Shanmugasundaram Kumar, Talwar Anjana, Madan Karan, Bade Geetanjali
Department of Physiology, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Tuberc Respir Dis (Seoul). 2022 Apr;85(2):175-184. doi: 10.4046/trd.2021.0127. Epub 2022 Mar 2.
Post-tuberculosis (TB) sequelae is a commonly encountered clinical entity, especially in high TB burden countries. This may represent chronic anatomic sequelae of previously treated TB, with frequent symptomatic presentation. This pilot study was aimed to investigate the pulmonary functions and systemic inflammatory markers in patients with post-TB sequelae (PTBS) and to compare them with post-TB without sequelae (PTBWS) participants and healthy controls.
A total of 30 participants were enrolled, PTBS (n=10), PTBWS (n=10), and healthy controls (n=10). Pulmonary function tests included spirometry and measurement of airway impedance by impulse oscillometry. Serum levels of matrix metalloproteinase (MMP)-1, transforming growth factor-β, and interferon-γ were estimated.
Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and peak expiratory flow were significantly lower in PTBS as compared to controls. SVC and FEV1 were significantly less in PTBS as compared to PTBWS. Total airway impedance (Z5), total airway resistance (R5), central airway resistance (R20), area of reactance (Ax), and resonant frequency (Fres) were significantly higher and respiratory reactance at 5 and 20 Hz (X5, X20) were significantly lower in PTBS as compared to PTBWS. Spirometry parameters correlated with impulse oscillometry parameters in PTBS. Serum MMP-1 level was significantly higher in PTBS as compared to other groups.
Significant pulmonary function impairment was observed in PTBS, and raised serum MMP-1 levels compared with PTBWS and healthy controls. Follow-up pulmonary function testing is recommended after treatment of TB for early diagnosis and treatment of PTBS.
肺结核后遗症是一种常见的临床病症，在结核病高负担国家尤为常见。这可能代表先前治疗的结核病的慢性解剖学后遗症，常有症状表现。本前瞻性研究旨在调查肺结核后遗症（PTBS）患者的肺功能和全身炎症标志物，并将其与无后遗症的肺结核患者（PTBWS）和健康对照进行比较。
共纳入30名参与者，PTBS组（n = 10）、PTBWS组（n = 10）和健康对照组（n = 10）。肺功能测试包括肺活量测定和通过脉冲振荡法测量气道阻力。评估血清基质金属蛋白酶（MMP）-1、转化生长因子-β和干扰素-γ水平。
与对照组相比，PTBS组的慢肺活量（SVC）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）、FEV1/FVC和呼气峰值流速显著降低。与PTBWS组相比，PTBS组的SVC和FEV1显著降低。与PTBWS组相比，PTBS组的总气道阻力（Z5）、总气道阻力（R5）、中心气道阻力（R20）、电抗面积（Ax）和共振频率（Fres）显著升高，5 Hz和20 Hz时的呼吸电抗（X5、X20）显著降低。PTBS组中肺活量测定参数与脉冲振荡法参数相关。与其他组相比，PTBS组的血清MMP-1水平显著升高。
PTBS组观察到显著的肺功能损害，与PTBWS组和健康对照组相比，血清MMP-1水平升高。建议在结核病治疗后进行随访肺功能测试，以便早期诊断和治疗PTBS。
