外周血Th17/CD4^(+)CD25^(+)CD127^(low)Treg细胞区分活动性肺结核和潜伏期结核合并肺炎  

Discrimination between active pulmonary tuberculosis and latent tuberculosis with pneumonia based on Th17/CD4^(+)CD25^(+)CD127^(low)Treg

作　　者：汪永强[1] 刘世军 李显勇[2] 邹同会 罗静[1] 游佳蓉 杨玉霖 WANG Yong-qiang;LIU Shi-jun;LI Xian-yong(Department of Laboratory Medicine,the Second People’s Hospital of Neijiang City,Sichuan Province,Neijiang641001,China;Department of Infectious Diseases,The Second People’s Hospital of Neijiang City,Sichuan Province,Neijiang641001,China)

机构地区：[1]四川省内江市第二人民医院检验科,四川内江641001 [2]四川省内江市第二人民医院感染性疾病科,四川内江641001

出　　处：《中国实验诊断学》2022年第11期1648-1655,共8页Chinese Journal of Laboratory Diagnosis

基　　金：四川省卫健委课题基金(18PJ124);内江市科技局基金(2018-13)资助。

摘　　要：目的研究外周血Th17/CD4^(+)CD25^(+)CD127^(low)Treg以及特异性TB Ag(早期分泌型抗原靶标6,ESAT-6,培养滤液蛋白10,CEP-10)诱导γ干扰素释放试验(TB-IGRAs)区分活动性肺结核和潜伏期结核(LTBI)合并肺炎的诊断价值。方法将2018年1月至2020年2月在内江市第二人民医院就诊并诊断为活动性肺结核患者41例为研究对象,48例初诊疑似结核患者(最后因诊断为肺炎,非结核感染肺炎),其中21例肺炎患者按照IGRAs阳性列为LTBI^(+)肺炎组(LTBI合并肺炎),27例肺炎患者按照IGRAs阴性列为LTBI-肺炎组(非LTBI肺炎)。所有研究对象均接受IGRAs检查,流式细胞术检测外周血Th17/CD4^(+)、Treg/CD4^(+)比值,ROC曲线评价活动性肺结核和肺炎以及与LTBI^(+)肺炎的诊断价值,并根据约登指数为最佳诊断点计算敏感度、特异度。结果活动性肺结核外周血Th17/CD4^(+)水平低于LTBI^(+)肺炎组和LTBI-肺炎组(P<0.01),LTBI^(+)肺炎组和LTBI-肺炎组之间无统计学意义,P>0.05。活动性肺结核Th17/Treg比值低于LTBI^(+)肺炎组(P<0.01),与LTBI-肺炎组比较无统计学意义,P>0.05。以肺炎(不论是否合并LTBI)为对照,Th17/CD4^(+)和Th17/Treg区分活动性肺结核和肺炎的ROC曲线下面积为AUC=0.7485(P<0.0001)与AUC=0.6796(P=0.0036),Th17/CD4^(+)<2.125为cut-off值,诊断灵敏度为87.80%,特异性为52.08%,Th17/Treg<0.355为cut-off值时,诊断灵敏度为63.41%(26/41),特异性为68.75%。以LTBI^(+)肺炎患者为参照,Th17/CD4^(+)和Th17/Treg诊断活动性肺结核的ROC曲线下面积为:AUC=0.8287(P<0.0001)与AUC=0.7439(P<0.0018),Th17/CD4^(+)<1.060为cut-off,诊断灵敏度为51.22%,特异性为95.23%,Th17/Treg<0.3550为cut-off,诊断灵敏度为63.41%,特异性为85.71%,以诊断活动性肺结核灵敏度大于85%为标准,ROC曲线显示Th17/CD4^(+)的cut-off值为小于2.10,其诊断活动性肺结核灵敏度为85.37%,特异性为57.14%。结论以TB-IGRAs为诊断第一步,外周血Th17/CD4^(+)可以较好的区分活动性肺结�Objective To study the value of Th17/CD4^(+)CD25^(+)CD127^(low)Treg and specific TB Ag(early secreted antigen target 6,ESAT-6,culture filtrate protein 10,CEP-10)induced gamma interferon release test(TB-IGRAs)in distinguishing active pulmonary tuberculosis and latent tuberculosis with pneumonia.Methods A total of 89hospitalized patients with suspected tuberculosis were recruited in the study between February 2018and January 2020.Out of these,41patients were diagnosed with active pulmonary tuberculosis.Whereas,48were newly diagnosed patients with suspected tuberculosis(finally diagnosed as pneumonia)classified as LTBI^(+)pneumonia group(latent tuberculosis with pneumonia,21Cases)and LTBI-pneumonia group(non-latent tuberculosis pneumonia,27cases)based on the interferongamma release test(IGRA).All study subjects were received IGRAs test and collected clinical data and laboratory test indicators.Th17/CD4^(+)and Treg/CD4^(+)were detected by flow cytometry,ROC curve was used to distinguish the diagnostic value of active tuberculosis and LTBI^(+)pneumonia,and calculating the sensitivity and specificity based on the best diagnostic point.Results The levels of Th17/CD4^(+)and Th17/Treg in the peripheral blood of active pulmonary tuberculosis were lower than those of the LTBI^(+)pneumonia and LTBI-pneumonia group,P<0.01.but there was no Statistically significant difference between the LTBI^(+)pneumonia and LTBI-pneumonia group,P>0.05.Using 48control cases of pneumonia,the area under the ROC curve of Th17/CD4^(+)and Th17/Treg to distinguish active tuberculosis from pneumonia was AUC=0.7485(P<0.0001)and AUC=0.6796(P=0.0036),The diagnostic sensitivity was 87.80%,the specificity was 52.08%When Th17/CD4^(+)<2.125was the cut-off,the sensitivity was 63.41%,and the specificity was 68.75%according to Th17/Treg<0.355.Taking patients with LTBI^(+)pneumonia as a reference,the area under the ROC curve of Th17/CD4^(+)and Th17/Treg for the diagnosis of active tuberculosis was AUC=0.8287(P<0.0001)and AUC=0.7439(P<0.0018),The diagnostic sen

关 键 词：Γ干扰素释放试验 活性性肺结核 潜伏期结核 肺炎 TH17 Treg 

分 类 号：R733.7[医药卫生—肿瘤]