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Am. J. Respir. Crit. Care Med., Volume 159, Number 1, January 1999, 143-148

Cytokine Levels Correlate with a Radiologic Score in Active Pulmonary Tuberculosis

MASSIMO CASARINI, FRANCO AMEGLIO, LUCILLA ALEMANNO, PROFETA ZANGRILLI, PAOLO MATTIA, GREGORINO PAONE, ALBERTO BISETTI, and SANDRO GIOSUÈ

Department of Cardiovascular and Respiratory Sciences, Lazzaro Spallanzani Institute, Instituto di Ricovero e Cura a Carattere Scientifico, La Sapienza University; San Gallicano Institute, Instituto di Ricovero e Cura a Carattere Scientifico; and Department of Pneumology, Carlo Forlanini Hospital, Rome, Italy

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This microorganism is capable of inducing a delayed hypersensitivity reaction in the lung, with subsequent expression of the disease. This reaction depends on the presence of different cytokines that exert specific functions. The aim of this study was to evaluate the presence and the concentrations of nine different modulators in bronchoalveolar lavage fluid (BALF). For this purpose, 15 patients with active pulmonary tuberculosis were enrolled at the time of diagnosis, prior to institution of antituberculous therapy. All the patients demonstrated M. tuberculosis in the sputum, and their disease extention was defined by high-resolution computed tomography (HRCT) using a score which included the presence of six findings: miliary nodules, nodules < 10 mm, consolidation, ground glass, cavity and bronchial wall thickening. This score was more sensitive than an equivalent score calculated on the basis of chest radiology. HRCT score was calculated for each area of the two lungs in order to define the more and the less affected lung for each patient. The bronchoalveolar lavage (BAL) was performed in the more affected area for each lung. The HRCT total score for each washed area ranged between 1 and 15, and showed more significant differences between the more and less affected lungs (p = 0.0004) than those obtained with the individual radiologic findings (p ranged between 0.60 and 0.004). The BAL concentrations of the nine cytokines evaluated for the more and less affected lungs were compared: interleukin-6 (IL-6), IL-8, IL-12, tumor necrosis factor-alpha (TNF-alpha ), and interferon gamma (IFN-gamma ) showed significant differences (p ranged between 0.016 and 0.0007). In addition, each cytokine concentration was correlated with the HRCT score. Significant correlations were found with IL-12, IL-6, IL-8, IL-2, and TNF-alpha . The correlations between cytokines and HRCT total score were better than those observed with the individual radiologic findings. A correlation matrix for the different cytokines evaluated one against each other, has also been added to show common behavior of these modulators. A similar analysis was also performed for the radiologic abnormalities.




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