血清gelsolin和补体C9检测水平与肺结核病灶侵及胸膜的相关性分析

Correlation between serum gelsolin and complement C9 levels and pulmonary tuberculosis lesions invading pleura

目的探讨血清gelsolin和补体C9检测水平与肺结核病灶侵及胸膜的相关性.方法选取2017年1月至2018年12月陕西省结核病防治院收治初治继发性肺结核患者100例,分为未侵及胸膜组(n=37)和侵及胸膜组(n=63).采用酶联免疫吸附法(ELISA)检测血清gelsolin水平,免疫透射比浊法检测血清补体C9水平.采用Logistic多元逐步回归分析筛选结核病灶侵及胸膜的影响因素,ROC曲线分析血清gelsolin和补体C9诊断结核病灶侵及胸膜的效能.结果侵及胸膜组白蛋白、γ干扰素释放试验水平低于未侵及胸膜组(t=12.274、10.917,P值均<0.05);侵及胸膜组痰菌检查阳性率和gelsolin、补体C9水平高于未侵及胸膜组(χ^2=5.420、t=61.230、21.195,P值均<0.05).血清gelsolin、补体C9水平与侵及胸膜面积、IGRA、痰菌检查呈正相关(r=0.851、0.492、0.695、0.641、0.430、0.510,P值均<0.05).血清gelsolin、补体C9和痰菌检查阳性为结核病灶侵及胸膜的危险因素(OR=3.315、1.706、1.408,P值均<0.05).血清gelsolin、补体C9和痰菌检查阳性诊断结核病灶侵及胸膜的ROC曲线下面积(AUC)分别为0.88、0.74和0.89,有一定的诊断价值.3组AUC进行比较,痰菌检查的最大,gelsolin次之,补体C9最小,但痰菌检查和gelsolin的AUC差异无统计学意义,痰菌检查诊断的敏感度和特异度均最高,分别为76.64%和95.65%.结论侵及胸膜的肺结核患者血清中gelsolin和补体C9水平升高,与肺结核病灶侵及胸膜呈相关性,可作为肺结核病灶侵及胸膜的辅助诊断指标.

Objective To investigate the correlation between serum gelsolin and complement C9 levels and pulmonary tuberculosis lesions invading pleura .Methods 100 newly treated patients with secondary pulmonary tuberculosis in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 2017 to December 2018 were divided into non-invasive pleural group ( n =37) and invasive pleural group ( n =63).Serum gelsolin level was detected by ELISA and serumcomplement C9 level was detected by immunoturbidimetry .Logistic stepwise regression analysis was used to screen the influencing factors of tuberculosis lesions invading pleura .ROC curve was used to analyze the efficacy of complement gelsolin and C9 in diagnosing tuberculosis lesions invading pleura .Results The levels of albumin and IGRA in invasive pleura group were lower than those of in non-invasive pleura group ( t = 12 .274 ,10 .917 ,both P <0 .05).The positive rate of sputum bacteria and the levels of gelsolin and complement C9 in invasive pleura group were higher than those of in non-invasive pleura group (χ^2 =5 .420 , t =61 .230 ,21 .195 ,all P <0 .05).Serum gelsolin and complement C9 levels were positively correlated with pleural invasion area ,IGRA and sputum bacteria ( r = 0 .851 ,0 .492 ,0 .695 ,0 .641 ,0 .430 ,0 .510 ,all P < 0 .05 ).Serum gelsolin , complement C9 and positive sputum bacteria were risk factors for tuberculosis lesions invading pleura ( OR =3 .315 ,1 .706 ,1 .408 ,all P < 0 .05).The area under ROC curve ( AUC) of serum gelsolin ,complement C9 and sputum bacterium in diagnosis of tuberculosis lesions invading pleura were 0 .88 ,0 .74 and 0 .89 respectively ,which had certain diagnostic value .Compared with the AUC of three groups , sputum bacterium examination was the largest , gelsolin was the second and complement C9 was the smallest ,but there was no significant difference between sputum bacterium examination and gelsolin′s AUC .The sensitivity and specificity of sputum bacterium examination were the highest ,76 .64% and 95 .65% respectively .Conclusions The serum levels of gelsolin and complement C9 are high in patients with pulmonary tuberculosis invading pleura , which are correlated with pulmonary tuberculosis invading pleura .Both can be used as an auxiliary diagnostic index for pulmonary tuberculosis invading pleura .