肺结核患者血清HLA-B27和SAA水平表达与病情严重程度及并发肺部其他病原菌感染的相关性研究  

Study on the Correlation between the Expression of Serum HLA-B27 and SAA Levels in Patients with Pulmonary Tuberculosis and the Severity of the Disease and the Infection of Other Pulmonary Pathogens

作　　者：刘菁 王宇 汤艳芬 陈丽 薛天娇 刘岩岩 李建彬 LIU Jing;WANG Yu;TANG Yanfen;CHEN Li;XUE Tianjiao;LIU Yanyan;LI Jianbin(Department of Respiratory and Critical Care,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China;Intensive Care Unit,Chinese People’s Liberation Army Rocket Army Special Medical Center,Beijing 100088,China)

机构地区：[1]首都医科大学附属北京地坛医院呼吸与危重症科,北京100015 [2]中国人民解放军火箭军特色医学中心重症监护室,北京100088

出　　处：《现代检验医学杂志》2025年第1期132-137,共6页Journal of Modern Laboratory Medicine

摘　　要：目的 探究肺结核患者血清人白细胞抗原B27(human leukocyte antigen B27,HLA-B27)和血清淀粉样蛋白A(serum amyloid A,SAA)水平表达与病情严重程度及并发肺部其他病原菌感染的相关性研究。方法 选取2021年9月~2023年9月期间在首都医科大学附属北京地坛医院就诊的120例肺结核并发肺部感染患者作为研究组,另选取同期就诊的120例肺结核患者作为对照组。根据肺炎严重度指数(pneumonia severity index,PSI)将研究组患者分为低危组(n=47)、中危组(n=42)及高危组(n=31)。采集患者痰液进行病原体检测;采用酶联免疫吸附法(ELISA)测定血清HLA-B27,SAA表达水平;采用多因素Logistic回归分析影响肺结核并发肺部感染患者病情严重程度的因素。采用受试者工作特征(ROC)曲线分析血清HLA-B27,SAA对肺结核并发肺部感染患者严重程度的诊断效能。结果 与对照组相比,研究组患者血清HLA-B27阳性率(72.50%vs 19.17%),SAA(9.32±2.32 ng/ml vs 4.64±1.04 ng/ml)表达水平均显著升高,差异具有统计学意义(χ^(2)=68.744,t=20.164,均P<0.05)。研究组患者中共分离出病原菌84株,包括革兰氏阴性菌46株,革兰氏阳性菌34株,真菌4株;其中肺炎克雷伯菌所占比例最高(15.48%)。与低危组相比,中危组、高危组肺结核并发肺部感染患者HLA-B27阳性率(76.19%,93.55%vs 55.32%),SAA表达水平(9.35±2.35ng/ml,10.94±2.42ng/ml vs 8.23±2.23ng/ml)、PSI评分(108.63±12.47分,145.93±12.44分vs 54.48±17.31分)依次显著升高,差异具有统计学意义(χ^(2)=4.256,13.130,t=2.306,5.077;15.021,25.384,均P<0.05)。肺结核并发肺部感染患者血清HLA-B27,SAA水平与PSI评分呈正相关(r=0.385,0.522,均P<0.05)。多因素Logistics回归分析结果发现,HLA-B27阳性、SAA表达水平升高是影响肺结核并发肺部感染患者病情严重程度的危险因素(P<0.05)。血清HLA-B27,SAA二者联合诊断肺部感染患者病情严重程度的曲线下面积(AUC)最高,优于血清HLA-B27,SAAObjective To explore the correlation between the expression of serum human leukocyte antigen B27(HLA-B27)and serum amyloid A(SAA)in patients with pulmonary tuberculosis and the severity of the disease and the infection of other pulmonary pathogens.Methods From September 2021 to September 2023,120 patients with pulmonary tuberculosis complicated with pulmonary infection in Beijing Ditan Hospital Affiliated to Capital Medical University were selected as the research group,and another 120 patients with pulmonary tuberculosis were selected as the control group.According to the pneumonia severity index(PSI),the study group patients were divided into low-risk group(n=47),medium risk group(n=42)and high-risk group(n=31).Collected patient sputum for pathogen detection.Enzyme-linked immunosorbent assay(ELISA)was applied to measure the expression levels of HLA-B27 and SAA in serum.Multivariate Logistic regression was applied to analyze the factors that affected the severity of pulmonary tuberculosis combined with pulmonary infection in patients.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic efficacy of serum HLA-B27 and SAA for the severity of pulmonary tuberculosis combined with pulmonary infection in patients.Results Compared with the control group,the positive rate of serum HLA-B27(72.50%vs 19.17%)in the study group,expression level of SAA(9.32±2.32 ng/ml vs 4.64±1.04 ng/ml)were significantly increased,and the differences were statistically significant(χ^(2)=68.744,t=20.164,all P<0.05).A total of 84 strains of pathogenic bacteria were isolated by the research group,including 46 Gram negative bacteria,34 Gram positive bacteria,and 4 fungi,with Klebsiella pneumoniae accounting for the highest proportion(15.48%).Compared with the low-risk group,the positive rate of HLA-B27(76.19%,93.55%vs 55.32%),the expression level of SAA(9.35±2.35ng/ml,10.94±2.42ng/ml vs 8.23±2.23ng/ml)and the PSI score(108.63±12.47score,145.93±12.44 score vs 54.48±17.31 score)in the middle-risk group and th

关 键 词：肺结核 肺部感染 人白细胞抗原B27 血清淀粉样蛋白A 病原菌 

分 类 号：R521[医药卫生—内科学] R446.61[医药卫生—临床医学]