Deniz Sami, Aydemir Yusuf, Şengül Aysun, Emre Jülide Çeldir, Tanrisev Mehmet, Özhan Mustafa Hikmet, Güney İbrahim
Clinic of Chest Diseases Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Education Hospital, İzmir, Turkey.
Chest Diseases Department, Sakarya University, Sakarya, Turkey.
Hemodial Int. 2019 Jan;23(1):81-87. doi: 10.1111/hdi.12676. Epub 2018 Oct 5.
The risk of TB is increased in patients with chronic kidney disease (CKD) when compared with individuals with normal renal function. We aimed to determine tuberculin skin test (TST) response and the factors which might affect the response in patients with CKD undergoing dialysis in this study.
The purified protein derivative solution was administered to the patients and the diameter of induration was measured. Additionally, the age, gender and smoking status of the patients were interrogated. Comorbidities were recorded both by patients' self-reports and data from the hospital files. The number of Bacille Calmette-Guerin (BCG) scars was recorded by checking both shoulders.
The study was conducted with a total of 371 patients (194 men and 177 women). The mean age was 60.09 ± 15.88, TST was 6.99 ± 6.9, duration of dialysis was 4.44 ± 4.5 (3.8-0.1,24). A total of 229 patients have comorbodities (61.7%, the most frequent was hypertension). Logistic regression model was performed. Gender, vitamin D treatment and high parathormone (PTH) levels remained in the final stage of the analysis and vitamin D intake and PTH levels were detected to be statistically significant (P = 0.002, 0.007, respectively).
This study is the first study which showed a correlation between TST negativity and increased PTH levels and receiving vitamin D treatment. Starting from this point, it was concluded that PTH may suppress the immune system and especially cellular immunity.
与肾功能正常的个体相比，慢性肾脏病（CKD）患者患结核病的风险增加。在本研究中，我们旨在确定接受透析的CKD患者的结核菌素皮肤试验（TST）反应以及可能影响该反应的因素。
将纯化蛋白衍生物溶液给予患者，并测量硬结直径。此外，询问患者的年龄、性别和吸烟状况。通过患者的自我报告和医院档案数据记录合并症。通过检查双肩记录卡介苗（BCG）疤痕的数量。
本研究共纳入371例患者（194例男性和177例女性）。平均年龄为60.09±15.88岁，TST为6.99±6.9，透析时间为4.44±4.5（3.8 - 0.1,24）。共有229例患者有合并症（61.7%，最常见的是高血压）。进行了逻辑回归模型分析。性别、维生素D治疗和高甲状旁腺激素（PTH）水平保留在分析的最终阶段，并且检测到维生素D摄入量和PTH水平具有统计学意义（分别为P = 0.002，0.007）。
本研究是第一项显示TST阴性与PTH水平升高和接受维生素D治疗之间存在相关性的研究。由此得出结论，PTH可能会抑制免疫系统，尤其是细胞免疫。
