Sustained elevated levels of C-reactive protein and ferritin in pulmonary tuberculosis patients remaining culture positive upon treatment initiation
Sustained elevated levels of C-reactive protein and ferritin in pulmonary tuberculosis patients remaining culture positive upon treatment initiation
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DOI：
10.1371/journal.pone.0175278
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发表时间：
2017-04-06
期刊：
影响因子：
3.7
通讯作者：
Kritski, Afranio
中科院分区：
文献类型：
--
作者：
Miranda, Pryscila;Gil-Santana, Leonardo;Kritski, Afranio
背景由于结核分枝杆菌感染清除缓慢以及缺乏预测治疗结果的早期生物标志物，评估新的抗结核药物和治疗方案的临床试验需要数年才能完成。宿主炎症标志物与结核病（TB）发病机制相关。在本研究中，我们测试，如果循环水平的C-反应蛋白（CRP）和铁蛋白反映结核分枝杆菌负荷和炎症在肺结核（PTB）患者进行抗结核治疗（ATT.MethodsProspective测量CRP和铁蛋白，作为读出的全身炎症，进行了冷冻保存的血清样本从165巴西患者主动PTB启动ATT。这些实验室参数与痰中的分枝杆菌载量以及在第60天的ATT.ResultsCirculating水平的铁蛋白和CRP随着时间的推移逐渐下降ATT与痰转换之间的关联进行了测试。在治疗前，这些参数的浓度无法区分患者痰培养抗酸杆菌（AFB）阳性和阴性。然而，与在该时间点培养呈阴性的患者相比，在ATT第60天培养仍呈阳性的患者显示出这些炎症标志物的水平升高。结论血清中的CRP和铁蛋白水平可能有助于识别在ATT第60天培养呈阳性的患者。
BackgroundClinical trials that evaluate new anti-tubercular drugs and treatment regimens take years to complete due to the slow clearance of Mycobacterium tuberculosis infection and the lack of early biomarkers that predict treatment outcomes. Host Inflammation markers have been associated with tuberculosis (TB) pathogenesis. In the present study, we tested if circulating levels of C-reactive protein (CRP) and ferritin reflect mycobacterial loads and inflammation in pulmonary TB (PTB) patients undergoing anti-tuberculous therapy (ATT).MethodsProspective measurements of CRP and ferritin, used as readouts of systemic inflammation, were performed in cryopreserved serum samples from 165 Brazilian patients with active PTB initiating ATT. Associations between levels of these laboratory parameters with mycobacterial loads in sputum as well as with sputum conversion at day 60 of ATT were tested.ResultsCirculating levels of both ferritin and CRP gradually decreased over time on ATT. At pretreatment, concentrations of these parameters were unable to distinguish patients with positive from those with negative acid-fast bacilli (AFB) in sputum cultures. However, patients who remained with positive cultures at day 60 of ATT exhibited heightened levels of these inflammatory markers compared to those with negative cultures at that time point.ConclusionsCRP and Ferritin levels in serum may be useful to identify patients with positive cultures at day 60 of ATT.