结核杆菌伽马干扰素释放试验联合NK细胞及炎症因子变化检测在肺结核诊断及预后中的应用价值分析

The clinical value of TB-IGRAs combined NK cells and inflammatory factors measurement in the diagnosis and prognosis of pulmonary tuberculosis

目的研究结核杆菌伽马干扰素释放试验(TB-IGRAs)联合NK细胞及炎症因子变化检测在肺结核诊断及预后中的应用价值。方法回顾性分析2015年12月至2017年12月我院收治的疑似肺结核患者600例,选择同期于我院体检正常的健康对照200例。所有受试者均行TB-IGRAs,并检测NK细胞及炎症因子变化情况,评价各指标单独及联合检测在肺结核诊断和预后中的应用价值。结果 600例患者中肺结核共355例,非肺结核共245例,非肺结核患者主要疾病为肺部感染(165例,67.35%)。3组受试者NK细胞、炎症因子水平以及TB-IGRAs阳性率差异显著,其中肺结核组IP-10、MIP-1α、IL-8水平以及TB-IGRAs阳性率显著高于非肺结核组和健康组,而NK细胞水平显著低于非肺结核组和健康组(P<0.05)。TB-IGRAs、NK细胞以及所有细胞因子联合诊断的敏感性、特异性以及准确度均显著高于单项检测(P<0.05)。IL-8、MIP-1α以及联合检测的ROC曲线下面积分别为0.713、0.784、0.898,差异具有统计学意义(P<0.05)。肺结核患者经6个月治疗后,死亡38例(10.70%),其中死亡组患者NK细胞水平显著低于生存组,而IL-2、IL-8、IL-15、IP-10、MIP-1α水平显著高于生存组,联合诊断阳性组患者死亡率(11.24%)显著高于TB-IGRAs阳性组(6.51%),差异有统计学意义(P<0.05)。结论 TB-IGRAs联合NK细胞及炎症因子变化可提高活动性肺结核诊断的灵敏度、准确度,以及有效反应患者预后进展,值得临床推广。

To evaluate the clinical value of TB-IGRAs combined with NK cells and inflammatory factors measurement in the diagnosis and prognosis of pulmonary tuberculosis,total of 600 patients with suspected tuberculosis admitted to our hospital were retrospectively analyzed,and 200 healthy individuals confirmed by physical examination in the same period were selected as healthy controls.All subjects were treated with TBIGRAS,and the changes in NK cells and inflammatory cytokines were detected.Among the 600 patients,there are355 patients with pulmonary tuberculosis and 245 patients with non tuberculosis,in which,the main disease was pulmonary infection(67.35%).The level of IP-10,MIP-1α,IL-8 and TB-IGRAs positive rate in the tuberculosis group was significantly higher than that in the non-tuberculosis group and the healthy group,while the NK cell level was significantly lower than that in the non-tuberculosis group and the healthy group(P<0.05).The sensitivity,specificity and accuracy of the combined diagnosis of TB-IGRAs,NK cells and all cytokines were significantly higher than that of single test(P<0.05).The area under the ROC curve of IL-8,MIP-1αand combined diagnosis were 0.713,0.784 and 0.898,respectively(P<0.05).NK cell levels of patients in the death group were significantly lower than those in the survival group,while the levels of IL-2,IL-8,IL-15,IP-10 and MIP-1αwere significantly higher than those in the survival group.The mortality rate of patients in the combined positive diagnosis group(11.24%)was significantly higher than that in the TB-IGRAs positive group(6.51%)(P<0.05).Taken togather,TB-IGRAs combined with NK cells and inflammatory factors detection could improve the sensitivity and accuracy of active tuberculosis diagnosis.