Evaluation of Plasma Protein C and Antithrombin III Levels in Egyptian Tuberculosis Patients

Abstract

SUMMARY AND CONCLUSION T uberculosis (TB) is a global health concern for both developing and developed countries and has recently become more complex due to persistence in aging populations and the rise of drug-resistant strain. Prompt diagnosis is a priority for TB control, both for treating the individual and for public health intervention to reduce further spread in the community. Infection with M. Tuberculosis can result in active TB or, more commonly, latent TB infection. Latently infected persons are estimated to be about 2 billion in the world, represent a vast reservoir of potential reactivation of TB, which can spread to other people. A key challenge to greater progress in TB control is the reservoir of latent TB infection (LTBI). Chronic inflammation induced by TB leads to hemostatic abnormalities, decreases the activity of natural anticoagulant and impairs the fibrinolytic system. These hemostatic abnormalities range from insignificant laboratory changes to severe DIC. Association between active PTB and hypercoagulable state has been previously described, and the occurrence of thromboembolism should be considered in those patients. In the light of this, the present work aimed to assess the plasma levels of PC and AT III in patients with active and latent TB and correlate their levels with patients' coagulation state and other laboratory findings. To achieve this, the present study was carried on 60 TB patients divided into 3 groups; group I included 20 newly diagnosed active PTB patients, group II included 20 active PTB patients after 1 month of anti-TB treatment and group III included 20 latent TB infected patients. They were all recruited from Abbasia Chest Hospital during the period from January 2014 to December 2015. A control group of 20 age- and sex- matched healthy subjects were included. Informed consent was obtained from all subjects to be included in the study to use their samples. All individuals included in the study were subjected to full history taking. Patients with chronic liver disease, renal diseases, pregnant or lactating females, patients taking OCPs or oral anticoagulants and patients with severe burn or trauma were excluded. Diagnosis of active TB was bases on clinical picture, microbiological examination of sputum smears and chest X-rays, while latent TB patients were diagnosed by QFT test and ruling out of active TB. Routine Laboratory investigations were done including CBC, ESR, PT, aPTT and clinical chemistry (ALT, AST, Bl. Urea and creatinine) for all patients, with assessment of PC and AT III activity levels using Sysmex CA 1500 (Siemens Healthcare Products GmbH, Marburg/ Germany) for patients and control groups. Follow up of all group I patients was done with reassessment of PC and AT III activity level after one month of anti-TB treatment, using ESR as a marker of response to treatment. The results of the present study revealed low activity levels of both PC and AT III in group I compared to controls with the existence of a high significant difference (P< 0.01). However, group II showed a high significant reduction of only PC level (P<0.01) with significant increase of AT III level (P<0.05) compared with the controls. In addition, a positive significant correlation between AT III level and HB concentration was proved in group I patients (P< 0.05). Moreover, PC level revealed a significant positive correlation with both HB concentration and platelets count (P<0.05) and significant negative correlation with the ESR (P<0.05) in group II. On the other hand, PC and AT III levels showed no significant difference between group III and the controls (P>0.05). While a highly significant positive correlation was found between AT III and PC activity levels (P<0.01) in group III, also both PC & AT III activity levels showed highly significant negative correlation with ESR (P<0.01). Interestingly, a significant decrease in levels of both PC and AT III was statistically confirmed in group I patients after 1 month of treatment when compared to their level before treatment (P<0.01).