痰涂片阳性肺结核患者强化治疗前后血清急性期蛋白水平变化  

Changes in serum acute phase protein levels before and after intensive treatment of AFB smear-positive sputum tuberculosis patients

作　　者：朱玲[1] 郭武 何文均 刘小梅[2] 钟粲野 卢安静 ZHU Ling;GUO Wu;HE Wenjun;LIU Xiaomei;ZHONG Canye;LU Anjing(Department of Infectious Diseases,Fuling Hospital Affiliated to Chongqing University,408000,China)

机构地区：[1]重庆大学附属涪陵医院感染性疾病科,408000 [2]重庆大学附属涪陵医院呼吸与危重症医学科,408000 [3]重庆大学附属涪陵医院老年医学科,408000

出　　处：《传染病信息》2024年第5期418-423,共6页Infectious Disease Information

基　　金：重庆市涪陵科技计划项目(FLKJ,2019ABB2032)。

摘　　要：目的探讨抗酸杆菌(acid-fast bacilli,AFB)痰涂片阳性肺结核(pulmonary tuberculosis,PTB)患者强化治疗前后血清急性期蛋白水平变化,及它们用于监测治疗反应的可行性。方法将2021年3月至2023年3月在重庆大学附属涪陵医院就诊的AFB阳性的PTB患者纳入研究。根据1:1:1比例和基线资料相匹配原则纳入3组患者:AFB 1+(平均3~9条AFB阳性/100个视野)组、AFB2+(平均1~9条AFB阳性/10个视野)组、AFB 3+(平均1~9条AFB阳性/1个视野)组,每组各44例。采集研究对象强化治疗前和强化治疗2个月后的血液样本,双抗体夹心酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)用于比较血清α2巨球蛋白(α2-macroglobulin,α2-MG)、血清淀粉样蛋白A-1(serum amyloid A-1,SAA-1)、触珠蛋白(haptoglobin,Hp)。免疫比浊法测定血清C反应蛋白(C-reactive protein,CRP)。结果治疗前血清α2-MG、SAA-1、Hp、CRP水平相比,AFB3+组最高,AFB2+组次之,AFB1+组最低(P均<0.05);且多数AFB1+组患者血清α2-MG、SAA-1、Hp、CRP水平低于研究对象整体水平的中位值。经过强化治疗2个月后,94例(71.21%)患者AFB痰涂片转阴,未转阴患者大都集中在AFB2+和AFB3+组(P<0.05)。强化治疗结束后3组患者的α2-MG水平变化差异具有统计学意义(P均<0.05),AFB3+组患者下降幅度最显著。痰涂片转阴患者经过治疗后血清α2-MG、SAA-1、CRP、Hp以及α2-MG、SAA-1、CRP、Hp下降幅度均显著低于痰涂片未转阴患者(P均<0.05)。结论本研究表明血清α2-MG、SAA-1、Hp、CRP水平的变化可作为监测PTB患者治疗反应的指标。经过强化治疗后血清α2-MG、SAA-1、Hp、CRP水平更低或者较治疗前下降幅度更高可能反映患者痰涂片AFB更容易转阴。Objective To investigate the changes in serum acute phase protein levels before and after intensified treatment in patients with pulmonary tuberculosis(PTB)positive for acid fast bacilli(AFB)sputum smear,and the feasibility of using them to monitor treatment response.Methods AFB-positive PTB patients who received treatment at Chongqing University Affiliated Fuling Hospital from March 2021 to March 2023 were recruited into the study.According to the matching principle of 1:1:1 ratio and baseline data,three groups of patients were included:AFB 1+(3-9 AFB+/100 fields of view)group,AFB2+(1-9 AFB+/10 fields of view)group,and AFB 3+(1-9 AFB+/1 field of view)group,with 44 cases in each group.Blood samples were collected from the research subjects before and after 2 months of intensive treatment,and detected by the double antibody sandwich enzyme-linked immunosorbent assay(ELISA)to compare serum levels ofα2-macroglobulin(α2-MG),amyloid A-1(SAA-1)and haptoglobin(Hp).Serum C-reactive protein(CRP)was measured using immunoturbidimetry.Results Serumα2-MG,SAA-1,Hp,and CRP levels were highest in the AFB3+group,followed by those in the AFB2+group,and lowest in the AFB1+group,P<0.05;and most of the patients in the AFB1+group had serumα2-MG,SAA-1,Hp,and CRP levels lower than the median values.After 2 months of intensive treatment,94 patients(71.21%)had negative sputum smears.The most significant decrease inα2-MG was observed in PTB patients in the AFB3+group of PTB patients after treatment(P<0.05).Most of the patients in AFB1+had their sputum turned negative,and most of the sputum non-transformed patients were concentrated in the AFB2+and AFB3+groups(P<0.05).The decreases in serumα2-MG,SAA-1,CRP,Hp,andΔα2-MG,ΔSAA-1,ΔCRP,andΔHp were significantly lower in the sputum-turned group than in the sputum-not-turned group after treatment(P<0.05).Conclusions This study suggests that changes in serumα2-MG,SAA-1,Hp,and CRP levels can be used as indicators to monitor the response to PTB treatment.After intensive treatment,lower or

关 键 词：肺结核 血清淀粉样蛋白A1 触珠蛋白 C反应蛋白 Α2巨球蛋白 

分 类 号：R521[医药卫生—内科学]