MicroRNA-625-5p、CD64对获得性免疫缺陷综合征结核病患者的诊断及预后价值研究

Diagnostic and prognostic values of microRNA-625-5p and CD64 for tuberculosis in AIDS patients

目的探究microRNA-625-5p(miR-625-5p)、CD64对获得性免疫缺陷综合征(AIDS)结核病患者的诊断及预后价值。方法选取2020年6月—2022年7月在江西省赣州市第五人民医院住院的76例AIDS患者为研究组。另取同期该院未患结核病的72例AIDS患者为对照组。采用实时荧光定量聚合酶链反应检测血清miR-625-5p的表达,流式细胞术检测外周血中性粒细胞和单核细胞表面CD64水平。结果研究组miR-625-5p相对表达量低于对照组(P<0.05),CD64水平高于对照组(P<0.05)。受试者工作特征曲线结果表明,miR-625-5p、CD64诊断AIDS患者合并结核病的敏感性分别为81.6%(95%CI:0.710,0.895)、82.9%(95%CI:0.725,0.906);特异性分别为66.7%(95%CI:0.546,0.773)、70.8%(95%CI:0.589,0.810)。两者联合诊断的敏感性和特异性分别为85.5%(95%CI:0.756,0.925)、88.9%(95%CI:0.793,0.951)。预后不良组HIV感染时间、CD64水平均高于良好组(P<0.05),CD4^(+)T、miR-625-5p水平均低于良好组(P<0.05)。多因素一般Logistic回归分析结果表明,HIV感染时间[OR=5.484(95%CI:1.874,16.042)]和CD64水平[OR=2.713(95%CI:1.022,7.207)]是患者预后不良的危险因素(P<0.05);CD4^(+)T水平[OR=0.357(95%CI:0.139,0.918)]和miR-625-5p相对表达量[OR=0.198(95%CI:0.074,0.530)]是患者预后不良的保护因素(P<0.05)。ROC曲线结果表明,miR-625-5p、CD64预测AIDS结核病患者预后的敏感性分别为79.3%(95%CI:0.603,0.920)、72.4%(95%CI:0.528,0.873);特异性分别为76.6%(95%,CI:0.620,0.877)、53.2%(95%CI:0.381,0.679);两者联合预测的敏感性和特异性分别为82.8%(95%CI:0.642,0.942)和78.7%(95%CI:0.643,0.893)。结论microRNA-625-5p和CD64可作为AIDS合并结核病的有效生物标志物,其不仅能提高诊断的准确性,还能预测患者的预后情况。

Objective To explore the diagnostic and prognostic values of microRNA-625-5p(miR-625-5p)and CD64 for tuberculosis in patients with acquired immune deficiency syndrome(AIDS).Methods A total of 76 AIDS patients hospitalized from June 2020 to July 2022 in the Fifth People's Hospital of Ganzhou City were selected as the study group.Additionally,72 AIDS patients without tuberculosis in the hospital during the same period were selected as the control group.Quantitative real-time polymerase chain reaction was used to measure the serum expression of miR-625-5p,and flow cytometry was employed to assess the CD64 expression on the surface of neutrophils and monocytes in peripheral blood.Results The relative expression of miR-625-5p in the study group was lower than that in the control group(P<0.05),while the CD64 expression in the study group was higher than that in the control group(P<0.05).The receiver operating characteristic(ROC)curve analysis demonstrated that the sensitivities of miR-625-5p and CD64 for diagnosing tuberculosis in AIDS patients were 81.6%(95%CI:0.710,0.895)and 82.9%(95%CI:0.725,0.906),with the specificities being 66.7%(95%CI:0.546,0.773)and 70.8%(95%CI:0.589,0.810).The sensitivity and specificity of the combination of miR-625-5p and CD64 for diagnosing tuberculosis in AIDS patients were 85.5%(95%CI:0.756,0.925)and 88.9%(95%CI:0.793,0.951),respectively.In the poor prognosis group,the duration of HIV infection and the CD64 expression were higher(P<0.05),while the frequency of CD4^(+)T cells and the expression of miR-625-5p were lower than those in the good prognosis group(P<0.05).The multivariable Logistic regression model analysis demonstrated that long duration of HIV infection[OR=5.484(95%CI:1.874,16.042)]and high expression of CD64[OR=2.713(95%CI:1.022,7.207)]were risk factors for poor prognosis(P<0.05),and that the high frequency of CD4^(+)T cell[OR=0.357(95%CI:0.139,0.918)]and high relative expression of miR-625-5p[OR=0.198(95%CI:0.074,0.530)]were protective factors for poor prognosis(P<0.05).The ROC curves showed that the sensitivities of miR-625-5p and CD64 for predicting the prognosis of AIDS patients with tuberculosis were 79.3%(95%CI:0.603,0.920)and 72.4%(95%CI:0.528,0.873),with the specificities being 76.6%(95%CI:0.620,0.877)and 53.2%(95%CI:0.381,0.679).The sensitivity and specificity of the combination of miR-625-5p and CD64 for predicting the prognosis of AIDS patients with tuberculosis were 82.8%(95%CI:0.642,0.942)and 78.7%(95%CI:0.643,0.893),respectively.Conclusions MicroRNA-625-5p and CD64 can serve as effective biomarkers for tuberculosis in AIDS patients,not only improving diagnostic accuracy but also predicting patient prognosis.