Cioboata Ramona, Balteanu Mara Amalia, Zlatian Ovidiu Mircea, Vlasceanu Silviu Gabriel, Driga Mircea Vasile Popescu, Mitroi Denisa Maria, Catana Oana Maria, Buciu Cezar Ionut, Camen Georgiana, Mirea Adina Andreea
Department of Pneumology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Department of Pneumology, Victor Babes University Hospital, Craiova, Romania.
Front Med (Lausanne). 2025 Apr 29;12:1554723. doi: 10.3389/fmed.2025.1554723. eCollection 2025.
BACKGROUND: Studies have shown that vitamin C is essential for the immune response to tuberculosis (TB), and that its deficiency may elevate the risk of TB and related complications. This prospective study investigated the association between disease severity, imaging findings and vitamin C levels. METHODS: This study enrolled 109 patients with confirmed pulmonary tuberculosis based on culture. Patients were divided into two groups based on serum vitamin C levels: 59 patients (54.13%) with normal levels and 50 (45.87%) with low levels. RESULTS: At baseline, patients in the low vitamin C group showed significantly higher bacillar loads, with 86.00% presenting loads of 2+ or higher compared with 59.32% in the normal group ( < 0.001). After 2 months of treatment, 83.05% of the normal vitamin C group achieved culture conversion, while only 28.00% of the low vitamin C group reached the same milestone ( < 0.001). CT imaging at baseline revealed that the low vitamin C group had a significantly higher mean frequency of the tree-in-bud pattern (2.66 vs. 2.05; < 0.001). Cavitary lesions were more prevalent in the low vitamin C group, in the superior right lobe (0.34 vs. 0.13; = 0.011) and superior left lobe (0.34 vs. 0.14; = 0.012). After 6 months of treatment, the low vitamin C group exhibited a higher prevalence of bronchiectasis (mean involvement in both lungs: 0.58 vs. 0.16; < 0.001), cavitary lesions (0.32 vs. 0.00; = 0.002), and fibrosis (0.90 vs. 0.36; < 0.001). Pulmonary function tests showed greater impairment in the low vitamin C group. The forced expiratory volume decreased by 5.77% compared to 3.59% in the normal group ( < 0.001), the forced vital capacity (FVC) decreased by 12.00% vs. 6.67% ( < 0.001), and the Tiffeneau index by 3.34 vs. 2.13 ( = 0.002). Receiver operating characteristic (ROC) analysis indicated that FVC (AUC = 0.826) and forced expiratory flow (AUC = 0.745) were stronger predictors of treatment success in patients with normal vitamin C levels. CONCLUSION: Vitamin C deficiency is correlated with increased disease severity, delayed bacterial clearance, and persistent pulmonary damage in patients with tuberculosis. Vitamin C supplementation can enhance treatment outcomes in tuberculosis therapy.
背景：研究表明，维生素C对于结核病（TB）的免疫反应至关重要，其缺乏可能会增加患结核病及相关并发症的风险。这项前瞻性研究调查了疾病严重程度、影像学表现与维生素C水平之间的关联。 方法：本研究纳入了109例经培养确诊为肺结核的患者。根据血清维生素C水平将患者分为两组：59例（54.13%）维生素C水平正常，50例（45.87%）维生素C水平较低。 结果：在基线时，维生素C水平较低组的患者杆菌负荷显著更高，86.00%的患者杆菌负荷为2+或更高，而正常组为59.32%（<0.001）。治疗2个月后，维生素C水平正常组83.05%的患者实现培养转阴，而维生素C水平较低组只有28.00%达到这一指标（<0.001）。基线时的CT影像显示，维生素C水平较低组的树芽征平均出现频率显著更高（2.66对2.05；<0.001）。空洞性病变在维生素C水平较低组更为常见，在右上叶（0.34对0.13；=0.011）和左上叶（0.34对0.14；=0.012）。治疗6个月后，维生素C水平较低组支气管扩张的患病率更高（两肺平均受累情况：0.58对0.16；<0.001），空洞性病变（0.32对0.00；=0.002），以及纤维化（0.90对0.36；<0.001）。肺功能测试显示维生素C水平较低组的损伤更严重。用力呼气量下降了5.77%，而正常组为3.59%（<0.001），用力肺活量（FVC）下降了12.00%对6.67%（<0.001），蒂芬诺指数下降了3.34对2.13（=0.002）。受试者工作特征（ROC）分析表明，FVC（AUC=0.826）和用力呼气流量（AUC=0.745）是维生素C水平正常患者治疗成功的更强预测指标。 结论：维生素C缺乏与结核病患者疾病严重程度增加、细菌清除延迟和持续性肺损伤相关。补充维生素C可提高结核病治疗的效果。
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