目的: 探讨继发性肺结核患者血浆S100钙结合蛋白A9（S100A9）及凝血四项水平变化的临床意义。方法: 选择2021年3月―2023年3月于广安市人民医院确诊的继发性肺结核患者217例,并展开为期6个月抗结核治疗,比较治疗前后血浆S100A9及凝血四项[纤维蛋白原（FIB）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）]水平。规范治疗6个月后,依据治疗结果将观察组患者分为转阴组与未转阴组,进一步对比两组临床资料及S100A9及凝血四项水平,并分析治疗转归的影响因素。以受试者工作特征（ROC）曲线的曲线下面积（AUC）判断S100A9及凝血四项对继发性肺结核诊断价值。结果: 治疗前S100A9、PT、APTT及FIB水平均明显高于治疗后,TT水平显著低于治疗后。治疗6个月后,痰结核菌检测结果转阴者共196例,设为好转组,余下21例设为未转阴组,两组年龄、S100A9、PT、APTT及TT比较差异均有统计学意义,纳入二元Logistic回归分析中,继发性肺结核治疗转归的独立危险因素包括年龄>60岁、高水平S100A9、高水平PT、高水平APTT及高水平FIB,保护因素为高水平TT。S100A9、PT、APTT、TT及FIB的AUC分别为0.838、0.710、0.833、0..841及0.649。结论: 继发性肺结核患者S100A9及凝血四项水平变化明显,与抗结核治疗转归密切相关,且可作为辅助诊断继发性肺结核的实验室指标。
Abstract
Objective To investigate the clinical significance of the changes of plasma S100 calcium binding protein A9(S100A9) and four coagulation parameters in patients with secondary pulmonary tuberculosis. Methods A total of 217 patients with secondary pulmonary tuberculosis diagnosed in Guang'an People's Hospital from March 2021 to March 2023 were selected, and they were given 6 months of anti-tuberculosis treatment. Plasma S100A9 and four coagulation parameters [fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT) and prothrombin time (PT) ] were compared before and after treatment. After 6 months of standard treatment, patients in the observation group were divided into negative conversion group and non-negative conversion group based on treatment outcomes. Clinical data, S100A9 level and four coagulation parameters were compared between the two groups. The influencing factors of treatment outcome were analyzed. The diagnostic value of S100A9, PT, APTT, TT, and FIB in secondary pulmonary tuberculosis was analyzed using the area under the receiver operating characteristic (ROC) curve (AUC). Results S100A9, PT, APTT and FIB level were significantly higher and longer before treatment than after treatment. TT was significantly shorter before treatment than after treatment. After 6 months of standard treatment, the results of sputum smear testing for mycobacterium tuberculosis showed that there were 196 patients with negative conversion and 21 patients without. There were statistically significant differences in age, S100A9, PT, APTT and TT between the two groups. Binary logistic regression analysis found that age >60 years, high S100A9 level, long PT, long APTT and high FIB level were independent risk factors for treatment outcomes of secondary pulmonary tuberculosis, while long TT was a protective factor. The AUC values of S100A9, PT, APTT, TT, and FIB were 0.838, 0.710, 0.833, 0.841, and 0.649, respectively. Conclusion There are significant changes of S100A9 and four coagulation parameters in patients with secondary pulmonary tuberculosis. These parameters are closely related to the outcome of anti-tuberculosis treatment, and can serve as laboratory indicators for auxiliary diagnosis of secondary pulmonary tuberculosis.
关键词
继发性肺结核 /
血浆S100钙结合蛋白 /
纤维蛋白原 /
凝血酶时间 /
凝血酶原时间 /
活化部分凝血活酶时间
Key words
secondary pulmonary tuberculosis /
plasma s100 calcium binding protein /
fibrinogen /
thrombin time /
prothrombin time /
activated partial thromboplastin time
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基金
四川省卫生健康委员会科研课题“个性化设计的全覆膜自膨式金属支架在恶性气道狭窄中的疗效与安全性评估研究”（20PJ310）
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