ESAT-6联合多项检测指标评估抗结核药物性肝损伤严重程度的关系  

The Association between ESAT-6 Combined Multiple Detection Indicators and the Severity of Anti-tuberculosis Drug-induced Liver Injury

作　　者：陆霓虹 刘洪璐 陈杨君 孙娅萍 杨艳 杨永锐 李杰 LU Nihong;LIU Honglu;CHEN Yangjun;SUN Yaping;YANG Yan;YANG Yongrui;LI Jie(The 3rd People’s Hospital of Kunming,Yunnan Provincial Clinical Medical Center for Infectious Diseases,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院/云南省传染性疾病临床医学中心,云南昆明650041

出　　处：《昆明医科大学学报》2024年第8期52-57,共6页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81960096);云南省科技厅科技计划项目地方高校联合专项基金资助项目(202001BA070001-134);云南省教育厅科学研究基金资助项目(2023J0916);昆明市科技计划项目重点项目(昆科计字2019-1-N-25318000003253)。

摘　　要：目的 检测ESAT-6联合IL-6、IL-10、IFN-γ、CK-18、MMP-7和MMP-9在抗结核药物性肝损伤(ATB-DILI)患者血清中的表达水平,分析上述指标与肝损伤严重程度的相关性,探讨7种因子对ATB-DILI的评估价值。方法 纳入2019年1月至2023年1月就诊于昆明市第三人民医院的肺结核患者,使用ELISA方法检测210例ATB-DILI的肺结核患者(A组)、120例抗结核治疗未发生肝损伤的肺结核患者(B组)及50例健康体检者(C组)血清中的ESAT-6、IL-6、IL-10、IFN-γ、CK-18、MMP-7、MMP-9水平,分析上述指标与肝损伤严重程度的相关性,以及评估肝损伤严重程度的准确性。结果 3组人群一般检查结果比较,A组患者年龄高于B、C组(P <0.05)。与对照组比较,A组血清ESAT-6、IL-10、CK-18、MMP-7和MMP-9表达上调,B组ESAT-6和MMP-7表达上调(P <0.05)。其中,A组CK-18、IL-10和MMP-9的表达量高于B组(P <0.05)。A组的年龄、ESAT-6、CK-18和MMP-9与肝损伤严重程度呈正相关关系(P <0.05)。Logistic回归分析显示,A组患者年龄>65岁、ESAT-6>31.3 pg/m L、CK-18>45.5 ng/m L是ATB-DILI的独立危险因素。结论 高龄患者更易发生ATB-DILI,ESAT-6、CK-18和MMP-9升高与ATB-DILI严重程度有关。年龄>65岁、ESAT-6>31.3 pg/m L、CK-18>45.5 ng/m L是ATB-DILI的独立危险因素,联合检测高龄患者ESAT-6和CK-18表达水平,对预判及评估ATB-DILI严重程度具有较高的临床价值。Objective To detect the expression level of ESAT-6 combined with IL-6,IL-10,IFN-γ,CK-18,MMP-7,MMP-9 in the serum of patients with anti-tuberculosis drug induced liver injury(ATB-DILI),to analyze the correlation between the above indicators and the severity of liver injury,and to explore the evaluation value of 7 factors for ATB-DILI.Methods From January 2019 to January 2023,pulmonary tuberculosis patients treated at the Third People's Hospital of Kunming were included.Using the ELISA method,the levels of ESAT-6,IL-6,IL-10,IFN-γ,CK-18,MMP-7,and MMP-9 in the serum of 210 ATB-DILI tuberculosis patients(Group A),120 tuberculosis patients without liver damage during anti-tuberculosis treatment(Group B),and 50 healthy individuals undergoing physical examinations(Group C)were tested.The correlation between the above indicators and the severity of liver damage was analyzed,as well as the accuracy of assessing the severity of liver damage.Results The age of patients in group A was higher than that in group B and C(P<0.05).Compared with the control group,the expression of serum ESAT-6,IL-10,CK-18,MMP-7 and MMP-9 was significantly up-regulated in group A,and the expression of ESAT-6 and MMP-7 was significantly up-regulated in group B(P<0.05).The expression levels of CK-18,IL-10,and MMP-9 in Group A were higher than in Group B(P<0.05).In Group A,age,ESAT-6,CK-18,and MMP-9 were positively correlated with the severity of liver injury(P<0.05).Logistic regression analysis indicated that age>65 years,ESAT-6>31.3 pg/mL,and CK-18>45.5 ng/mL in Group A patients were independent risk factors for ATB-DILI.Conclusion Elderly patients are more prone to ATB-DILI.Elevated levels of ESAT-6,CK-18,and MMP-9 are related to the severity of ATB-DILI.Age over 65,ESAT-6>31.3 pg/mL,and CK-18>45.5 ng/mL are independent risk factors for ATB-DILI.The combined detection of ESAT-6 and CK-18 expression levels in elderly patients holds significant clinical value for predicting and assessing the severity of ATB-DILI.

关 键 词：早期分泌靶向抗原6 细胞角蛋白18 抗结核药物性肝损伤 白介素 基质金属蛋白酶 

分 类 号：R521[医药卫生—内科学]