Nisa Zaib Un, Zeshan Basit, Ambreen Atiqa, Mustafa Tehmina
Department of Pathology, Gulab Devi Hospital, Lahore, Pakistan.
Department of Microbiology, Faculty of Science & Technology, University of Central Punjab, Lahore, Pakistan.
BMC Infect Dis. 2024 Dec 2;24(1):1375. doi: 10.1186/s12879-024-10228-z.
We aimed to assess the plasma levels of ferritin, C-reactive protein (CRP), and adenosine deaminase (ADA) at baseline and their utility as biomarkers to monitor response to treatment in extrapulmonary tuberculosis (EPTB) patients.
Prospective measurements of ferritin, CRP, and ADA were done in unstimulated plasma samples of 92 EPTB (49 TB lymphadenitis and 43 TB pleuritis) patients registered for anti-TB treatment. Blood samples were taken at the start, 2, and 6 months of treatment, plasma levels of ferritin and CRP were measured by the enzyme-linked immunosorbent assay and ADA levels by kinetic chemistry method at each time point. Data was analyzed using SPSS version 22. Non-parametric tests were used for paired analysis and two groups' comparison. Spearman's rank test was used for correlation analysis. A Chi-square test was used for categorical variables. A p-value < 0.05 was considered statistically significant.
Before the start of treatment, plasma levels of ferritin were raised in 13% and 45%, CRP in 21% and 64%, and ADA in 70% and 60% of TB lymphadenitis and pleuritis cases respectively. Levels of all three biomarkers with raised values at baseline decreased significantly with treatment at both 2 and 6 months in all patients. [Ferritin (2 months p = 0.001, 6 months p < 0.001), CRP (2 months p < 0.001, 6 months p < 0.001), ADA (2 months p = 0.039, 6 months p < 0.004)]. Plasma levels of ferritin (median 300 ng/ml range = 145-758 ng/ml) and CRP (median 11.73 mg/L, range = 10.45-17.84 mg/L) were significantly higher in TB pleuritis patients, while the levels of ADA were not significantly different among the two groups. Biosignatures generated by different combinations showed that a combination of all three biomarkers could predict treatment response in 83% and 100% of all patients at 2 and 6 months of treatment respectively.
A combination of serum ferritin, CRP, and ADA shows a promising role in monitoring response to treatment in TB lymphadenitis and TB pleuritis patients. Similar studies in larger cohorts are needed to establish a definite role of these biomarkers in EPTB patients.
我们旨在评估肺外结核（EPTB）患者基线时的铁蛋白、C反应蛋白（CRP）和腺苷脱氨酶（ADA）血浆水平，以及它们作为监测治疗反应生物标志物的效用。
对92例登记接受抗结核治疗的EPTB患者（49例结核性淋巴结炎和43例结核性胸膜炎）的未刺激血浆样本进行铁蛋白、CRP和ADA的前瞻性测量。在治疗开始时、治疗2个月和6个月时采集血样，每个时间点采用酶联免疫吸附测定法测量铁蛋白和CRP的血浆水平，采用动力学化学方法测量ADA水平。使用SPSS 22版软件进行数据分析。配对分析和两组比较采用非参数检验。相关性分析采用Spearman秩检验。分类变量采用卡方检验。p值<0.05被认为具有统计学意义。
在治疗开始前，结核性淋巴结炎和胸膜炎病例中，分别有13%和45%的患者铁蛋白血浆水平升高，21%和64%的患者CRP升高，70%和60%的患者ADA升高。所有患者在治疗2个月和6个月时，基线时升高的所有三种生物标志物水平均随治疗显著下降。[铁蛋白（2个月p = 0.001，6个月p < 0.001），CRP（2个月p < 0.001，6个月p < 0.001），ADA（2个月p = 0.039，6个月p < 0.004）]。结核性胸膜炎患者的铁蛋白（中位数300 ng/ml，范围 = 145 - 758 ng/ml）和CRP（中位数11.73 mg/L，范围 = 10.45 - 17.84 mg/L）血浆水平显著更高，而两组间ADA水平无显著差异。不同组合产生的生物标志物特征显示，在治疗2个月和6个月时，所有三种生物标志物的组合分别可预测83%和100%的所有患者的治疗反应。
血清铁蛋白、CRP和ADA的组合在监测结核性淋巴结炎和结核性胸膜炎患者的治疗反应中显示出有前景的作用。需要在更大队列中进行类似研究，以确定这些生物标志物在EPTB患者中的明确作用。
