艾滋病合并肺结核患者IL-6、hs-CRP、TNF-α水平和危险因素分析

目的 探究艾滋病（AIDS）合并肺结核的危险因素及患者白介素-6（IL-6）、超敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）水平检测的临床意义。方法 在2010年1月—2020年12月发现515例AIDS患者中,选择73例AIDS合并肺结核患者为研究组,分析其感染性特点及临床特征。并以同期51例AIDS未合并肺结核患者为对照组,分别采用Logistic回归、ROC曲线分析AIDS患者合并肺结核的危险因素及各危险因素对其出现肺结核的预测价值;比较研究组及对照组的IL-6、hs-CRP、TNF-α水平,分析其与AIDS患者合并肺结核的关系。结果 研究组和对照组基线CD4⁺T细胞≤200个/μL、吸烟和结核病患者接触史比例分别为57.5%（42/73）和33.3%（17/51）、38.4%（28/73）和19.6%（10/51）、46.6%（34/73）和23.5%（12/51） ,而卡介苗接种史比例分别为24.7%（18/73）和45.1%（23/51） ,差异均有统计学意义（χ²=7.050,4.965,6.834,5.668,P<0.05）;基线CD4⁺T细胞≤200个/μL、有结核病患者接触史为导致AIDS患者合并肺结核的危险因素,有卡介苗接种史为保护因素（P<0.05）;基线CD4⁺T细胞、吸烟、结核病患者接触史、卡介苗接种史联合检测预测AIDS患者合并肺结核的AUC大于各指标单独检测（P<0.05）;研究组IL-6、hs-CRP、TNF-α水平高于对照组（P<0.05）。结论 AIDS合并肺结核患者IL-6、hs-CRP、TNF-α水平显著升高,基线CD4⁺T细胞≤200个/μL、有结核病患者接触史为导致AIDS患者合并肺结核的危险因素,且各危险因素联合检测对AIDS患者合并肺结核具有预测价值。

Risk factors and the detection of IL-6, hs-CRP and TNF-α levels in AIDS patients with tuberculosis

Objective To explore the risk factors and clinical detection significance of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) levels in patients with acquired immune deficiency syndrome (AIDS) with pulmonary tuberculosis. Methods A total of 73 patients with AIDS and tuberculosis were enrolled as study group between January 2010 and December 2020 (Total 515 AIDS cases were found). The infectious characteristics and clinical characteristics were analyzed. And other 51 AIDS patients without tuberculosis during the same period were enrolled as control group. The risk factors of tuberculosis and their predictive value for tuberculosis in AIDS patients were analyzed by Logistic regression analysis and ROC curves. The levels of IL-6, hs-CRP and TNF-α between study group and control group were compared, and their relationship with tuberculosis was analyzed. Results The proportions of cases with baseline CD4⁺ cells ≤200 cells/μL, smoking and contact history of tuberculosis patients in study group were higher than those in control group 57.5%（42/73）vs 33.3%（17/51）, 38.4%（28/73）vs 19.6%（10/51）, 46.6%（34/73）vs 23.5%（12/51）], while proportion of cases with BCG vaccination history was lower than that in control group 24.7%（18/73）vs 45.1%（23/51）（χ²=7.050,4.965,6.834,5.668,P<0.05）. The baseline CD4⁺ cells≤200 cells/μL and contact history of tuberculosis patients were risk factors of AIDS patients with tuberculosis, while BCG vaccination history was a protective factor (P<0.05). AUC of baseline CD4⁺ cells combined with smoking, contact history of tuberculosis patients and BCG vaccination history for predicting tuberculosis in AIDS patients was greater than that of single index (P<0.05). The levels of IL-6, hs-CRP and TNF-α in study group were higher than those in control group (P<0.05). Conclusions The levels of IL-6, hs-CRP and TNF-α significantly increase in patients with AIDS and tuberculosis, the baseline CD4+ cells ≤200 cells/μL and contact history of tuberculosis patients are risk factors of tuberculosis in AIDS patients. The combined detection of risk factors is of predictive value for tuberculosis in AIDS patients.