血清25羟基维生素D、基质金属蛋白酶抑制剂-1、粒细胞-巨噬细胞集落刺激因子在肺结核患者中的表达及与病情的关系

SERUM 25-(OH)VD,TIMP-1,GM-CSF EXPRESSION CHANGES IN PULMONARY TUBERCULOSIS PATIENTS AND ITS RELATIONSHIP WITH THE DEGREE OF ILLNESS

目的探究血清25羟基维生素D[25-(OH)VD]、基质金属蛋白酶抑制剂-1(TIMP-1)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)在肺结核患者中的表达变化及与病情程度的关系。方法选取2017年6月—2020年2月重庆大学附属三峡医院94例肺结核患者作为观察组,另选同期94例健康体检者作为对照组。比较二组血清25-(OH)VD、TIMP-1、GM-CSF水平,并比较观察组不同临床特征(性别、年龄、肺病变范围、有无空洞、痰菌阴阳性)、不同病情程度(重症、轻症)患者血清各指标水平,比较观察组不同病情程度患者高分辨CT(HRCT)评分,探究血清25-(OH)VD、TIMP-1、GM-CSF与肺结核发病、肺结核患者HRCT评分的关系,探讨肺结核患者血清各指标间的关联性。结果观察组血清25-(OH)VD水平低于对照组,TIMP-1、GM-CSF水平均高于对照组(均P<0.05);经Logistic回归分析显示,在控制了性别、年龄等基线资料后,随着血清25-(OH)VD水平降低和血清TIMP-1、GM-CSF水平升高,肺结核发病风险逐渐升高(均P<0.05);肺结核患者血清25-(OH)VD与TIMP-1水平间存在负相关关系,TIMP-1与GM-CSF间存在正相关关系,GM-CSF与25-(OH)VD间存在负相关关系(P<0.05);肺病变范围≥2个肺野、有空洞、痰菌阳性患者血清25-(OH)VD水平低于肺病变范围<2个肺野、无空洞、痰菌阴性患者,TIMP-1、GM-CSF水平高于肺病变范围<2个肺野、无空洞、痰菌阴性患者(P<0.05);肺结核患者HRCT评分与血清25-(OH)VD水平间存在负相关关系,与血清TIMP-1、GM-CSF水平间存在正相关关系(均P<0.05),以上差异均具有统计学意义。结论肺结核患者血清25-(OH)VD水平明显降低,血清TIMP-1、GM-CSF异常升高,均为肺结核发生的影响因素,且与肺结核患者肺部病变存在良好线性关系,有助于临床评估患者病情,指导针对性治疗方案的制定。

Objective To investigate the expression of serum 25-hydroxy vitamin D[25-(OH)VD],tissue inhibitor of metalloproteinase-1(TIMP-1),granulocyte macrophage colony factor(GM-CSF)in patients with pulmonary tuberculosis and its relationship with the degree of the disease.Methods From June 2017 to February 2020,ninety-four cases of pulmonary tuberculosis patients in Three Gorges Hospital were selected as the research group,and 94 healthy patients in the same period were selected as the control group.Comparing the serum 25-(OH)VD,TIMP-1,GM-CSF levels between the two groups,and comparing the serum levels of patients in the study group with different clinical characteristics(gender,age,lung lesion range,presence or absence of voids,sputum bacteria negative),and different degrees of illness(severe,mild).Comparing the high-resolution CT(HRCT)scores of patients with different degrees of illness in the study group to explore the relationship between serum 25-(OH)VD,TIMP-1,GM-CSF and the incidence of tuberculosis and HRCT scores of patients with tuberculosis,and exploring the correlation between serum tuberculosis patients with various indexes.Results The serum 25-(OH)VD level of the study group was lower than that of the controlgroup,and the levels of TIMP-1 and GM-CSF were higher than that of the control group(P<0.05);Logistic regression analysis showed that after controlling for baseline data such as gender and age,as the serum 25-(OH)VD level decreased and serum TIMP-1 and GM-CSF levels increased,the risk of pulmonary tuberculosis gradually increased(P<0.05);there was a negative correlation between serum 25-(OH)VD and TIMP-1 levels in patients with pulmonary tuberculosis,a positive correlation between TIMP-1 and GM-CSF,and a negative correlation between GM-CSF and 25-(OH)VD(P<0.05);serum 25-(OH)VD level in patients with lung lesions≥2 lung fields,cavitation,positive sputum bacteria was lower than the range of lung lesions<2 lung fields,no cavity,sputum bacteria negative patients,TIMP-1,GM-CSF levels were higher than the range of lung lesions<2 lung fields,no cavity,sputum bacteria negative patients(P<0.05);there was a negative correlation between the HRCT score of patients with pulmonary tuberculosis and serum 25-(OH)VD levels,and a positive correlation between serum TIMP-1 and GM-CSF levels,above differences are statistically significant(auP<0.05).Conclusion The serum 25-(OH)VD level of pulmonary tuberculosis patients is significantly reduced,and the serum TIMP-1 and GM-CSF are abnormally increased,both of which are influencing factors for the occurrence of pulmonary tuberculosis,and there is a good linear relationship with lung lesions of pulmonary tuberculosis patients,which is helpful for clinical evaluation of patients’conditions and guides the formulation of targeted treatment plans.