Alterationsinserum Antitrypsin Level and Its Association with Pulmonary Complications Among Patients with Lung Tuberculosis

Abstract

Background: Antitrypsin is one of the factors that increases during inflammatory responses. The aim of this study was to monitor alterations in serum antitrypsin level during pulmonary tuberculosis treatment and determine its association with pulmonary function and fibrotic changes. Methods: This quasi-experimental study was done on all 40 patients who had pulmonary tuberculosis and were referred in 2015 - 2017 to a tuberculosis care center in Birjand, Iran. Sampling was done through the census method. After the establishment of tuberculosis diagnosis, all patients received tuberculosis treatment for 6 consecutive months. Before, 2 and 6 months after treatment onset, 5-milliliter blood samples were obtained from each patient for antitrypsin measurement. Moreover, chest radiography was performed for each patient both before and 6 months after treatment onset, while pulmonary function test or spirometry was done 2 and 6 months after treatment onset. The one-way analysis of variance, independent-sample t-test, Mann-Whitney U, Friedman, and Kruskal-Wallis tests were performed for statistical data analysis. Results: From the 40 recruited patients, only 24 completed the study. The mean of serum antitrypsin level at baseline was 201.72 ± 47.66, which significantly decreased to 157.61 ± 36.98 and 141.10 ± 26.76, at respectively 2 and 6 months after treatment onset (P < 0.001). Post-treatment chest radiography showed that 15 patients had fibrotic residue and 9 had normal chest radiography. The mean of serum antitrypsin among patients with fibrotic residue was not significantly different from that of patients with normal chest radiography (75.05 ± 13.51 vs. 36.57 ± 14.22; P = 0.7). Pulmonary dysfunction was observed among 75% of patients. The prevalence rates of post-treatment restrictive, obstructive, and normal spirometry patterns were 41.7%, 33.3%, and 25%, respectively. There was no significant difference among patients with restrictive, obstructive, and normal spirometry patterns respecting the amount of decrease in the mean of serum antitrypsin (56.12 ± 64.41, 63.27 ± 35.6, and 64.60 ± 54.14, respectively; P = 0.94). Conclusions: The serum level of antitrypsin decreases during pulmonary tuberculosis treatment. Therefore, antitrypsin, as an acute-phase protein, can be used for the follow-up assessment of response to treatment among patients with pulmonary tuberculosis.