肺结核并发真菌感染CT影像特征及miR-29a-3p、miR-223-3p、IFN-γ、IL-23R水平  

Characteristics of CT images of pulmonary tuberculosis complicated by fungal infection and levels of miR-29a-3p,miR-223-3p,IFN-γ,IL-23R

作　　者：周丹[1] 黄胜[1] 胡雅萍 胡雪莲 陈江红 ZHOU Dan;HUANG Sheng;HU Ya-ping;HU Xue-lian;CHEN Jiang-hong(Songzi People's Hospital,Songzi,Hubei 434200,China)

机构地区：[1]松滋市人民医院感染性疾病科,湖北松滋434200

出　　处：《中华医院感染学杂志》2024年第19期2947-2951,共5页Chinese Journal of Nosocomiology

基　　金：湖北省卫健委科研基金资助项目(WJ2019F220)。

摘　　要：目的分析肺结核并发真菌感染电子计算机断层扫描(CT)影像特点及微小RNA-29a-3p(miR-29a-3p)、miR-223-3p、干扰素-γ(IFN-γ)、白细胞介素-23受体(IL-23R)水平。方法纳入2019年6月-2023年6月松滋市人民医院收治的肺结核并发真菌感染患者104例(研究组),另择同期肺结核未合并真菌感染患者115例纳入对照组;分析肺结核并发真菌感染的真菌类型,比较两组CT影像特点、临床表现、miR-29a-3p、miR-223-3p、IFN-γ、IL-23R表达水平,绘制受试者工作特征(ROC)曲线分析miR-29a-3p、miR-223-3p、IFN-γ、IL-23R表达水平对肺结核并发真菌感染患者预后不良的预测价值。结果肺结核并发真菌感染104例患者共检出121株真菌,主要为白假丝酵母、隐球菌;研究组空洞、新月征及结节、晕征、段叶状实变影、树芽征、咯血、湿啰音比例更高(P<0.05)。研究组血清miR-29a-3p、miR-223-3p、IFN-γ和IL-23R水平分别为1.46±0.41、0.78±0.21、(72.02±13.19)ng/ml和(29.08±5.27)ng/ml高于对照组(P<0.05);预后不良组血清miR-29a-3p、miR-223-3p、IFN-γ和IL-23R水平分别为1.77±0.31、0.98±0.26、(76.04±7.43)ng/ml和(33.02±4.39)ng/ml高于预后良好组(P<0.05);将预后不良纳入阳性,预后良好纳入阴性,绘制ROC曲线分析血清miR-29a-3p、miR-223-3p、IFN-γ、IL-23R及联合检测对肺结核并发真菌感染患者预后的预测价值,曲线下面积(AUC)为0.830、0.834、0.740、0.789及0.867,联合检测优于单独检测(P<0.05)。结论肺结核并发真菌感染的临床特征与CT影像特点明显,随着肺结核并发真菌感染的发生及预后恶化血清miR-29a-3p、miR-223-3p、IFN-γ、IL-23R表达水平增加,联合检测对患者预后的预测价值较高。OBJECTIVE To analyze the characteristics of computed tomography(CT)images of pulmonary tubercu-losis complicated with fungal infection and the levels of micrornas 29a-3p(miR-29a-3p),miR-223-3p,interferon-γ(IFN-γ)and interleukin-23 receptor(IL-23R).METHODS Totally 104 cases of pulmonary tuberculosis compli-cated with fungal infection treated in Songzi People's Hospital from Jun.2019 to Jun.2023 were included(the study group),and 115 cases of pulmonary tuberculosis patients without fungal infection were included in the control group.The fungal types of pulmonary tuberculosis complicated by fungal infection were analyzed,and the CT image characteristics,clinical manifestations,expression levels of miR-29a-3p,miR-223-3p,IFN-γ and IL-23R were compared between the two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of miR-29a-3p,miR-223-3p,IFN-γ and IL-23R expression levels for the poor prognosis of patients with pulmonary tuberculosis complicated with fungal infection.RESULTS A total of 121 strains of fungi were detected in 104 cases of pulmonary tuberculosis complicated by fungal infection,mainly Candida alba and Cryptococcus.The proportion of cavities,crescent signs and nodules,halo signs,segmental lobed solid shadow,tree bud signs,hemoptysis and moist rales were higher in the study group(P<0.05).The serum levels of miR-29a-3p,miR-223-3p,IFN-γ,and IL-23R in the study group were 1.46±0.41,0.78±0.21,(72.02±13.19)ng/ml,and(29.08±5.27)ng/ml,respectively,higher than those in the control group(P<0.05);The serum levels of miR-29a-3p,miR-223-3p,IFN-γ,and IL-23R in the poor prognosis group were 1.77±0.31,0.98±0.26,(76.04±7.43)ng/ml,and(33.02±4.39)ng/ml,respectively,higher than those in the good prognosis group(P<0.05).Poor prognosis was included in positive,good prognosis was included in negative,ROC curve was plotted to analyze the predictive value of serum miR-29a-3p,miR-223-3p,IFN-γ and IL-23R expression levels on the prognosis of patients with pulmonary tubercul

关 键 词：肺结核 真菌感染 临床特征 电子计算机断层扫描 微小核糖核酸-29a-3p 微小核糖核酸-223-3p 干扰素-γ 白细胞介素-23受体 

分 类 号：R521[医药卫生—内科学]