IL-33在肺结核中的诊断价值

目的通过检测外周血IL-33水平的差异,探讨IL-33用于肺结核诊断的临床价值,并探讨联合结核感染T细胞检测(T-SPOT.TB)和痰分枝杆菌核酸检测能否提高肺结核的诊断率。方法选择无锡市第五人民医院收治的肺结核患者、肺炎患者,结核科筛查的结核潜伏感染者和健康体检人员作为研究对象,用ELISA法检测各组血浆中IL-33的浓度,使用受试者工作特征曲线(ROC)分析IL-33水平用于肺结核诊断的灵敏度和特异度。同时利用ELISPOT法检测结核组、肺炎组及结核潜伏感染组的T-SPOT.TB,利用PCR-荧光探针法检测结核组、肺炎组的痰分枝杆菌核酸。结果肺结核组外周血IL-33浓度平均值高于其余三组,差异有统计学意义(P<0.05)。IL-33诊断肺结核的诊断ROC曲线下面积(AUC)为0.818,95%CI:0.740~0.897,最佳诊断分界点为228.5 ng/L,对应的灵敏度为77.6%,特异度为80.0%,具有较高的灵敏度和特异度。IL-33联合T-SPOT.TB检测具有更高的灵敏度(P<0.05)。IL-33检测法灵敏度高于核酸检测法,且差异有统计学意义(P<0.05)。菌阳肺结核组与菌阴肺结核组患者外周血IL-33水平比较差异无统计学意义(P>0.05),初治肺结核患者组与复治肺结核患者组外周血中IL-33水平比较差异无统计学意义(P>0.05),IL-33对诊断肺结核具有较好的适用价值。结论外周血IL-33检测对诊断肺结核具有较高的灵敏度和特异度,同时联合TSPOT.TB检测及痰结核菌核酸检测,可以提供更高的诊断率。

Diagnostic value of IL-33 in pulmonary tuberculosis

Objective To detect the level of IL-33 from peripheral blood plasma ,to explore its diagnostic value in pulmonary tuberculosis, and we explore whether combined detection of T-SPOT.TB and Mycobacterium tuberculosis DNA can improve the diagnostic rate of tuberculosis. Methods Patients with tuberculosis and pneumonia in Wuxi Fifth People's Hospital, latent tuberculosis patients screened by Tuberculosis Department and health examination personnel were selected as the subjects. Plasma concentrations of IL-33 were detected by ELISA (Enzyme-linked immunosorbent assay), ROC curve (receptive operation curve) was used to analyze the sensitivity and specificity of IL-33 level in the diagnosis of tuberculosis. Meanwhile, T-SPOT.TB was detected by ELISPOT in tuberculosis group, pneumonia group and latent infection group. Mycobacterium tuberculosis DNA was detected by PCR-fluorescence probe in tuberculosis group and pneumonia group. Results The average concentration of IL-33 in peripheral blood of the tuberculosis group was higher than that of the other three groups, and the difference was statistically significant (P<0.05). The area under the ROC curve of IL-33 in the diagnosis of pulmonary tuberculosis was 0.818, and its 95% confidence interval was 0.740-0.897; the optimal diagnostic cut-off point was 228.5 ng/L; the corresponding sensitivity was 77.6%, specificity was 80.0%, with high sensitivity and specificity. IL-33 combined with T-SPOT.TB detection has higher sensitivity（P<0.05）. The sensitivity of IL-33 was higher than that of Mycobacterium tuberculosis DNA detection, and the difference was statistically significant (P<0.05). There was no significant difference in the level of IL-33 in peripheral blood between sputum positive pulmonary tuberculosis and sputum negative pulmonary tuberculosis (P>0.05). There was no significant difference in the level of IL-33 between initial treatment of tuberculosis and retreatment of tuberculosis (P>0.05), suggesting that IL-33 has a good applicability for the diagnosis of tuberculosis. Conclusion The detection of IL-33 in peripheral blood has a high sensitivity and specificity in the diagnosis of tuberculosis. At the same time, combined with T-SPOT.TB detection and Mycobacterium tuberculosis DNA detection can provide a higher diagnostic rate.