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血清应激诱导蛋白2和胎球蛋白A水平与重症肺结核患者疾病转归的关系

Relationships of serum Sestrin2 and Fetuin-A levels with disease outcome in patients with severe pulmonary tuberculosis

    摘要
  • 摘要:
    目的 探讨血清应激诱导蛋白2(Sestrin2)、胎球蛋白A(Fetuin-A)与重症肺结核患者疾病转归的关系。
    方法 选取2020年12月—2022年12月收治的108例重症肺结核患者为研究对象。采用酶联免疫吸附法检测血清Sestrin2、Fetuin-A水平。根据30 d疾病转归情况将患者分为死亡组22例和生存组86例。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析血清Sestrin2、Fetuin-A水平对重症肺结核患者死亡的预测价值，采用多因素Logistic回归分析探讨重症肺结核患者预后的影响因素。
    结果 生存组血清Fetuin-A水平高于死亡组，血清Sestrin2水平低于死亡组，差异有统计学意义(P < 0.05)。血清Sestrin2、Fetuin-A预测重症肺结核疾病转归的AUC(95%CI)分别为0.752(0.712~0.797)、0.887(0.842~0.937), 截断值分别为12.39 ng/mL、350.67 μg/mL, 特异度分别为55.64%、65.57%, 灵敏度分别为92.73%、92.73%。两者联合诊断的AUC为0.920(0.875~0.970), 特异度为86.06%, 灵敏度为88.21%。死亡组糖尿病史占比高于生存组，呼气流量峰值(PEF)、最大呼气中段流量(MMEF)、第1秒用力呼气容积(FEV1)水平、左心室射血分数(LVEF)低于生存组，差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示, LVEF≤50.00%(OR=3.777, 95%CI: 1.393~10.243)、Fetuin-A < 350.67 μg/mL(OR=3.031, 95%CI: 1.943~4.730)、Sestrin2≥12.39 ng/L(OR=5.709, 95%CI: 1.933~16.355)是重症肺结核疾病转归的危险因素(P < 0.05)。
    结论 血清Sestrin2、Fetuin-A水平变化与重症肺结核患者疾病转归密切相关，可作为评估重症肺结核疾病转归的生物学指标，且两者联合检测的准确率更高。

     

    Abstract:
    Objective To explore the relationships of serum Sestrin2 and Fetuin-A with disease outcome in patients with severe pulmonary tuberculosis.
    Methods A total of 108 patients with severe pulmonary tuberculosis admitted to our hospital from December 2020 to December 2022 were selected as study objects. Serum Sestrin2 and Fetuin-A levels were determined by enzyme-linked immunosorbent assay. According to 30 d disease outcomes, the patients in the study group were divided into death-disease group (22 cases) and survival group (86 cases). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of serum Sestrin2 and Fetuin-A levels in patients with severe pulmonary tuberculosis. The influencing factors of prognosis in patients with severe pulmonary tuberculosis were explored by multivariate Logistic regression.
    Results The serum Fetuin-A level in the survival group was higher than that in the death group, and the serum Sestrin2 level was lower than that in the death group (P < 0.05). The AUC (95%CI) of serum Sestrin2 and Fetuin-A were 0.752 (0.712 to 0.797) and 0.887 (0.842 to 0.937), respectively, with truncation values of 12.39 ng/mL and 350.67 μg/mL, the specificity of 55.64% and 65.57%, and the sensitivity of 92.73% and 92.73%. The AUC of the combined diagnosis was 0.920 (0.875 to 0.970), the specificity was 86.06%, and the sensitivity was 88.21%. The proportion of diabetes history in the death group was higher than that in the survival group, and peak expiratory flow (PEF), maximum mid-expiratory flow (MMEF), forced expiratory volume in the first second (FEV1) and left ventricular ejection fraction (LVEF) were lower than those in the survival group(P < 0.05). Multiple Logistic regression analysis showed that LVEF≤50.00% (OR=3.777, 95%CI, 1.393 to 10.243), Fetuin-A < 350.67 μg/mL (OR=3.031, 95%CI, 1.943 to 4.730), Sestrin2≥12.39 ng/L (OR=5.709, 95%CI, 1.933 to 16.355) were the risk factors of the outcome of severe pulmonary tuberculosis(P < 0.05).
    Conclusion Serum Sestrin2 and Fetuin-A levels are closely related to the outcome of patients with severe pulmonary tuberculosis, and can be used as biological indicators to evaluate the outcome of severe pulmonary tuberculosis. The combined prediction has higher accuracy.

     

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