India.
J Clin Diagn Res. 2017 Jun;11(6):BC01-BC04. doi: 10.7860/JCDR/2017/23734.9975. Epub 2017 Jun 1.
Both pulmonary Tuberculosis (TB) and anaemia are prevalent in India. Magnesium levels also influence TB. There is limited and inconsistent literature on the association among anaemia, serum magnesium levels and sputum conversion during tuberculosis treatment.
To study the effect of anaemia and serum magnesium levels on sputum conversion in pulmonary TB patients.
One hundred each of newly diagnosed sputum smear positive Pulmonary Tuberculosis (PTB), sputum smear negative PTB patients initiated on Directly Observed Treatment Short Course chemotherapy (DOTS) and healthy age and sex matched controls were recruited in the study. Patients were followed up prospectively until completion of first two months of intensive phase. Patients were evaluated before initiation of TB treatment by performing the complete blood counts with peripheral blood smear, serum biochemistry, serum iron, serum magnesium, serum ferritin and microscopic examination of sputum. After giving two months of Antitubercular Therapy (ATT), sputum smears were re-examined for presence of acid fast bacilli. Haemoglobin values less than 13 g/dl in males or 12 g/dl in females was defined as anaemia. Mean and Standard deviations were calculated. Independent t-test was used to compare between the groups.
Serum iron and serum ferritin was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls. Anaemia was present in 162 (81%) patients of the study PTB cases. About 60% of anaemia in sputum positive cases was iron deficiency anaemia. Serum magnesium level was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls though not in hypomagnesemic range. Delayed sputum smear conversion occurred in 12 (12%) sputum positive PTB patients. Of these, eight had severe iron deficiency anaemia, four with moderate anaemia. All 12 delayed sputum smear conversion had serum magnesium levels < 1.7 mg/dl (below normal reference range) (mean 1.42 ±0.22 mg/dl).
Sputum was found to be positive even after two months of ATT course because of baseline anaemia and lower levels of serum magnesium. Further multicentric studies are warranted to study mechanisms for TB associated anaemia and possible role of intervention for anaemia in TB patients. One needs to find out the mechanisms behind the role of anaemia and lower magnesium levels in delaying the sputum smear conversion in order to lay the foundation of effective interventions. Randomized controlled trials are warranted to generate higher levels of evidences to support our findings.
肺结核（TB）和贫血在印度都很常见。镁水平也会影响结核病。关于贫血、血清镁水平与结核病治疗期间痰菌转阴之间的关联，现有文献有限且不一致。
研究贫血和血清镁水平对肺结核患者痰菌转阴的影响。
本研究招募了100例新诊断的痰涂片阳性肺结核（PTB）患者、100例开始接受直接观察下的短程化疗（DOTS）的痰涂片阴性PTB患者以及年龄和性别匹配的100名健康对照者。对患者进行前瞻性随访，直至强化期的前两个月结束。在开始结核病治疗前，通过进行全血细胞计数及外周血涂片、血清生化、血清铁、血清镁、血清铁蛋白检查和痰涂片镜检对患者进行评估。给予两个月的抗结核治疗（ATT）后，重新检查痰涂片以确定是否存在抗酸杆菌。男性血红蛋白值低于13 g/dl或女性低于12 g/dl被定义为贫血。计算均值和标准差。采用独立t检验对各组进行比较。
与痰涂片阴性PTB患者和对照组相比，痰涂片阳性PTB患者的血清铁和血清铁蛋白显著降低。本研究中的PTB病例有162例（81%）存在贫血。痰涂片阳性病例中约60%的贫血为缺铁性贫血。与痰涂片阴性PTB患者和对照组相比，痰涂片阳性PTB患者的血清镁水平显著降低，尽管未处于低镁血症范围。12例（12%）痰涂片阳性PTB患者出现痰涂片转阴延迟。其中，8例患有严重缺铁性贫血，4例患有中度贫血。所有12例痰涂片转阴延迟的患者血清镁水平均<1.7 mg/dl（低于正常参考范围）（均值1.42±0.22 mg/dl）。
由于基线贫血和血清镁水平较低，即使经过两个月的ATT疗程，痰菌仍为阳性。有必要开展进一步的多中心研究，以探讨结核病相关贫血的机制以及贫血干预措施在结核病患者中的可能作用。需要找出贫血和低镁水平在延迟痰涂片转阴中所起作用的背后机制，以便为有效干预奠定基础。有必要进行随机对照试验以提供更高水平的证据来支持我们的研究结果。
