Jon Pangarapan Saragih, Bintang Sinaga, Zainuddin Amir
Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sumatera Utara, RSUP H. Adam Malik, Medan
Abstract
Background: Vitamin D is known to have an important role in macrophage activation and the subsequent restriction of Mycobacterium tuberculosis growth, and it has been implicated as a risk factor for TB. Vitamin D also induced the expression of cathelicidin, which is involved in the first line of defense in TB patients. An association between 25(OH) vitamin D (25[OH]D) levels and TB has been described in several studies. Objective of this study to compare serum vitamin D level in subjects with and without TB, to find out association of serum vitamin D level with TB and association of serum vitamin D level with extent of lesion in chest x ray.
Methods: A cross sectional study was conducted in Adam Malik Hospital Medan, Indonesia from January to June 2013. New TB cases was diagnosed by the presence of acid-fast bacilli on sputum smears and chest x ray. We excluded TB patients with DM, HIV, malignancy, immunosupresant treatment and immunocompromized patients. Non TB subjects were selected randomly from health care staff, who didn’t have TB from anamnesis and chest X ray. The serum concentrations of 25(OH)D were determined by an CLIA method. Vitamin D deficiency, vitamin D insufficiency, vitamin D sufficiency, vitamin D optimal defined as serum 25(OH)D concentrations of ≤ 10 ng/ml, 10–20 ng/ml, 20-30 ng/ml and >30 ng/ml respectively.
Results: Thirty one subjects with TB and 31 subjects without TB were enrolled. Mean serum vitamin D level of subjects with and without TB were 25.21 (SD±7.93)ng/ml and 21.50 (SD±9.37)ng/ml, respectively (p=0.098). Vitamin D deficiency was not found in all subjects. Mean serum vitamin D level in advanced and minimal lesion in TB patients (21.61±5.50ng/ml versus 29.58 ±8.39ng/ml, p=0.04), respectively. Regression test was performed to asess the influence of vitamin D in extent of lesion of TB patients (R=0.000 and p model=0.897).
Conclusion: There was no significant association between serum vitamin D level and TB. There was a significant difference in vitamin D level between advance lesion and minimal lesion in TB patients. (J Respir Indo. 2015; 35: 51-6)
Keywords: Tuberculosis, vitamin D, extent of lesion.