活动性结核患者CD4+T淋巴细胞的影响因素及诊断价值

Analysis of the risk factors and diagnostic value of CD4+T lymphocytes in patients with active tuberculosis

目的探讨活动性结核患者中CD4+T淋巴细胞相关影响因素及诊断价值。方法对2016年10月1日至2018年6月30日在我院住院治疗的确诊活动性结核患者进行回顾性横断面研究,收集了患者的基本情况(包括性别、年龄等)、血常规检查、血清蛋白电泳及细菌学4个方面的信息。根据CD4+T淋巴细胞计数分为免疫功能低下组和正常组。单因素筛选后,采用多因素Logistic回归分析法分析免疫功能低下的危险因素。通过受试工作特征曲线(ROC)评估危险因素的诊断效能。结果单因素分析显示:合并肺外结核、年龄、体质量指数、血红蛋白、红细胞沉降率、白蛋白、a1球蛋白和β1球蛋白与CD4+T淋巴细胞相关(均P<0.05)。多因素分析显示:白蛋白(OR=1.094,95%CI:1.041~1.151,P<0.001)和β1球蛋白水平(OR=1.508,95%CI:1.013~2.244,P=0.043)是CD4+T淋巴细胞的独立危险因素。ROC曲线分析显示:白蛋白和β1球蛋白可预测活动性结核患者的免疫功能,最佳临界值、灵敏度、特异度分别为29.62 g/L、82.50%、47.18%和3.81 g/L、53.75%、68.72%。结论白蛋白和β1球蛋白降低是活动性结核患者免疫功能低下的独立危险因素,其最大使用价值可能是支持性的诊断作用。

Objective To investigate the risk factors and diagnostic value of CD4+T lymphocytes in pa-tients with active tuberculosis.Methods A retrospective cross-sectional study was performed in patients who were diagnosed with active tuberculosis and were hospitalized in our hospital from October 1,2016 to June 30,2018.The demographic information of the patients(including gender,age,etc.),results of blood routine examination,serum protein electrophoresis and bacteriology were collected.According to the number of CD4+T lymphocyte,the patients were further divided into immunodeficiency-and control group.After single-factor screening,multivariate logistic regression analysis was adopted to analyze the risk factors of immunocompromised patients.The diagnostic efficacy of risk factors was evaluated by Receive Operating Characteristic(ROC).Results Univariate analysis showed 8 parameters:extrapulmonary tuberculosis,gender,body mass index,hemoglobin level,erythrocyte sedimentation rate,albumin level,a1 globulin,β1 globulin,were correlated with CD4+T cell(P<0.05 for all).Multivariate analysis showed that albumin(OR=1.094,95%CI:1.041~1.151,P<0.001)andβ1 globulin level(OR=1.508,95%CI:1.013~2.244,P=0.043)were risk factors for CD4+T cell.ROC curve analysis showed that albumin andβ1 globin could predict that the immune function of patients and the optimal critical value,sensitivity and specificity of patients with active tuberculosis were 29.62 g/L,82.50%,47.18%,3.81 g/L,53.75%and 68.72%,respectively.Conclusion The decrease of albumin andβ1 globin level serves as the inde-pendent risk factors for immune dysfunction in patients with active tuberculosis,and their greatest roles may reflect on diagnostic support.