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目的探讨血清新喋呤(Np)水平诊断活动性肺结核的敏感性和特异性。方法选择2009年4月-2010年5月连续入住新疆维吾尔自治区胸科医院结核科的肺结核患者,于入院次日清晨采血,酶联免疫吸附法(ELISA)检测血清Np水平,同时行卡介苗纯蛋白衍生物(PPD)皮试。结果共收集58例活动性、18例稳定型肺结核患者以及32名健康对照。活动性肺结核组Np值(54.14±19.85nmol/L)显著高于稳定型肺结核组(29.51±8.23nmol/L)和对照组(20.67±9.68nmol/L,P<0.01),而稳定性肺结核组与对照组间无统计学差异(P>0.05)。纤维空洞型肺结核的Np值(77.43±22.13nmol/L)显著高于浸润型肺结核(46.07±13.04nmol/L)及血行播散型肺结核(48.48±8.34nmol/L,P<0.01),而后两者间比较差异无统计学意义(P>0.05)。ROC曲线分析显示,以36.73nmol/L为临界值,血清Np值判断活动性肺结核的曲线下面积为0.951,其敏感性和特异性分别为86%和92%,均显著高于PPD试验的预测价值(分别为52%和78%,P<0.01)。结论血清Np值具有较高的敏感性和特异性,可作为活动性肺结核早期重要的辅助诊断指标。
Objective To investigate the sensitivity and specificity of serum neopterin (Np) in diagnosis of active pulmonary tuberculosis. Methods From April 2009 to May 2010, patients with tuberculosis were enrolled in tuberculosis department of Xinjiang Uygur Autonomous Region Chest Hospital. Blood samples were collected on the morning of the second day of hospitalization, serum Np level was detected by enzyme-linked immunosorbent assay (ELISA) Derivatives (PPD) skin test. Results A total of 58 cases of active, 18 stable tuberculosis patients and 32 healthy controls were collected. Np in active tuberculosis group was significantly higher than that in stable tuberculosis group (54.14 ± 19.85nmol / L) and stable group (29.51 ± 8.23nmol / L) and control group (20.67 ± 9.68nmol / L, P <0.01) No significant difference between the control group (P> 0.05). The Np value of fibrous hollow tuberculosis (77.43 ± 22.13nmol / L) was significantly higher than that of infiltrative pulmonary tuberculosis (46.07 ± 13.04nmol / L) and hematogenous disseminated pulmonary tuberculosis (48.48 ± 8.34nmol / L, P <0.01) There was no significant difference between the two groups (P> 0.05). ROC curve analysis showed that under the curve of 36.73nmol / L as the cutoff value, the area under the curve of Np value for determining active tuberculosis was 0.951, with a sensitivity and specificity of 86% and 92%, respectively, which were significantly higher than those predicted by PPD test Value (52% and 78%, respectively, P <0.01). Conclusion Serum Np has high sensitivity and specificity, which can be used as an important auxiliary diagnostic indicator of early active pulmonary tuberculosis.