重症肺结核患者SAA/CRP、IL-6水平及其临床意义  

Clinical significance of SAA/CRP and IL-6 level in patients with severe pulmonary tuberculosis

作　　者：张琳 余彦廷 陈静 范稚坚 ZHANG Lin;YU Yanting;CHEN Jing;FAN Zhijian(Department of Emergency,Third People′s Hospital of Kunming,Kunming,Yunnan 650041,China;Department of Drug-Resistant and Severe Tuberculosis,Changpo Branch,Third People′s Hospital of Kunming,Kunming,Yunnan 650000,China)

机构地区：[1]云南省昆明市第三人民医院急诊科,云南昆明650041 [2]云南省昆明市第三人民医院长坡院区耐药与重症结核科,云南昆明650000

出　　处：《检验医学与临床》2025年第4期461-465,共5页Laboratory Medicine and Clinic

基　　金：云南省卫生健康委员会临床医学中心2020-2023年建设任务(ZX20201223)。

摘　　要：目的探讨重症肺结核患者白细胞介素(IL)-6水平、血清淀粉样蛋白A(SAA)/C反应蛋白(CRP)及其临床意义,为临床诊治提供参考。方法选取2021年1月至2023年8月昆明市第三人民医院收治的147例肺结核患者为研究对象,根据病情程度分为重症组、轻症组,比较不同程度肺结核患者临床资料、血清IL-6水平及SAA/CRP。分析重症肺结核的影响因素,以及血清IL-6、SAA/CRP与肺结核程度的相关性。采用受试者工作特征(ROC)曲线分析血清IL-6、SAA/CRP对重症肺结核的预测价值。结果轻症组、重症组红细胞沉降率(ESR)、血小板/淋巴细胞比值(PLR)、血小板/白细胞比值(PWR)比较,差异均有统计学意义(P<0.05),重症组血清IL-6、SAA、CRP水平及SAA/CRP高于轻症组(P<0.05)。PWR、PLR、IL-6、SAA/CRP均是重症肺结核的影响因素(P<0.05)。血清IL-6、SAA/CRP与肺结核程度均呈正相关(r=0.560、0.483,P<0.05),血清IL-6水平与SAA/CRP水平呈正相关(r=0.657,P<0.05)。血清IL-6、SAA/CRP联合预测重症肺结核的曲线下面积为0.927(95%CI:0.872~0.963)。结论PWR、PLR、IL-6、SAA/CRP均是重症肺结核的影响因素,血清IL-6、SAA/CRP与肺结核病情程度相关,血清IL-6、SAA/CRP联合对肺结核进展至重症的预测价值较高。Objective To investigate the level of interleukin-6(IL-6),serum amyloid A(SAA)/C-reactive protein(CRP)and their clinical significance in patients with severe pulmonary tuberculosis,providing reference for clinical diagnosis and treatment.Methods A total of 147 patients with pulmonary tuberculosis admitted to the Third People′s Hospital of Kunming from January 2021 to August 2023 were selected as research subjects.According to the severity of the disease,the patients were divided into the severe group and the mild group.The clinical data,serum IL-6 level and SAA/CRP were compared between the different severity groups.The influencing factors of severe pulmonary tuberculosis were analyzed,and the correlation between serum IL-6,SAA/CRP and the severity of pulmonary tuberculosis was assessed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of serum IL-6 and SAA/CRP for severe pulmonary tuberculosis.Results There were significant differences in erythrocyte sedimentation rate(ESR),platelet-to-lymphocyte ratio(PLR)and platelet-to-white blood cell ratio(PWR)between the mild group and the severe group(P<0.05).The levels of serum IL-6,SAA,CRP and SAA/CRP in the severe group were higher than those in the mild group(P<0.05).PWR,PLR,IL-6 and SAA/CRP were identified as influencing factors for severe pulmonary tuberculosis(P<0.05).Serum IL-6 and SAA/CRP were positively correlated with the severity of pulmonary tuberculosis(r=0.560,0.483,P<0.05).Additionally,serum IL-6 level was positively correlated with SAA/CRP(r=0.657,P<0.05).The area under the curve(AUC)for the combined prediction of severe pulmonary tuberculosis by serum IL-6 and SAA/CRP was 0.927(95%CI:0.872-0.963).Conclusion PWR,PLR,IL-6 and SAA/CRP are all influencing factors of severe pulmonary tuberculosis.Serum IL-6 and SAA/CRP are correlated with the severity of pulmonary tuberculosis.The combination of serum IL-6 and SAA/CRP has a higher predictive value for the progression of pulmonary tuberculosis to severe forms.

关 键 词：肺结核 白细胞介素-6 淀粉样蛋白A C反应蛋白 重症 

分 类 号：R517.9[医药卫生—内科学] R446.11[医药卫生—临床医学]