不同类型肺结核患者外周血维生素D与抗菌肽LL-37表达水平的研究

doi:10.3969/j.issn.1000-6621.2019.02.013

摘要/Abstract

摘要：

目的评价不同类型活动性肺结核患者血清维生素D及抗菌肽LL-37表达水平的差异。方法搜集2017年6—12月成都市公共卫生临床医疗中心住院的178例活动性肺结核患者(包括81例单纯肺结核患者、57例肺结核并发肺外结核患者和40例结核病并发糖尿病患者,分别作为B组、C组和D组;根据病情严重程度划分,分为重症肺结核患者79例和轻症肺结核患者99例)及同期在我院进行健康体检的100名医务人员(A组)作为研究对象。采用酶联免疫吸附试验(ELISA)测定纳入人群维生素D[以25-羟基维生素D3(25-(OH)D₃)水平衡量]及LL-37的水平,分析不同类型肺结核患者与健康对照者25-(OH)D₃和LL-37水平的差异,以及肺结核严重程度与25-(OH)D₃和LL-37水平的关系。结果 B组、C组和D组患者外周血25-(OH)D₃水平分别为(31.58±11.89)nmol/L、(25.68±13.57)nmol/L和(26.39±10.01)nmol/L,均明显低于A组的(40.57±14.32)nmol/L,差异均有统计学意义(t=4.61,P=0.000;t=6.48,P=0.000;t=5.72,P=0.000);LL-37水平分别为(26.97±10.29)μg/L、(30.75±10.16)μg/L和(31.84±11.36)μg/L,均明显高于A组的(24.38±4.57)μg/L,差异均有统计学意义(t=2.26,P=0.025;t=4.48,P=0.000;t=4.03,P=0.000)。与B组患者相比,C组和D组25-(OH)D₃水平均明显降低,LL-37水平均明显升高,差异均有统计学意义(t=2.64,P=0.008;t=2.52,P=0.011和t=2.14,P=0.032;t=2.29,P=0.022)。79例重症肺结核患者的25-(OH)D₃和LL-37水平分别为(24.59±12.36)nmol/L和(31.97±11.43)μg/L,明显低于轻症肺结核患者(99例)的25-(OH)D₃水平[(33.79±15.47)nmol/L],但高于轻症肺结核患者的LL-37水平[(27.32±10.69)μg/L],差异均有统计学意义(t=4.41,P=0.000;t=2.77,P=0.006)。结论活动性肺结核患者血清中维生素D水平明显低于健康人群,LL-37水平明显高于健康人群,且不同类型活动性肺结核患者血维生素D及LL-37表达水平存在差异。

关键词: 结核,肺, 维生素D, 抗菌肽类, 临床对照试验

Abstract:

Objective To evaluate the difference in expression levels of 25-(OH)D₃ and LL-37 in patients with different types of active pulmonary tuberculosis (PTB). Methods One hundred and seventy-eight PTB patients admitted to Chengdu Public Health Clinical Medical Center from June 2017 to December 2017 were enrolled as case group. One hundred and seventy-eight patients included 81 PTB cases (Group B), 57 PTB cases with extrapulmonary tuberculosis (Group C) and 40 PTB cases complicated with diabetes (Group D). According to the severity of the disease, the patients were divided into severe PTB (79 cases) and mild PTB (99 cases). One hundred medical workers who had physical examination in our hospital during the same period were selected as the healthy control group (Group A). The levels of 25-(OH)D₃ and LL-37 were measured by ELISA. The difference of 25-(OH)D₃ and LL-37 expression between the groups, and the correlation between the severity of PTB and levels of 25-(OH)D₃ and LL-37 were analyzed. Results The concentrations of 25-(OH)D₃ in peripheral blood in Group B, Group C and Group D were (31.58±11.89) nmol/L, (25.68±13.57) nmol/L and (26.39±10.01) nmol/L respectively, which were significantly lower than that in Group A ((40.57±14.32) nmol/L) (respectively t=4.61, P=0.000; t=6.48, P=0.000; t=5.72, P=0.000). The levels of LL-37 in Group B, Group C and Group D were (26.97±10.29) μg/L, (30.75±10.16) μg/L and (31.84±11.36) μg/L respectively, which were significantly higher than that in Group A ((24.38±4.57) μg/L), the differences were statistically significant (respectively t=2.26, P=0.025; t=4.48, P=0.000; t=4.03, P=0.000). Compared with Group B, the concentrations of 25-(OH) decreased and LL-37 increased in Group C and Group D, with statistically significant differences (respectively t=2.64, P=0.008; t=2.52, P=0.011 and t=2.14, P=0.032; t=2.29, P=0.022). In patients with severe PTB, the concentration of 25-(OH)D₃ was (24.59±12.36) nmol/L, and the level of LL-37 was (31.97±11.43) μg/L, which was statistically significant compared with those with mild PTB ((33.79±15.47) nmol/L and (27.32±10.69) μg/L; t=4.41, P=0.000; t=2.77, P=0.006). Conclusion The serum levels of vitamin D in patients with active PTB are significantly lower than that in normal adults, and the levels of LL-37 in active PTB cases are significantly higher than that in normal adults, and there are differences in the expression levels of vitamin D and LL-37 of patients with different types of active PTB in blood.

Key words: Tuberculosis,pulmonary, Vitamin D, Dermcidins, Controlled clinical trial

吴桂辉,黄涛,罗槑,蔡阳,何畏,陈蕾. 不同类型肺结核患者外周血维生素D与抗菌肽LL-37表达水平的研究[J]. 中国防痨杂志, 2019, 41(2): 190-194. doi: 10.3969/j.issn.1000-6621.2019.02.013

Gui-hui WU,Tao HUANG,Mei LUO,Yang CAI,Wei HE,Lei CHEN. Correlation between vitamin D level and LL-37 expression in peripheral blood of different forms of active pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2019, 41(2): 190-194. doi: 10.3969/j.issn.1000-6621.2019.02.013

图/表 3

表1

各组研究对象一般情况的比较

组别	研究对象 (例或名)	年龄 (岁, $x ˉ$ ±s)	性别[例(构成比,%)]
组别	研究对象 (例或名)	年龄 (岁, $x ˉ$ ±s)	男	女
A组(健康对照者)	100	35.87±11.10	58(58.00)	42(42.00)
B组(单纯肺结核患者)	81	33.59±12.36	56(69.14)	25(30.86)
C组(肺结核并发肺外结核患者)	57	36.24±10.76	38(66.67)	19(33.33)
D组(结核病并发糖尿病患者)	40	39.69±10.93	24(60.00)	16(40.00)
统计学检验值		F=2.60	χ²=2.86
P值		0.060	0.410

表1

表2

各组患者外周血25-(OH)D3和LL-37水平的比较

组别	例数	25-(OH)D₃(nmol/L, $x ˉ$ ±s)	LL-37(μg/L, $x ˉ$ ±s)
A组(健康对照者)	100	40.57±14.32	24.38±4.57
B组(单纯肺结核患者)	81	31.58±11.89	26.97±10.29
C组(肺结核并发肺外结核患者)	57	25.68±13.57	30.75±10.16
D组(结核病并发糖尿病患者)	40	26.39±10.01	31.84±11.36
F值		21.30	10.27
P值		0.000	0.000

表2

表3

不同病情肺结核患者外周血25-(OH)D3和LL-37水平的比较

病情严重程度	例数	25-(OH)D₃(nmol/L, $x ˉ$ ±s)	LL-37(μg/L, $x ˉ$ ±s)
重症	79	24.59±12.36	31.97±11.43
轻症	99	33.79±15.47	27.32±10.69
t值		4.41	2.77
P值		0.000	0.006

表3

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