THE DISTURBANCES OF THE ANTIOXIDANT DEFENSE AND PROTEIN METABOLISM BIOMARKERS IN THE SERUM OF THE PATIENTS WITH PULMONARY TUBERCULOSIS

Objectives. Evolution of the infection with Mycobacterium tuberculosis and treatment outcome depends on the balances between the adaptive immunity to reduce the bacterial replication and the capacity of the antioxidant defense to prevent the damages following the immune activation and oxidative stress. The purpose of the study was to assess the disturbances of the antioxidant defense and protein metabolism in the serum of the patients with pulmonary tuberculosis.

Material and methods. A prospective, case-control study, which included 137 patients, distributed in 3 groups: 1^st study group (N=54 new cases with drug susceptible tuberculosis), 2^nd group (N=56 new cases with multidrug-resistant tuberculosis) and 3^rd group (N=27 cases with acquired multidrug-resistant tuberculosis) diagnosed between 2017 and 2019, similar distributed according to the sex and age were compared with a control group constituted from 50 healthy persons. The investigations were realized according to the national protocol and biochemical analysis standards. The antioxidant defense was assessed through the total serum antioxidant capacity, the activity of the enzymes and the proteins with antioxidant role: superoxidismutase, catalase, ceruloplasmin and active phase reactants (fibrinogen and C-reactive protein), protein metabolism indicators (total serum proteins, alanine aminotransferase and aspartate aminotransferase).

Results. The depletion of the antioxidant defense was confirmed through the diminished of the total serum antioxidant capacity and superoxidismutase, regardless the drug resistance of mycobacteria, compared with the control group. A higher anti-oxidant protection was demonstrated by the increased activity of catalase in all groups and ceruloplasmin in patients registered as new cases compared with the control group. The acute phase reactants: C-reactive protein and fibrinogen and enzymes of the protein metabolism were increased in all patients, but the concentration was higher in patients who acquired the drug resistance during the treatment.

Conclusions. The depletion of the the antioxidant defense, increased acute phase reactants and enzymes of the protein metabolism should be taken into account for recommending the individualized therapy for metabolic disturbances.