Effect of antituberculosis treatment on dynamics of carbohydrate and lipid profile

Abstract

Objective — study the effect of antituberculosis treatment on the dynamics of carbohydrate and lipid profile in patients with newly diagnosed pulmonary tuberculosisMaterials and methods. We examined 76 patients with drug-susceptible pulmonary tuberculosis and 64 patients with drug-resistant pulmonary tuberculosis. The treatment was carried out according to the current order of the Ministry of Health of Ukraine. Material for the study (venous blood) was collected before treatment and one month later in the morning on an empty stomach. Additionally, an oral glucose tolerance test was performed, the fasting insulin level was determined, the lipid profile was measured, the insulin resistance index (HOMA-IR) and atherogenic index of plasma were calculated. For statistical processing used the software package Statistica for Windows version 13.2.Results and discussion. In the process of treatment with І-line antituberculosis drugs, the level of glucose in 2 hour GTT increased from 4.34 mmol/L to 5. 29 mmol/L. In patients who received ІI-line antituberculosis drugs, the glucose level decreased from 5.77 mmol/L to 4.33 mmol/L, and the fasting insulin level also decreased from 16.30 to 14.47 µcU/mL; the median level of insulin resistance decreased from 3.31 to 2.22 (p = 0.0057). In the process of treatment we found a significant decrease in VLDL levels (р = 0.0028) in drug-susceptible tuberculosis patients. Due to treatment, mean value of HDL-c in in drug-susceptible tuberculosis patients increased slightly from 1.01 mmol/L till 1.12 mmol/L, while in drug-resistant tuberculosis patients it decreased significantly (р=0.0171) from 1.07 mmol/L till 0.94 mmol/L.Conclusions. We found the negative effect of І-line antituberculosis drugs on the carbohydrate metabolism of patients with pulmonary tuberculosis, which manifested as impared glucose tolerance, which makes it possible to recommend OGTT for objectivizing the effect of anti-tuberculosis drugs on carbohydrate metabolism. While in patients who were treated with IІ-line antituberculosis drugs, we found a significant decrease in 2-hour glucose level and fasting insulin level, which indicates the modeling effect of these drugs on carbohydrate metabolism. Our findings suggest that drug-susceptible tuberculosis treatment had a positive effect on the lipid metabolism, which was manifested by the growth of the anti-atherogenic pool of lipoproteins and the decrease in very low-density lipoprotein level. At the same time, we found a negative effect of drug-resistant tuberculosis treatment on lipid metabolism, which manifested as increase of atherogenic index of plasma due to increase of total cholesterol level in patients with newly diagnosed pulmonary tuberculosis.