肺结核合并侵袭性肺曲霉菌感染血清标志物检测分析  

Analysis of Serum Biomarkers in Patients with Pulmonary Tuberculosis Complicated by Invasive Pulmonary Aspergillosis

作　　者：王晓燕 万鑫蕊 许世涛 陈薇 毛红艳 王霖 马志强 WANG Xiaoyan;WAN Xinrui;XU Shitao;CHEN Wei;MAO Hongyan;WANG Lin;MA Zhiqiang(Department of Laboratory Medicine,The Third People’s Hospital of Kunming/Clinical Medical Center for Infectious Diseases of Yunnan Province,Kunming Yunnan 650301,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检验科,云南昆明650301

出　　处：《昆明医科大学学报》2025年第3期132-138,共7页Journal of Kunming Medical University

基　　金：国家自然科学基金项目(82260408);昆明市卫健委卫生科研基金(2023-11-01-023);昆明市卫生科技人才培养“千”工程基金[2022-SW(后备)-70;2022-SW(后备)-85];昆明市卫生科技人才培养医学技术中心建设项目[2022-SW(技)-21]。

摘　　要：目的分析肺结核患者合并侵袭性肺曲霉菌感染的血清标志物在临床中的诊断价值。方法回顾性收集昆明市第三人民医院2021年1月至2024年5月间收治的54例首诊肺结核合并侵袭性肺曲霉菌感染患者实验室检测的血液分析、肝功能、淋巴细胞及细胞因子等血清标志物结果,收集首诊单纯肺结核患者70例以及健康体检人群50例作为对照组,比较三组的血清标志物水平,分析其对肺结核患者合并侵袭性肺曲霉菌感染的相关因素及诊断价值。结果肺结核合并侵袭性肺曲霉菌感染在不同年龄段占比中,青年29例(53.7%)、中年15例(27.8%)、老年10例(18.5%);在不同性别占比中男性41例(75.9%),女性13例(24.1%)。肺结核合并侵袭性肺曲霉菌组的CRP 6.85(2.10,27.0)ng/L、PCT 0.05(0.05,0.15)ng/mL、RBC(4.55±0.65)10^(12)/L、Hb(129.13±19.10)g/L、TP(66.23±6.82)g/L、ALB(37.03±4.77)g/L、CHOL 4.30(3.71,4.91)mmol/L与单纯结核组和健康对照组相比无明显差异(P>0.05)。肺结核合并侵袭性肺曲霉菌组的CD3^(+)T、CD4^(+)T、CD8^(+)T与单纯结核组和健康对照组相比均较低,差异有统计学意义(P<0.05)。肺结核合并侵袭性肺曲霉菌组的IL-2、IL-4、IL-5、IL-8、IL-10、IL-12p70、IFN-α、TNF-α与健康对照组相比均较高,差异有统计学意义(P<0.05);IL-8、IL12p70、IFN-α与单纯结核组相比均较高,差异有统计学意义(P<0.05)。结论肺结核合并侵袭性肺曲霉菌感染人数以男性和青年人群为主。肺结核合并侵袭性肺曲霉菌感染者的感染程度及营养状况血清指标与单纯结核感染类似,缺乏特异性,但免疫功能明显低于单纯结核感染者,细胞因子多指标升高,其中IL-8、IL12p70、IFN-α明显升高有助于鉴别诊断于肺结核感染。Objective To analyze the diagnostic value of serum biomarkers in patients with pulmonary tuberculosis complicated by invasive pulmonary aspergillosis.Methods A retrospective collection of laboratory test results,including blood analysis,liver function,lymphocyte counts,and cytokine levels,from 54 patients diagnosed with pulmonary tuberculosis and invasive pulmonary aspergillosis admitted to the Third People's Hospital of Kunming between January 2021 and May 2024.Additionally,70 patients with simple pulmonary tuberculosis and 50 healthy individuals were collected as control groups to compare serum biomarker levels across the three groups and analyze relevant factors and diagnostic value for pulmonary tuberculosis patients with invasive pulmonary aspergillosis.Results Among different age groups,the incidence of pulmonary tuberculosis with invasive pulmonary aspergillosis was 29 cases(53.7%)in youth,15 cases(27.8%)in middle age,and 10 cases(18.5%)in the elderly.In terms of gender distribution,there were 41 males(75.9%)and 13 females(24.1%).The serum levels of CRP(6.85[2.10,27.0])ng/L,PCT(0.05[0.05,0.15])ng/mL,RBC(4.55±0.65)×10^(12)/L,Hb(129.13±19.10)g/L,TP(66.23±6.82)g/L,ALB(37.03±4.77)g/L,and CHOL(4.30[3.71,4.91])mmol/L in the invasive pulmonary aspergillosis group showed no significant difference compared to the simple tuberculosis group and healthy control group(P>0.05).The levels of CD3^(+)T,CD4^(+)T,and CD8^(+)T in the invasive pulmonary aspergillosis group were significantly lower than those in the simple tuberculosis group and healthy control group(P<0.05).The levels of IL-2,IL-4,IL-5,IL-8,IL-10,IL-12p70,IFN-α,and TNF-αin the invasive pulmonary aspergillosis group were significantly higher than those in the healthy control group(P<0.05);IL-8,IL-12p70,and IFN-αwere also higher compared to the simple tuberculosis group,with statistical significance(P<0.05).Conclusion The population with pulmonary tuberculosis complicated by invasive pulmonary aspergillosis is predominantly male and younger.The serum ind

关 键 词：肺结核 侵袭性肺曲霉菌 血清标志物 诊断价值 

分 类 号：R183.3[医药卫生—流行病学] R519.1[医药卫生—公共卫生与预防医学]