Kaçmaz Özen BAŞOĞLU, Gülay AŞÇI, Ömür ARDENİZ, Asuman GÜZELANT, Gündüz Canan TELLİ, Alev ATASEVER, Duygu ÖZOL, Abdullah SAYINER, Feza BACAKOĞLU

Kronik böbrek yetmezlikli olgularda tüberkülin cilt testi yanıtı ve T-lenfosit alt grupları

Kronik böbrek yetmezliği (KBY) olan olgularda anerji sık görüldüğü için tüberküloz (Tbc) tanısında tüberkülin cilt testi (TCT)’nin yararı tartışmalıdır. Bu nedenle, TCT yanıtını etkileyen faktörlerin bilinmesi, testin tanısal değerini artıracaktır. Bu çalışmada, KBY olgularında TCT yanıtını etkileyebilecek faktörlerin belirlenmesi, yanı sıra TCT yanıtı ile T-lenfosit alt grupları arasındaki ilişkinin araştırılması amaçlanmıştır. Çalışmaya KBY tanılı 44 (yaş ortalaması 46.6 ± 15.6 yıl, 25 erkek, hastalık süresi 5.6 ± 5.2 yıl) olgu alınarak tümüne biyokimyasal incelemeler, T-lenfosit alt grup analizleri ve TCT yapılmış, 5 mm ve üzeri pozitif kabul edilmiştir. Olguların 23’ü hemodiyaliz, altısı periton diyalizi, sekizi tıbbi tedavi altında olup, yedisine renal transplantasyon uygulanmıştır. Onbir (%25) olguda immünsüpresif tedavi öyküsü vardır. Dört (%9) olguda BCG skarı yokken, 29 (%66) olguda bir, 11 (%25) olguda iki skar izlenmiştir. Beden kitle indeksi (BKİ) 5 (%11) olguda düşük saptanmıştır. T-lenfosit alt grup analizlerinde; CD4= %40.7 ± 7.6, CD8= %32 ± 8.9, CD4/CD8= %1.7 ± 2.5, CD3= %71.4 ± 9.4, CD19= %6.3 ± 5.1 ve natural killer (NK)= %9.7 ± 5.9 bulunmuştur. Olguların %50’sinde TCT pozitif bulunmuştur. TCT’yi etkileyen parametreler değerlendirildiğinde; yaş, cinsiyet, eşlik eden hastalık, BCG skarı, BKİ, KBY süre ve tedavisi, immünsüpresif tedavi ile TCT pozitifliği arasında ilişki saptanmamıştır. Çalışmaya alınan olguların biyokimyasal parametreleri ve T-lenfosit alt grup analizleri ile TCT yanıtı arasında da ilişki bulunmamıştır. Bu bulgularla, KBY’li olgularda T-lenfosit alt grup değerlerinin ve olguların klinik özelliklerinin TCT yanıtını etkilemediği sonucuna varılmıştır.

T-lymphocyte subgroups and tuberculin skin test reactivity in patients with chronic renal failure

As anergy is common in patients with chronic renal failure (CRF), the use of tuberculin skin test (TST) is controversial. Therefore, determination of the factors that affect the TST reactivity would increase the diagnostic value of the test. The aim of the present study was to investigate the factors affecting TST reactivity and evaluate the relationship between T-lymphocyte subsets and TST reactivity. We thus examined 44 patients (mean age 46.6 ± 15.6 years, 25 males, duration of CRF 5.6 ± 5.2 years), performed TST (an induration with a diameter of 5 mm or more was considered as positive) and measured Tlymphocyte subsets and biochemical parameters. Twenty-three patients were on hemodialysis, six were on peritoneal dialysis, seven were transplant recipients, and eight were on medical treatment. Eleven patients (25%) had immunosuppressive treatment. Eleven patients (25%) had two, 29 patients (66%) had one, and four patients (9%) had no BCG scars. Five patients (11%) had low body mass index (BMI). T-lymphocyte subsets were as follows: CD4= 40.7 ± 7.6%, CD8= 32 ± 8.9%, CD4/CD8= 1.7 ± 2.5%, CD3= 71.4 ± 9.4%, CD19= 6.3 ± 5.1%, NK= 9.7 ± 5.9. Twenty-two patients had positive TST reactivity. No relation was found between TST reactivity and age, gender, co-morbidity, BCG vaccination, BMI, immunosuppressive therapy, duration and treatment of CRF. Similarly, TST reactivity was not related to the biochemical parameters and Tlymphocyte subsets. These data provide that tuberculin reactivity does not seem to be associated with T-lymphocyte dysfunction and clinical features in patients with chronic renal failure.

PDF

___

1.Murthy BV, Pereira BJ. A 1990s perspective of hepatitis C, human immunodeficiency virus, and tuberculosis in fections in dialysis patients. Semin Nephrol 1997; 17: 346-63.
2.Woeltje KF, Mathew A, Rothstein M, et al. Tuberculosis infection and anergy in hemodialysis patients. Am J Kid- ney Dis 1998; 31: 848-52.
3.Simon TA, Paul S, Wartenberg D, Tokars Jl. Tuberculosis in hemodialysis patients in New Jersey: A statewide study. Infect Control Hosp Epidemiol 1999; 20: 607-9.
4.Smirnoff M, Patt C, Seckler B, Adler JJ. Tuberculin and anergy skin testing of patients receiving long-term hemodialysis. Chest 1998; 113:25-7.
5.Goldblum SE, Reed WP. Host defenses and immunologic alterations associated with chronic hemodialysis. Ann Intern Med 1980; 93:597-13.
6.Reichert T, DeBruyere M, Deneys V, et at. Lymphocyte subset reference ranges in adult caucasions. Clin Immunol Immunopath 1991; 60: 190-208.
7.Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults - The Evidence Report. National Institutes of Health. Obes Res 1998; 2 (Suppl 6): 51S-209S.
8.Taskapan H, Utas C, Oymak FS, et al. The outcome of tuberculosis in patients on chronic hemodialysis. Clin Nephrol 2000; 54: 134-7.
9.Wauters A, Peetermans WE, Van den Brande P, et al. The value of tuberculin skin testing in haemodialysis patients. Nephrol Dial Transplant 2004; 19: 433-8.
10.Taskapan H, Oymak O, Utas C Tuberculin and anergy skin testing in CAPD patients. Perit Dial Int 2000; 20:807-9.
11.Poduval RD, Hammes MD. Tuberculosis screening in dialysis patients--is the tuberculin test effective? Clin Neph rol 2003; 59: 436-40.
12.Akiyama M, Numata A, Imagawa A. Influence of protein intake on phytohemagglutinin skin test in patients undergoing maintenance hemodialysis. Nippon Hinyokika Gakkai Zasshi 1989; 80: 1175-80.
13.Kaysen GA, Eiserich JP. Characteristics and effects of inflammation in end-stage renal disease. Semin Dial 2003;16: 438-46.
14.Bansal VK, Popli S, Pickering J, et al. Protein-calorie malnutrition and cutaneous anergy in hemodialysis maintained patients. Am J Clin Nutr 1980; 33: 1608-11.
15.Deenitchina SS, Ando T, Okuda S, et al. Cellular immunity in hemodialysis patients: A quantitative analysis of immune cell subsets by flow cytometry. Am J Nephrol 1995; 15:57-65.
16.Yildiz A, Akkaya V, Yildiz P, et al. No relation of tuberculin reactivity with quantitative analysis of peripheral blood lymphocyte subsets in haemodialysis patients. Respir Med 1999; 93: 119-22.