تقييم مستويات بعض العوامل المناعية لدى مرضى المجاري البولية المصابين بالبكتيريا الموجبة والسالبة وعلاقتها بمستويات الزنك وفيتامينD

Evalution The Levels of some Immunological Markers in Patients with Urinary Tract Infection Infected with Gram Positive and Gram Negative Bacteria and Association with Levels of Zinc and Vitamin D

Abstract
Urinary tract infection (UTI) is a common disease in Iraq and the world, which has serious health effects. Many studies around the world have covered this disease from various aspects related to its causes, immune factors (natural and acquired immunity), and effective treatments. The current study attempts to focus on the immune aspect of infection by studying some factors of innate and adaptive immunity and its relationship to zinc and Vit. D3.
The methods used in this research include drawing venous blood from the patients and controls for the purpose of separating the sera. Then, the immune factors were Immunoglobulin G (IgG), Immunoglobulin M IgM, Toll-like receptor 2 (TLR2) and Toll-like receptor (TLR4) were measured by ELISA. Vitamin D3 and zinc were also measured.
General urine examination of patients and controls along with urine culture was performed on the same day as the venous blood sample was taken. The research design of the current study involved the collection of 80 urine and blood serum samples. Of these, 60 samples were taken from patients who visited Imam Hassan Al-Mujtaba Hospital and Imam Hussein Medical Educational City / Holy Karbala between December 2022 and April 2023 with complaints of urinary tract infections, and 20 samples were taken from healthy individuals during the same period.
A questionnaire specifically designed for the present study and it was used to collect all data related to patients and controls, including age, sex, congenital anomalies, diabetes, autoimmune diseases, pregnancy, elderly, etc. The sex was distributed to 50% females and 50% males. The ages of the participants ranged from 18 to 50 years, where patients and controls groups were divided into age subgroups. 35 (58.3%) of patients were diagnosed with recurrent urinary tract infections while 25 (41.6%) were diagnosed with non-recurrent urinary tract infections. It was found that most of the patients had a significant difference in the mean level of Pus Cells, RBCs, Epithelial Cells compared to the healthy controls.
The Results showed an increased IgG antibodies in UTI patients compared to the control group, with a significant increase in serum IgG (17.68 ng/ml) compared to the average amount of IgG (10.57 ng/ml) in controls.
However, there was a decreased level of IgM antibodies in UTI patients compared to the control group, This decrease was not significant. IgM was (153.7 ng/ml) in patients and (366.8 ng/ml) the controls group. The results of TLRs (2 and 4) showed that the serum level of TLR2 in patients’ group increased significantly compared to controls group. The mean level of TLR2 in patients’ group was 0.23ng/mL while in the control group was 0.16ng/mL.
Non-significant increase was noticed in the serum level of TLR4 in patients’ group compared to healthy controls group. It was 215.6 pg/mL in patients’ group and 187.6 pg/mL in the group of controls. Statistical analysis showed no differences between UTI patients and healthy subjects in vitamin D3 levels, but healthy subjects had a higher average preference. UTI patients had lower blood zinc levels than those of controls group.
The infection rates for each type of bacteria were also examined. E. coli had the highest percentage, followed by Staphylococcus epidermidis (21.66%), Pseudomonas aeruginosa (16.66%), Klebsiella pneumoniae (5%), and Staphylococcus aureus (1.66%). The study also measured the levels of TLR2 and TLR4, based on the types of bacteria, including Gram-negative and Gram-positive. The mean levels of TLR2 in patients with Gram-negative pathogens were lower than their levels with Gram-positive pathogens, while TLR4 in patients with Gram-positive pathogens was lower than in Gram-negative groups.
In both recurrent and non-recurrent groups, there was a significant difference in the mean levels of IgG compared to the controls group. The mean of IgM was in lowest levels in recurrent infections; however, it was non-significant. The mean level of IgM in recurrent infections, non-recurrent infections and controls were 77.68 ng/ml, 260.1 ng/ml, and 238.4 ng/ml, respectively.
Serum levels of TLR2 were increased in non-recurrent infections, with a significant increase compared to the recurrent infection group and controls group. Serum levels of TLR4 were slightly increased in non-recurrent infections, with no significant differences found among all groups. For vit. D3 and zinc there were no significant differences appear when the three groups of recurrent, non- recurrent, and controls compared among each other. The Spearman rank test analysis was used to show the response relationship among all immune markers (IgG, IgM, TLR2, and TLR4) and among vit. D3 and zinc in UTI patients. One significant correlation was found, and it was between TLR2 and D3.
In conclusion, IgG and TLR2 were significantly high, while IgM was insignificantly decreased, That may indicate to the importance of these factors in UTI pathogenicity and treatment. In general IgG, and TLR2 were dropped significantly in recurrent infections compared to non-recurrent infections and that could be because these factors are consumed during the recurrent infections.
The low levels of vit. D3 and Zn in patients may have a negative impact on the immune system in general and may have a role in increasing the UTIs. The correlation between D3 and zinc and UTI still needs much investigation to determine exactly when these two factors can have significant effect on the developing UTI and what other factors that can alter the results.