脂阿拉伯甘露聚糖、干扰素γ、腺苷脱氨酶联合临床评分系统应用于活动性肺结核的早期诊断应用价值  

Clinical utility of LAM,IFN-γ,and ADA combined with a clinical scoring system for early diagnosis of active pulmonary tuberculosis

作　　者：康建军[1] 王海娥 李春梅 王启源 KANG Jianjun;WANG Haie;LI Chunmei;WANG Qiyuan(Department of Respiratory and Critical Care Medicine,Yulin First Hospital,719000,China)

机构地区：[1]榆林市第一医院呼吸与危重症医学科,719000 [2]解放军空军军医大学第二附属医院呼吸内科,西安710000 [3]陕西省结核病防治院内三科,西安710000

出　　处：《传染病信息》2025年第2期144-148,共5页Infectious Disease Information

基　　金：陕西省重点研发计划(2022SF-346)。

摘　　要：目的探究脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)、干扰素γ(interferon-γ,IFN-γ)、腺苷脱氨酶(adenosine deaminase,ADA)联合临床评分系统应用于活动性肺结核的早期诊断应用价值。方法回顾性分析2023年1月至2024年4月就诊于榆林市第一医院的63例活动性肺结核患者(病例组)及63例健康体检者(对照组)一般及临床资料,对比2组患者血清LAM免疫球蛋白G(immunoglobulin G,IgG)阳性率、IFN-和ADA水平、肺结核临床诊断评分系统评分的差异。通过Logistic回归分析筛选活动性肺结核的潜在诊断指标,通过受试者工作特征(receiver operating characteristic,ROC)曲线评价各因素对活动性肺结核的早期诊断效能。结果相较于对照组患者,病例组患者血清LAM-IgG阳性率(66.67%us:28.57%)、IFN-γ水平(50.60pg/mLus.40.40pg/mL)、ADA水平(27.62U/Lus.24.79U/L)及肺结核诊断评分系统评分(8.21分us.3.51分)均显著升高(P均<0.05)。多因素Logistic回归分析显示LAM-IgG阳性(OR=2.232)、IFN-γ高水平(OR-1.628)、ADA高水平(OR=2.176)及肺结核临床诊断评分系统评分(OR=2.971)均是诊断活动性肺结核影响因素(P均<0.05);ROC曲线分析显示,LAM-IgG、IFN-γ、ADA及临床诊断评分系统评分均有较好独立诊断效能,曲线下面积(area under curve,AUC)均0.6,4个指标联合诊断效能最高,AUC达0.936,灵敏度为87.8%,特异度为92.5%。结论LAM-IgG、IFN-γ、ADA及肺结核临床诊断评分系统的联合应用可显著提高活动性肺结核的诊断灵敏度和特异度,对于疾病早期诊断具有一定临床意义。Objective To investigate the diagnostic value ofcombining lipoarabinomannan(LAM),interferon-γ(IFN-γ),serum adenosine deaminase(ADA),and clinical diagnostic scoring system for early detection of active pulmonary tuberculosis.Methods A retrospective study was conducted on 63 patients diagnosed with active pulmonary tuberculosis(case group)and 63 healthy individuals(control group)recruitedfromYulin FirstHospital between January 2023 and April 2024.We compared differencesbetween the two groupsin serum LAM-IgGpositivity,IFN-γlevels,ADA levels,and clinical diagnostic scores derived from the pulmonary tuberculosis clinical diagnostic scoring system.Potential diagnostic indicators were screened using univariate and multivariate logistic regression analyses.Additionally,we evaluated the diagnostic performance of individual factors in identifying active pulmonary tuberculosis at an early stageby receiver operating characteristic(ROC)curves.Results The case group showed significantly higher serum LAM-IgG positivity(66.67%us.28.57%),IFN-γlevels(50.60 pg/mL vs.40.40 pg/mL),ADA levels(27.62 U/L us.24.79 U/L),and clinical diagnostic scores(8.21 us.3.51)compared to the control group(P<0.05).Multivariate logistic regression analysisidentified LAM-IgG positivity(OR=2.232),high level of IFN-(OR=1.628),high level of ADA(OR=2.176),and clinical diagnostic score(OR=2.971)asinfluence factorof active pulmonary tuberculosis(P<0.05).ROC analysis revealed area under curves(AUC)>0.6 for individual markers,while the combination achieved the highest AUC of 0.936 with 87.8%sensitivity and 92.5%specificity.Conclusion The combination of LAM-IgG,IFN-γ,ADA,and clinical diagnostic scoring system significantly improves the sensitivity and specificity for diagnosing active pulmonary tuberculosis,thus holding significant clinical importance in enabling early detection of the disease.

关 键 词：活动性肺结核 脂阿拉伯甘露聚糖 干扰素 腺苷脱氨酶 

分 类 号：R573.1[医药卫生—消化系统]