Complex Anemia in Tuberculosis: The Need to Consider Causes and Timing When Designing Interventions
Complex Anemia in Tuberculosis: The Need to Consider Causes and Timing When Designing Interventions
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DOI：
10.1093/cid/ciu945
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发表时间：
2015-03-01
影响因子：
11.8
通讯作者：
McDermid, Joann M.
中科院分区：
文献类型：
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作者：
Minchella, Peter A.;Donkor, Simon;McDermid, Joann M.
背景。贫血在结核病中很常见，多种病因需要有针对性的干预措施。与因结核病相关免疫激活或炎症导致的铁吸收/再分配受损而导致的铁反应性贫血相比，因缺铁而导致的铁反应性贫血的比例尚不清楚。这阻碍了安全有效的治疗方法和适当干预时机的选择。在冈比亚的 45 名确诊肺结核患者（病例）、47 名结核菌素皮试 (TST) 阳性对照和 39 名 TST 阴性对照中测量了基线血红蛋白、铁蛋白、铁调素、可溶性转铁蛋白受体 (sTfR) 和转铁蛋白。结核病病例在结核病治疗开始后 2 个月和 6 个月另外进行随访。基于铁生物标志物浓度的相互排斥的贫血类别为缺铁性贫血（IDA）、炎症性贫血（AI）和多因素贫血（IDA+AI）。结果。结核病病例 (67%) 贫血发生率高于 TST 阳性 (36%) 或 TST 阴性 (21%) 对照。 AI 是结核病诊断时的主要贫血，治疗 6 个月后从 36% 下降至 8%；然而，铁反应成分（IDA、IDA+AI）贫血的相应减少并不明显。铁生物标志物可区分活动性结核病和 TST 阳性或 TST 阴性对照，以及未治疗的活动性结核病和已治疗的结核病。这对于铁调素最为明显，其中位数从诊断时的 84.0 ng/mL 降至 2 个月后的 9.7 ng/mL (P < .001)。结论。结核病化疗与 AI 显着降低相关，但 IDA 和 IDA+AI 仍未得到解决。 IDA 和 IDA+AI 需要基于铁的干预措施，对铁生物标志物的监测揭示了最早在结核病治疗后 2 个月就开启干预措施的窗口。
Background. Anemia is common in tuberculosis, and multiple etiologies necessitate targeted interventions. The proportion of iron-responsive anemia due to iron deficiency compared with iron-unresponsive anemia due to impaired iron absorption/redistribution from tuberculosis-associated immune activation or inflammation is unknown. This impedes selection of safe and effective treatment and appropriate intervention timing.Methods. Baseline hemoglobin, ferritin, hepcidin, soluble transferrin receptor (sTfR), and transferrin were measured in 45 patients with confirmed pulmonary tuberculosis (cases), 47 tuberculin skin test (TST)-positive controls, and 39 TST-negative controls in The Gambia. Tuberculosis cases were additionally followed 2 and 6 months after tuberculosis treatment initiation. Mutually exclusive anemia categories based on iron biomarker concentrations were iron deficiency anemia (IDA), anemia of inflammation (AI), and multifactorial anemia (IDA+AI).Results. Anemia was more frequent in tuberculosis cases (67%) than in TST-positive (36%) or TST-negative (21%) controls. AI was the predominant anemia at tuberculosis diagnosis, declining from 36% to 8% after 6 months of treatment; however, a corresponding reduction was not evident for anemia with iron-responsive components (IDA, IDA+AI). Iron biomarkers discriminated between active tuberculosis and TST-positive or TST-negative controls, as well as between active untreated and treated tuberculosis. This was most noticeable for hepcidin, which decreased from a median of 84.0 ng/mL at diagnosis to 9.7 ng/mL after 2 months (P < .001).Conclusions. Tuberculosis chemotherapy is associated with significant reductions in AI, but IDA and IDA+AI remain unresolved. Iron-based interventions are needed for IDA and IDA+AI, and monitoring of iron biomarkers reveals a window for intervention opening as early as 2 months into tuberculosis treatment.