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STUDIES
Year : 1997  |  Volume : 63  |  Issue : 2  |  Page : 78-81

Serum lipid profile in leprosy




Correspondence Address:
S N Bansal


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Source of Support: None, Conflict of Interest: None


PMID: 20944279

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  Abstract 

Serum lipids and lipoproteins were assessed in 40 patients of leprosy and 20 healthy controls (age & sex matched). The leprosy cases included 20 cases each of paucibacillary and multibacillary leprosy.


Keywords: Serum lipids, Paucibacillary leprosy, Multibacillary leprosy


How to cite this article:
Bansal S N, Jain V K, Dayal S, Nagpal R K. Serum lipid profile in leprosy. Indian J Dermatol Venereol Leprol 1997;63:78-81

How to cite this URL:
Bansal S N, Jain V K, Dayal S, Nagpal R K. Serum lipid profile in leprosy. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Jun 25];63:78-81. Available from: http://www.ijdvl.com/text.asp?1997/63/2/78/4522



  Introduction Top


Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Besides the immunological approach to the problem, workers have also attempted to study the biochemical alterations including the study of lipid metabolism as a guide for early diagnosis. The ability to synthesise different lipid moieties and their distribution through plasma to all body tissues seem to be disturbed in leprosy.[1] It has been reported that HDL-cholesterol estimation have some relevance for early diagnosis of lepromatous leprosy and it is also an index for differentiating between paucibacillary and multibacillary leprosy.[2] Investigation of lipid metabolism is of additional interest as atherosclerosis and myocardial infarction are rare in leprosy.[3] Lipids may also play an important role as an aetiological agent in vascular abnormality seen in leprosy patients.

Various studies have been done on the alteration in lipid metabolism in leprosy.[4][5][6] There are several reports regarding serum triglyceride, HDL-cholesterol, lipoproteins in leprosy and their correlation with the disease status.[7-9] However, there is only on report of quantitative estimates of VLDL in leprosy.[1]This prompted us to perform a comprehensive study to estimate the levels of all the fractions of serum lipids and lipoproteins in both paucibacillary and multibacillary leprosy patients.


  Materials and Methods Top


The study comprised of total 40 patients, 29 were males and 11 were females. Out of the 40 patients, 20 were of paucibacillary leprosy and 20 were of multibacillary leprosy. The age ranged from 10-60 years. 20 healthy volunteers (age and sex matched) of same socioeconomic status were taken as controls.

After a detailed history and a thorough clinical examination all patients were subjected to slit skin smear examination and histopathological examination of skin lesions and were classified according to Ridley Jopling scale.

The duration of illness was from 3 months to 5 years. Out of the 40 patients included in the study, 24 were new cases and remaining 16 were on multidrug therapy of duration ranging from 2 months to 2 years. All the 16 patients on treatment were of multibacillary group. Patients of alcoholism, diabetes mellitus, coronary heart disease and smokers were excluded from the study.

In all the cases, 10 ml of fasting venous blood samples were taken using aseptic technique and dry syringe. Serum was separated within one hour and complete lipid profile was done on the same day. Similarly lipid profiles of normal controls were done.

Serum triglyceride levels were estimated by the method of Neri and Frienges[10] and total cholesterol by method of Jung, Bigge and Moorahead.[11] HDL-cholesterol was estimated by method of Grove.[12] LDL-cholesterol and VLDL-cholesterol were estimated by method of Burstein[13] and Freidwald.[14] All concetrations were expressed in mg%.

In addition to lipid fractions liver function tests (serum glutamic oxalo-acetic transaminase, serum glutamic pyruvic transaminase and albumin/globulin ratio) were also done in each case.

Student 't' test was applied for determination of statistical significance.


  Results Top


It was observed that the serum triglyceride concentration both in paucibacillary and multibacillary groups was low as compared to control group but the difference was not statistically significant.

The values of total serum cholesterol were significantly decreased when compared between paucibacillary group and control group (p-value <0.025) and but no statistically significant difference was noted between multibacillary group and control group.

The levels of HDL-cholesterol were found to be significantly increased both in paucibacillary group (p-value <0.05) and multibacillary group (P-value <0.05) as compared to controls. VLDL-cholesterol values did not show any significant change in either of the groups when compared to controls. It was also noticeable that LDL-cholesterol values were significantly decreased for both paucibacillary and multibacillary groups when compared with control group (p-value <0.05 and p-value <0.005 respectively).

When values of various lipid parameters were compared between paucibacillary and multibacillary group it was found that the difference was not statistically significant.

The results of various liver function tests ie SGOT, SGPT and A/G ratio were within normal limits in all the cases.


  Discussion Top


The significant decrease in serum triglyceride levels in various forms of leprosy have been reported by various workers.[1][4][5][6][7][9] This decrease may be in part due to overall decrease of total lipids seen in leprosy patients[4] or it may be due to decreased lipogenic activity as a result of reported adrenocortical dysfunction.[15] In the present report also the serum triglyceride levels were found to be decreased in both the groups of leprosy patients as compared to controls but the changes were not statistically significant.

Significant reduction in serum cholesterol in multibacillary leprosy patients has onsistently been reported by earlier workers.[1][4][5][6][7]9] But in the present study statistically significant decrease in the total serum cholesterol levels has been observed in paucibacillary leprosy group of patients. This observation is in contrast to the earlier reports which have shown a marked decrease in multibacillary group. Low serum cholesterol in LL patients reported by earlier workers may be due to hepatic involvement as evidenced by several studies indicating hepatic dysfunction.[16][17] In our study no hepatic dysfunction was oberved in our multibacillary patients. This may be the reason for not finding any significant decrease of serum cholesterol in our multibacillary leprosy-patients. The more pronounced fall of serum cholesterol levels in paucibacillary group found in our study may also be due to the fact that most of our multibacillary patients were on drugs (16 patients out of 20) for a period ranging from 2 months to 2 years. It has been shown that treatment of leprosy patients results in rise in cholesterol levels which may even return to normal.[10]

Our study also indicates that in both paucibacillary and multibacillary patients there is a significant increase in (HDL-cholesterol levels (P<0.05 for both groups). These results are comparble with those of earlier reports.[1][2][8] High levels of serum HDL cholesterol are associated with a low incidence of complications of atherosclerosis and coronary heart disease.[1] This may be the reason for the rarity of atherosclerosis and coronary heart disease in leprosy patients.[3]

We have also found a significant decrease in LDL cholesterol in both paucibacillary and multibacillary leprosy patients. This is in accordance to the findings by the earlier workers.[1][5][6]

Values of very low density lipoproteins cholesterol was not significantly altered in our study in both groups of leprosy patients as compared to controls. There is only one earlier report of VLDL cholesterol levels in leprosy patients which have shown a highly significant decrease in VLDL cholesterol levels.[1] Hence, our report regarding VLDL cholesterol levels is not in accordance to this earlier report[18].

 
  References Top

1.Ahaley SK, Sardeshmukh AS, Suryakar AN, Samson PD. Correlation of serum lipids and lipoproteins in liprosy. Ind J Lep 1992;64:91-8.  Back to cited text no. 1  [PUBMED]  
2.Kumar N, Saraswat PK, Sankar A. Estimation of high density lipoprotein cholesterol in the diagnosis of lepromatous leprosy. Ind J Lep 1988;60:60-3.  Back to cited text no. 2    
3.Desikan KV, Job CK. A review of post-mortem findings in 37 cases of lepromatous leprosy. Int J Lep 1968;36:32.  Back to cited text no. 3    
4.Misra UK, Venkitasubramaniam TA. Serum lipids in leprosy by silicic acid column chromatography. Int J Lep 1964;32:248-59.  Back to cited text no. 4    
5.Sritharan V, Venkatesan K, Bhardwaj VP, Ramu G. Serum lipid profile in leprosy. Lep India 1979;51:515-20  Back to cited text no. 5    
6.Kher JR, Baji PS, Ganeriwal SK, Reddy BV, Bulakh PM. Serum lipoproteins in lepromatous leprosy. Lep India 1983;55:80-5.  Back to cited text no. 6  [PUBMED]  
7.Kumar B, Kaur S, George T, Chakravarty RN, Ganguly NK. Serum lipids in leprosy. Lep India 1980;52:433-9.  Back to cited text no. 7    
8.Sritharan VF, Bhardwaj VP, Venkatesan K, Girdhar BK, Desikan KV. High density lipoprotein cholesterol (HDL-C) analysis in leprosy patients. Lepro Rev 1984;55:67-71.  Back to cited text no. 8    
9.Chung TH, Lee KS, Suh SB. Determination of high density lipoprotein cholesterol and individual cholesteryl esters in leprosy patients. Int J Lep 1986;54:490.  Back to cited text no. 9    
10.Neri BP, Frienges CS. Improved methods of determination of triglycerides in serum. Clin Chem 1973;19:1201.  Back to cited text no. 10    
11.Jung DH, Bigge HG, Moorehead WR. Colorimetry in serum cholesterol with the use of ferric acetate uranyl acetate and ferrous sulphate/sulphuric acid regagents. Clin Chem 1975;21:1526-30.  Back to cited text no. 11    
12.Grove CH. The estimation of HDL-cholesterol in serum. Clin Chem 1979;25:560.  Back to cited text no. 12    
13.Burstein M, Samaille J. On rapid determination of cholesterol bound to beta and pre-beta lipoproteins. Clin Chem Acta 1960;5:609.  Back to cited text no. 13  [PUBMED]  
14.Freidwald Wt, Levy Rl, Fredrickson DS. Estimation of concentration of LDL-cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem 1972;18:499.  Back to cited text no. 14    
15.Moshe B, et al. Adrenal cortical dysfunction in leprosy. Int J Lep 1969;37:35.  Back to cited text no. 15    
16.Shivde AV, Junnarkar RV. Serum transminases in leprosy in relation to liver damage. Int J Lep 1976;35:366-4.  Back to cited text no. 16    
17.Venkatesan K, Bhardwaj VP. Sequential biochemical investigations in lepromatous leprosy. Lep Ind 1987;50:166-1.  Back to cited text no. 17    
18.Dhople AM, Magar NG. Blood Cholesterol and phospholipids in leprosy. Lep Ind 1964;36:87-92.  Back to cited text no. 18    


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