肺结核预后评价中血清学标志物的研究进展

doi:10.19982/j.issn.1000-6621.20250513

摘要/Abstract

摘要：

肺结核的精准预后评估对改善临床结局至关重要。血清学标志物可动态、定量地反映宿主的炎症、代谢及免疫状态,弥补传统方法的不足。笔者综述了五类预后相关血清学标志物的研究进展:(1)非特异性炎症与急性期反应指标(如C反应蛋白、降钙素原),其动态变化与疾病活动度及治疗反应相关;(2)营养与代谢状态指标(如白蛋白、血清阴离子间隙),评估全身状况与死亡风险;(3)固有免疫与微环境调控标志物(如可溶性髓系细胞触发受体-1、γ-干扰素诱导蛋白10),揭示免疫病理状态;(4)免疫效应细胞因子(如γ-干扰素、白细胞介素6、白细胞介素10),其平衡影响疾病转归;(5)细胞程序性死亡与代谢重编程新型标志物(如消皮素D、谷胱甘肽过氧化物酶4),从细胞命运层面提供新见解。多指标联合与预测模型是提升效能的关键方向。尽管部分标志物预测价值良好,但仍面临特异性不足、标准化欠缺等挑战。未来需通过多维度整合、模型构建及前瞻性验证,推动其向临床精准管理转化。笔者结合国内外最新研究进展,旨在对肺结核预后评价中血清学标志物的价值进行探讨,以期为肺结核患者预后评价提供新视角。

关键词: 结核, 肺, 血清, 生物学标记, 预后

Abstract:

Accurate prognostic evaluation is crucial for improving clinical outcomes in pulmonary tuberculosis (TB). Serological markers can dynamically and quantitatively reflect the host’s inflammatory, metabolic, and immune status, complementing the limitations of traditional methods. This article systematically reviews the research progress on five categories of serological markers related to prognosis: (1) Non-specific inflammatory and acute-phase response indicators (e.g., CRP, PCT), whose dynamic changes correlate with disease activity and treatment response; (2) Nutritional and metabolic status indicators (e.g., Alb, AG), which assess systemic condition and mortality risk; (3) Innate immune and microenvironment regulatory markers (e.g., sTREM-1, IP-10), revealing immunopathological status; (4) Immune effector cytokines (e.g., IFN-γ, IL-6, IL-10), whose balance influences disease progression; (5) Novel markers related to programmed cell death and metabolic reprogramming (e.g., GSDMD, GPX4), providing new insights from the perspective of cell fate. Multi-marker combinations and predictive models are key directions for enhancing prognostic efficacy. Although some markers show good predictive value, challenges remain, such as lack of specificity and standardization. Future efforts should focus on multi-dimensional integration, model construction, and prospective validation to advance their translation into precise clinical management.

Key words: Tuberculosis, pulmonary, Serum, Biological markers, Prognosis

中图分类号:

R521

张文雅, 张艳秋, 王伟东, 许晓莞, 何梦雅, 孙定勇. 肺结核预后评价中血清学标志物的研究进展[J]. 中国防痨杂志, 2026, 48(6): 892-902. doi: 10.19982/j.issn.1000-6621.20250513

Zhang Wenya, Zhang Yanqiu, Wang Weidong, Xu Xiaowan, He Mengya, Sun Dingyong. Research progress of serological markers for the prognostic evaluation of pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 892-902. doi: 10.19982/j.issn.1000-6621.20250513

图/表 1

表1

肺结核预后相关血清学指标的诊断参数

第一作者及文献序号	研究设计	研究人群特征	预后终点	生物标志物	样本量 (例)	曲线下面积	95%CI	敏感度 (%)	特异度 (%)
Miranda^[7]	前瞻性队列研究	新诊断活动性肺结核患者	短期预后不良	CRP	165	0.770	0.610~0.920	77.80	81.10
Huang^[5]	前瞻性队列研究	新诊断活动性肺结核患者	临床死亡	PCT	243	0.790	0.710~0.870	87.20	56.90
				sTREM-1	243	0.770	0.680~0.840	79.50	66.20
刘日红^[23]	回顾性队列研究	活动性肺结核患者	不良治疗结局	ESR	75	0.699	0.567~0.831	65.00	74.00
				ADA	75	0.655	0.523~0.788	80.00	72.00
张瀚文^[74]	病例-对照研究	重症肺结核患者	临床死亡	Alb	60	0.728	0.486~0.947	61.90	79.50
				AG	60	0.769	0.596~0.929	81.00	69.20
Pandiarajan^[6]	巢式病例- 对照研究	新诊断、药物敏感性肺结核患者	不良治疗结局	IFN-γ	58	0.724	/	100.00	51.61
				TNF-α	58	0.773	/	88.89	61.29
				IL-10	58	0.975	/	100.00	96.77
Gupte^[50]	巢式病例- 对照研究	新诊断、药物敏感性肺结核患者	不良治疗结局	IL-6	200	0.730	0.660~0.800	78.00	57.00
刘林^[61]	前瞻性队列研究	活动性肺结核患者	短期预后不良	IL-34	103	0.882	0.841~0.949	71.80	71.90
Stefanescu^[16]	前瞻性队列研究	新诊断活动性肺结核患者	痰培养转阴	IP-10	26	0.780	0.530~1.000	/	/
Miranda^[7]	前瞻性队列研究	新诊断活动性肺结核患者	短期预后不良	SF	165	0.750	0.630~0.880	87.50	72.90
潘美民^[90]	病例-对照研究	老年肺结核患者	短期预后不良	sIL-2R	80	0.726	0.579~0.873	79.72	69.51
				TNFSF14	80	0.703	0.549~0.857	89.15	55.00
梁朝坤^[91]	病例-对照研究	肺结核患者	不良治疗结局	SOCS1	200	0.697	0.568~0.826	51.92	83.33
Wang^[67]	前瞻性队列研究	肺结核患者	临床死亡	MIF	304	0.680	0.600~0.760	/	/
Kumar^[92]	巢式病例对照研究	新诊断药物敏感性肺结核患者	治疗失败	SAP	54	0.972	/	94.00	88.00
				Hp	54	0.746	/	66.00	71.00

表1

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