血清腺苷脱氨酶、糖类抗原199、红细胞沉降率与活动性肺结核患者病情严重程度及预后的关系研究

摘要 目的：探讨血清腺苷脱氨酶（ADA）、糖类抗原199（CA199）、红细胞沉降率（ESR）与活动性肺结核（ATB）患者病情严重程度及预后的关系。方法：选取2021年1月～2022年10月湖南省胸科医院收治的75例ATB患者作为观察组，另外选取60例同期在我院体检健康的体检者作为对照组。比较两组血清ADA、CA199及ESR水平。根据病情严重程度将ATB患者分为轻度组、中度组和重度组。比较不同病情严重程度ATB患者的血清ADA、CA199及ESR水平。观察组接受抗结核治疗，根据疗效分为预后良好组和预后不良组，比较不同预后ATB患者的血清ADA、CA199及ESR水平。收集ATB患者的临床资料，多因素Logistic回归分析ATB患者预后的影响因素。受试者工作特征（ROC）曲线分析血清ADA、CA199、ESR对ATB患者预后的预测价值。结果：观察组血清ADA、CA199、ESR均高于对照组（P＜0.05）。将观察组患者分为轻度组26例、中度组34例和重度组15例。中度组和重度组血清ADA、CA199、ESR高于轻度组（P＜0.05），重度组血清ADA、CA199、ESR高于中度组（P＜0.05）。治疗后，根据疗效将观察组患者分为预后良好组50例和预后不良组25例，预后良好组和预后不良组在性别、年龄、BMI、吸烟史、饮酒史、糖尿病史、居住地、哮喘、支气管扩张、乙型肝炎、胸片改变等方面比较差异无统计学意义（P＞0.05），预后不良组患者血清PCT、白细胞计数、ADA、CA199、ESR高于预后良好组（P＜0.05）。经多因素Logistic回归分析结果显示，血清ADA、CA199、ESR升高是ATB患者预后不良的危险因素（P＜0.05）。绘制ROC曲线结果显示，血清ADA、CA199、ESR单独预测ATB患者预后不良的AUC分别为0.655、0.675、0.699，血清ADA、CA199、ESR联合预测ATB患者预后不良的AUC为0.828，大于各指标单独检测。结论：血清ADA、CA199、ESR升高可提示ATB患者的病情严重程度，血清ADA、CA199、ESR联合检测对预测ATB患者预后不良具有较高的价值。

Study on the Relationship between Serum Adenosine Deaminase, Carbohydrate Antigen 199, Erythrocyte Sedimentation Rate and the Severity and Prognosis of Patients with Active Pulmonary Tuberculosis

ABSTRACT Objective: To investigate the relationship between serum adenosine deaminase (ADA), carbohydrate antigen 199 (CA199), erythrocyte sedimentation rate (ESR) and the severity and prognosis of patients with active pulmonary tuberculosis (ATB). Methods: 75 ATB patients who were admitted to Hunan Provincial Chest Hospital from January 2021 to October 2022 were selected as observation group, and 60 healthy people who underwent physical examination in our hospital during the same period were selected as control group. The levels of serum ADA, CA199 and ESR were compared between two groups. ATB patients were divided into mild group, moderate group and severe group according to the severity of the disease. The levels of serum ADA, CA199 and ESR in ATB patients with different severity were compared. Observation group received anti-tuberculosis treatment, and was divided into good prognosis group and poor prognosis group according to the curative effect, the serum ADA, CA199 and ESR levels of ATB patients with different prognosis were compared. The clinical data of ATB patients were collected, and the influencing factors of prognosis of ATB patients were analyzed by multivariate Logistic regression. The predictive value of serum ADA, CA199 and ESR on the prognosis of ATB patients were analyzed by receiver operating characteristic(ROC) curve. Results: The levels of serum ADA, CA199 and ESR in observation group were higher than those in control group (P<0.05); Patients in observation group were divided into mild group (26 cases), moderate group (34 cases) and severe group (15 cases), the levels of serum ADA, CA199 and ESR in moderate group and severe group were higher than those in mild group(P<0.05), and the levels of serum ADA, CA199 and ESR in severe group were higher than those in moderate group(P<0.05); After treatment, patients in observation group were divided into good prognosis group(50 cases) and poor prognosis group (25 cases) according to the curative effect, there was no significant difference in gender, age, BMI, smoking history, drinking history, diabetes history, place of residence, asthma, bronchiectasis, hepatitis B and chest X-ray changes between good prognosis group and poor prognosis group (P>0.05), The serum PCT, leucocyte count, ADA, CA199 and ESR in poor prognosis group were higher than those in good prognosis group(P<0.05). Multivariate Logistic regression analysis showed that, elevated serum ADA, CA199 and ESR were risk factors for poor prognosis in ATB patients(P<0.05); The results of ROC curve showed that, the AUC of serum ADA, CA199 and ESR alone in predicting poor prognosis of ATB patients were 0.655, 0.675 and 0.699 respectively, The AUC of serum ADA, CA199 and ESR combined to predict the poor prognosis of ATB patients was 0.828, which was greater than that of each index alone. Conclusion: The increase of serum ADA, CA199 and ESR can indicate the severity of ATB patients, the combine detection of serum ADA,CA199 and ESR has a high value in predicting the poor prognosis of ATB patients.