活動性肺結核患者の末梢血単球のIL-1β，TNFα およびIL-6産生能と栄養障害との相互関連性の検討

Abstract

Nutritional disturbance has been empirically observed in patients with pulmonary tuberculosis. We have already demonstrated that malnutrition is frequent in these patients by scientific nutritional assessment, although the mechanism of this nutritional disturbance remains unclear. To elucidate this mechanism, I measured the production of interleukin-1β (IL-1β), tumor necrosis factor α (TNFα), and interleukin-6 (IL-6) by peripheral blood monocytes, and correlated them with nutritional parameters in those patients. Supernatants of monocyte cultures after 24 hours stimulation by lipopolysaccharide were analysed by enzyme liked immunosorbent assay for IL-1β, TNFα, and IL-6. In order to assess nutritional status I measured some visceral proteins (serum albumin, transferrin, prelbumin, retionl binding protein), plasma amino acids, and anthropometrics. The results are as follows. (1) Patients with pulmonary tuberculosis were confirmed to be malnourished in visceral proteins, plasma amino acids, and anthropometric indices. (2) In patients with moderate and mild nutritional depletion the production of IL-1β, TNFα, and IL-6 was significantly higher than in healthy controls, and correlated inversely with the nutritional parameters. (3) In patients with severe nutritional depletion the production of these cytokines was significantly lower than in healthy controls. The present study suggested an interaction between nutritional status and these cytokines : the hypermetabolic effects of IL-1β, TNFα, and IL-6 might induce nutritional disturbance in patients with pulmonary tuberculosis, and severe nutritional disturbance might in turn diminish the production of these cytokines.