外周血过氧化物酶体增殖物激活受体γ联合γ-干扰素检测对终末期肾病患者结核感染的早期诊断价值

Early diagnosis value of peripheral blood PPARγcombined with IFN-γdetection for tuberculosis infection in patients with end-stage renal disease

目的 探讨外周血过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor γ, PPARγ)联合γ-干扰素(γ-interferon, IFN-γ)释放试验(γ-interferon release assay, IGRA)对终末期肾病(end-stage renal disease,ESRD)患者肺结核的早期诊断价值,为临床诊断治疗提供参考。方法 选取2019年1月—2021年12月在河北省胸科医院治疗70例合并有肺结核可疑症状终末期肾病患者为研究对象,根据检查结果分为终末期肾病患者40例(ESRD组)、终末期肾病合并肺结核患者30例(合并症组),另以肺结核(pulmonary tuberculosis, PTB)患者40例作为PTB组。3组患者均进行IGRA试验,同时酶联免疫吸附试验检测外周血PPARγ水平,探讨PPARγ联合IGRA检测对终末期肾病合并肺结核的诊断价值。结果 PTB组与合并症组PPARγ表达水平及IFN-γ含量高于ESRD组(P<0.05),而PTB组与合并症组间PPARγ表达水平及IFN-γ含量相比差异无统计学意义(P>0.05)。受试者工作特征(receiver operator characteristic, ROC)曲线显示,PPARγ、IGRA诊断终末期肾病合并肺结核曲线下面积为0.823(95%CI:0.722~0.925)、0.773(95%CI:0.662~0.883),联合检测的曲线下面积为0.928(95%CI:0.871~0.984)优于单独PPARγ、IGRA(Z=2.057、2.843,P=0.039、0.005)。血清PPARγ、IGRA试验诊断终末期肾病合并肺结核与临床金标准结果比较Kappa值为0.557、0.444(P<0.05)。二者联合筛出ESRD合并肺结核与临床金标准一致性较高(Kappa=0.661,P<0.05)。30例终末期肾病合并肺结核患者中,PPARγ联合IGRA试验诊断终末期肾病合并肺结核的灵敏度为93.33%(28/30),高于PPARγ、IGRA试验单独诊断的灵敏度70.00%(21/30)、66.67%(20/30)(P<0.05)。结论 外周血PPARγ、IGRA试验对终末期肾病合并肺结核有一定的诊断价值,二者联合检测能够提高灵敏度,降低漏诊率,值得临床推广。

Objective To explore the early diagnostic value of peripheral blood peroxisome proliferator-activated receptorγ(PPARγ)combined withγ-interferon(IFN-γ)release assay(IGRA)in the diagnosis of pulmonary tuberculosis in patients with end-stage renal disease(ESRD),and to provide reference for clinical diagnosis and treatment.Methods From January 2019 to December 2021,70 ESRD patients with suspicious symptoms of pulmonary tuberculosis were treated at Hebei Chest Hospital were selected as the research objects.According to the examination results,they were divided into ESRD group(40 cases)and ESRD complicated by pulmonary tuberculosis(40 cases,comorbidity group).In addition,40 cases with pulmonary tuberculosis were used as the PTB group.All three groups of patients underwent IGRA test,and the peripheral blood PPARγlevel was detected by enzyme-linked immunosorbent assay,and the diagnostic value of PPARγcombined with IGRA test for ESRD patients with pulmonary tuberculosis was explored.Results The expression level of PPARγand IFN-γcontent in the PTB group and the comorbidity group were obviously higher than those in the ESRD group(P<0.05),while the differences in PPARγexpression level and IFN-γcontent between the PTB and comorbidity groups were not statistically significant(P>0.05).The ROC curve showed that the areas under the curve(AUC)of PPARγand IGRA in the diagnosis of endstage renal disease combined with tuberculosis were 0.823(95%CI:0.722-0.925)and 0.773(95%CI:0.662-0.883),respectively,and the AUC of combined detection was 0.928(95%CI:0.871-0.984),which was better than that of PPARγand IGRA alone(Z/P=2.057/0.039,2.843/0.005).The Kappa values of serum PPARγand IGRA test compared with the clinical gold standard results in the diagnosis of ESRD complicated with pulmonary tuberculosis were 0.557 and 0.444(P<0.05).The combined screening of ESRD with pulmonary tuberculosis was consistent with the clinical gold standard(Kappa=0.661,P<0.05).Among the 30 ESRD patients complicated with pulmonary tuberculosis,the sensitivity of PPARγcombined with IGRA test in diagnosis of ESRD complicated with pulmonary tuberculosis was 93.33%(28/30),which was higher than 70.00%(21/30)of PPARγand 66.67%(20/30)of IGRA test alone(P<0.05).Conclusions Peripheral blood PPARγand IGRA tests have certain diagnostic value for ESRD complicated with tuberculosis,and the combined detection of the two can improve the sensitivity and reduce the rate of missed diagnosis,which is worthy of clinical promotion.