[1]刘 菁,王 宇,汤艳芬,等.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[J].现代检验医学杂志,2025,40(01):132-137.[doi:10.3969/j.issn.1671-7414.2025.01.025]
　LIU Jing,WANG Yu,TANG Yanfen,et al.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[J].Journal of Modern Laboratory Medicine,2025,40(01):132-137.[doi:10.3969/j.issn.1671-7414.2025.01.025]
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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()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年01期
页码:
132-137
栏目:
论著
出版日期:
2025-01-15

文章信息/Info

Title:
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
文章编号:
1671-7414（2025）01-132-06
作者:
刘 菁1; 王 宇1; 汤艳芬1; 陈 丽1; 薛天娇1; 刘岩岩1; 李建彬2
（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）
Author(s):
LIU Jing1;  WANG Yu1;  TANG Yanfen1;  CHEN Li1;  XUE Tianjiao1;  LIU Yanyan1;  LI Jianbin2
（1. Department of Respiratory and Critical Care,Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing 100015, China； 2.Intensive Care Unit, Chinese People’s Liberation Army Rocket Army Special Medical Center, Beijing 100088, China）
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；R446.61
DOI:
10.3969/j.issn.1671-7414.2025.01.025
文献标志码:
A
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（serumamyloid 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（χ2=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（χ2=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，SAA 各自单独诊断（Z=3.132，2.131，P=0.002，0.033）。结论 肺结核并发肺部感染患者的病原菌分布主要以革兰氏阴性菌为主，血清HLA-B27 阳性率、SAA 表达水平升高与肺结核并发肺部感染患者病情发展密切相关，二者联合可以更好地诊断肺部感染患者病情严重程度。
Abstract:
Objective 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(χ2=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 the severe-risk group were significantly higher, and the differences were statistically significant （χ2=4.256, 13.130, t=2.306, 5.077; 15.021, 25.384, all P<0.05）. Serum HLA-B27 and SAA levels in patients with pulmonary tuberculosis complicated with pulmonary infection were positively correlated with PSI score (r=0.385, 0.522, all P<0.05). The results of multivariate Logistic regression analysis showed that HLA-B27 positivity and SAA were risk factors affecting the severity of pulmonary tuberculosis combined with pulmonary infection in patients (P<0.05). The combined diagnosis of serum HLA-B27 and SAA had the highest area under the curve (AUC) for the severity of pulmonary infection in patients, which was superior to the individual diagnosis of serum HLA-B27 and elevated SAA expression levels (Z =3.132, 2.131, P=0.002, 0.033). Conclusion The pathogenic bacteria in patients with pulmonary tuberculosis and pulmonary infection are mainly Gram negative bacteria. The increases in serum HLA-B27 positive rate and SAA expression level are closely related to the disease progression in patients with pulmonary tuberculosis and pulmonary infection. The combination of the two can better diagnose the severity of the disease in patients with pulmonary infection.

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备注/Memo

备注/Memo:
作者简介：刘菁（1986-），女，硕士，主治医师，主要研究方向：呼吸与危重症，E-mail：chp6c02p@163.com。
更新日期/Last Update: 2025-01-15