肺结核患者外周血干扰素-γ、D-二聚体、CD4+/CD8+水平与病情的相关性分析

Correlation Analysis of IFN-γ,D-D and CD4+/CD8+Levels in Peripheral Blood of Patients with Pulmonary Tuberculosis

目的:探讨肺结核患者外周血干扰素-γ(IFN-γ)、D-二聚体(D-D)、CD4^(+)/CD8^(+)水平与病情的相关性。方法:选取2020年3月—2023年3月信阳市第五人民医院收治的115例肺结核患者纳入研究组,选取同期115例健康体检者纳入对照组。根据疾病活动性将研究组患者分为活动性肺结核组72例和非活动性肺结核组43例,根据病情严重程度将活动性肺结核患者分为轻症组43例和重症组29例。比较不同疾病活动性、不同病情严重程度患者入院时外周血IFN-γ、D-D、CD4^(+)/CD8^(+)水平,分析入院时外周血IFN-γ、D-D、CD4^(+)/CD8^(+)水平与肺结核、疾病活动性、病情严重程度的相关性,采用受试者工作特征曲线(ROC)分析入院时外周血IFN-γ、D-D、CD4^(+)/CD8^(+)水平联合检测对重症肺结核的诊断价值。结果:入院时,研究组患者外周血IFN-γ、D-D水平均高于对照组患者,研究组患者CD4^(+)/CD8^(+)水平低于对照组患者,差异均有统计学意义(t=36.373、34.110、23.504,P<0.05)。入院时,活动性肺结核组患者外周血IFN-γ、D-D水平均高于非活动性肺结核组患者,活动性肺结核组患者CD4^(+)/CD8^(+)水平低于非活动性肺结核组患者,差异均有统计学意义(t=10.062、12.572、42.224,P<0.05)。入院时,重症组患者外周血IFN-γ、D-D水平均高于轻症组患者,重症组患者CD4^(+)/CD8^(+)水平低于轻症组患者,差异均有统计学意义(t=7.237、11.421、7.311,P<0.05)。入院时,外周血IFN-γ、D-D水平与肺结核、疾病活动性、病情严重程度均呈正相关,外周血CD4^(+)/CD8^(+)水平与肺结核、疾病活动性、病情严重程度均呈负相关。入院时,外周血IFN-γ、D-D、CD4^(+)/CD8^(+)水平联合诊断重症肺结核的曲线下面积(AUC)大于各单独指标诊断。结论:外周血IFN-γ、D-D、CD4^(+)/CD8^(+)水平与肺结核发生发展密切相关,联合检测有助于辅助临床诊断肺结核,且具有较高的诊断效能。

Objective:To investigate the correlation between the levels of interferon-γ(IFN-γ),D-dimer(D-D)and CD4^(+)/CD8^(+)in peripheral blood of patients with pulmonary tuberculosis.Methods:115 patients with pulmonary tuberculosis admitted to the hospital from March 2020 to March 2023 were selected as the study group,and 115 healthy subjects in the same period were selected as the control group.According to the disease activity,the patients with tuberculosis were divided into active tuberculosis(72 cases)and inactive tuberculosis(43 cases).According to the severity of the disease,the patients with active tuberculosis were divided into mild tuberculosis(43 cases)and severe tuberculosis(29 cases).The levels of peripheral blood IFN-γ,D-D and CD4^(+)/CD8^(+)were compared between the two groups,patients with different disease activity and severity of disease at admission,and the correlation between peripheral blood IFN-γ,D-D and CD4^(+)/CD8^(+)levels at admission and tuberculosis,disease activity and severity of disease was analyzed.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of combined detection of IFN-γ,D-D and CD4^(+)/CD8^(+)levels in peripheral blood on admission to hospital.Results:The levels of IFN-γand D-D in peripheral blood of the study group were higher than those of the control group,and the levels of CD4^(+)/CD8^(+)were lower than those of the control group(t=36.373,34.110,23.504;P<0.05).The levels of IFN-γand D-D in peripheral blood of severe patients were higher than those of mild patients,and the levels of CD4^(+)/CD8^(+)were lower than those of mild patients(t=10.062,12.572,42.224;P<0.05).At admission,the levels of IFN-γand D-D in peripheral blood of patients in the severe group were higher than those in the mild group,and the levels of CD4^(+)/CD8^(+)in the severe group were lower than those in the mild group,with statistically significanct difference(t=7.237,11.421,7.311;P<0.05).At admission,peripheral blood IFN-γand D-D levels were positively correlated with tuberculosis,disease activity,and disease severity,while peripheral blood CD4^(+)/CD8^(+)levels were negatively correlated with tuberculosis,disease activity,and disease severity.The AUC of the combined diagnosis of severe pulmonary tuberculosis with peripheral blood IFN-γ,D-D and CD4^(+)/CD8^(+)levels was greater than that of each single indicator at admission.Conclusion:IFN-γ,D-D,CD4^(+)/CD8^(+)are involved in the occurrence and development of pulmonary tuberculosis,and have high efficacy in the diagnosis of pulmonary tuberculosis.