淋巴细胞亚群分类对肾移植受者活动性肺结核的诊断价值

Diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis in renal transplant recipients

目的探讨淋巴细胞亚群分类在诊断肾移植受者活动性肺结核中的临床价值。方法回顾性分析52例肾移植术后受者的临床资料。根据影像学检查和病原学检查结果,将52例受者分为稳定组(19例)、结核组(9例)、细菌组(12例)以及真菌组(12例)。比较各组受者的肾功能情况;分析并比较各组受者淋巴细胞亚群的比例和绝对值;分析淋巴细胞亚群分类在肾移植术后活动性肺结核中的诊断价值。结果与稳定组比较,结核组、细菌组、真菌组的血尿素氮和血清肌酐水平均明显升高(均为P<0.05),CD3^+、CD8^+、CD4^+、自然杀伤(NK)细胞和CD19^+淋巴细胞亚群的比例差异无统计学意义(均为P>0.05),CD3^+、CD8^+、CD4^+、NK和CD19^+淋巴细胞亚群的绝对值明显降低(均为P<0.05)。结核组和真菌组的CD8^+淋巴细胞亚群比例明显高于细菌组(均为P<0.05)。CD8^+淋巴细胞亚群比例在鉴别诊断肾移植受者活动性肺结核和细菌性肺炎中的最佳临界值是33.27%,灵敏度和特异度分别为0.889和0.833,曲线下面积(AUC)为0.880。结论淋巴细胞亚群分类可为肾移植受者活动性肺结核与细菌性肺炎的鉴别诊断和个体化治疗方案提供辅助诊断依据。

Objective To evaluate the clinical value of lymphocyte subset classification in the diagnosis of active pulmonary tuberculosis in renal transplant recipients.Methods Clinical data of 52 recipients undergoing renal transplantation were retrospectively analyzed.According to the results of imaging and etiological examination,52 recipients were divided into the stable group(n=19),tuberculosis group(n=9),bacteria group(n=12)and fungi group(n=12),respectively.The renal function of recipients was compared,and the proportion and absolute value of lymphocyte subset were analyzed and compared among four groups.The diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis after renal transplantation was evaluated.Results Compared with the stable group,the levels of blood urea nitrogen and serum creatinine in the tuberculosis group,bacteria group and fungi group were significantly increased(all P<0.05).The proportion of CD3^+,CD8^+,CD4^+,natural killer(NK)cells and CD19^+lymphocyte subsets were not significantly different(all P>0.05).And the absolute values of CD3^+,CD8^+,CD4^+,NK cells and CD19^+lymphocyte subsets were significantly decreased(all P<0.05).The proportion of CD8^+lymphocyte subset in the tuberculosis group and fungi group was significantly higher than that in the bacteria group(both P<0.05).The optimal cut-off value of CD8+lymphocyte subset ratio in the differential diagnosis of active pulmonary tuberculosis and bacterial pneumonia was 33.27%,and the sensitivity and specificity were 0.889 and 0.833,respectively.The area under the curve(AUC)was 0.880.Conclusions The classification of lymphocyte subset can provide auxiliary diagnostic basis for differential diagnosis and individualized treatment of active pulmonary tuberculosis and bacterial pneumonia in renal transplant recipients.