支气管灌洗液SIRT-1、TGF-β1及PINP水平与肺结核患者支气管狭窄发生风险的关系及其预测价值分析

Relationship between the Levels of SIRT-1,TGF-β1 and PINP in Bronchial Lavage Fluid and the Risk of Bronchial Stenosis in Patients with Pulmonary Tuberculosis and Their Predictive Value Analysis

目的:探讨支气管灌洗液中沉默信息调节因子1(SIRT-1)、转化生长因子-β1(TGF-β1)及I型前胶原N端前肽(PINP)水平与肺结核患者支气管狭窄发生风险的关系,并分析三指标预测肺结核发生支气管狭窄的价值。方法:选择2020年2月至2023年2月江苏大学附属宜兴医院收治的187例肺结核患者,根据是否发生支气管狭窄分为狭窄组(86例)和非狭窄组(101例)。检测并比较两组支气管灌洗液SIRT-1、TGF-β1及PINP水平和肺功能。Pearson相关性分析支气管灌洗液SIRT-1、TGF-β1及PINP水平与肺功能的相关性。多因素Logistic回归模型分析肺结核患者发生支气管狭窄的影响因素。受试者工作特征(ROC)曲线分析支气管灌洗液SIRT-1、TGF-β1及PINP水平预测肺结核患者发生支气管狭窄的价值。结果:狭窄组肺不张、呼吸困难比例、支气管灌洗液TGF-β1、PINP水平高于非狭窄组(P<0.05),SIRT-1水平、第1秒用力呼气量(FEV1)、用力肺活量(FVC)、最大呼气峰流速(PEF)低于非狭窄组(P<0.05)。支气管狭窄肺结核患者的支气管灌洗液SIRT-1水平与FEV1、FVC、PEF呈正相关(P<0.05),TGF-β1、PINP水平与FEV1、FVC、PEF呈负相关(P<0.05)。多因素Logistic回归分析,结果显示,呼吸困难、高水平TGF-β1、高水平PINP是肺结核患者发生支气管狭窄的危险因素(P<0.05),高水平SIRT-1则是保护因素(P<0.05)。支气管灌洗液SIRT-1、TGF-β1及PINP单独检测预测肺结核患者发生支气管狭窄的曲线下面积(AUC)为0.736、0.799、0.730,联合检测支气管灌洗液SIRT-1、TGF-β1及PINP预测的AUC为0.861,高于单独指标检测的预测效能。结论:支气管狭窄肺结核患者的支气管灌洗液中SIRT-1水平降低,TGF-β1、PINP升高,且与肺功能下降以及支气管狭窄发生风险增加有关,支气管灌洗液SIRT-1、TGF-β1及PINP水平检测对肺结核患者发生支气管狭窄具有一定预测价值,且联合检测的预测效能更高。

Objective:To investigate the relationship between the levels of silent information regulator 1(SIRT-1),transforming growth factor-β1(TGF-β1)and type I procollagen N-terminal propeptide(PINP)in bronchial lavage fluid and the risk of bronchial stenosis in patients with pulmonary tuberculosis,and to analyze the value of three indicators in predicting bronchial stenosis in patients with pulmonary tuberculosis.Methods:187 patients with pulmonary tuberculosis who were admitted to Yixing Hospital Affiliated to Jiangsu University from February 2020 to February 2023 were selected,and patients were divided into stenosis group(86 cases)and non-stenosis group(101 cases)according to whether bronchial stenosis occurred.The levels of SIRT-1,TGF-β1 and PINP in bronchial lavage fluid and lung function were detected and compared between two groups.The correlation between the levels of SIRT-1,TGF-β1 and PINP in bronchial lavage fluid and lung function were analyzed by pearson correlation analysis.The influencing factors of bronchial stenosis in patients with pulmonary tuberculosis were analyzed by multivariate Logistic regression model.The value of SIRT-1,TGF-β1 and PINP levels in bronchial lavage fluid in predicting bronchial stenosis in patients with pulmonary tuberculosis were analyzed by receiver operating characteristic(ROC)curve.Results:The proportion of atelectasis and dyspnea,the levels of TGF-β1 and PINP in bronchial lavage fluid in stenosis group were higher than those in non-stenosis group(P<0.05),and the levels of SIRT-1,forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and peak expiratory flow(PEF)were lower than those in non-stenosis group(P<0.05).The level of SIRT-1 in bronchial lavage fluid of patients with bronchial stenosis and pulmonary tuberculosis was positively correlated with FEV1,FVC and PEF(P<0.05),and the levels of TGF-β1 and PINP were negatively correlated with FEV1,FVC and PEF(P<0.05).Multivariate logistic regression analysis showed that,dyspnea,high level of TGF-β1 and high level of PINP were risk factors for bronchial stenosis in patients with pulmonary tuberculosis(P<0.05),while high level of SIRT-1 was a protective factor(P<0.05).The area under the curve(AUC)of bronchial lavage fluid SIRT-1,TGF-β1 and PINP for predicting bronchial stenosis in patients with pulmonary tuberculosis was 0.736,0.799 and 0.730 respectively.The AUC of combined detection of bronchial lavage fluid SIRT-1,TGF-β1 and PINP was 0.861,which was higher than that of single index detection.Conclusion:The level of SIRT-1 in bronchial lavage fluid of patients with bronchial stenosis and pulmonary tuberculosis decrease,and the levels of TGF-β1 and PINP increase,which are relate to the decrease of lung function and the increase of the risk of bronchial stenosis,the detection of SIRT-1,TGF-β1 and PINP levels in bronchial lavage fluid has certain predictive value for bronchial stenosis in patients with pulmonary tuberculosis,and the predictive efficiency of combine detection is higher.