老年肺结核患者耐药菌群分布及外周血RBP4、caspase-3、IL-17水平变化  

The distribution of drug-resistant bacteria in elderly patients with pulmonary tuberculosis and the significance of changes RBP4,caspase-3 and IL-17 levels in peripheral blood

作　　者：韩微微 殷红邦 HAN Weiwei;YIN Hongbang(The Third People’s Hospital of Kunming City,Yunnan,Kunming 650032,China)

机构地区：[1]云南省昆明市第三人民医院,650032

出　　处：《河北医药》2022年第21期3225-3229,共5页Hebei Medical Journal

摘　　要：目的探讨老年肺结核患者耐药菌群分布情况及外周血视黄醇结合蛋白4(RBP4)、半胱氨酸天冬氨酸蛋白酶-3(caspase-3)、白介素-17(IL-17)水平变化意义。方法回顾性选取2015年5月至2020年4月收治的300例老年肺结核患者,统计耐药情况,比较耐药与非耐药患者临床资料、外周血RBP4、caspase-3、IL-17水平,分析外周血RBP4、caspase-3、IL-17与老年肺结核患者耐药关系,绘制受试者工作特征(ROC)曲线,评价外周血RBP4、caspase-3、IL-17水平对老年肺结核患者耐药的评估价值,比较ROC曲线中各指标联合评估阳性与阴性患者预后情况。结果300例老年肺结核患者中,共68例患者耐药,总耐药率22.67%。仅1种药物耐药构成比最高占61.76%,其次为2种药物耐药者占29.41%,再次为3种药物耐药者占5.88%,4种药物耐药者构成比最低仅占2.94%,差异有统计学意义(P<0.05);老年肺结核患者抗结核药物耐药以异烟肼药物为主,耐药率为13.33%,乙胺丁醇耐药率为1.33%,差异有统计学意义(P<0.05);老年肺结核耐药患者年龄、初治、肺部空洞比例、外周血caspase-3、IL-17水平均高于非耐药患者,RBP4水平低于非耐药患者,差异有统计学意义(P<0.05);Logistic回归分析显示,外周血RBP4、caspase-3、IL-17水平仍为老年肺结核患者耐药的独立影响因素(P<0.05);绘制外周血RBP4、caspase-3、IL-17水平对老年肺结核患者耐药评估价值的ROC曲线,结果显示外周血RBP4、caspase-3、IL-17水平对老年肺结核患者耐药评估价值的AUC分别为0.852、0.790、0.685,应用Logistic二元回归拟合,构建各指标联合预测的AUC,结果显示各指标预测的AUC为0.899;参考ROC曲线评估结果,外周血RBP4、caspase-3、IL-17水平联合评估阳性患者1年内病死率高于阴性患者,差异有统计学意义(P<0.05)。结论老年肺结核患者在所有耐药菌群中以单一药物耐药及耐药异烟肼药物为主,且外周血RBP4水平明显下降,caspase-3�Objective To investigate the distribution of drug-resistant bacterial groups in elderly patients with pulmonary tuberculosis,and to explore the significance of the changes of peripheral blood retinol binding protein 4(RBP4),caspase-3,and interleukin-17(IL-17)levels.Methods A total of 300 elderly patients with pulmonary tuberculosis who were treated in our hospital from May 2015 to April 2020 were enrolled in the study.The drug resistance status was analyzed,and the clinical data of drug-resistant patients and non-drug-resistant patients,peripheral blood RBP4,caspase-3,and IL-17 levels were observed.Moreover the correlation between peripheral blood RBP4,caspase-3,IL-17 and drug resistance of patients was analyzed,and the receiver operating characteristic(ROC)curve was drawn.The evaluation value of drug resistance was analyzed,and the correlation between the indxes of ROC curve and the prognosis of positive patients as well as negative patients was analyzed.Results Of the 300 elderly patients with pulmonary tuberculosis,there were 68 cases of drug resistance,with total drug-resistant rate being 22.67%and the proportion of one drug resistance was the highest,accounting for 61.76%,followed by two drug resistance,accounting for 29.41%,and 3 drug resistance again,accounting for 5.88%,and the proportion of 4 drug resistance was the lowest(2.94%),there were significant differences among the four drugs(P<0.05).The anti-tuberculosis drug resistance was dominated by isoniazid drugs,with drug resistant rate being 13.33%,and drug resistant rate of ethambutol was the lowest(1.33%).The patient’s age,initial treatment,proportion of pulmonary voids,peripheral blood caspase-3 and IL-17 levels in elderly pulmonary tuberculosis patients with drug resistance were higher than those of patients without drug resistance,however the RBP4 levels were significantly lower than those of patients without drug resistance(P<0.05).Logistic regression analysis showed that the levels of RBP4,caspase-3,and IL-17 in peripheral blood were independen

关 键 词：肺结核 老年 耐药菌群 视黄醇结合蛋白4 半胱氨酸天冬氨酸蛋白酶-3 白介素-17 

分 类 号：R521[医药卫生—内科学]