艾滋病合并肺结核CT征象与血浆可溶性CD14的相关性研究  

Study on correlation between CT signs and plasma sCD14 in AIDS complicating pulmonary tuberculosis

作　　者：董春娇[1] 崔树彦[1] 李蓓蕾 李若旭[1] 王立静[2] 李冰洁 张艳[4] 邢卫红[1] DONG Chunjiao;CUI Shuyan;LI Beilei;LI Ruoxu;WANG Lijing;LI Bingjie;ZHANG Yan;XING Weihong(Department of Radiology,Shijiazhuang Municipal Fifth Hospital,Shijiazhuang,Hebei 050051,China;Department of Infection,Shijiazhuang Municipal Fifth Hospital,Shijiazhuang,Hebei 050051,China;Department of Pathology,Hebei Provincial People′s Hospital,Shijiazhuang,Hebei 050051,China;Cancer Detection Center,Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei 050051,China)

机构地区：[1]石家庄市第五医院放射科,050051 [2]石家庄市第五医院感染科,050051 [3]河北省人民医院病理科,石家庄050051 [4]河北医科大学第四医院癌检中心,石家庄050051

出　　处：《重庆医学》2021年第23期4018-4023,共6页Chongqing medicine

基　　金：河北省医学科学研究重点课题计划项目(20160787);河北省石家庄市科技研究与发展指导计划课题(181201423)。

摘　　要：目的探讨艾滋病(AIDS)合并肺结核(PTB)CT征象与血浆可溶性白细胞分化抗原14(sCD14)的相关性。方法选取2015年1月至2020年12月收治的AIDS合并PTB患者93例作为AIDS-PTB组,同期选择单纯PTB患者30例作为PTB组。观察两组患者肺部CT征象、血浆sCD14、CD4+T细胞水平,分析AIDS-PTB组患者血浆sCD14、CD4+T细胞水平和CT半定量评分的相关性,采用受试者工作特征(ROC)曲线判断sCD14在AIDS合并PTB患者中的应用价值。结果AIDS-PTB组患者肺部CT征象较PTB组表现更为复杂,AIDS-PTB组不典型PTB为59例(63.44%),明显高于PTB组的7例(23.33%),差异有统计学意义(P<0.05);AIDS-PTB组sCD14水平、CT半定量评分明显高于PTB组,而CD4+T细胞计数则低于PTB组,差异均有统计学意义(P<0.01)。相关性分析显示,CT半定量评分与sCD14水平呈正相关(r=0.666,P<0.001),与CD4+T细胞计数呈负相关(r=-0.692,P<0.001),sCD14水平与CD4+T细胞计数呈负相关(r=-0.778,P<0.001)。sCD14诊断AIDS合并PTB的ROC曲线下面积为0.879,最佳截断值为39.79μg/mL,灵敏度为87.10%,特异度为52.50%。sCD14最佳截断值以上患者,CT出现斑片或大片实影、多肺段渗出、胸腔积液、肺门及纵隔淋巴结肿大、粟粒状结节影的比例明显高于截断值以下患者(P<0.05)。结论AIDS合并PTB患者的CT征象更加复杂和不典型,sCD14在诊断AIDS合并PTB及判断肺部病变程度方面具有一定的临床应用价值。Objective To explore the correlation between the CT signs and soluble leukocyte differentiation antigen 14(sCD14)in acquired immune deficiency syndrome(AIDS)complicating pulmonary tuberculosis(PTB).Methods Ninety-three patients with AIDS complicating PTB receiving the treatment in the hospital from January 2015 to December 2020 were selected as the AIDS-PTB group,and contemporaneous 30 patients with simple PTB served as the PTB group.The lung CT signs,plasma sCD14 and CD4+T cell levels were observed in the two groups;the correlation between the CT semi-quantitative score with plasma sCD14 and CD4+T cell levels in the AIDS-PTB group was analyzed;the application value of sCD14 in the patients with AIDS complicating PTB was judged through the receiver operating characteristic(ROC)curve.Results The pulmonary CT imaging features of the AIDS-PTB group were more complex than those of the PTB group,moreover there were 59 cases(63.44%)of atypical PTB in the AIDS-PTB group,which was significantly higher than 7 cases(23.33%)in the PTB group,and the difference was styatistically significant(P<0.05).The sCD14 level and CT semiquantitative score in the AIDS-PTB group were significantly higher than those in the PTB group,while the CD4+T cell level was lower than that in the PTB group,and the differences were statistically significant(P<0.01).The correlation analysis showed that the CT semiquantitative score was positively correlated with the sCD14 level(r=0.666,P<0.001),but negatively correlated with the CD4+T cells count(r=-0.692,P<0.001);sCD14 level was negatively correlated with CD4+T cell count(r=-0.778,P<0.001).The area under the ROC curve of sCD14 for diagnosing AIDS complicating PTB was 0.879,its optimal cutoff value was 39.79μg/mL,the sensitivity was 87.10%,and the specificity was 52.50%.In the patients with above optimal cutoff value of sCD14,the proportions of the patients with appearing patchy or large solid shadows in CT,exudation in multiple lung segments,pleural effusion,hilar and mediastinal lymphadenopathy and

关 键 词：艾滋病 肺结核 计算机断层扫描征象 血浆可溶性白细胞分化抗原14 相关性分析 

分 类 号：R512.91[医药卫生—内科学]