摘要
目的探讨血清基质金属蛋白酶-9(MMP-9)测定联合肺泡灌洗液Xpert MTB/RIF检测、γ-干扰素(INF-γ)释放试验对肺结核的诊断效能。方法选取2019年5月—2020年5月河北省胸科医院200例疑似肺结核患者,根据检查结果分为菌阳肺结核组(62例)、菌阴肺结核组(88例)、非肺结核组(50例),比较3组血清MMP-9、白细胞介素(IL)-15、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、红细胞沉降率(ESR)和INF-γ释放试验、结核分枝杆菌(MTB)培养、肺泡灌洗液Xpert MTB/RIF检测结果的差异,多因素分析采用Logistic回归分析,采用受试者工作特征(ROC)曲线评价血清MMP-9测定、肺泡灌洗液Xpert MTB/RIF检测、INF-γ释放试验单独和联合诊断肺结核的效能。结果菌阳肺结核组、菌阴肺结核组及非肺结核组MMP-9、INF-γ水平差异均有统计学意义(P<0.05),其他指标差异均无统计学意义(P>0.05)。肺结核患者MMP-9、INF-γ水平均高于非肺结核患者(P<0.05)。菌阳肺结核组Xpert MTB/RIF阳性率明显高于菌阴肺结核组(P<0.05),2个组之间INF-γ释放试验阳性率及INF-γ水平差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,MMP-9[比值比(OR)值为1.687,P=0.004]、INF-γ(OR=2.511,P=0.005)和Xpert MTB/RIF(OR=1.340,P=0.005)是肺结核的危险因素。Xpert MTB/RIF检测诊断肺结核的敏感性为86.7%,特异性为96.0%,准确性为89.0%;INF-γ释放试验诊断肺结核的敏感性为80.0%,特异性为62.0%,准确性为75.5%;MMP-9诊断肺结核的敏感性为80.7%,特异性为60.0%,准确性为75.0%;3种方法联合诊断肺结核的敏感性为90.7%,特异性为78.0%,准确性为87.5%。结论MMP-9和INF-γ高表达、Xpert MTB/RIF阳性是肺结核的危险因素,3种方法联合诊断肺结核的敏感性和特异性明显增强,具有一定的临床意义。
Objective To investigate the diagnostic efficacy of serum matrix metalloproteinase-9(MMP-9)combined with Xpert MTB/RIF assay in alveolar lavage fluid and interferon gamma(INF-γ)release test for pulmonary tuberculosis.Methods Totally,200 patients with suspected pulmonary tuberculosis in Hebei Chest Hospital from May 2019 to May 2020 were enrolled.According to the examination results,pulmonary tuberculosis group was subclassified into mycotic-positive pulmonary tuberculosis group(62 cases),mycoticnegative pulmonary tuberculosis group(88 cases)and non-pulmonary tuberculosis group(50 cases).The result differences of serum MMP-9,interleukin(IL)-15,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),INF-γrelease test,culture of sputum Mycobacterium tuberculosis(MTB),Xpert MTB/RIF assay in alveolar lavage fluid were compared among the 3 groups on the day of admission.Logistic regression analysis was used to draw receiver operating characteristic(ROC)curve to evaluate the diagnostic efficacy of serum MMP-9,Xpert MTB/RIF assay in alveolar lavage fluid and INF-γrelease test for pulmonary tuberculosis.Results There was statistical significance for MMP-9 and INF-γamong the 3 groups(P<0.05),and there was no statistical significance for the other indicators(P>0.05).The levels of MMP-9 and INF-γin pulmonary tuberculosis group were higher than those in non-pulmonary tuberculosis group(P<0.05).The positive rate of Xpert MTB/RIF in mycotic-positive pulmonary tuberculosis group was higher than that in mycoticnegative pulmonary tuberculosis group(P<0.05).Between mycotic-positive and mycotic-negative pulmonary tuberculosis groups,there was no statistical significance for the positive rate of INF-γrelease test and INF-γlevel(P>0.05).The positive rate of INF-γhad no statistical significance between mycotic-positive and mycotic-negative pulmonary tuberculosis groups(P>0.05).Logistic regression analysis showed that MMP-9[odds ratio(OR)=1.687,P=0.004],INF-γ(OR=2.511,P=0.005)and Xpert MT
作者
李晓倩
王智慧
池跃朋
王玉红
谢兰品
梁亚充
LI Xiaoqian;WANG Zhihui;CHI Yuepeng;WANG Yuhong;XIE Lanpin;LIANG Yachong(The Second Tuberculosis Department,Hebei Chest Hospital,Shijiazhuang 050041,Hebei,China)
出处
《检验医学》
CAS
2022年第1期11-15,共5页
Laboratory Medicine
基金
河北省医学科学研究课题(20200027)。
