老年肺结核患者血清TNFSF14、sIL-2R水平及与短期预后的相关性研究

doi:10.19982/j.issn.1000-6621.20240226

摘要/Abstract

摘要：

目的：分析老年肺结核患者血清肿瘤坏死因子超家族成员14(tumor necrosis factor superfamily 14, TNFSF14)、可溶性白细胞介素2受体(soluble interleukin 2 receptor, sIL-2R)水平变化及与短期预后的相关性。方法：选择2019年6月至2022年7月于长沙市第一医院接收的80例老年肺结核患者作为观察组,另选同期80例老年健康体检者作为对照组。观察组治疗后随访3个月,按照患者短期预后情况分为预后良好组(65例)和预后不良组(15例)。采用logistic回归分析血清TNFSF14、sIL-2R与短期预后的关系。结果：观察组血清TNFSF14水平为(12.55±1.20)ng/L,sIL-2R水平为(255.80±25.15)pmol/L,均高于对照组[(3.80±0.53)ng/L和(100.96±10.10)pmol/L],差异均有统计学意义(t=9.434,P<0.001;t=8.166,P<0.001)。化疗后随访3个月发现,观察组痊愈10例(12.50%),有效55例(68.75%),无效15例(18.75%);预后良好合计65例(81.25%),预后不良合计15例(18.75%)。预后不良组血清TNFSF14水平为(14.35±1.51)ng/L,sIL-2R水平为(275.64±27.10)pmol/L,均高于预后良好组[(12.09±1.18)ng/L和(253.33±25.13)pmol/L],差异均有统计学意义(t=6.334,P<0.001;t=3.055,P=0.003)。预后不良组的痰菌阳性比例为93.33%(14/15),高于预后良好组的58.46%(38/65),差异有统计学意义(χ²=6.515,P=0.011)。经logistic回归分析发现,血清TNFSF14水平升高(OR=8.913,95%CI:1.993~48.002)和sIL-2R水平升高(OR=7.132,95%CI:1.054~35.172)、痰菌阳性(OR=9.947,95%CI:1.233~80.253)均是导致老年肺结核患者预后不良的危险因素。ROC曲线显示,血清TNFSF14、sIL-2R及二者联合预测老年肺结核患者短期预后的AUC分别为0.703(95%CI:0.549~0.857)、0.726(95%CI:0.579~0.873)和0.901(95%CI:0.818~0.999)。结论：老年肺结核患者血清TNFSF14、sIL-2R均呈高表达,TNFSF14、sIL-2R表达升高会增加患者短期不良预后发生的风险,临床应密切监测二者表达,以预测患者不良预后的发生。

关键词: 结核, 肺, 老年人, 肿瘤坏死因子类, 受体, 白细胞介素2, 预后

Abstract:

Objective: To analyze the changes of serum tumor necrosis factor superfamily member 14 (TNFSF14) and Soluble interleukin 2 receptor (sIL 2R) levels in elderly patients with pulmonary tuberculosis and their correlation with short-term prognosis. Methods: A total of 80 elderly patients with pulmonary tuberculosis who admitted to the First Hospital of Changsha City from June 2019 to July 2022 were selected as the observation group, and other 80 elderly healthy persons who received physical examinations during the same period were selected as the control group. The patients in observation group were followed up for 3 months after treatment and were divided into good prognosis group (65 cases) and poor prognosis group (15 cases) according to their short-term prognosis. Logistic regression was used to analyze the relevance between serum TNFSF14, sIL-2R and short-term prognosis. Results: The serum TNFSF14 level and sIL-2R level in the observation group were (12.55±1.20) ng/L and (255.80±25.15) pmol/L respectively, which were higher than those in the control group ((3.80±0.53) ng/L and (100.96±10.10) pmol/L). The differences were statistically significant (t=9.434, P<0.001; t=8.166, P<0.001). After the patients in the observation group received treatment, a 3-month follow-up found that 10 cases (12.50%) were cured, 55 cases (68.75%) were effective and 15 cases (18.75%) were ineffective. So a total of 65 cases (81.25%) had good prognosis, while 15 cases (18.75%) had poor prognosis. The serum TNFSF14 level and the serum sIL-2R level of the patients in the poor prognosis group were (14.35±1.51) ng/L and (275.64±27.10) pmol/L respectively, which were higher than those in the good prognosis group ((12.09±1.18) ng/L and (253.33±25.13) pmol/L). The differences were statistically significant (t=6.334, P<0.001; t=3.055, P=0.003). The positive rate of sputum bacteria in poor prognosis group (93.33% 14/15) was higher than that in good prognosis group (58.46%, 38/65), and the difference was statistically significant (χ²=6.515, P=0.011). Logistic regression analysis results showed that the increased levels of serum TNFSF14 (OR=8.913, 95%CI: 1.993-48.002), sIL-2R (OR=7.132, 95%CI: 1.054-35.172) and positive sputum bacteria (OR=9.947, 95%CI: 1.233-80.253) were risk factors for poor prognosis in elderly patients with pulmonary tuberculosis. The results of ROC curve showed that the AUC of serum TNFSF14 alone, sIL-2R alone and their combination in predicting the short-term prognosis of elderly patients with pulmonary tuberculosis were 0.703 (95%CI: 0.549-0.857), 0.726 (95%CI: 0.579-0.873) and 0.901 (95%CI: 0.818-0.999), respectively. Conclusion: Serum TNFSF14 and sIL-2R are at high levels in elderly patients with pulmonary tuberculosis, and the high level of TNFSF14 and sIL-2R will increase the risk of short-term poor prognosis in patients. In clinical practice, the levels of both serum TNFSF14 and sIL-2R should be closely monitored to predict the occurrence of poor prognosis in patients.

Key words: Tuberculosis, pulmonary, Aged, Tumor necrosis factors, Receptors, interleukin-2, Prognosis

中图分类号:

R521

潘美民, 李文娟, 张雪红, 杨丽晖, 何娟, 谭永卫. 老年肺结核患者血清TNFSF14、sIL-2R水平及与短期预后的相关性研究[J]. 中国防痨杂志, 2025, 47(1): 66-71. doi: 10.19982/j.issn.1000-6621.20240226

Pan Meimin, Li Wenjuan, Zhang Xuehong, Yang Lihui, He Juan, Tan Yongwei. Study on serum TNFSF14 and sIL-2R levels in elderly patients with pulmonary tuberculosis and their correlation with short-term prognosis[J]. Chinese Journal of Antituberculosis, 2025, 47(1): 66-71. doi: 10.19982/j.issn.1000-6621.20240226

图/表 5

表1

表2

预后良好组和预后不良组相关指标对比情况

指标	预后良好组(65例)	预后不良组(15例)	统计检验值	P值
性别[例(构成比,%)]			χ²=0.137	0.712
男性	40(61.54)	10(66.67)
女性	25(38.46)	5(33.33)
吸烟史[例(构成比,%)]			χ²=0.036	0.849
有	5(7.69)	2(13.33)
无	60(92.31)	13(86.67)
饮酒史[例(构成比,%)]			χ²=0.108	0.742
有	3(4.62)	1(6.67)
无	62(95.38)	14(93.33)
痰菌结果[例(构成比,%)]			χ²=6.515	0.011
阳性	38(58.46)	14(93.33)
阴性	27(41.54)	1(6.67)
体质量指数[例(构成比,%)]			χ²=0.001	0.971
>24	35(53.85)	8(53.33)
≤24	30(46.15)	7(46.67)
合并疾病[例(发生率,%)]			χ²=0.844	0.839
糖尿病	15(23.08)	4(26.67)
高血压	17(26.15)	5(33.33)
高脂血症	18(27.69)	4(26.67)
其他疾病	15(23.08)	2(13.33)
年龄(岁, $x ˉ$ ±s)	59.63±3.85	58.71±4.03	t=0.827	0.411
病灶数(个, $x ˉ$ ±s)^a	3.65±0.39	3.61±0.42	t=0.353	0.725
TNFSF14(ng/L, $x ˉ$ ±s)	12.09±1.18	14.35±1.51	t=6.334	<0.001
sIL-2R(pmol/L, $x ˉ$ ±s)	253.33±25.13	275.64±27.10	t=3.055	0.003

表2

表3

老年肺结核患者短期预后情况的logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
TNFSF14	2.188	0.690	9.924	0.002	8.913	1.993~48.002
sIL-2R	1.965	0.696	7.969	0.005	7.132	1.054~35.172
痰菌阳性	2.297	1.065	4.651	0.031	9.947	1.233~80.253

表3

表4

图1

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