Estudo de marcadores inflamatórios de fase aguda nos estados reacionais da hanseníase

Abstract

Leprosy reactions are acute inflammatory episodes that occur mainly in the multibacillary forms of the disease. The reactions are classified as type 1 (reverse reaction) or type 2 (erythema nodosum leprosum). The type 2 reactions are systemic episodes, while in type 1 reaction the inflammation is located in the skin lesions and peripheral nerve. Few studies have assessed the nonspecific inflammatory markers in the follow up of the reactional episodes of leprosy. The aim of this study was to describe the profile and the kinetics of some hematological and biochemical markers of systemic inflammatory response in patients with leprosy reactions before and after treatment of the reactional episode. Methods: The study included patients aged 18 to 69 years assisted at a leprosy treatment reference center in the Hospital Universitário Júlio Muller – University Federal of Mato Grosso, Cuiabá, Mato Grosso, Brazil. Patients who were pregnant; were using immunosuppressant drugs or immunobiologicals; or had an autoimmune disease, human immunodeficiency virus infection, acquired immune deficiency syndrome, or tuberculosis were excluded. Patients were divided to three groups: with type 1 reaction, with type 2 reaction and without leprosy reaction (control). Upon recruitment, all individuals were clinically assessed for skin lesions and neural or systemic impairment. Some patients had already completed treatment for leprosy, while others were still undergoing treatment or had initiated treatment after being admitted. The treatment of the reactional episode was started only after the initial evaluation. Laboratory assessments were performed upon admission (baseline) and at approximately 30 and 60 days (time points 1 and 2, respectively). The results of the acute phase laboratory tests were compared between the three groups. Results: A total of 124 leprosy patients were recruited between June 2012 and August 2015; among them, 56, 42, and 26 presented with type 1, type 2, and no reactions, respectively. The changes found in patients with type 1 reaction were monocytosis and neutrophilia. After the introduction of therapeutic, only monocytosis remained. Patients with type 2 reaction showed changes in several inflammation markers of acute phase, such as: leukocytosis, neutrophilia, increased erythrocyte sedimentation rate, elevated serum levels of C-reactive protein and α-1 acid glycoprotein, reduction [Digite uma citação do [Digite uma citação do [Digite uma citação do 16 of serum levels of albumin and lipoproteins. Conclusion: Anemia, leukocytosis, neutrophilia and monocytosis are present at the diagnosis of type 2 leprosy reaction and return to normal values normalize after the treatment of the reaction episode, except for monocytosis. The serum levels of α-1 acid glycoprotein and C-reactive protein, as well as the erythrocyte sedimentation rate are increased and reduced with the treatment. Serum levels of uric acid, albumin, cholesterol, HDL and LDL cholesterol are reduced and increase after treatment. The changes in acute phase inflammatory markers observed in this study may help in the diagnosis of type 2 reactions and also to differentiate between type 1 and type 2 leprosy reactions. The systematic analysis of these changes may be useful for therapeutic monitoring of patients with type 2 leprosy reaction.