Aktif Akciğer Tüberkülozu Hastalarında 25(OH)D3 Düzeylerinin Hastalık Şiddeti ve Tedavi Süreci Üzerindeki Etkisinin Araştırılması
Abstract
Amaç: Tüberküloz (TB), önemli bir küresel sağlık sorunu olmaya devam etmektedir. D vitamini eksikliğinin, artmış hastalık şiddeti ve progresyonuyla bağlantılı olduğuna dair yeni kanıtlar ortaya çıkmaya devam etmektedir. D vitamini, özellikle makrofaj aktivasyonu ve antimikrobiyal savunmada bağışıklık tepkilerinde önemli bir rol oynarken kalsiyum, fosfor ve kemik metabolizmasını düzenler. Bu çalışma, TB hastalarında serum 25(OH)D3 düzeyleri ile klinik, radyolojik ve tedavi sonuçları arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır.
Yöntem ve Gereçler: Yeni tanı almış 70 TB hastası (18-69 yaş) ve 20 sağlıklı kontrol içeren prospektif bir çalışma on ay boyunca yürütülmüştür. TB tanısı, ARB yayması ve M. tuberculosis kültür pozitifliği dahil olmak üzere klinik, radyolojik ve mikrobiyolojik bulgularla doğrulanmıştır. Katılımcılara fiziksel muayeneler, rutin kan testleri ve serum 25(OH)D3 düzeyi ölçümleri yapılmıştır. D vitamini düzeyleri eksik (<10 ng/mL), yetersiz (10-24 ng/mL) veya yeterli (25-80 ng/mL) olarak kategorize edilmiştir.
Bulgular: TB hastalarında ortalama serum 25(OH)D3 düzeyi (22,01±9,24 ng/mL) olarak, kontrollerden (37,8±18 ng/mL, p<0,001) önemli ölçüde düşü saptanmıştır. TB hastalarının %61,5'inde eksik veya yetersiz 25(OH)D3 düzeyleri gözlenirken, 6 kişide ciddi eksiklik (<10 ng/mL) saptanmıştır. Yüksek 25(OH)D3 düzeyleri hemoglobin, hematokrit, albümin ve kalsiyum düzeyleri ile pozitif, WBC sayısı ile negatif korelasyon göstermiştir. Daha yüksek 25(OH)D3 düzeylerine sahip hastalarda, bir aylık tedaviden sonra daha iyi radyolojik iyileşme bulguları saptanmıştır (p<0,05, r= -0,223).
Sonuç: Çalışma, düşük 25(OH)D3 düzeylerinin TB şiddetinin artması ve iyileşmenin gecikmesi ile ilişkili olduğu sonucuna vararak, TB yönetiminde D vitamini takviyesi konusunda daha fazla araştırma yapılması gerektiğini vurgulamaktadır.
Keywords
References
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Investigation of The Effect of 25(OH)D3 Levels on the Disease Severity and the Course of the Treatment in Active Pulmonary Tuberculosis Patients
Abstract
Background and Aim: Emerging evidence suggests a link between vitamin D deficiency and increased susceptibility to TB. Vitamin D regulates calcium, phosphorus, and bone metabolism and plays a pivotal role in immune responses. This study investigates the relationship between 25(OH)D3 levels and the clinical course, radiological findings, and treatment outcomes in TB patients.
Materials and Methods: This prospective study was conducted over ten months at a tertiary care hospital, involving 70 newly diagnosed TB patients (aged 18-69 years) and 20 healthy controls. TB diagnosis was confirmed through clinical, radiological, and microbiological findings, including acid-resistant bacteria (ARB) smear and M. tuberculosis culture positivity.
All participants underwent physical examinations, routine blood tests, and serum 25(OH)D3 level measurements. Serum 25(OH)D3 levels were categorized as deficient (<10 ng/mL), insufficient (10-24 ng/mL), or adequate (25-80 ng/mL).
Results: The mean age of TB patients was 39.7 ± 16.8 years, with a control group mean age of 42.3 ± 14.5 years. Serum 25(OH)D3 levels were significantly lower in TB patients (22.01 ± 9.24 ng/mL) compared to controls (37.8 ± 18 ng/mL, p < 0.001). Among TB patients, 43 (61.5%) had deficient or insufficient vitamin D levels, with six exhibiting severe deficiency (<10 ng/mL).
Higher 25(OH)D3 levels correlated positively with hemoglobin (Hb), hematocrit (Hct), total protein, albumin, and calcium levels, and negatively with white blood cell (WBC) count. No significant relationship was found between 25(OH)D3 levels and sputum smear negativity at two months. However, patients with higher baseline 25(OH)D3 levels showed better radiological improvement after one month of treatment (p < 0.05, r = -0.223).
Conclusion: Low serum 25(OH)D3 levels are associated with greater TB severity and slower radiological improvement. These findings underscore the potential role of vitamin D in modulating TB progression and recovery. Further studies are needed to evaluate the therapeutic benefits of vitamin D supplementation in TB management.
Keywords
References
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- 2. Sangmin J, and Lee KC. Comparison of cephalometric measurements between conventional and automatic cephalometric analysis using convolutional neural network. Prog Orthod 2021;22:1-8.
- 3. Faliya N, Mamatha J, Doshi J, Gandhi P, Mathakiya L, Bind P. Comparing the Efficacy between OneCeph digital software versus Manual Cephalometric Tracing. J Adv Health 2021; 2:2-13.
- 4. Liu JK, Chen YT, Cheng KS. Accuracy of computerized automatic identification of cephalometric landmarks. Am J Orthod Dentofacial Orthop 2000;118:535-40.
- 5. Forsyth DB, Shaw WC, Richmond S, Roberts CT. Digital imaging of cephalometric radiographs, Part 2: image quality. Angle Orthod 1996; 66: 43-50.
- 6. Harrell WE Jr. 3-D Diagnosis and treatment planning in orthodontics. Semin Orthod 2009;15:35-41.
- 7. Rawat S, Jadhav VV, Paul P. A Comparative Analysis of Skeletal and Dental Parameters in Bilateral Cleft Lip and Palate vs. Non-bilateral Cleft Lip and Palate Patients in the Central Indian Population: A NemoCeph Study. Cureus 2024;16:2-13.
- 8. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. New Jersey, Prentice Hall; 2000. p. 11-5.
- 9. Kumar V, Ludlow J, Cevidanes LHS, Mol A. In vivo comparison of conventional and cone beam CT synthe- sized cephalograms. Angle Orthod 2008;78:873-9.
- 10. Pavan KM, Praveen KN, Murthy S. Model analysis on a smartphone. J Clin Orthod 2012; 46:356–8.
- 11. Keim RG, Gottlieb EL, Vogels DS 3rd, Vogels PB. 2014 JCO study of orthodontic diagnosis and treatment procedures, Part 1: results and trends. J Clin Orthod 2014; 48:607-30.
- 12. Mohan A, Sivakumar A, Nalabothu P. Evaluation of accuracy and reliability of OneCeph digital cephalometric analysis in comparison with manual cephalometric analysis: A cross-sectional study. BDJ open 2021;7:1-4.
- 13. Khatoon B, Hill KB, Walmsley AD. Can we learn, teach and practise dentistry anywhere, anytime? Br Dent J 2013;215:345–7.
- 14. Richardson A. A comparison of traditional and computerized methods of cephalometric analysis. Eur J Orthod 1981;3:15–20.
- 15. Turner PJ, Weerakone S. An evaluation of the reproducibility of landmark identification using scanned cephalometric images. J Orthod 2001;28: 221–9.
- 16. Steiner, C. C. Cephalometrics for you and me. Am J Orthod 1953;39:729–55.
- 17. Erkan M, Gurel HG, Nur M, Demirel B. Reliability of four different computerized cephalometric analysis programs. Eur J Orthod 2011; 34:318-21.
- 18. Yassir YA, Nabbat SA, and Hamdan HA. Evaluation of Semi-Automated Software and Application for Cephalometric Analysis. International Medical Journal 2021;28:16-20.
- 19. Paixao MB, Sobral MC, Vogel CJ, Martin de Araujo T. Comparative study between manual and digital cephalometric tracing using Dolphin Imaging software with lateral radio- graphs. Dent Press J Orthod 2010;15:123–30.
- 20. Santoro M, Jarjoura K, Cangialosi TJ. Accuracy of digital and analogue cephalometric measurements assessed with the sandwich technique. Am J Orthod Dentofac Orthoped 2006;129:345–51.
- 21. Goracci, C, Ferrari M. Reproducibility of measurements in tablet-assisted, PC- aided, and manual cephalometric analysis. Angle Orthod 2014;84:437–42.
- 22. Paul L, Tania SDM, Rathore S, Missier S, Shaga B. Comparison of accuracy and reliability of automated tracing Android app with conventional and semiautomated computer aided tracing software for cephalometric analysis - a cross-sectional study. Int J Orthod Rehabil 2022,13:39-51.
Details
| Primary Language | English |
|---|---|
| Subjects | Public Health (Other), Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | June 22, 2025 |
| Publication Date | June 23, 2025 |
| Submission Date | January 3, 2025 |
| Acceptance Date | April 24, 2025 |
| Published in Issue | Year 2025 Volume: 26 Issue: 2 |
