Yurdanur ERDOĞAN, Ebru ÜNSAL, Müjgan GÜLER, Bülent ÇİFTÇİ, Neslihan BUKAN, Deniz HÜDDAM, Nermin ÇAPAN

Akciğer tüberkülozlu hastalarda aktivasyon ve tedaviye yanıtın değerlendirilmesinde serum neopterin düzeyinin yeri

Neopterin hücresel aracılıklı immünitenin aktivasyonunu gösteren önemli bir parametredir. Bu çalışmada, serum neopterin düzeyinin akciğer tüberkülozlu olgularda aktivasyon ve tedaviye yanıtın değerlendirilmesinde yardımcı bir tetkik olarak kullanılıp kullanılmayacağını göstermeyi amaçladık. Çalışmaya 40 yeni olgu yayma pozitif akciğer tüberkülozlu hasta ile 40 sağlıklı kontrol alındı. Tüberkülozlu hastaların tedavi öncesi ve tedavinin ikinci ayında olmak üzere iki kez serum neopterin düzeyleri ölçüldü. Ayrıca, tedavi öncesi serum neopterin düzeyi ile klinik, radyolojik ve bakteriyolojik parametreler arasındaki ilişki araştırıldı. Hastaların tedavi öncesi ortalama serum neopterin düzeyleri 35.1 ± 13.4 nmol/L, tedavinin ikinci ayında ise 21.2 ± 10.4 nmol/L olarak bulundu. Kontrol grubunun ortalama serum neopterin düzeyi ise 19 ± 10.4 nmol/L olarak tespit edildi. Tüberkülozlu hastaların tedavi öncesi serum neopterin düzeyleri kontrol grubuna göre anlamlı olarak yüksek bulundu (p= 0.001). Tedavi öncesi ve tedavinin ikinci ayında ölçülen serum neopterin düzeyleri arasındaki farklılık anlamlıydı (p= 0.000). Yaygın hastalığı olan grupta serum neopterin düzeyi sınırlı lezyonları bulunan gruba göre yüksek saptandı (p= 0.02). Sonuç olarak; neopterinin tüberkülozda aktivasyon ve tedaviye yanıtın değerlendirilmesinde güvenilir bir immünolojik belirleyici olarak kullanılabileceğini düşünmekteyiz.

The role of serum neopterin level in the evaluation of activation and response to treatment in the patients with pulmonary tuberculosis

Neopterin is an important parameter showing cell mediated immunity activation. In this study we aimed to determine whether serum neopterin level could be used as a marker in the evaluation of tuberculosis activation and response to treatment. The study comprised 40 new case smear positive pulmonary tuberculosis patients and 40 healthy control. Serum neopterin levels were measured both before the treatment and 2nd month of the treatment in the patient group. The association between serum neopterin level and clinical, radiological and bacteriological parameters were also investigated. In patients with pulmonary tuberculosis the mean levels of serum neopterin were 35.1 ± 13.4 nmol/L before the treatment and 21.2 ± 10.4 nmol/L in the 2nd month of the treatment. In the control group, serum neopterin level was 19 ± 10.4 nmol/L. The serum neopterin levels of the patients were significantly higher than the control group (p= 0.001). Also, there was significant difference between serum neopterin levels before the treatment and the 2nd month of the treatment (p= 0.000). Serum neopterin level was higher in the group with extensive disease than the cases with limited disease (p= 0.02). In conclusion, we think that serum neopterin level might be used as a reliable immunological marker in the evaluation of tuberculosis activation and response to treatment.

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