结核菌素试验和血清载脂蛋白A1与抗结核药物性肝损伤的关系

Relationship between tuberculin test with serum apolipoprotein A-1 and anti-tuberculosis drug-induced liver injury

目的探讨结核菌素(PPD)试验、血清载脂蛋白A1(apolipoprotein A-1,ApoA-1)水平与抗结核药物性肝损伤(anti-tuberculosis drug-induced liver injury,ATB-DILI)的关系。方法选取2017年1月至2021年6月于中国人民解放军联勤保障部队第九六七医院住院治疗且确诊为肺结核的患者541例,依据是否发生ATB-DILI分为病例组(56例)和对照组(485例)。记录所有患者一般临床资料。采用二元Logistic回归分析ATB-DILI发生的影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线判断PPD试验及ApoA-1水平对ATB-DILI的预测价值。结果与对照组比较,病例组PPD试验呈强阳性的数量较多,ApoA-1水平较低,差异有统计学意义(均P<0.05)。ROC曲线显示,PPD试验强阳性、ApoA-1<1.175 g/L可以作为判断ATB-DILI的独立影响因素。结论PPD试验反应强度和ApoA-1水平对ATB-DILI具有一定的预测价值,两者联合对ATB-DILI的预测价值更高。

Objective To explore the relationship between tuberculin test(PPD)with serum apolipoprotein A-1(ApoA-1)and anti-tuberculosis drug-induced liver injury(ATB-DILI).Methods Totally 541 tuberculosis patients diagnosed at 967 Hospital of the Joint Logistics Support Force of PLA from January 2017 to June 2021 were divided into case group(56 cases)and control group(485 cases)as whether or not ATB-DILI,and the general clinical data of included subjects were recorded.Influencing factors of ATB-DILI were analyzed by binary Logistic regression,and receiver operating characteristic(ROC)curve was used to determine the predictive value of PPD test and serum ApoA-1 for ATB-DILI.Results The patients in case group were more positive PPD test,decreased ApoA-1 level as compared to the patients in control group,and with statistically significant difference between groups(all P<0.05).The ROC curve showed that strong positive PPD test and ApoA-1 level<1.175 g/L could play a part of independent factors for judging ATB-DILI.Conclusion Response intensity of PPD test and ApoA-1 level has certain predictive value for ATB-DILI,and the combination of the two displays a more higher predictive value for ATB-DILI.