人中性粒细胞分化抗原CD64指数在结核病辅助诊断中的应用价值

Application value of the CD64 index of human neutrophil leukocyte differentiation antigen in the auxiliary diagnosis of tuberculosis

目的探讨中性粒细胞分化抗原CD64(nCD64)作为一种新的生物标志物在结核病诊断中的应用价值。方法选取2019至2020年在湖南省胸科医院就诊的部分肺结核患者和非结核肺部疾病患者,以及健康对照人群为研究对象,收集患者外周血并通过流式细胞术进行nCD64检测,绘制受试者工作曲线(ROC),计算其灵敏度和特异度。同时,以干扰素释放试验(IGRA)为对照,评价其临床诊断参考价值。结果共纳入141例结核病患者、85例非结核肺部疾病患者(包括非结核分枝杆菌病患者52例和其他呼吸道疾病患者33例)以及76例健康对照组(包括结核潜伏感染者22例和非结核潜伏感染的健康人群54例)。结核病患者的nCD64指数为2.03(0.71,5.58),均显著高于非结核肺部疾病患者[1.48(1.14,2.56)](t=3.06,P<0.01)、结核潜伏感染者[0.57(0.25,0.71)](t=4.312,P<0.01)和健康人群[0.58(0.33,0.79)](t=4.322,P<0.01),差异均有统计学意义(P<0.01)。nCD64指数用于结核病诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为80.9%、72.4%、84.4%、67.1%和77.9%,同IGRA结果相比较,差异均无统计学意义,Kappa值为0.657,两种方法具有较好的一致性。结论nCD64指数在检测活动性结核病患者中具有良好的灵敏度和特异度,作为一个诊断标志物,在诊断结核病和鉴别结核潜伏感染者和非结核分枝杆菌病中具有临床诊断价值。

This study explored the value of neutrophil differentiation antigen CD64(nCD64)as a new biomarker for auxiliary diagnosis of tuberculosis.Patients with tuberculosis and non-tuberculosis pulmonary disease treated at Hunan Chest Hospital from 2019 to 2020,as well as healthy controls,were studied.The peripheral blood of participants was collected,and nCD64 detection was performed through flow cytometry.A receiver operating curve(ROC)was drawn to calculate the sensitivity and specificity.The clinical reference value of the interferon release test(IGRA)was evaluated.We enrolled 141 patients with tuberculosis;85 patients with non-tuberculous pulmonary disease,including 52 with non-tuberculous mycobacterium(NTM)disease and 33 with other respiratory diseases;and 76 healthy controls,including 22 with latent tuberculosis infection(LTBI)and 54 healthy people without LTBI.The nCD64 index of tuberculosis patients was 2.03(0.71,5.58),a value significantly higher than that of patients with non-tuberculous pulmonary disease[1.48(1.14,2.56)](t=3.06,P<0.01),participants with LTBI[0.57(0.25,0.71)](t=4.372,P<0.01),and healthy people[0.58(0.33,0.79)](t=4.322,P<0.01).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of nCD64 index for tuberculosis diagnosis were 80.9%,72.4%,84.4%,67.1%,and 77.9%,respectively.Differences were not statistically significant with respect to the IGRA results.Kappa analysis indicated a Kappa value of 0.657.The two methods had good consistency.In conclusion,the sensitivity and specificity of the nCD64 index were very effective in the detection of patients with active tuberculosis.As a diagnostic marker,the nCD64 index has clinical diagnostic value forthe diagnosis of tuberculosis,and differentiation between LTBI and NTM disease.