结核性胸膜炎胸腔积液ADAM17、sCD163水平与胸膜粘连的关联性研究-东南大学学报医学版

结核性胸膜炎胸腔积液ADAM17、sCD163水平与胸膜粘连的关联性研究

单位：青岛市中心医院北部院区胸科, 山东青岛 266043

分类号：R521.7

出版年·卷·期（页码）：2025·44·第一期（79-84）

摘要：

目的:探究胸腔积液解聚素-金属蛋白酶17(adisintegrin and metalloprotease 17,ADAM17)、可溶性血红蛋白清道夫受体(soluble hemoglobin scavenger receptor,sCD163)水平与结核性胸膜炎(tuberculous pleuritis,TP)患者胸膜粘连的相关性。方法:选取2020年6月至2022年6月本院收治的96例TP患者为TP组,根据胸膜粘连严重程度分为轻度粘连组(54例)和重度粘连组(42例),随机选取同期非结核性胸膜炎胸腔积液患者(96例)为对照组;采用胸腔穿刺抽取受试者胸腔积液,酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测研究对象胸腔积液中ADAM17、sCD163水平;利用Spearman相关性分析ADAM17、sCD163与胸膜粘连分级的相关性;采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析胸腔积液ADAM17、sCD163对胸膜重度粘连的诊断价值;用多因素Logistic回归分析影响胸膜重度粘连发生的危险因素。结果:TP组胸腔积液ADAM17、sCD163水平分别为(182.14±16.95)pg·mL^-1、(121.63±12.74)μg·mL^-1,明显高于对照组的(138.76±14.52)pg·mL^-1、(75.42±9.83)μg·mL^-1(t值分别为19.044、28.137,均P<0.001);重度粘连组胸腔积液中ADAM17、sCD163水平分别为(196.57±17.28)pg·mL^-1、(135.50±13.51)μg·mL^-1,明显高于轻度粘连组的(170.92±15.03)pg·mL^-1、(110.84±12.32)μg·mL^-1(t值分别为7.768、9.326,均P<0.001);轻度粘连组与重度粘连组患者病程及降钙素原(PCT)、C反应蛋白(CRP)、腺苷脱氨酶(ADA)、γ干扰素(IFN-γ)水平差异具有统计学意义(t值分别为5.406、5.463、12.879、27.089、21.095,均P<0.001),随着粘连程度的加重,病程及PCT、CRP、ADA、IFN-γ水平升高;TP患者胸腔积液ADAM17、sCD163表达水平与病程及PCT、CRP、ADA、IFN-γ、粘连分级呈正相关(r值分别为0.410、0.498、0.613、0.627、0.554、0.658,0.536、0.607、0.532、0.457、0.539、0.602,均P＜0.05);ADAM17、sCD163及联合预测胸膜重度粘连AUC分别为0.870、0.839、0.926,联合诊断优于单独诊断(Z_A_DAM17=2.273,Z_sCD163=2.461,均P＜0.05);Logistic多因素回归分析显示,ADA(OR=1.485)、IFN-γ(OR=1.729)、ADAM17(OR=1.583)、sCD163(OR=1.605)均是胸膜重度粘连发生的独立危险因素(均P＜0.05)。结论:TP患者胸腔积液ADAM17、sCD163表达水平显著升高,且其表达水平随着胸膜粘连严重程度加重而升高。两者都是重度胸膜粘连的独立危险因素,ADAM17与sCD163联合检测对重度胸膜粘连的判断具有一定辅助参考价值。

Objective: To investigate the correlation between levels of adisintegrin and metalloprotease 17(ADAM17) and soluble hemoglobin scavenger receptor(sCD163) in pleural effusion and pleural adhesions in patients with tuberculous pleuritis(TP). Methods:A total of 96 patients with confirmed TP admitted to our hospital from June 2020 to June 2022 were selected as TP group. According to the severity of pleural adhesion, they were divided into mild adhesion group(54 cases) and severe adhesion group(42 cases). Patients with non-TP pleural effusion(96 cases) during the same period were randomly selected as control group. Thoracic puncture was performed to extract pleural effusion, enzyme linked immunosorbent assay(ELISA) was applied to detect the levels of ADAM17 and sCD163 in the pleural effusion of the study subjects; Spearman correlation was applied to analyze the correlation between ADAM17, sCD163, and pleural adhesion grading; receiver operating characteristic(ROC) curve was applied to analyze the diagnostic value of ADAM17 and sCD163 in pleural effusion for severe pleural adhesion; multivariate Logistic regression was applied to analyze the risk factors affecting the occurrence of severe pleural adhesion. Results:The levels of ADAM17 and sCD163 in pleural effusion in the TP group were(182.14±16.95) pg·mL^-1 and (121.63±12.74) μg·mL^-1, respectively, which were obviously higher than those in the control group(138.76±14.52) pg·mL^-1 and (75.42±9.83) μg·mL^-1(The t values were 19.044, 28.137, respectively, all P<0.001); the levels of ADAM17 and sCD163 in pleural effusion in the severe adhesion group were(196.57±17.28) pg·mL^-1 and (135.50±13.51) μg·mL^-1, respectively, which were obviously higher than those in the mild adhesion group(170.92±15.03) pg·mL^-1 and (110.84±12.32) μg·mL^-1(The t values were 7.768, 9.326, respectively, all P<0.001); the difference in disease course, procalcitonin(PCT), C-reactive protein(CRP), adenosine deaminase(ADA), and IFN-γ levels between the mild adhesion group and the severe adhesion group was statistically obvious(The t values were 5.406, 5.463, 12.879, 27.089, and 21.095, respectively, all P<0.001), as the degree of adhesion worsened, the course of disease, PCT, CRP, ADA, and IFN-γ levels obviously increased; the expression levels of ADAM17 and sCD163 in pleural effusion of TP patients were positively correlated with disease course, PCT, CRP, ADA, IFN-γ, and adhesion grade(The r values were 0.410, 0.498, 0.613, 0.627, 0.554, 0.658, and 0.536, 0.607, 0.532, 0.457, 0.539, 0.602, respectively, all P<0.05); AUC of ADAM17, sCD163, and the combination in the prediction of severe pleural adhesions was 0.870, 0.839, and 0.926, respectively, the combined diagnosis was superior to the single diagnosis(Z_ADAM17=2.273, Z_sCD163=2.461, all P<0.05); Logistic multivariate factors regression analysis showed that ADA(OR=1.485), IFN-γ(OR=1.729), ADAM17(OR=1.583) and sCD163(OR=1.605) were independent risk factors for severe pleural adhesion(all P<0.05). Conclusion:The expression levels of ADAM17 and sCD163 in pleural effusion of TP patients were significantly increased, and the expression levels were significantly increased with the severity of pleural adhesion. Both of them are independent risk factors for severe pleural adhesion. The combined detection of ADAM17 and sCD163 has certain auxiliary reference value for judging severe pleural adhesion.

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