Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Nutrients. 2019 Feb 5;11(2):343. doi: 10.3390/nu11020343.
As microbiological diagnostic techniques improve and the frequency of nontuberculous mycobacterial pulmonary disease (NTM-PD) infection increases worldwide, NTM-PD is becoming increasingly important to clinicians and researchers. Vitamin activity has been associated with the host immune response in tuberculosis; however, such information is very limited in NTM-PD. We performed a case-control study in 150 patients with NTM-PD and 150 healthy controls to investigate serum vitamin status. We measured concentrations of vitamins A, D, and E along with homocysteine and methylmalonic acid (MMA) as indicators of vitamin B deficiency, using high-performance liquid chromatography (HPLC) or HPLC-tandem mass spectrometry. The serum concentrations of vitamins A and E were significantly lower in patients with NTM-PD than in healthy controls (1.5 vs. 2.1 µmol/L, < 0.01 for vitamin A; and 27.3 vs. 33.1 µmol/L, < 0.01 for vitamin E). In contrast, the serum concentrations of vitamin D and homocysteine were not significantly different between the two groups. Vitamin A deficiency (< 1.05 µmol/L) was significantly more prevalent in patients with NTM-PD than in healthy controls ( < 0.01) and was associated with an 11-fold increase in risk of NTM-PD. Multiple vitamin deficiencies were only observed in patients with NTM-PD (7.3% of all NTM-PD patients). Positive correlations were observed among vitamins (vitamins A and D; r = 0.200, < 0.05; vitamins D and E, r = 0.238, < 0.05; vitamins A and E, r = 0.352, < 0.05). Serum vitamin status, demographic variables, and biochemical indicators were not associated with treatment outcomes. Vitamin A deficiency was strongly associated with patients with NTM-PD. Our study suggests that altered vitamin status is associated with mycobacterial disease. Future well-designed prospective studies with large patient cohorts addressing these issues are needed to clarify the significance of vitamins in NTM-PD.
随着微生物学诊断技术的提高和非结核分枝杆菌肺病（NTM-PD）感染在全球范围内的频率增加，NTM-PD 对临床医生和研究人员变得越来越重要。维生素活性与结核病中的宿主免疫反应有关；然而，关于 NTM-PD 的此类信息非常有限。我们对 150 例 NTM-PD 患者和 150 例健康对照者进行了病例对照研究，以研究血清维生素状态。我们使用高效液相色谱法（HPLC）或 HPLC-串联质谱法测量了维生素 A、D 和 E 的浓度以及同型半胱氨酸和甲基丙二酸（MMA）作为维生素 B 缺乏的指标。NTM-PD 患者的血清维生素 A 和 E 浓度明显低于健康对照组（维生素 A 为 1.5 对 2.1 µmol/L， < 0.01；维生素 E 为 27.3 对 33.1 µmol/L， < 0.01）。相比之下，两组间血清维生素 D 和同型半胱氨酸浓度无显著差异。NTM-PD 患者中维生素 A 缺乏症（< 1.05 µmol/L）的患病率明显高于健康对照组（< 0.01），NTM-PD 的风险增加 11 倍。仅在 NTM-PD 患者中观察到多种维生素缺乏症（所有 NTM-PD 患者的 7.3%）。维生素之间存在正相关（维生素 A 和 D；r = 0.200， < 0.05；维生素 D 和 E，r = 0.238， < 0.05；维生素 A 和 E，r = 0.352， < 0.05）。血清维生素状态、人口统计学变量和生化指标与治疗结果无关。维生素 A 缺乏症与 NTM-PD 患者密切相关。我们的研究表明，维生素状态的改变与分枝杆菌病有关。需要进行设计良好的前瞻性研究，纳入大型患者队列，以解决这些问题，以阐明维生素在 NTM-PD 中的意义。
