肺结核继发性纤维化指标检测的临床研究

The Clinical Study of the Detection of Serum Fibrosis Markers and Others in the Patients with Secondary Fibrosis Following Pulmonary Tuberculosis

目的通过测定肺结核不同性质病变患者的血清纤维化指标及炎症指标的含量,研究血清纤维化四项检测对肺结核继发性纤维化的早期诊断与防治的临床意义,探讨纤维化与炎症的关系。方法活动性肺结核患者根据病变性质分为3组:浸润渗出组、干酪坏死组、纤维空洞组。选择稳定期肺结核为阴性对照,肺纤维化患者为阳性对照。各组进行炎性指标血沉、腺苷脱氨酶、C反应蛋白、乳酸脱氢酶,及血清纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原肽(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)的测定。结果稳定期肺结核患者血清炎性指标及纤维化指标结果正常。活动性肺结核患者各项指标除Ⅳ-C外均有明显升高,与稳定期肺结核对比差异有统计学意义(P<0.05);与纤维化组比较除LN外其余指标无统计学差异。纤维化指标HA、PC-Ⅲ、Ⅳ-C间存在显著正相关性。HA、CRP、LDH三者之间存在显著正相关性。ADA、ESR、LN三者之间有显著正相关性。结论肺结核的早期即有纤维化的发生,纤维化的程度与炎症程度成正比。检测纤维化指标可了解结核的活动性及其纤维化程度。

Objective Via detecting of the fibrosis and inflammation markers in patients with pulmonary tuberculosis in different type,study the clinical value of the makers in the early diagnosis and preventive treatment in patients of secondary fibrosis following pulmonary tuberculosis,and investigate the correlation between the serum level of fibrosis and inflammation makers.Methods According to the characteristic of the pathological changes in lung CT,the patients with active pulmonary tuberculosis were divided in three groups：infiltration group,cheesy necrosis group and chronic fibrotic cavitys group.Selected patients with the stable pulmonary tuberculosis as the negative control group.Selected patients with pulmonary interstitial fibrosis as the positive control.Detected the level of erythrocyte sedimentation rate（ESR）,serum lactate dehydrogenase（LDH）,adenosine deaminase（ADA）,c-reactive protain（CRP）,hyaluronic acid（HA）,type Ⅲ precollagen（PC-Ⅲ）,type Ⅳ collagen（Ⅳ-C）,laminin（LN） in everyone′s blood.Results The serum level of the fibrosis and inflammation markers was normal in patients with stable tuberculosis.The levels of all the markers except Ⅳ-C in patients with active tuberculosis increased significantly and there are statistical difference compared to the patients with stable tuberculosis（P0.05）,but no significant difference compared to that with fibrosis except for the marker LN.Among the following combined markers-HA,LDH,CRP,there were positive correlation.Same result could be observed among the other two combined makers：HA,PC-Ⅲ,Ⅳ-C and LN,ESR,ADA.Conclusion In the early stage of pulmonary tuberculosis,fibrosis had occurred in lung and the degree of fibrosis is relative to the degree of the local inflammation.Detecting the fibrosis markers can help us to understand the reactivity of the pulmonary tuberculosis and the degree of the fibrosis in lung.