摘要
目的探讨白细胞介素(interleukin,IL)-31、乳铁蛋白(lactoferrin,LF)、IL-10联合检测对肺结核的诊断价值。方法选取2021年1月至2022年12月邯郸市第一医院收治的活动期肺结核患者100例作为结核组,非结核肺部疾病患者100例作为非结核肺病组,并招募健康体检者50例作为对照组。采用双抗体夹心检测3组研究对象血清IL-31、IL-10水平,酶联免疫吸附法检测血清LF水平,高分辨率CT(high resolution CT,HRCT)评分检测肺结核活动度,实时荧光定量PCR法检测结核分枝杆菌载量。比较3组研究对象及结核组不同特征患者血清IL-31、LF、IL-10水平,分析血清IL-31、LF、IL-10水平与HRCT评分、结核分枝杆菌载量相关性,评价血清IL-31、LF、IL-10联合诊断肺结核价值及不同诊断方案的临床效用。结果与非结核肺病组、对照组相比,结核组血清IL-31、LF、IL-10水平明显升高,差异有统计学意义[pg/L:(14.83±4.90)比(8.79±2.86)比(39.66±12.57),pg/mL:(839.76±278.03)比(812.59±268.34)比(1103.64±359.77),pg/mL:(60.83±17.19)比(52.42±13.78)比(94.57±25.60),F=298.02,23.13、98.48,P值均<0.001]。结核组不同性别、年龄、体质量指数患者血清IL-31、LF、IL-10水平比较,差异无统计学意义(P>0.05)。病变肺野数>2个患者、有空洞患者、菌阳性患者、重症患者血清IL-31、LF、IL-10水平均明显高于病变肺野数≤2个患者、无空洞患者、痰菌阴性患者、轻症患者,差异有统计学意义[IL-31(pg/L):(47.25±13.94)比(30.00±9.99),(49.18±14.87)比(25.38±8.26),(51.34±12.78)比(30.10±9.52),(59.04±13.85)比(30.54±9.11);LF(pg/mL):(1395.18±348.00)比(924.95±232.08),(1491.50±381.69)比(521.85±171.22),(1267.88±308.26)比(969.26±281.59),(1548.71±368.47)比(894.20±257.19);IL-10(pg/mL):(136.58±19.66)比(68.82±14.02),(133.22±28.49)比(36.60±11.34),(120.79±22.62)比(73.12±14.58),(157.38±21.74)比(65.01±16.68),t=7.19、9.21、6.52、12.27、8.02、15.07、5.06、10.28、20.08、20.37、12.73,23.38,P值均<0.001]。Pearson相关分析显示,血清IL-31、LF、IL-10水平与HRCT评分、结核分枝杆菌载量呈正相关(r=0.77、0.72、0.66、0.77、0.76、0.72,P值均<0.05)。血清IL-31+LF+IL-10联合诊断肺结核的AUC为0.933,特异度为91.33%,敏感度为83.00%,临床决策曲线(decision curve analysis,DCA)显示三者联合的临床净获益阈值范围最大。结论肺结核患者血清-IL-31、LF、IL-10水平异常表达,三者联合检测具有一定诊断效用和临床应用性,可为肺结核临床诊断提供参考。
Objective:To explore the diagnostic value of combined detection of interleukin(IL)-31,lactoferrin(LF)and IL-10 for pulmonary tuberculosis.Methods:A total of 100 patients with active tuberculosis admitted to the First Hospital of Handan City from January 2021 to December 2022 were selected as a tuberculosis group,and 100 patients with non-tuberculous pulmonary disease were selected as the non-tuberculous pulmonary disease group,50 healthy individuals were recruited as the control group.The levels of serum IL-31 and IL-10 in the three groups of subjects were detected using a double antibody sandwich assay.The level of serum LF was detected by enzyme-linked immunosorbent assay.High-resolution CT(HRCT)scoring is used to detect the activity of tuberculosis.The load of Mycobacterium tuberculosis was detected by real-time quantitative PCR.The levels of serum IL-31,LF and IL-10 were compared among the three groups of subjects and patients with different characteristics in the tuberculosis group.The correlation between the levels of serum IL-31,LF,IL-10,and the HRCT score and the load of Mycobacterium tuberculosis was analyzed.The value of serum IL-31,LF and IL-10 in the combined diagnosis of pulmonary tuberculosis and the clinical utility of different diagnostic schemes were evaluated.Results:Compared with the non-tuberculosis pulmonary disease group and the control group,the levels of serum IL-31,LF and IL-10 in the tuberculosis group were significantly higher[pg/L:(14.83±4.90)vs(8.79±2.86)vs(39.66±12.57),pg/mL:(839.76±278.03)vs(812.59±268.34)vs(1103.64±359.77),pg/mL:(60.83±17.19)vs(52.42±13.78)vs(94.57±25.60),F=298.02,23.13,98.48,all P values<0.001].There was no significant difference in the levels of serum IL-31,LF and IL-10 among patients with different gender,age and body mass index in the tuberculosis group(P>0.05).The levels of serum IL-31,LF and IL-10 in patients with diseased lung fields>2,cavities,positive bacteria and severe disease were significantly higher than those in patients with diseased lung fields≤2,no cavities,negative sputum bacteria and mild diseas[IL-31(pg/L):(47.25±13.94)vs(30.00±9.99),(49.18±14.87)vs(25.38±8.26),(51.34±12.78)vs(30.10±9.52),(59.04±13.85)vs(30.54±9.11);LF(pg/mL):(1395.18±348.00)vs(924.95±232.08),(1491.50±381.69)vs(521.85±171.22),(1267.88±308.26)vs(969.26±281.59),(1548.71±368.47)vs(894.20±257.19);IL-10(pg/mL):(136.58±19.66)vs(68.82±14.02),(133.22±28.49)vs(36.60±11.34),(120.79±22.62)vs(73.12±14.58),(157.38±21.74)vs(65.01±16.68),t=7.19,9.21,6.52,12.27,8.02,15.07,5.06,10.28,20.08,20.37,12.73,23.38,all P values<0.001].Pearson correlation analysis showed that the levels of serum IL-31,LF and IL-10 were positively correlated with HRCT scores and Mycobacterium tuberculosis load(r=0.77,0.72,0.66,0.77,0.76,0.72,all P values<0.05).The AUC of serum IL-31+LF+IL-10 combined diagnosis of pulmonary tuberculosis was 0.933,with a specificity of 91.33%and a sensitivity of 83.00%respectively.The clinical decision curve analysis(DCA)shows that the clinical net benefit threshold range of the combination of the three was the largest.Conclusion:There is abnormal expression of serum IL-31,LF and IL-10 levels in patients with pulmonary tuberculosis.The combined detection of the serum IL-31,LF and IL-10 has certain diagnostic utility and clinical applicability,and can provide a reference for clinical diagnosis of pulmonary tuberculosis.
作者
赵艳艳
贾浩
郭杰
王烜
ZHAO Yanyan;JIA Hao;GUO Jie;WANG Xuan(Clinical Laboratory Department,Handan First Hospital,Handan 056002,China;Experimental Medicine Department,Handan First Hospital,Handan 056002,China)
出处
《国际免疫学杂志》
2025年第3期274-282,共9页
International Journal of Immunology
基金
邯郸市科学技术研究与发展计划项目(21422083069)。
作者简介
通信作者:贾浩,Email:jiahao301@163.com,电话:15003101013。
