Abstract:

Objective To investigate the correlation between the results of serum carbohydrate antigen 125 (CA125), ferritin (SF) and other laboratory tests with the pleura invasion among the patients with pulmonary tuberculosis (TB).Methods From November 2013 to April 2017, a total of 296 patients with secondary pulmonary TB were admitted to Zhangjiakou Infectious Disease Hospital. The related data and information were collected from those patients. According to whether the pleura of the patients were invasive from their pulmonary lesions or not, the patients were divided into the pleura invasion group (207 cases) and the pleura non-invasion group (89 cases). Chemiluminescent immunoassay was used to exam the levels of serum CA125 and ferritin, and the examination results were showed with the median (quartile: Q₁, Q₃). The following examinations were performed to the patients, including sputum smear (Ziehl-Neelsen acid-fast staining method), Mycobacterium tuberculosis culture (MGIT 960 liquid culture), interferon gamma releasing assays (IGRA), highsensitive creactive protein (hsCRP) and other related laboratory tests such as hemoglobin (Hb), albumin (ALB) and pre-albumin (PA). The Mann-Whitney U test, chi-square test, spearman correlation analysis, logistic stepwise regression analysis were used, and the new variable regression equation (logit (P)), the receiver-operating characteristic curve (ROC) and the optimal cut-off value were also established to explore the causes of the changes of CA125, SF, hs CRP, sputum Mycobacterium tuberculosis, IGRA, Hb, ALB and PA, as well as the relationship between those indicators and the pleura invasion by pulmonary TB lesions.Results Among the examination results of the patients in two groups, CA125 (31.55 (18.45, 71.80)kU/L; 16.15 (9.55, 23.15)kU/L), SF (234.68 (128.27, 504.12)μg/L; 127.39 (86.31, 201.76)μg/L), hs-CRP (47.50 (16.00, 82.55)mg/L; 3.40 (0.78,7.73)mg/L) and the sputum bacteriological positive rate (32.85%, 68/207; 11.24%, 10/89) had the statistically significant differences (Z=-5.84, -4.87, -6.34 respectively, χ ²=296.00; P=0.000, respectively). The indicators of CA125, SF and hs-CRP in the patients of two groups were found to have significantly correlated with whether or not the pleura were invasive by pulmonary TB lesions through the spearman correlation analysis (r=0.38, 0.32,0.64, respectively; P=0.000, respectively). Logistic stepwise regression analysis showed that the results of CA125, SF, sputum Mycobacterium tuberculosis examination were correlated with whether or not the pleura were invasive by pulmonary TB lesions (OR=1.11, P=0.001; OR=1.01, P=0.005; OR=5.89, P=0.025). The area under the ROC curve of the new variable logit (P) (AUC, 0.88) was higher than that of the indicators of CA125 and SF (AUC, 0.78 respectively), and had obvious prediction probability (P=0.000, respectively). Spearman correlation analysis showed a significant correlation between the indicators of CA125, SF and the area of the invasive pleura by pulmonary TB lesions (Y) (r=0.69, 0.55, respectively; P=0.000, respectively). In linear regression analysis, Anova showed that lnCA125 and lnSF were significantly correlated with the pleura invasion (F=68.65, 29.45, respectively; P=0.000, respectively). Conclusion Sputum TB bacteriological positive, the increased levels of hs-CRP, serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the pleura invasion by pulmonary TB lesions, there is no correlation between IGRA and the pleura invasion. The increased levels of serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the area of the pleura invasion by pulmonary TB lesions.

Key words: Tuberculosis,pulmonary, Tuberculosis,pleural, Antigens,tumor-associated,carbohydrate, Ferritins, Factor analysis,statistical