肺结核合并下呼吸道感染患者CT影像特点及IL-23R水平表达的临床意义

摘要 目的：探讨肺结核合并下呼吸道感染患者CT影像特点及IL-23R水平表达的临床意义。方法：选取2015年1月-2018年8月于我院就诊的123例肺结核患者,将所选取的患者按是否合并下呼吸道感染分为单纯肺结核组73例和肺结核合并下呼吸道感染组50例。分析两组组患者临床表现、CT影像学图片、CT影像学表现、血清IL-23R的表达水平的差异。结果：单纯肺结核组患者出现14例低热、11例胸闷、17例消瘦、14例气短、18例痰中带血、14例颈部淋巴结肿大、23例咳嗽、21例胸痛。肺结核合并下呼吸道感染组患者出现16例低热、13例胸闷、21例消瘦、19例气短、20例痰中带血、15例颈部淋巴结肿大、26例咳嗽、23例胸痛,两组患者临床表现差异均无统计学意义（P＞0.05）。单纯肺结核组CT影像学图片显示可见结节影或包块影,呈明显分叶征、短毛刺征、空泡征并发肺不张、棘状突起,边缘较清晰,增强扫描后明显强化。肺结核合并下呼吸道感染组CT影像学图片显示有分叶、毛刺,同时肺内肿物周边存在晕征、血管聚集征、卫星灶征、胸膜凹陷等表现,此外伴纵膈及肺门淋巴结明显肿大,胸壁侵犯。肺结核合并下呼吸道感染组CT影像中毛刺状结节、胸膜凹陷、空洞、分叶征、肿块、条索影比例均高于单纯肺结核组,差异有统计学意义（P＜0.05）。肺结核合并下呼吸道感染组患者IL-23R水平明显高于单纯肺结核组,差异有统计学意义（P＜0.05）。结论：与单纯肺结核患者相比较,肺结核合并下呼吸道感染患者临床表现更为严重,CT影像学特点更为明显,患者血清中IL-23R表达水平明显升高,临床可通过CT影像学结合血清IL-23R检测,以提高肺结核合并下呼吸道感染患者的临床诊断。     

Glucose Metabolism Disorder Is Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil

BackgroundDiabetes mellitus (DM) has been associated with increased risk for pulmonary tuberculosis (PTB) in endemic settings but it is unknown whether PTB risk is also increased by pre-DM. Here, we prospectively examined the association between glucose metabolism disorder (GMD) and PTB in patients with respiratory symptoms at a tuberculosis primary care reference center in Brazil.MethodsOral glucose tolerance test was performed and levels of fasting plasma glucose and glycohemoglobin (HbA1c) were measured in a cohort of 892 individuals presenting with respiratory symptoms of more than two weeks duration. Patients were also tested for PTB with sputum cultures. Prevalence of pre-DM and DM (based on HbA1c) was estimated and tested for association with incident PTB. Other TB risk factors including smoking history were analyzed.ResultsThe majority of the study population (63.1%) exhibited GMD based on HbA1c ≥5.7%. Patients with GMD had higher prevalence of PTB compared to normoglycemic patients. Individuals with DM exhibited increased frequency of TB-related symptoms and detection of acid-fast bacilli in sputum smears. Among patients with previous DM diagnosis, sustained hyperglycemia (HbA1c ≥7.0%) was associated with increased TB prevalence. Smoking history alone was not significantly associated with TB in our study population but the combination of smoking and HbA1c ≥7.0% was associated with 6 times higher odds for PTB.ConclusionsSustained hyperglycemia and pre-DM are independently associated with active PTB. This evidence raises the question whether improving glycemic control in diabetic TB patients would reduce the risk of TB transmission and simultaneously reduce the clinical burden of disease. A better understanding of mechanisms underlying these associations, especially those suggesting that pre-DM may be a factor driving susceptibility to TB is warranted.     

Prevalence of Type 2 Diabetes among Newly Detected Pulmonary Tuberculosis Patients in China: A Community Based Cohort Study

Background

Patients with type 2 diabetes (DM) have a higher risk of developing pulmonary tuberculosis (PTB); moreover, DM co-morbidity in PTB is associated with poor PTB treatment outcomes. Community based prevalence data on DM and prediabetes (pre-DM) among TB patients is lacking, particularly from the developing world. Therefore we conducted a prospective study to investigate the prevalence of DM and pre-DM and evaluated the risk factors for the presence of DM among newly detected PTB patients in rural areas of China.

Methods and Findings

In a prospective community based study carried out from 2010 to 2012, a representative sample of 6382 newly detected PTB patients from 7 TB clinics in Linyi were tested for DM. A population of 6674 non-TB controls from the same community was similarly tested as well. The prevalence of DM in TB patients (6.3%) was higher than that in non-TB controls (4.7%, p<0.05). PTB patients had a higher odds of DM than non-TB controls (adjusted OR 3.17, 95% CI 1.14–8.84). The prevalence of DM increased with age and was significantly higher in TB patients in the age categories above 30 years (p<0.05). Among TB patients, those with normal weight (BMI 18.5–23.9) had the lowest prevalence of DM (5.8%). Increasing age, family history of DM, positive sputum smear, cavity on chest X-ray and higher yearly income (≥10000 RMB yuan) were positively associated and frequent outdoor activity was negatively associated with DM in PTB patients.

Conclusions

The prevalence of DM in PTB patients was higher than in non-TB controls with a 3 fold higher adjusted odds ratio of having DM. Given the increasing DM prevalence and still high burden of TB in China, this association may represent a new public health challenge concerning the prevention and treatment of both diseases.     

Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with Multidrug-Resistant Tuberculosis

Background

Until now, radiographic manifestations of multidrug-resistant pulmonary tuberculosis (MDR- TB) in patients with diabetes mellitus (DM) have not been reported. We conducted a study to investigate the imaging features of pulmonary computed tomography (CT) for type 2 diabetic (T2DM) patients with MDR-TB.

Methods

The clinical data and pulmonary CT findings of 39 type 2 diabetic patients with MDR-TB, 46 type 2 diabetic patients with drug-susceptible tuberculosis (DS-TB), and 72 pure drug-susceptible TB cases (without T2DM and MDR) treated at Dalian Tuberculosis Hospital from 2012 to 2015 were collected, and the clinical features and imaging differences of the three groups were compared.

Results

The clinical characteristics of the three groups of patients were not significantly different except with respect to age and previous treatment history. However, on imaging, the patients with MDR-TB showed consolidation in and above the pulmonary segments was significantly more extensive than that seen in the DS-TB group with or without T2DM.

Conclusion

Consolidation in or above multiple pulmonary segments with multiple mouth-eaten cavities and bronchial damage on pulmonary CT images in type 2 diabetic patients with tuberculosis suggests the possibility of multi-drug resistance.     

BDNF与T2DM 及糖尿病周围神经病变的相关性研究

目的:探讨脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)与2型糖尿病(Diabetes mellitus type2,T2DM)及糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)的相关性研究。方法:纳入T2DM及DPN患者各45例,分别对两组患者血压、血糖、血脂、胰岛素抵抗指数(HOMA-IR)、BDNF等指标进行对比分析。对两组患者BDNF表达水平变化的相关因素进行Pearson相关分析以及多因素线性回归分析。结果:DPN组病程、FBG、HOMA-IR、BDNF分别为(12.16±5.84)年、(10.24±3.93)mmol/L、(3.75±2.02)、(3.43±0.94),T2DM组病程、FBG、HOMA-IR、BDNF分别为(7.43±5.29)年、(8.19±3.35)mmol/L、(2.69±1.84)、(4.91±1.67),差异有显著性(P0.05);多因素线性回归分析显示,病程、感觉阈值与BDNF表达水平相关(P0.05);Pearson相关分析显示,BDNF表达水平与HOMA-IR存在显著负相关(P0.05)。结论:DPN患者BDNF水平明显降低,其水平与感觉阈值、病程、HOMA-IR呈现负相关。     

多层螺旋CT对肺结核合并肺癌患者的诊断价值

目的:研究多层螺旋CT对肺结核合并肺癌的鉴别诊断价值。方法:选择2013年3月至2015年9月在我院确诊的肺结核合并肺癌患者32例和单纯肺结核患者39例应用多层螺旋CT扫描患者肺部病变情况。结果:肺结核合并肺癌组:陈旧性肺结核28例、活动性肺结核4例;病灶位置经典部位29例、非经典部位3例,合并鳞癌11例、腺癌13例、小细胞癌5例、未分化癌3例;10例结核病灶与肺癌病灶不同侧、13例结核病灶与肺癌病灶同侧不同叶、9例结核病灶于肺癌病灶同侧同叶。单纯性肺结核组胨旧性肺结核36例、活动性肺结核3例;病灶位置经典部位34例(上叶尖段11例、后段9例、下叶背段14例)、非经典部位5例。肺结核合并肺癌组患者分叶征、毛刺征、胸膜凹陷征、阻塞性肺炎及肺不张以及棘状突起比例高于单纯肺结核组,而空泡影比例低于单纯肺结核组,差异具有统计学意义(P0.05);两组钙化、斑片条索影、结节影以及空洞或空腔比较,差异无统计学意义(P0.05)。结论:多层螺旋CT对肺结核合并肺癌具有较高的临床鉴别诊断价值。     

Type 2 diabetes mellitus coincident with pulmonary or latent tuberculosis results in modulation of adipocytokines

Type 2 diabetes mellitus (T2DM) is recognized as major risk factor for the progress of active pulmonary tuberculosis (PTB), although the mechanistic link between diabetes and tuberculosis remains poorly characterized. Moreover, the influence of poorly controlled diabetes on the baseline levels of adipocytokines in the context of tuberculosis has not been explored in detail. To characterize the influence of coexistent DM on adipocytokine levels in pulmonary or latent TB (LTB), we examined circulating levels of adipocytokines in the plasma of individuals with PTB–DM or LTB–DM and compared them with those without DM (PTB or LTB). PTB–DM or LTB–DM is characterized by diminished circulating levels of adiponectin and adipsin and/or heightened circulating levels of leptin, visfatin and PAI-1. In addition, adiponectin and adipsin exhibit a significant negative correlation, whereas leptin, visfatin and PAI-1 display a significant positive correlation with HbA1C levels and random blood glucose levels. Therefore, our data reveal that PTB–DM or LTB–DM is characterized by alterations in the systemic levels of adipocytokines, indicating that altered adipose tissue inflammation underlying Type 2 diabetes potentially contributes to pathogenesis of TB disease.     

2型糖尿病患者APPL1、AFABP与胰岛素抵抗指数的相关性研究

目的:分析2型糖尿病(T2DM)患者磷酸酪氨酸衔接蛋白(APPL1)、脂肪细胞型脂肪酸结合蛋白(AFABP)与稳态模型评估胰岛素抵抗指数(HOMA-IR)的相关性。方法:选择2015年6月~2016年5月至我院就诊T2DM患者100例作为患病组,选取同期在我院健康体检者100例作为健康组,对研究对象进行指标如空腹血糖(FPG)、空腹血清胰岛素(FINS)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、APPL1、AFABP等检测,并根据公式计算HOMA-IR、及体重指数(BMI),分析APPL1、AFABP与各指标相关性。结果:患病组与健康组TC、HDL、LDL水平无明显差异(P0.05),患病组BMI、FPG、FINS、Hb A1c、TG、HOMA-IR、APPL1、AFABP与健康组比较明显较高(P0.05);APPL1与BMI、FINS、Hb A1c、HOMA-IR呈负相关性(P0.05),与FPG呈正相关性;AFABP与BMI、FPG、FINS、Hb A1c、HOMA-IR呈正相关性(P0.05)。结论:T2DM患者APPL1、AFABP较高,APPL1、AFABP与HOMA-IR呈直线相关性,表明APPL1、AFABP与T2DM患者胰岛素抵抗密切相关,该研究为APPL1、AFABP可以作为T2DM治疗的新靶点提供了理论依据。     

The IL-17F sequence variant is associated with susceptibility to tuberculosis

The interleukin (IL)-17 gene plays a key role in host defence against infections from microbes, including Mycobacterium tuberculosis. Genetic factors contribute to host defence. However, whether genetic variation in IL-17 is associated with altered susceptibility to tuberculosis is unknown. A total of 596 pulmonary tuberculosis (PTB) patients, 176 extra-pulmonary tuberculosis (EPTB) patients, and 622 control patients from a Chinese Han population were recruited. Two single-nucleotide polymorphisms (SNPs) in IL-17F (rs1889570 and rs763780) and one SNP in IL-17A (rs2275913) were genotyped using the SNaPshot technique. Of the three SNPs in the IL-17 gene tested, there was an increased frequency of the rs1889570 G allele and the rs763780 C allele in the PTB patients and an increased frequency of the rs763780 C allele in the EPTB patients compared with the control patients. There were also significant differences in the distribution of the rs763780 genotype between the PTB and EPTB patients and the controls. The patients who had the CT/TT genotype of the rs763780 SNP were more susceptible to tuberculosis, compared to the CC genotype. There was no significant difference observed between the IL-17 SNPs when the PTB and EPTB patients were compared. Genetic variation in IL-17F is associated with altered susceptibility to tuberculosis and may provide valuable information in the development of tuberculosis.     

成人不典型肺结核的CT 表现及鉴别诊断分析( 附30 例报告)

目的：回顾性分析成人不典型肺结核的CT表现,探讨与其他同影性疾病的鉴别方法,做到早诊断早治疗,减低病人的治疗成本和思想负担。方法：选择性收集病变不典型。CT影像检壹曾误诊或诊断困难的病例30例做回顾性分析。所有病例均有最后治疗结果或术后病理结果证实。结果：节段性阴影12例,局灶性斑片及斑点状影8例,散在少数小结节样影4例,多发结节并空洞影3例,肺内弥漫分布的粟粒结节影3例,肺内阴影伴有肺门淋巴结及纵隔淋巴结肿大者9例以青壮年病人吸收较快,病程较短,以粟粒影和大片影表现者吸收最快。讨论：对于不典型的成人肺结核,不能片面的强调或突出某一方面征象,年龄因素、临床症状、实验室检查如结核茵素试验（PPD）、痰结核茵培养、抗结核抗体阳性在鉴别诊断中有着重要意义。进一步正确认识及探究病变的影像特点,对于正确的诊断提供了强有力的理论根据。     

Cytokine single nucleotide polymorphisms in Iranian patients with pulmonary tuberculosis

BACKGROUND: Several genes coding for different cytokines may affect host susceptibility to tuberculosis. METHODS: In the present study, the allele and genotype frequencies of a number polymorphic genes coding for cytokines or cytokine receptors were investigated in Iranian patients with pulmonary tuberculosis (PTB). RESULTS: From the IL-1 cluster, a positive, significant difference was found at position -889, where the T/T genotype was over represented in PTB patients (p = 0.01); a positive, significant increase was found in the IL1R PstI 1970 C/C genotype, where the C allele was over represented in the PTB patients (p = 0.01). A significant negative association at codon 10 TGF-beta, T allele, was shown in our patients and the C allele and C/C genotype were over represented in the PTB patients (P<0.005). For TNF-alpha at position -238, we found a negative association for the G/A genotype and a positive association for the G/G genotype (p = 0.0009). Significant negative associations at position -590 IL-4, T allele and the T/T genotype were shown in our patients (p = 0.0007); also, the C allele and T/C genotype were significantly increased in our patients (P<0.05). With IL-6 at -174, G/G increased and G/C decreased significantly in the patients (P<0.005). CONCLUSION: Pro-inflammatory cytokines such as TNF-alpha and TGF-beta seem to be decreased, and IL-6 increased in PTB patients.     

Biomarker potential of C-peptide for screening of insulin resistance in diabetic and non-diabetic individuals

Insulin resistance is a hallmark feature of type-2 diabetes mellitus (T2DM). We determined the homeostatic model assessment insulin resistance (HOMA-IR) and evaluated its association with C-peptide, insulin, fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) in T2DM patients and non-diabetic subjects. This study comprised a total of 47 T2DM patients and 38 non-diabetic controls. Venous blood samples from all the subjects were collected and sera were analyzed for FBG, HbA1c, insulin and C-peptide using an autoanalyzer. HOMA-IR was calculated using the following equation: HOMA-IR?=?fasting insulin (µU/ml)?×?fasting glucose (mmol/L)/22.5. There was a significant increase in the levels of FBG and HbA1c in diabetic patients. Although the levels of C-peptide and insulin did not differ significantly between the two groups, a significant increase in HOMA-IR was observed in T2DM patients. Both insulin and C-peptide were significantly correlated with HOMA-IR. In conclusion, C-peptide may serve as a simple and convenient predictor of HOMA-IR.     

X线片和多层螺旋CT诊断及鉴别周围型肺癌的对比研究

目的:对比X线平片和多层螺旋CT诊断及鉴别周围型肺癌的效果。方法:选取了100例周围型肺癌患者,所有患者入院后先行X线片检查,后进行多层螺旋CT检查。通过观察并记录X线片与多层螺旋CT对周围型肺癌的影像学特征、临床TNM分期的诊断效果,评价X线平片和多层螺旋CT对周围型肺癌的诊断效果。结果:多层螺旋CT对周围型肺癌的肿块、分叶征、支气管气象征、空洞、胸膜凹陷、血管集束征,胸腔积液的检出率均高于X线片(P0.05)。根据外科病理TNM分期结果,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率为92.0%,X线对周围型肺癌的临床TNM分期诊断符合率为61.0%,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率明显高于X线(P0.05)。结论:多层螺旋CT对于周围型肺癌各类型影像学征象具有较好的检出率,对周围型肺癌临床TNM分期诊断准确性接近病理诊断结果。     

达格列净对2型糖尿病合并非酒精性脂肪性肝病患者血清FGF-21水平的影响

摘要 目的：分析血清成纤维细胞生长因子-21（FGF-21）与2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者常见指标及NAFLD纤维化评分（NFS）的相关性,进一步探讨达格列净对T2DM合并NAFLD患者血清FGF-21水平的影响。方法：选取2022年1月至2022年6月徐州医科大学附属徐州市立医院收治的80例T2DM合并NAFLD患者为研究对象（T2DM合并NAFLD组）,选择同期80例T2DM不合并NAFLD患者为T2DM组。收集腰围（WC）、身高、体重数据,计算体重指数（BMI）。测定空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）,低密度脂蛋白胆固醇（LDL-c）、肌酐（Cr）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST ）、白蛋白（Alb）、血小板计数（PLT）等指标,计算胰岛素抵抗指数（HOMA-IR）、NFS。采用酶联免疫吸附（ELISA）法测定FGF-21水平。比较T2DM组和T2DM合并NAFLD组各项指标的差异,探讨血清FGF-21水平与T2DM合并NAFLD患者其他指标的相关性,Logistic回归分析T2DM合并NAFLD的影响因素,受试者工作特征曲线（ROC）分析各影响因素对T2DM合并NAFLD的诊断价值。将80例T2DM合并NAFLD患者按随机数字表法随机分为二甲双胍组和达格列净组各40例,治疗前后观测各项指标变化,并密切监测不良反应。结果：T2DM合并NAFLD组患者WC、BMI、FINS、HbA1c、TG、AST、ALT、HOMA-IR、NFS及FGF-21均高于 T2DM组（P＜0.05）。相关性分析显示,FGF-21水平与T2DM合并NAFLD组患者WC、BMI、HbA1c、TG、HOMA-IR、NFS均存在正相关（P<0.05）。Logistic回归分析显示,BMI、HbA1c、FGF-21、HOMA-IR为影响T2DM患者合并NAFLD的危险因素。ROC曲线分析显示,BMI、HbA1c、FGF-21、HOMA-IR对T2DM合并NAFLD均具有一定预测价值,其中以FGF-21的预测效能最佳。治疗后,达格列净组TG、AST、ALT、NFS、FGF-21水平较二甲双胍组降低更为明显（P＜0.05）。结论：血清FGF-21水平为T2DM合并NAFLD的危险因素,参与了T2DM合并NAFLD发病及进展,且对T2DM合并NAFLD有较好的预测效能。相较于二甲双胍,达格列净可明显降低T2DM合并NAFLD患者血清FGF-21水平并改善NFS,具有一定程度的肝脏保护作用。     

不同剂量多排螺旋CT扫描对儿童肺结核的诊断价值比较研究

目的:探讨不同剂量多排螺旋CT扫描对儿童肺结核(PTB)的诊断价值。方法:以我院于2016年5月～2018年11月收治的156例PTB患儿为研究对象,根据患儿年龄分为A组52例(0～5岁)、B组52例(6～9岁)、C组52例(10～14岁)。三组患儿均进行低剂量64排螺旋CT扫描,其中A组剂量为20 MA,B组剂量为30 MA,C组剂量为40 MA,2 d后,三组患儿均进行常规剂量64排螺旋CT扫描,其中A组剂量为100 MA,B组和C组剂量均为150 MA。分别对比A组、B组、C组患儿低剂量与常规剂量CT扫描的扫描效果、图像优良率及辐射剂量。结果:A组、B组、C组患儿低剂量与常规剂量CT扫描对病灶数量、结节、空洞、胸膜粘连、钙化灶的显像率比较差异无统计学意义(P0.05),但A组、B组、C组患儿低剂量CT扫描对毛刺、磨玻璃影的显像率明显低于常规剂量CT扫描(P0.05);A组、B组、C组患儿低剂量与常规剂量CT扫描的图像优良率比较差异无统计学意义(P0.05);与常规剂量CT扫描相比,A组、B组、C组患儿低剂量CT扫描的剂量长度乘积(DLP)、CT剂量指数(CTDIvoI)、CT加权剂量指数(CTDIw)、放射剂量明显更低(P0.05)。结论:使用常规剂量多排螺旋CT扫描对PTB儿童毛刺、磨玻璃影的显像效果较好,但是使用低剂量多排螺旋CT扫描同样能够确保图像的质量,达到诊断要求,并且能够降低对患儿的辐射剂量,在考虑人体健康的前提下,建议使用低剂量多排螺旋CT扫描。     

Ultrasonography and computed tomography in the detection of overlooked gauze surgical dressings]

USI and CT were performed in 14 patients with textile foreign bodies left in the abdominal cavity and retroperitoneal space during operation on the biliary tracts (6 cases), kidneys (4 cases), pancreas (2), stomach (1), and during appendectomy (1). A decisive sign in USI that enabled one to detect gauze foreign bodies, was a stable echogenic zone corresponding to a proximal body contour with a solid acoustic shadow behind. Extra-organic localization of these changes contributed to making diagnosis. A certain amount of fluid could be seen around a foreign body during an exudative reaction. In CT, diagnosis was based on the detection of a formation with a capsule containing calcinates and air masses.     

Cold reactive lymphocytotoxic antibodies in pulmonary tuberculosis: correlation with disease activity and HLA

Cold reactive lymphocytotoxic antibodies (LCA) are more reactive in cold than at 37 degrees C and occur following infection, immunization or vaccination and in various autoimmune diseases. In the present study, LCA activity against T and B-lymphocytes has been investigated in patients with pulmonary tuberculosis (PTB), their various clinical sub-groups and consanguineous relatives. Further, the relevance of HLA factors in LCA activity was analyzed. The sera from 144 PTB patients, 52 family contacts and 52 healthy individuals were tested for presence of LCAs by a modified two-stage NIH microlymphocytotoxicity assay. A significant increase in LCA activity against both T (32.6% vs 5.7%, P < 0.0001) and B (59.7% vs 13.4%, P < 0.0000001) cells was observed in PTB patients as compared to healthy controls. There was no correlation between serum LCA activity and sputum acid-fast bacilli status. However, only B cell LCAs revealed significant increase in parallel to disease advancement as assessed by X-ray chest examination. Further, LCA activity was more pronounced in drug responders than drug failure group of patients. No significant difference in the distribution of HLA class I and class II antigens was observed between LCA positive and LCA negative patients. However, panel cells carrying HLA-A1, -A11 and -DR3 were often found reactive in LCA positive patient sera. In household family contacts, LCAs were significantly increased only against B cells as compared to healthy controls (38.4% vs 13.4%, P < 0.01). This study suggests that Mycobacterium tuberculosis infection/exposure could account for the occurrence of LCAs in pulmonary tuberculosis and the strength of these antibodies is related to disease severity and the extent of lung involvement.     

IL-22基因多态性与中国人群肺结核易感性的相关性研究

本研究旨在探讨白细胞介素22(interleukin 22,IL-22)基因多态性位点与肺结核易感性的关系。采用SNPscan™多重单核苷酸多态性(single nucleotide polymorphism,SNP)分型技术,对453例肺结核患者(结核病组)和373例与患者长期密切接触者〔包括109例潜伏结核感染(latent tuberculosis infection,LTBI)者、264例健康对照者〕的IL-22基因的4个SNP位点(rs1179249、rs2227491、rs17224704、rs2227478)多态性进行分析。结核病组、LTBI组和对照组中4个SNP位点的基因型分布经哈温平衡(Hardy-Weinberg equilibrium,HWE)检验均处于遗传平衡状态。结果显示,rs17224704位点存在AA、TA和TT基因型。＞55岁人群中,此位点TA基因型在对照组中的分布显著高于结核病组(P＝0.047 9,OR＝0.365,95% CI＝0.135～0.991);AA基因型在LTBI组中的分布显著低于结核病组(P＝0.027 6);TA基因型在LTBI组中的分布显著高于结核病组(P＝0.007 37,OR＝0.213,95% CI＝0.069～0.660)。对照组和LTBI组的等位基因T频率显著高于结核病组(P＝0.026 9,OR＝0.388,95% CI＝0.167～0.897;P＝0.025 0,OR＝0.322,95% CI＝0.119～0.867)。IL-22基因rs17224704的多态性可能与中国重庆地区汉族人群肺结核易感性显著相关,其等位基因T可能是肺结核的保护基因。     

Meta-Analysis on the Associations of TLR2 Gene Polymorphisms with Pulmonary Tuberculosis Susceptibility among Asian Populations

Background

Publications regarding the associations of toll-like receptor 2 (TLR2) G2258A and T597C polymorphisms with pulmonary tuberculosis (PTB) susceptibility are inconsistent. A meta-analysis was conducted to investigate the relationship between TLR2 G2258A and T597C polymorphisms with PTB susceptibility.

Methods

A systematic search was performed for published studies on the relationship between TLR2 polymorphisms and PTB susceptibility. Information was gathered from each eligible study, and statistically analyzed.

Results

6 eligible studies, totaling 1301 cases and 1217 controls on G2258A genotypes, and 8 studies, totaling 2175 cases and 2069 controls on T597C genotypes, were included in the analysis. TLR2 2258G allele and 2258GG genotype were found to be associated with decreased PTB susceptibility (A vs. G: OR  = 3.02, 95% CI: 2.22–4.12, P<0.001, GA+AA vs. GG: OR  = 2.69, 95% CI = 1.49–4.87, P = 0.001). In the subgroup analyses, the 2258G allele and 2258GG genotype also exhibited a protective effect of PTB risk in Asians (A vs. G: OR  = 2.95, 95% CI: 1.91–4.55, P<0.001; GA+AA vs. GG: OR  = 3.59, 95% CI: 2.23–5.78, P<0.001), while no associations were observed in Caucasians. No significant associations between T597C polymorphism and PTB were found in the allele model (C vs. T: OR  = 0.95, 95% CI: 0.86–1.04, P = 0.28), co-dominant model (CC vs. TT: OR  = 0.88, 95% CI = 0.92–1.40, P = 0.25; CT vs. TT: OR  = 0.92, 95% CI = 0.80–1.06, P = 0.28), recessive model (CC vs. TT+TC: OR  = 0.96, 95% CI: 0.80–1.16, P = 0.69), or dominant model (TC+CC vs. TT: OR  = 0.93, 95% CI = 0.76–1.15, P = 0.51). The associations of T597C polymorphism with PTB susceptibility, in the ethnic-specific analyses, were still not significant.

Conclusion

TLR2 2258G allele may provide protective effects against PTB susceptibility, particularly among Asians, whereas TLR2 T597C polymorphism might not be associated with PTB susceptibility.