Ni Wayan Putu Lestari, I Desak Putu Agung Krisdanti, Ni Luh Putu Eka Arisanti, Putu Andrika, Ni Wayan Candrawati, Made Agustya Darma Putra Wesnawa, Dewa Gde Mahiswara Suadiatmika

Hubungan antara kadar vitamin D serum, kadar zinc serum dengan bacterial load tes cepat molekuler sputum dan derajat kerusakan paru pada foto toraks pasien tuberkulosis paru di Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia

Introduction

Hubungan antara kadar vitamin d serum, kadar zinc serum dengan bacterial load tes cepat molekuler sputum dan derajat kerusakan paru pada foto toraks pasien tuberkulosis paru di rumah sakit umum pusat prof. Dr. I.g.n.g. Ngoerah denpasar, bali, indonesia. Penelitian di Bali menemukan defisiensi vitamin D berhubungan signifikan dengan beban kuman tinggi pada pasien TB paru, namun tidak dengan kerusakan paru. Kadar zinc serum tidak berhubungan.

Abstract

Background: Tuberculosis (TB) remains a global health issue, with Indonesia ranked as the country with the second-highest TB burden worldwide. Vitamin D and zinc are known to play a role in the immune response against Mycobacterium tuberculosis, yet local data on serum levels of these micronutrients in pulmonary TB patients is still limited, particularly in Bali. Therefore, this study aimed to assess the correlation between serum levels of vitamin D and zinc with sputum bacterial load (as measured by TCM) and the degree of lung damage in TB patients. Methodology: This was an observational analytic study with a cross-sectional design involving 50 pulmonary TB patients. Data were collected through interviews, clinical and laboratory assessments, chest radiography, and serum measurements of vitamin D and zinc. Bivariate analysis was conducted using the Chi-square test, while multivariate analysis used logistic regression. Results: The majority of respondents were male (34, 68%) and aged <60 years (38, 76%). A total of 31 patients (62%) had low vitamin D levels (<30 ng/mL), and 48 patients (96%) were zinc deficient (<60 µg/dL). Vitamin D levels were significantly associated with the Cycle Threshold (CT) values of TCM sputum (p = 0.009), but not with the degree of lung damage on chest X-ray (p = 0.500). Multivariate analysis showed that low vitamin D levels increased the risk of having a high bacterial load (TCM high, CT <16) with an odds ratio (OR) of 34.27 (p = 0.010). In contrast, serum zinc levels were not significantly associated with bacterial load, degree of lung damage, or other demographic variables (p>0.05). Meanwhile, a high TCM category was significantly associated with moderate lung damage (p = 0.028; OR = 4.883; 95% CI: 1.183–20.148). Conclusion: Vitamin D deficiency is significantly associated with a higher bacterial burden in pulmonary TB patients but is not related to the degree of lung damage. Serum zinc levels show no significant association with bacterial load or lung damage seen in chest x-ray imaging. Monitoring vitamin D levels could be considered as an additional biomarker in the clinical evaluation of pulmonary TB. Latar Belakang: Tuberkulosis (TB) masih menjadi masalah kesehatan global, termasuk di Indonesia sebagai negara dengan beban TB tertinggi kedua di dunia. Vitamin D dan zinc diketahui mempengaruhi imunitas terhadap Mycobacterium tuberculosis (MTB), namun data lokal mengenai kadar kedua mikronutrien ini pada pasien TB paru masih terbatas, khususnya di Bali. Oleh karena itu, penelitian ini bertujuan untuk menilai hubungan kadar vitamin D, zinc serum dengan bacterial load tes cepat molekuler (TCM) sputum dan derajat kerusakan paru pada TB. Metodologi: Penelitian ini merupakan studi observasional analitik dengan desain potong lintang yang melibatkan 50 pasien TB paru. Data dikumpulkan melalui wawancara, pemeriksaan klinis, laboratorium, radiologi, serta pengukuran kadar vitamin D dan zinc serum. Analisis bivariat menggunakan uji chi-square dan multivariat menggunakan regresi logistik. Hasil: Mayoritas responden adalah laki-laki 34 (68%) dan usia <60 tahun 38 (76%). Sebanyak 31 (62%) memiliki kadar vitamin D rendah (<30 ng/mL) dan 48 (96%) mengalami defisiensi zinc (<60 µg/dL). Kadar vitamin D berhubungan signifikan dengan nilai Cycle Threshold (CT) TCM sputum (p = 0.009), namun tidak signifikan dengan derajat kerusakan paru pada foto toraks (p = 0.500). Analisis multivariat menunjukkan bahwa kadar vitamin D rendah meningkatkan risiko memiliki bacterial load tinggi (TCM high, CT <16) dengan OR = 34,27 (p = 0.010). Sebaliknya, kadar zinc serum tidak menunjukkan hubungan bermakna dengan bacterial load, derajat kerusakan paru, maupun variabel demografis lainnya (p > 0.05). Disisi lain TCM high menunjukan hubungan yang signifikan dengan derajat kerusakan paru sedang (p =0,028; OR =4,883; (95% CI: 1,183–20,148). Simpulan: Defisiensi vitamin D berhubungan signifikan dengan tingginya beban kuman pada pasien TB paru, tetapi tidak berhubungan dengan derajat kerusakan paru. Kadar zinc serum tidak berhubungan dengan beban kuman maupun kerusakan paru. Pemantauan kadar vitamin D dapat dipertimbangkan sebagai biomarker tambahan dalam evaluasi klinis TB paru.

Review

This study addresses a crucial area in global health, investigating the role of micronutrients, specifically vitamin D and zinc, in pulmonary tuberculosis (TB) patients in Indonesia, a country with a significant TB burden. The research is particularly relevant given the acknowledged role of these micronutrients in immune responses against *Mycobacterium tuberculosis* and the stated scarcity of local data in Bali. The objective to assess correlations between serum levels of vitamin D and zinc with sputum bacterial load (via TCM) and the degree of lung damage on chest radiography is well-defined and contributes valuable insights into the pathophysiology and potential adjunctive management strategies for TB. The methodology employed a cross-sectional, observational analytic design involving 50 pulmonary TB patients, utilizing standard data collection methods including interviews, clinical assessments, laboratory tests, chest radiography, and direct serum measurements of vitamin D and zinc. The findings reveal a high prevalence of vitamin D deficiency (62%) and remarkably high zinc deficiency (96%) within the study cohort. Critically, low vitamin D levels were significantly associated with a higher bacterial load (TCM high, CT <16), with a compelling odds ratio of 34.27, highlighting a strong potential link. Conversely, vitamin D levels showed no significant association with the degree of lung damage. Serum zinc levels, despite the high prevalence of deficiency, did not demonstrate significant associations with either bacterial load or lung damage. Interestingly, a high TCM category itself was found to be significantly associated with moderate lung damage. The study’s robust finding regarding vitamin D deficiency and bacterial burden provides compelling evidence for its role in TB pathogenesis and disease severity, supporting the notion of vitamin D as a potential adjunctive biomarker. While the lack of association for zinc is noteworthy, it may warrant further investigation given the extremely high prevalence of deficiency, perhaps suggesting different mechanistic roles or the need for more sensitive markers. The cross-sectional design limits causal inferences, and the relatively small sample size (n=50) from a single center in Bali might affect the generalizability of the findings. Nonetheless, the results strongly advocate for considering vitamin D status in the clinical evaluation of pulmonary TB patients, potentially guiding supplementation strategies and future research into larger, prospective, and interventional studies to confirm causality and explore the impact of correcting these deficiencies on clinical outcomes.

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