Dr Md Shamim, Junior Consultant of Medicine, M Abdur Rahim Medical College Hospital, Dinajpur, Bangladesh.
Mymensingh Med J. 2023 Oct;32(4):1064-1072.
Approximately 10.0% of tuberculosis (TB) Infected individuals develop clinical disease in the absence of immune suppression suggests that individual factors may play a role in the response to infection. Body's immune function is boosted by micronutrient and also plays a major role in response to tubercular infection. Someone, may argue that cell mediated immunity is compromised in iron deficiency before anemia becomes apparent. This descriptive observational study intended to assess serum iron profile in patients suffering from pulmonary tuberculosis. This study included 56 newly diagnosed sputum smear positive and negative pulmonary tuberculosis patients as per inclusion and exclusion criteria and was conducted at the department of the Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh with the collaboration of the Biochemistry department, BSMMU, Bangladesh from February 2017 to January 2018. Collected data were recorded in a structured questionnaire and compiled and appropriate analyses were done by using computer-based software Statistical Package for Social Sciences (SPSS) version 23.0. Out of 56 patients, majority was young and at reproductive age, male was predominant (78.6%) with a male to female ratio of 3.7:1. More than three fourth 43(81.0%) patients were found to have low serum iron concentration. Majority 45(80.4%) patients had normal serum TIBC, 6(10.7%) had low serum total iron binding capacity (TIBC) and 5(8.9%) had high serum TIBC. Almost two third 36(64.3%) patients had low serum transferrin saturation and 20(35.7%) had normal serum transferrin saturation. Majority 31(55.4%) patients had normal serum ferritin, 2(3.6%) had low serum ferritin and 23(41.1%) had high serum ferritin. Serum iron concentration and serum ferritin were significantly associated with chest x-ray abnormalities (p<0.01). Half of the patients were smear positive for acid fast bacilli (AFB) (50.0%). No significant association was found between sputum positive for AFB with iron profile status. In smear positive pulmonary tuberculosis patients, more than three fourth (78.6%) patients had low serum iron concentration at baseline and majority 20(80.0%) patients had normal serum iron concentration after 2(two) months. Mean serum iron concentration was 41.8±17.6mcg/l in baseline and 70.4±29.7mcg/l in at 2(two) month. More than sixty percent (60.7%) patients had low serum transferrin saturation at baseline and 20(80.0%) patients had normal serum transferrin saturation after 2(two) months. Mean serum transferrin saturation was 18.1±7.6% at baseline and 31.2±19.4% in at 2(two) months. After 2(two) months follow up serum iron concentration and serum transferrin saturation had significant improvement (p<0.05). Significant iron deficiency status occurred in pulpmonary tuberculosis and which improved after anti-tubercular treatment without iron supplementation.
大约 10.0%的结核病（TB）感染者在没有免疫抑制的情况下出现临床疾病，这表明个体因素可能在感染反应中起作用。微量营养素可以增强身体的免疫功能，并且在对结核感染的反应中也起着主要作用。有人可能会认为，在出现贫血之前，缺铁会导致细胞介导的免疫功能受损。本描述性观察研究旨在评估患有肺结核的患者的血清铁谱。这项研究包括 56 名新诊断的痰涂片阳性和阴性肺结核患者，符合纳入和排除标准，并于 2017 年 2 月至 2018 年 1 月在孟加拉国 Bangabandhu Sheikh Mujib 医科大学（BSMMU）的内科部门与 BSMMU 的生物化学部门合作进行。收集的数据记录在结构化问卷中，并进行编译，使用基于计算机的软件统计软件包（SPSS）版本 23.0 进行适当分析。在 56 名患者中，大多数是年轻人和生育年龄，男性占优势（78.6%），男女比例为 3.7:1。超过四分之三（81.0%）的患者发现血清铁浓度较低。大多数（80.4%）患者的血清总铁结合力（TIBC）正常，6（10.7%）患者的血清总铁结合力（TIBC）低，5（8.9%）患者的血清 TIBC 高。近三分之二（64.3%）的患者血清转铁蛋白饱和度低，20（35.7%）的患者血清转铁蛋白饱和度正常。大多数（55.4%）患者的血清铁蛋白正常，2（3.6%）患者的血清铁蛋白低，23（41.1%）患者的血清铁蛋白高。血清铁浓度和血清铁蛋白与胸部 X 线异常显著相关（p<0.01）。一半的患者（50.0%）对酸性快速分枝杆菌（AFB）的痰涂片呈阳性。痰涂片阳性的 AFB 与铁谱状态之间未发现显著相关性。在痰涂片阳性肺结核患者中，超过四分之三（78.6%）的患者在基线时有低血清铁浓度，大多数（80.0%）患者在两个月后（2(two) 个月）血清铁浓度正常。基线时血清铁浓度平均值为 41.8±17.6mcg/l，两个月后为 70.4±29.7mcg/l。超过 60%（60.7%）的患者在基线时血清转铁蛋白饱和度低，两个月后（2(two) 个月）有 20（80.0%）的患者血清转铁蛋白饱和度正常。基线时血清转铁蛋白饱和度平均为 18.1±7.6%，两个月后为 31.2±19.4%。两个月随访后，血清铁浓度和血清转铁蛋白饱和度均有显著改善（p<0.05）。肺结核患者出现明显的缺铁状态，在抗结核治疗而不补充铁剂后得到改善。
