监测治疗反应是脊柱结核(TB)的重要预防措施,特别是在临床诊断而不是细菌学证实的情况下,以及未进行药物敏感性测试时。传统的监测措施有局限性,需要有利的替代办法。因此,这项研究旨在调查脊髓结核治疗过程中免疫生物标志物的变化,并将这些反应与常规监测措施进行比较。红细胞沉降率(ESR)。
脊髓结核患者是从西开普省的一家三级医院招募的,南非,并在结核病治疗0、3、6、9和12个月时提供血液样本。对血样进行ESR分析,使用标准技术,对于19种细胞因子,使用多路复用平台。使用混合模型ANOVA和最小显著差异事后检验研究ESR和细胞因子水平的变化。
研究中纳入了26名脊髓结核患者,尽管在12个月时只有15名患者仍在随访中。七个生物标志物在治疗过程中发生了显着变化(CRP,纤维蛋白原,IFN-γ,铁蛋白,VEGF-A,ApoA1和NCAM,p<0.01),另外三个显示出强烈的变化趋势(CCL1,CXCL9和GDF-15,0.05≥p≤0.06)。反应性生物标志物可以根据渐进模式大致分组,初始或延迟更改。ESR执行类似于CRP,纤维蛋白原和IFN-γ在治疗0、6和12个月之间均显示出显著降低。个体ESR反应是可变的。
个体ESR反应可能是不可靠的,并且支持多标记方法评估脊髓结核治疗反应的研究。当前研究中确定的治疗反应的生物标志物需要在更大的研究中进行验证。这也可能包括一些方面,如在治疗的第一周内评估生物标志物和纳入健康对照组。
Monitoring treatment response is an important precaution in spinal tuberculosis (TB), particularly when the condition was clinically diagnosed rather than bacteriologically confirmed and when drug susceptibility testing was not performed. Conventional monitoring measures have limitations and there is a need for favourable alternatives. Therefore, this
study aimed to investigate changes in immune biomarkers over the course of treatment for spinal TB and to compare these responses to the conventional monitoring measure, erythrocyte sedimentation rate (ESR).
Patients with spinal TB were recruited from a tertiary hospital in the Western Cape, South Africa, and provided blood samples at 0, 3, 6, 9 and 12 months of TB treatment. Blood samples were analysed for ESR, using standard techniques, and for 19 cytokines, using a multiplex platform. Changes in ESR and cytokine levels were investigated using a mixed model ANOVA and Least Significant Difference post-hoc testing.
Twenty-six patients with spinal TB were included in the
study although only fifteen remained in follow-up at 12 months. Seven biomarkers changed significantly over the course of treatment (CRP, Fibrinogen, IFN-γ, Ferritin, VEGF-A, ApoA1 and NCAM, p < 0.01) with a further three showing a strong trend towards change (CCL1, CXCL9 and GDF-15, 0.05 ≥ p ≤ 0.06). Responsive biomarkers could be approximately grouped according to patterns of progressive, initial or delayed change. ESR performed similarly to CRP, Fibrinogen and IFN-γ with all showing significant decreases between 0, 6 and 12- months of treatment. Individual ESR responses were variable.
Individual ESR responses may be unreliable and support the investigation of multi-marker approaches to evaluating treatment response in spinal TB. Biomarkers of treatment response identified in the current
study require validation in a larger
study, which may also incorporate aspects such as evaluating biomarkers within the first week of treatment and the inclusion of a healthy control group.