肺结核患者血清PGRN、LCN2水平及其与病情严重程度的相关性-东南大学学报医学版

肺结核患者血清PGRN、LCN2水平及其与病情严重程度的相关性

单位：1. 无锡市第五人民医院呼吸与危重症医学科, 江苏无锡 214000;
2. 无锡市第五人民医院结核科, 江苏无锡 214000

分类号：R521

出版年·卷·期（页码）：2024·43·第四期（610-615）

摘要：

目的: 探讨肺结核(PTB)患者血清颗粒蛋白前体(PGRN)、脂质运载蛋白2(LCN2)水平及其与病情严重程度的相关性。方法: 选取2020年2月至2023年2月于本院就诊的127例肺结核患者,根据病情严重程度将其分为轻症组(n=78)和重症组(n=49),另选取同期体检健康者72例作为对照组。采用酶联免疫吸附法测定各组血清PGRN和LCN2水平;Spearman法分析血清PGRN和LCN2水平与Bandim 结核病(TB)评分之间的相关性;多因素Logistic回归分析重症PTB发生的影响因素;绘制受试者工作特征(ROC)曲线分析血清PGRN和LCN2水平对重症PTB的诊断价值。结果: 重症组血清PGRN和LCN2水平明显高于轻症组和对照组(P＜0.05);重症组糖尿病史占比,Bandim TB评分,IL-10、IFN-γ、PCT、CRP水平明显高于轻症组(P＜0.05);血清PGRN和LCN2水平与Bandim TB评分均呈正相关(r_s值分别为0.428、0.420,均P＜0.001);PGRN(OR=1.576,95%CI:1.112~2.234)和LCN2(OR=2.163,95%CI:1.320~3.545)为重症PTB发生的危险因素(P＜0.05);血清PGRN和LCN2水平联合诊断重症PTB的曲线下面积(AUC)为0.943,敏感度为91.84%,二者联合优于各自单独诊断(Z_{二者联合-PGRN}=2.327,P=0.020;Z_{二者联合-LCN2}=2.061,P=0.039)。结论: PTB患者血清PGRN和LCN2水平与Bandim TB评分呈正相关,二者血清水平与患者病情严重程度密切相关。

Objective: To investigate the levels of progranulin(PGRN) and lipocalin-2(LCN2) in the serum of patients with pulmonary tuberculosis(PTB) and their correlation with the severity of the disease. Methods: From February 2020 to February 2023, 127 pulmonary tuberculosis patients who visited our hospital were regarded as the study subjects. They were separated into mild disease group(n=78) and severe disease group(n=49) based on the severity of the disease. Additionally, 72 healthy individuals who underwent physical examination were regarded as the control group. Enzyme-linked immunosorbent assay(ELISA) was applied to determine the levels of serum PGRN and LCN2 in each group; Spearman method was applied to analyze the correlation between serum PGRN and LCN2 levels and Bandim TB score; multivariate Logistic regression was applied to analyze the influencing factors of severe PTB occurrence; receiver operating characteristic(ROC) curve was plotted to analyze the diagnostic value of serum PGRN and LCN2 levels for severe PTB. Results: The serum levels of PGRN and LCN2 in the severe group were obviously higher than those in the mild group and the control group(P<0.05); the proportion of diabetes history, Bandim TB score, IL-10, IFN-γ, PCT, CRP levels in severe group were obviously higher than those in mild group(P<0.05); the levels of serum PGRN and LCN2 were positively correlated with Bandim TB score(r_s=0.428, 0.420, all P<0.001); PGRN (OR=1.576, 95%CI=1.112-2.234) and LCN2 (OR=2.163, 95%CI=1.320-3.545) were risk factors for the occurrence of severe PTB(P<0.05); the area under the curve(AUC) of the combination of serum PGRN and LCN2 levels for diagnosing severe PTB was 0.943, with a sensitivity of 91.84%, the combination of the two was superior to individual diagnosis(Z_{combination-PGRN}=2.327, P=0.020; Z_{combination-LCN2}=2.061, P=0.039). Conclusion: The serum levels of PGRN and LCN2 in PTB patients are positively correlated with Bandim TB score, and their serum levels are closely related to the severity of disease.

参考文献：

[1] 谢明,邓葵珍,谭晴心,等.外周血血清sTREM-1、Treg/Th17、miR-99b与耐多药结核病相关性及联合预测疗效的ROC分析[J].现代医学,2021,49(10):1176-1182.
[2] BANSAL A,YANAMALADODDI V R,SARVEPALLI S S,et al.Surviving pulmonary tuberculosis:navigating the long term respiratory effects[J].Cureus,2023,15(5):e38811.
[3] PREDA M,TǎNASE B C,ZOB D L,et al.The bidirectional relationship between pulmonary tuberculosis and lung cancer[J].Int J Environ Res Public Health,2023,20(2):1282-1294.
[4] 王丽亚,陈玉红,赵淑敏,等.PGRN的生物学功能及在自身免疫性疾病中的相关研究进展[J].临床医学研究与实践,2021,6(18):196-198.
[5] GUPTA U,GHOSH S,WALLACE C T,et al.Increased LCN2(lipocalin 2) in the RPE decreases autophagy and activates inflammasome-ferroptosis processes in a mouse model of dry AMD[J].Autophagy,2023,19(1):92-111.
[6] 中华人民共和国国家卫生和计划生育委员会.肺结核诊断标准(WS 288-2017)[J/CD].新发传染病电子杂志,2018,3(1):59-61.
[7] RUDOLF F,JOAQUIM L C,VIEIRA C,et al.The Bandim tuberculosis score:reliability and comparison with the Karnofsky performance score[J].Scand J Infect Dis,2013,45(4):256-264.
[8] GALVIN J,TIBERI S,AKKERMAN O,et al.Pulmonary tuberculosis in intensive care setting,with a focus on the use of severity scores,a multinational collaborative systematic review[J].Pulmonology,2022,28(4):297-309.
[9] 韩莉,徐红艳,王立,等.耐药肺结核患者血清可溶性白细胞分化抗原14、降钙素原、白介素-22水平变化及对抗结核疗效的预测价值[J].陕西医学杂志,2023,52(11):1535-1540.
[10] 李向蓉.肺结核流行病学特征与发病趋势预测及延误治疗的危险因素[J].现代医学,2022,50(4):471-475.
[11] 任荟蓉,徐婷娟,武涛,等.血清颗粒蛋白前体在Ⅰ型自身免疫性肝炎预后评估中的价值[J].检验医学,2023,38(3):245-250.
[12] JING C,ZHANG X,SONG Z,et al.Progranulin mediates proinflammatory responses in systemic lupus erythematosus:implications for the pathogenesis of systemic lupus erythematosus[J].J Interferon Cytokine Res,2020,40(1):33-42.
[13] TóTH N M,MüLLER V,NAGY T,et al.Serum progranulin level might differentiate non-IPF ILD from IPF[J].Int J Mol Sci,2023,24(11):9178-9188.
[14] HUNTER L,RUEDAS-TORRES I,AGULLÓ-ROS I,et al.Comparative pathology of experimental pulmonary tuberculosis in animal models[J].Front Vet Sci,2023,10(1):1264833.
[15] LUIES L,DU PREEZ I.The echo of pulmonary tuberculosis:mechanisms of clinical symptoms and other disease-induced systemic complications[J].Clin Microbiol Rev,2020,33(4):e00036-20.
[16] XIE T,HAN L,CHEN Y,et al.Progranulin and activin A concentrations are elevated in serum from patients with acute exacerbations of idiopathic pulmonary fibrosis[J].Lung,2021,199(5):467-473.
[17] 钟静,路晨菲,王萌萌,等.脂质运载蛋白2在心血管疾病中的研究进展[J].国际心血管病杂志,2021,48(5):285-288.
[18] MIN J H,LEE H,CHUNG S J,et al.Neutrophil gelatinase-associated lipocalin for predicting intensive care unit admission andmortality in patients with pneumonia[J].Tohoku J Exp Med,2020,250(1):243-251.
[19] WANG X,ZHANG C,ZOU N,et al.Lipocalin-2 silencing suppresses inflammation and oxidative stress of acute respiratory distress syndrome by ferroptosis via inhibition of MAPK/ERK pathway in neonatal mice[J].Bioengineered,2022,13(1):508-520.
[20] AN H S,YOO J W,JEONG J H,et al.Lipocalin-2 promotes acute lung inflammation and oxidative stress by enhancing macrophage iron accumulation[J].Int J Biol Sci,2023,19(4):1163-1177.
[21] WANG D,LI X,JIAO D,et al.LCN2 secreted by tissue-infiltrating neutrophils induces the ferroptosis and wasting of adipose and muscle tissues in lung cancer cachexia[J].J Hematol Oncol,2023,16(1):30-48.

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