Study of copper, zinc and cerruloplasmin albumin ratio in pulmonary tuberculosis patients on different drug regimes

Introduction: Pulmonary Tuberculosis (PTB) is a severe bacterial infection that continues to be the main cause of morbidity and mortality. Compromised immune status due to micronutrient deficiency is one of the key factors predisposing to PTB infection. The aim of the present study was to assess the trace elements Copper and Zinc status in PTB patients and to evaluate the diagnostic role of Cerruloplasmin (Cp) and Cerruloplasmin Albumin ratio (Cp/Alb). Method: 120 Adult PTB patients (60 newly diagnosed and 60 relapse) attending the Institute of Respiratory Disease, SMS Medical College, Jaipur and 60 healthy non family members of patients / Controls were enrolled for the study. After informed consent, sputum examination and Routine Biochemical analysis along with Serum Copper (Cu), Zinc (Zn) and Cerruloplasmin (Cp) were estimated in fasting sample for all subjects. Result and Discussion: Serum Protein, Albumin and Zinc were significantly reduced in PTB group as compared to controls due to increased catabolism, anorexia, pre-existing undernutrition and Acute Phase Response associated with PTB. Serum Cu and Cp were significantly high which may be due to increased hepatic synthesis of acute phase proteins. Cu correlated strongly only to Cu/Zn ratio but the later was found to have good correlation with all parameters estimated. Similarly, Cp/Alb ratio correlates well with Cp as well as Cu and Zinc. Conclusion: Trace elements alteration in PTB is significant and can be used in nutritional monitoring of patients. Early estimation of micronutrient status can help identify at risk individuals and prevent occurrence of relapse. This would also enhance survival and early recovery of patients. Cp/Alb ratio can be used as additional tool to assist diagnosis and Prognosis of PTB.