AKCİĞER TÜBERKÜLOZU TANISINDA 38kDa ANTİJENİNE ÖZGÜL IgG’NİN ÖLÇÜLMESİNİN ÖNEMİ VE DEĞERİ

Abstract

Tüberkülozun (TB) erken ve hızlı tanısı hala önemli bir problemdir. Bu nedenle klasik tanı yöntemlerinin dışında spesifik, hızlı, pratik ve güvenilir yeni tanı yöntemleri araştırılmaktadır. Bu çalışmada, aktif TB hastalarında Enzim Linked Immun Assay (ELISA) ile mikobakterilerin 38kDa antijenine karşı oluşan IgG antikor cevabının ve PPD testi ile bu antikor cevabı arasındaki ilişkinin araştırılması planlandı. Çalışmaya 486 aktif akciğer TB’lu, 23 inaktif tüberkülozlu, 100 TB dışı akciğer hastalığı olan ve 48 sağlıklı olgu alındı. Bu hastaların serumlarında mikobakterilerin 38 kDa antijenine karşı oluşan IgG antikoruna bakıldı. PPD pozitifliği ile ilişkisi değerlendirildi. Çalışmamızda; 486 aktif akciğer TB’lu hastada IgG (+)’liği %53 (257 olgu) idi. Aktif akciğer TB’lu hastalarda IgG (+)’liğinin sensitivitesi %53 ve spesifitesi %99 bulundu. Aktif akciğer TB hastaları ile inaktif akciğer TB’lu, TB dışı akciğer hastaları ve sağlıklı kontrol grupları karşılaştırıldığında; aktif akciğer tüberkülozlu grubun IgG (+)’liğinde diğer gruplara göre anlamlı artış gösterilmiştir (p=0,0002 ve p=0,00001). PPD testi pozitif olanlarla negatif olanların IgG düzeyleri karşılaştırıldığında IgG düzeyi PPD testi pozitif olanlarda anlamlı olarak yüksekti) [1.065±1.06, 0.587±0.66 (p=0,003)] ve aradaki fark istatistiksel olarak anlamlı bulundu . Çalışma sonuçlarında, aktif akciğer tüberkülozlu olgularla inaktif formların ayırımında serum IgG (+) ölçümünün tanıya büyük katkı sağladığı düşünülmüştür. Ayrıca 38 kDa antijenine dayalı ELISA yöntemi; kolay temin edilebilen; hızlı, spesifik ve ucuz bir yöntem olduğundan epidemiyolojik araştırmalarda ve taramalarda da kullanılabileceği sonucuna varılmıştır. Dr.Ayşegül ŞENTÜRK Dr. Hatice Kutbay ÖZÇELİK Dr.Arman POLUMAN

Keywords

• Aktif akciğer tüberkülozu
• IgG pozitifliği
• sensitivite
• 38 kDa antijeni

VALUE OF THE DETECTİON OF IgG LEVELS TO 38kDa ANTIGEN IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS

Abstract

Early and rapid diagnosis of tuberculosis is still an important problem. Therefore, outside the classical diagnostic methods, specific, rapid, practical and reliable new diagnostic methods are being investigated. In this study, IgG antibody response against 38kDa antigen of mycobacterium and correlation between PPD test and IgG antibody response was investigated in patients with active tuberculosis, by ELISA. 486 patients with active pulmonary tuberculosis, 23 patients with inactive tuberculosis, 100 patients with non-tuberculosis lung disease and 48 healthy subjects were enrolled into the study. IgG antibodies against mycobacterium 38kDa antigen were measured in the serum of these patients. And the correlation of the resuts to the PPD positiveness was evaluated. In our study, IgG seropositivity was 53% (257 cases) in 486 patients with active pulmonary tuberculosis. Sensitivity and specificity of IgG positivity in active pulmonary tuberculosis patients were found 53% and 99%, respectively. Between active pulmonary tuberculosis patients and inactive pulmonary tuberculosis patients, non-tuberculosis lung disease patients and healthy control groups, IgG positivity was significantly higher in favor of the first group. (p=0,0002 and p=0,00001). IgG levels were significantly higher in the PPD positive patients than the PPD negative patients [1 065±1.06, 0.587+0.66 (p=0,003)] Therefore, we think the test will greatly help in the differential diagnosis of active forms and inactive forms. Furthermore, because 38 kDa antigen ELISA method is a specific and cheap method it can be usufull especially in the epidemiological studies .

Keywords

• Active pulmonary tuberculosis
• IgG antibodies
• sensitivity
• 38kDa antigen.

References

1. 1. Global tuberculosis Global Tuberculosis Control World Health Organization WHO Report 2010:Geneve
2. 2. Drowart A, Huygen K, De Bruyn J. Antibody levels to whole culture filtrate antigens and to prufied p32 during treatment or smear posit-tive tuberculosis. Chest 1991;100:685-687
3. 3. Roya AN, Maliheh M, Ebrahim A, Hassan M. Patho-TB test for the rapid diagnosis of pulmonary tuberculosis. JRMJ 2009; 14:301-307
4. 4. Chiang IH, Suo J, Bai KJ, Lin TP, Luh KT, Yu CJ et al. Serodiagnosis of tuberculosis: A study comparing three specific mycobacterial antigens. Am J Resir Crit Care Med 1997;156:906-11
5. 5. Bothamley GH. Serological diagnosis of tuberculosis. Eur Respir J( Suppl)1995; 20:676-688
6. 6. Gennaro ML. Immunolojic diagnosis of tuberculosis. Clin Infect Dis 2000; 30: 243-46
7. 7. Hendrickson RC, Douglass JF, Reynolds LD, McNeill PD, Carter D. Mass spectromet-ric identification of mtb81, a novel seroloji-cal marker for tuberculosis. J Clin Microbiol 2000; 38:2354-61
8. 8. Mısırlıgil Z. Tüberküloz İmmünolojisi. Kocabaş A (ed). Tüberküloz kliniği ve kontrolü. Adana: Çukurova Ünv. Basımevi; 1991. p.73-5

9. 9. Apan TZ, Aksoy A, Kuyumcu G, Çanga ö, Kocamaz H, özan M. Klinik ve Radyolojik Olarak Tüberküloz ön Tanısı Konulan Hastalarda Direkt Mikroskobi ve Kültür Yöntemlerinin ELISA Sonuçları İle Kıyaslanması. Infeksiyon Dergisi (Turkish Journal of Infection) 2004;18:433-439
10. 10. Xueqiong W, Yourong Y, Zhang J, Bangying L, Yan L, Chuiying Z. Humoral Immune Responses against the Mycobacterium tuberculosis 38-kilodalton, MTB48,and CFP-10/ ESAT-6 Antigens in Tuberculosis. Clinical and Vaccine Immunology Mach 2010; 17:372-375
11. 11. öztürk R. Tüberküloz Tanımı ve Bu Alandaki Yenilikler. Türkiye Hastane Tıp Derg 1998; 52:67-68
12. 12. Omega Diagnostics Limited.” TB or not TB ” Omega Diagnostics, Product Insert. Review 1994; 63:2-10
13. 13. Karen RS, Megan H, Suman L, Philip CH, Andrew R. Commercial Serological Antibody Detection Tests for the Diagnosis of Pulmonary Tuberculosis. A Systematic Review. PLOS Med 2007; 4:202
14. 14. Zeiss CR, Kalish SB, Erlich KS. IgG antibody to purified protein derivate by enzyme-linked immunosorbent assay in the diagnosis of pulmoner tuberculosis. Am Rev Respir Dis 1984; 130:845
15. 15. Muz M H, Turgut T, Deveci T, öz O. Tübekül-oz tanısında A 60 Antijeninin yeri. Solunum 2002; 4:386-390
16. 16. Daniel TM. ELISA Using mycobacterium tuberculosis. Antigen 5 and PPD for the serodiagnosis of Tuberculosis. Chest 1988; 3:292-368
17. 17. Verbon A, Weverlign GJ, Kujper S, Speel-man P, Jansan H.M, Kokla A.H.S. Evaluation of different tests for the serodiagnosis of tuberculosis and the use of likelihood rations in serology. Am Rev Respir Dis 1993; 148:378-84
18. 18. Balestriono EA, Daniel TM. Serodiagnosis of pulmonary tuberculasis in Argentina by ELISA of IgG WHO 1984
19. 19. Grubek JH, Zwolska Z. Serum and bronkoal-veolar IgG against AGÖ and 38 kDa antigens in the diagnosis of tuberculosis. Int. J. Tuberc. Lung. Dis. 1997; 1:556-62
20. 20. JI Sook Lee , Jo EK, Noh YK, Shin AR, Shin DM, Son JW et al. Diagnosis of pulmonary tuberculosis using MTB12 and 38-kDa antigens.Respirology 2008; 13:432-437
21. 21. Imaz MS, Schmelling MF, Kaempfer S, Spallek R and Singh M. Evaluation of Commercial Enzyme-Linked Immunosorbent Assay Kits for Detection of Tuberculosis in Argentinean Population. J Clin Microbiol . 2004; 884-88
22. 22. Brian A, Danial TM, Evaluation of the Potan-tial Role of Serodiagnosis of tuberculosis in a clinic in Bolivia by Decision Analysis. Am Rev Respir Dis 1991; 143:713-16
23. 23. Yorgancıoğlu A, Kılınç Ö, Kalenci D. Tüberküloz Aktivitesinde Nonspesifik Im-munglobulinlerin Değeri. Izmir Göğüs Hastanesi Dergisi 1995; 1:21-25
24. 24. Chan SL, Reggiardo Z, Daniel TM, Girling DJ, Mitchison DA. Serodiagnosis of tubercu- losis using an ELISA with antigen 56 and a hemagglutination assay with glycolipid antigens. Results in patients with newly diagnosed pulmonary tuberculosis ranging inextent of disease from minimal to extensive. Am Rev Respir Dis 1991; 125:720-23
25. 25. Demkow U, Filewska M, Michalowska-Mıtczuk D, Kus J, Jagodzınskı J, Zielonka T et al. Heterogeneity of Antibody Response to Mycobacterial Antigens in Different Clinical Manifestations of Pulmonary Tuberculosis .Journal of Physiology and Pharmacology 2007; 58: (Suppl) 5,117-127
26. 26. Maes R, Hamosson JP .Development of an Enzyme Immunoassay for the Serodiagnos-tik of Tuberculosis and Mycobacteriores. Med Microbiol Immunol 1989; 178:323-35
27. 27. Kardijito T. Diagnosis of Active Tuberculosis by Immunological methods. The Effect of Tuberculin Reactivity and Previous BCG Vaccianation on the Antibody Levels. ELISA, Tubercle 1982; 63:69-74
28. 28. Ivanys J, Krambouvitis E. Evaluation of a monoclonal antibody (TB72) based serological test for tuberculosis. Clin Exp Immunol 1983;54:337-45
29. 29. Ahmad A, Afghan S, Raykundalia C, Catty D. Diagnosis of tuberculosis by using ELISA to detect 38kDa Mycobacterial antigen in the patients. Journal of Islamic Academy of Sciences 1995; 8:7-13
30. 30. Pottumarthy S, Wella VC, Morris AJ. A Comparison of seven tests for serolojical diagnosis of tuberculosis. J Clin Microbiol 2000; 38:2227-31
31. 31. Demkow U, Zielonko TM, Nowak-Misiak M, Filewska M, Bialas B, Strzalkowski J et al. Humoral immune response against 38-kDa mycobacterial antigens in bone and joint tuberculosis. Int J Tuber Lung Dis 2002; 6:1023-8
32. 32. Bhatia AS, Kumar S, Harinath B.C. Immunodiagnosis of tuberculosis: an uptade Indian Journal of Clinical Bio Chemistry 2003; 18:1-5
33. 33. Julian E, Mates L, Alcaide J, Luquin M. Comparison of antibody response to a potential combination of specific glycolipids and proteins for test sensitivity improvement in tuberculosis serodiagnosis. Clin Diagn Lab Immunol 2004; 11:70-76 Araujo Z, Waard JH, Larrea CF, Lopez D,