肺结核患者感染新冠病毒免疫功能的相关性分析

Correlation Analysis of Immune Function of Tuberculosis Patients Infected with COVID-19

目的分析肺结核患者共感染新冠肺炎的免疫学指标,明确其免疫状态,探讨相关指标与免疫状态的关系及特点。方法以昆明市第三人民医院收治的TB共感染COVID-19者为研究组(n=111),另选同期未感染COVID-19的TB患者为对照组(n=1649),分析2组血清学免疫指标。结果经PSM倾向性匹配排除年龄、性别等混杂因素后,TB-COVID组CD19^(+)、CD3^(+)、CD4^(+)、lymphocyte和IL-8水平低于TB组,IL-10、IL-17、IL-6高于TB组,差异有统计学意义(P<0.05);对以上差异指标做ROC曲线,分析TB-CCVID免疫危险因素,CD19^(+)、IL-10和IL-6对TB感染COVID-19的灵敏度和特异性分别为71.4%和56.7%、59.1%和77.0%、59.1%和77.7%,AUC分别为0.659(95%CI:0.583~0.736,P<0.05)、0.645(95%CI:0.558~0.732,P<0.05)、0.649(95%CI:0.564~0.734,P<0.05);根据年龄划分亚组比较,结果TB-COVID组IL-1β、IL-2、IL-4、IL-8、TFN-α、IL-12p70在21~40岁急剧攀升远超TB组,并随年龄增长逐渐回落。结论TB患者共感染COVID-19后免疫状态交叉影响,相较于TB患者,TB-COVID多项免疫指标降低,与细胞免疫及细胞因子风暴相关,需加强关注。

Objective To analyze the immunological indicators of TB patients co-infected with COVID-19,clarify their immune status,and explore the relationship and characteristics of relevant indicators with immune status.Methods The study group consisted of TB patients infected with COVID-19 admitted to the Third People's Hospital of Kunming City(n=111),while TB patients who were not infected with COVID-19 during the same period were selected as the control group(n=1649)for the analysis of serum immunological indicators.Results After excluding confounding factors such as age and gender through PSM propensity matching,the TBCOVID group showed lower levels of CD19^(+),CD3^(+),CD4^(+),lymphocyte,and IL-8 compared to the TB group,while IL-10,IL-17,and IL-6 were higher in the TB-COVID group,with statistically significant differences(P<0.05).ROC curve analysis of the above differing indicators was performed to analyze the immune risk factors of TBCOVID.The sensitivity and specificity of CD19^(+),IL-10,and IL-6 for TB infection with COVID-19 were 71.4%and 56.7%,59.1%and 77.0%,59.1%and 77.7%,respectively.The AUC values were 0.659(95%CI:0.583~0.736,P<0.05),0.645(95%CI:0.558~0.732,P<0.05),and 0.649(95%CI:0.564~0.734,P<0.05).When comparing subgroups based on age,in the TB-COVID group,IL-1β,IL-2,IL-4,IL-8,TFN-α,and IL-12p70 sharply increased in the 21-40 age group far beyond the TB group,and gradually declined with increasing age.Conclusion TB patients have a weakened immune system after being infected with COVID-19,with multiple immune indicators lower compared to TB patients.This is related to cell immunity and cytokine storm,so we need to pay more attention to TB-COVID cases.