首次复治菌阳肺结核合并糖尿病患者血清IAP、25(OH)D水平及对疗效的预测价值  

Serum IAP and 25(OH)D Levels and Predictive Value of Therapeutic Effect in Patients with First Retreatment of Positive Pulmonary Tuberculosis Complicated with Diabetes

作　　者：王玉红[1] 刘丽景[1] 杨帆[1] 王智慧[1] 董雅坤[1] 李晓倩 WANG Yuhong;LIU Lijing;YANG Fan;WANG Zhihui;DONG Yakun;LI Xiaoqian(The Second Department of Tuberculosis,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院结核二科,河北石家庄050041

出　　处：《标记免疫分析与临床》2024年第4期642-646,726,共6页Labeled Immunoassays and Clinical Medicine

基　　金：2020年度河北省医学科学研究课题计划(编号:20200819)。

摘　　要：目的探讨首次复治菌阳肺结核(TB)合并糖尿病(DM)患者血清免疫抑制酸性蛋白(IAP)、25-羟基维生素D[25(OH)D]表达变化及2者对治疗疗效的预测价值。方法选取本院2019年1月至2022年4月首次复治菌阳TB合并DM患者48例为实验组,另选同期单纯TB患者48例为对照组。测定并比较两组患者治疗前后血清IAP、25(OH)D水平;多因素Logistic回归分析影响菌阳TB合并DM患者痰菌阴转的可能因素;受试者工作特征(ROC)曲线评估IAP、25(OH)D对患者痰菌未转阴的预测价值。结果实验组痰菌阴转患者31例(64.58%)显著低于对照组痰菌阴转患者40例(83.33%)。治疗2个月后,实验组、对照组血清IAP均显著降低,25(OH)D水平均显著升高(P<0.05);且治疗2个月后实验组血清IAP水平显著低于对照组,25(OH)D水平显著高于对照组(P<0.05)。多因素Logistic回归分析显示,IAP高水平是首次复治菌阳TB合并DM患者痰菌未阴转的危险因素(P<0.05),25(OH)D高水平是首次复治菌阳TB合并DM患者痰菌未阴转的保护因素(P<0.05)。ROC曲线显示,IAP预测痰菌未阴转的AUC为0.719,25(OH)D预测痰菌未阴转的AUC为0.791,2者联合预测痰菌未阴转的AUC为0.871,明显高于2者单独诊断(Z_(联合vs IAP)=2.605、P=0.009;Z_(联合vs 25(OH)D)=2.408、P=0.016),且灵敏度、特异性分别为78.46%、82.86%。结论首次复治菌阳TB合并DM患者经治疗后血清IAP水平降低、25(OH)D水平升高,2者联合对菌阳TB合并DM患者痰菌未阴转具有一定预测价值。Objective To investigate expression changes of serum immunosuppressive acidic protein(IAP)and 25-hydroxyvitamin D[25(OH)D]in patients with bacteria positive TB combined with DM after the first retreatment and to evaluate their predictive values for treatment efficacy.Methods From January,2019 to April,2022,48 patients with bacterial-positive TB combined with DM who were initially re-treated in our hospital were gathered as the experimental group,while another 48 patients with simple TB were enrolled as the control group.Serum IAP and 25(OH)D levels of patients in these two groups before and after treatment were measured and compared;Multivariate logistic regression was applied to identify the potential factors affecting sputum bacteria negative conversion in patients with bacteria-positive TB combined with DM;Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of IAP and 25(OH)D for no sputum bacteria negative conversion.Results 31 cases(64.58%)of the patients with sputum bacteria negative conversion in the experimental group were significantly lower than the 40 cases(83.33%)in the control group.After 2 months of treatment,serum IAP in the experimental group and the control group was significantly decreased,while the 25(OH)D level was significantly increased(P<0.05);After 2 months of treatment,the serum IAP level in the experimental group was significantly lower than that in the control group,while the 25(OH)D level was significantly higher than that in the control group(P<0.05).Multivariate logistic regression analysis showed that high IAP level was a risk factor for no sputum bacteria negative conversion in patients with sputum bacteria positive TB combined with DM after the first retreatment(P<0.05),and high level of 25(OH)D was the risk factor for no sputum bacteria negative conversion in patients with sputum bacteria positive TB combined with DM after the first retreatment(P<0.05).ROC curve showed that the AUC of IAP for predicting no sputum bacteria negative conversion was

关 键 词：复治菌阳肺结核 糖尿病 免疫抑制酸性蛋白 25-羟基维生素D 疗效 预测价值 

分 类 号：R521[医药卫生—内科学]