血清SHBG与SAA4联合检测对涂阴肺结核辅助诊断的价值

目的 评价性激素结合球蛋白（SHBG）、血清淀粉样蛋白4（SAA4）两项指标联合检测对涂阴肺结核的诊断预测价值。方法 采集2017年3-5月广西柳州市龙潭医院收治的88例涂阴肺结核患者的血清标本，同一时期采集56例广西柳州市本地区的健康体检人员的血清标本作为健康对照组，采用酶联免疫吸附试验（ELISA）法检测涂阴肺结核组和健康对照组血清中SHBG、SAA4蛋白水平，应用受试者工作特征（ROC）曲线比较两者单一与联合诊断涂阴肺结核的效能，并与近三年相关涂（菌）阴肺结核的结核感染T细胞斑点试验（T-SPOT.TB）检测方法的诊断效能进行比较。结果 涂阴肺结核组的血清SHBG、SAA4浓度分别为52.32（24.58~81.19）nmol/L和56.71（41.87~77.57）ng/mL，健康对照组的血清SHBG、SAA4浓度分别为25.97（16.60~36.45）nmol/L和35.79（29.81~41.07）ng/mL，涂阴肺结核患者血清SHBG、SAA4表达水平高于健康对照组，差异均有统计学意义（均P<0.001）。SHBG、SAA4单项及联合诊断涂阴肺结核的ROC曲线下面积分别为0.781、0.829、0.906（均P<0.001），两者联合诊断涂阴肺结核的灵敏度和特异度分别为84.1%、91.1%，约登指数为0.752。与近三年已报道涂（菌）阴肺结核T-SPOT.TB检测方法的诊断效能相比，SHBG与SAA4两者联合诊断涂阴肺结核具有优势。结论 SHBG、SAA4对涂阴肺结核具有良好的辅助诊断价值，联合检测有利于提高涂阴肺结核的诊断率。

Diagnostic value of combined detection of serum SHBG and SAA4 in smear-negative pulmonary tuberculosis

Objective To evaluate the diagnostic and predictive value of combined detection of sex hormone-bin-ding globulin (SHBG) and serum amyloid A4 (SAA4) in smear-negative pulmonary tuberculosis(SNPT). Methods Serum specimens of 88 SNPT patients who were admitted to Lontan Hospital, Liuzhou, Guangxi from March to May, 2017 were collected, serum specimens of 56 healthy physical examination people in Liuzhou City collected at the same time were as control group. Serum levels of SHBG and SAA4 in SNPT group and control group were measured by enzyme-linked immunosorbent assay (ELISA), efficacy of single and combined diagnosis for SNPT was compared by receiver operating characteristic(ROC) curve, and compared with the diagnostic efficacy of T cell spot test of tuberculosis infection (T-SPOT TB) for SNPT in recent three years. Results Concentrations of serum SHBG and SAA4 were 52.32 (24.58-81.19) nmol/L and 56.71 (41.87-77.57) ng/mL in SNPT group, 25.97 (16.60-36.45) nmol/L and 35.79 (29.81-41.07) ng/mL in control group, expression levels of serum SHBG and SAA4 in SNPT group were both significantly higher than those in control group (both P<0.001). The area under ROC curve of single and combined diagnosis of SNPT by SHBG and SAA4 were 0.781, 0.829, and 0.906, respectively (all P<0.001), sensitivity and specificity of the combined diagnosis were 84.1% and 91.1% respectively, Jordan index was 0.752. Compared with T-SPOT TB detection method reported in recent three years, combined detection of SHBG and SAA4 has advantage for the diagnosis of SNPT. Conclusion SHBG and SAA4 has good auxi-liary diagnostic value for SNPT, and the combined detection can improve the diagnosis rate of SNPT.