Kivrane Agnija, Ulanova Viktorija, Grinberga Solveiga, Sevostjanovs Eduards, Viksna Anda, Ozere Iveta, Bogdanova Ineta, Simanovica Ilze, Norvaisa Inga, Pahirko Leonora, Bandere Dace, Ranka Renate
Pharmacogenetic and Precision Medicine Laboratory, Pharmaceutical Education and Research Centre, Riga Stradins University, Konsula Street 21, LV1007 Riga, Latvia.
Latvian Biomedical Research and Study Centre, Ratsupites Street 1, k-1, LV1067 Riga, Latvia.
Antibiotics (Basel). 2024 Dec 14;13(12):1216. doi: 10.3390/antibiotics13121216.
Serum C-reactive protein (CRP) levels vary depending on radiological and bacteriological findings at the time of tuberculosis (TB) diagnosis. However, the utility of this biomarker in monitoring response to anti-TB treatment and identifying patients at risk of treatment failure is not well established. This study evaluated the impact of patients' baseline characteristics and anti-TB drug plasma exposure on the early reduction in serum CRP levels and its relationship with treatment response. We enrolled 42 patients with drug-susceptible pulmonary TB, who received a standard six-month regimen. The plasma concentrations of four anti-TB drugs were analysed using LC-MS/MS. Clinically relevant data, including serum CRP levels before and 10-12 days after treatment initiation (CRP), were obtained from electronic medical records and patient questionnaires. In 10-12 days, the median serum CRP level decreased from 21.9 to 6.4 mg/L. Lower body mass index, positive sputum-smear microscopy results, and lung cavitations at diagnosis were related to higher biomarker levels at both time points; smoking had a more pronounced effect on serum CRP levels. Variability in anti-TB drug plasma exposure did not significantly affect the reduction in serum CRP levels. The serum CRP levels, or fold change from the baseline, did not predict the time to sputum culture conversion. Disease severity and patient characteristics may influence the pattern of early CRP reduction, while anti-TB drug plasma exposure had no significant effect at this stage. These early changes in serum CRP levels were not a predictor of response to anti-TB therapy.
血清C反应蛋白（CRP）水平因结核病（TB）诊断时的放射学和细菌学检查结果而异。然而，这种生物标志物在监测抗结核治疗反应和识别治疗失败风险患者方面的效用尚未得到充分证实。本研究评估了患者基线特征和抗结核药物血浆暴露对血清CRP水平早期下降的影响及其与治疗反应的关系。我们招募了42例药物敏感型肺结核患者，他们接受了标准的六个月疗程。使用液相色谱-串联质谱法分析了四种抗结核药物的血浆浓度。从电子病历和患者问卷中获取了临床相关数据，包括治疗开始前和开始后10 - 12天的血清CRP水平（CRP）。在10 - 12天内，血清CRP水平中位数从21.9毫克/升降至6.4毫克/升。较低的体重指数、痰涂片显微镜检查结果阳性以及诊断时的肺空洞与两个时间点较高的生物标志物水平相关；吸烟对血清CRP水平的影响更为显著。抗结核药物血浆暴露的变异性对血清CRP水平的下降没有显著影响。血清CRP水平或相对于基线的变化倍数不能预测痰培养转阴时间。疾病严重程度和患者特征可能会影响CRP早期下降的模式，而在此阶段抗结核药物血浆暴露没有显著影响。血清CRP水平的这些早期变化不是抗结核治疗反应的预测指标。
