活动期肺结核患者血浆miR-29家族及血清、外周血单个核细胞中γ干扰素的表达及意义

Expression and significance of the plasma miR-29 family and interferon-gamma in serum and peripheral blood mononuclear cells of patients with active pulmonary tuberculosis

目的观察分析活动期肺结核患者血浆miR-29家族及血清、外周血单个核细胞中γ干扰素(IFN-γ)的表达及其临床意义。方法选取2018年1月—2020年1月济南市人民医院、山东省胸科医院收治的肺结核患者104例,按有无临床症状分为活动性肺结核组(n=52)和潜伏结核感染组(n=52),另选同期医院体检健康者45例作为健康对照组,收集临床资料,ELISA法测定血清IFN-γ水平,RT-PCR法分别测定血浆miR-29a、miR-29b、miR-29c和外周血单个核细胞IFN-γmRNA水平。分析血清IFN-γ、血浆miR-29a水平与活动性肺结核临床症状的关系及其对活动性肺结核的临床诊断价值。结果血浆miR-29a表达比较,活动性肺结核组>潜伏结核感染组>健康对照组,差异具有统计学意义(F=3.841,P=0.020);血浆miR-29b和miR-29c比较,3组差异无统计学意义(P>0.05)。单个核细胞IFN-γmRNA和血清IFN-γ比较,活动性肺结核组<潜伏结核感染组<健康对照组,差异具有统计学意义(F/P=30.840/0.000,1475.000/0.000)。活动性肺结核组有无发热、咯血患者中血清IFN-γ、血浆miR-29a水平比较差异有统计学意义(P<0.01)。ROC曲线分析显示,血清IFN-γ、血浆miR-29a诊断活动性肺结核的临界值为257.31 pg/ml、1.13,曲线下面积(AUC)为0.614、0.753,敏感度为0.573、0.682,特异度为0.801、0.802;二者联合诊断活动性肺结核的AUC为0.784,敏感度为0.710,特异度为0.850。结论血浆miR-29a和血清IFN-γ表达可能与结核病的发病、临床表现有关,可用于活动期肺结核的诊断。

Objective To observe and analyze the expression of plasma miR-29 family and interferon gamma(IFN-γ)in serum and peripheral blood mononuclear cells of patients with active pulmonary tuberculosis and its clinical significance.Methods A total of 104 pulmonary tuberculosis patients admitted to Jinan People's Hospital and Shandong Chest Hospital from January 2018 to January 2020 were selected and divided into active pulmonary tuberculosis group(n=52)and latent tuberculosis infection group(n=52).Another 45 healthy patients in the hospital during the same period were selected as the healthy control group.Clinical data were collected.Serum IFN-γlevels were determined by ELISA,and plasma miR-29a,miR-29b,miR-29c and IFN-γmRNA levels in peripheral blood mononuclear cells were determined by RT-PCR.The relationship between serum IFN-γ,plasma miR-29a levels and clinical symptoms of active pulmonary tuberculosis and its clinical diagnostic value for active pulmonary tuberculosis were analyzed.Results Plasma miR-29a expression was compared,the active tuberculosis group>latent tuberculosis infection group>healthy control group,the difference was statistically significant(F=3.841,P=0.020).Compared with plasma miR-29b and miR-29c,there was no significant difference between the three groups(P>0.05).Compared with monocyte IFN-γmRNA and serum IFNγ,the active tuberculosis group<latent tuberculosis infection group<healthy control group,the difference was statistically significant(F/P=30.840/0.000,1475.000/0.000).There were statistically significant differences in serum IFNγand plasma miR-29a levels in patients with active pulmonary tuberculosis with or without fever and hemoptysis(P<0.01).ROC curve analysis showed that the cut-off values of serum IFN-γand plasma miR-29a for the diagnosis of active pulmonary tuberculosis were 257.31 pg/ml,1.13,the area under the curve(AUC)was 0.614,0.753,the sensitivity was 0.573,0.682,and the specificity was 0.801,0.802;The AUC of the combined diagnosis of active pulmonary tuberculosis is 0.784,the sensitivity is 0.710,and the specificity is 0.850.Conclusion The expression of plasma miR-29a and serum IFN-γmay be related to the incidence and clinical manifestations of tuberculosis,and can be used for the diagnosis of active pulmonary tuberculosis.