Abstract
224 tuberculosis cases with concurrent HIV infection were examined. Nutritional status was defined based on the body mass index (BMI), levels of transthyretin, albumin and total protein in the blood serum. It was found out that tuberculosis patients with concurrent HIV infection had a severe nutritional deficiency, which was confirmed by the confident reduction of BMI, transthyretin and albumin levels in blood serum. Whereby, the intensity of protein and energy deficiency in tuberculosis patients with concurrent HIV infection was associated on the one hand with the specific course of tuberculosis and on the other hand with the course of HIV infection. The most significant reduction of nutritional status was observed in the patients with fibrous cavernous tuberculosis, multiple localizations of tuberculosis, dissemination of tuberculous lesions in more than two lobes, lung tissue destruction and bacillary excretion and extensive drug resistance. It was found out that the most severe protein-energy deficiency was detected if the CD4 count was below 0.35 x 109/L and viral load exceeded 500,000 copies/ml. The dynamic follow-up showed that the effective treatment provided a significant improvement of protein-energy deficiency. Despite it, even in 6 months of treatment, there was no complete recovery of nutritional status. Should the treatment fail, protein-energy deficiency deteriorated, which was proved by the reduction of BMI, transthyretin, albumin and total protein levels.
Highlights
224 tuberculosis cases with concurrent HIV infection were examined
Nutritional status was defined based on the body mass index (BMI), levels of transthyretin, albumin and total protein in the blood serum
It was found out that tuberculosis patients with concurrent HIV infection had a severe nutritional deficiency, which was confirmed by the confident reduction of BMI, transthyretin and albumin levels in blood serum
Summary
Для больных со слабо выраженной туберкулезной интоксикацией были характерны недомогание, потливость, слабость, похудение, повышение температуры тела до субфебрильных величин. Проявлениями резко выраженной интоксикации были сильная слабость и недомогание, значительное снижение массы тела (10 кг и более), повышение температуры тела до фебрильных цифр. При этом у 37 (16,5%) больных число CD4-лимфоцитов составило более 0,5 × 109/л, у 82 (36,6%) – 0,35-0,5 × 109/л, у 43 (19,2%) – 0,2-0,35 × 109/л, у 20 (8,9%) – 0,2-0,05 × 109/л и у 42 (18,8%) – менее 0,05 × 109/л. Для оценки выраженности белково-энергетической недостаточности организма рассчитывали индекс массы тела (ИМТ) каждого больного, в сыворотке крови определяли содержание ОБ, ТТР и А. Исследования показателей белково-энергетической недостаточности проводили в сыворотке/плазме крови при поступлении больных в клинику, далее через 3 и 6 мес. При легкой степени выраженности нарушений нутритивного статуса (1-я степень) уровень А снижен до 30 г/л. Оценку взаимосвязей изучаемых показателей выполняли путем вычисления коэффициента корреляции Спирмена, величину которого считали статистически значимой при p < 0,05
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