耐药肺结核患者血清可溶性白细胞分化抗原14、降钙素原、白介素-22水平变化及对抗结核疗效的预测价值

Changes of serum soluble CD14,procalcitonin and interleukin-22 levels in drug-resistant pulmonary tuberculosis and their value in predicting antituberculosis efficacy

目的:探究耐药肺结核患者血清可溶性白细胞分化抗原14(sCD14)、降钙素原(PCT)、白介素-22(IL-22)水平变化,并分析其对抗结核疗效的预测价值。方法:选取196例肺结核患者为研究对象,根据耐药情况分为耐药组(n=97)和非耐药组(n=99)。比较两组血清sCD14、PCT、IL-22水平,比较耐药组不同临床特征患者血清各指标水平,分析其与耐药肺结核临床特征的相关性。耐药组均根据结核菌培养及药敏试验结果进行规范化抗结核治疗6个月,对比转阴患者、未转阴患者治疗前、治疗1、3、6个月后血清sCD14、PCT、IL-22水平及变化值。分析治疗前后血清指标水平变化值与抗结核疗效的关系及其预测抗结核疗效的价值。结果:耐药组血清sCD14、PCT、IL-22水平高于非耐药组高(均P<0.05);耐药组血清各指标水平与肺部空洞、耐药程度、病情程度呈正相关(均P<0.05);未转阴患者治疗前、治疗1、3、6个月后血清各指标水平高于转阴患者,其水平变化值低于转阴患者(均P<0.05);血清各指标变化值与抗结核疗效呈正相关(P<0.05);治疗3个月后血清各指标变化值联合预测抗结核疗效的AUC大于治疗1个月后血清各指标变化值联合预测的AUC(P<0.05)。结论:耐药肺结核患者血清sCD14、PCT、IL-22水平升高,且与病情严重程度、抗结核疗效有关,联合检测其水平对抗结核疗效具有一定预测价值。

Objective:To investigate the serum levels of soluble leukocyte differentiation antigen 14(sCD14),procalcitonin(PCT)and interleukin-22(IL-22)in patients with drug-resistant tuberculosis,and to analyze the predictive value of their anti-tuberculosis efficacy.Methods:A total of 196 patients with pulmonary tuberculosis were selected as research objects,and divided into drug-resistant group(97 cases)and non-drug-resistant group(99 cases)according to drug resistance.Serum levels of sCD14,PCT and IL-22 were compared between the two groups.The serum levels of different clinical characteristics of patients in drug-resistant group were compared,and the correlation between them and the clinical characteristics of drug-resistant pulmonary tuberculosis was analyzed.The drug-resistant group received standardized anti-tuberculosis therapy for 6 months according to the results of tuberculosis culture and drug sensitivity test.Serum levels and changes of sCD14,PCT and IL-22 in patients with negative conversion and patients without negative conversion were compared before treatment,and 1,3 and 6 months after treatment.The relationship between the change of serum indexes levels before and after treatment and the antituberculous effect and the value of predicting the antituberculous effect were analyzed.Results:The serum levels of sCD14,PCT and IL-22 in drug-resistant group were higher than those in non-drug-resistant group(all P<0.05).The levels of serum indexes in drug resistant group were positively correlated with pulmonary cavity,drug resistance degree and disease degree(all P<0.05).The levels of serum indexes in patients without conversion to negative were higher than those in patients with conversion to negative before treatment,and 1,3 and 6 months after treatment,and the change values were lower than those in patients with conversion to negative(all P<0.05).The changes of serum indexes were positively correlated with the antituberculosis efficacy(all P<0.05).The AUC combined with the changes of serum indexes after 3 months of treatment was greater than the AUC combined with the changes of serum indexes after 1 month of treatment(P<0.05).Conclusion:The serum levels of sCD14,PCT and IL-22 in patients with drug-resistant tuberculosis are increased,which is related to the severity of the disease and the anti-tuberculosis efficacy.The combined detection of their levels has certain predictive value for the anti-tuberculosis efficacy.