血清基质金属蛋白酶-9在肺结核鉴别诊断中的价值分析
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摘要
目的:分析血清基质金属蛋白酶-9(MMP-9)在肺结核鉴别诊断中的价值。方法:选取肺结核、肺炎、肺癌患者及健康志愿者各60例分别作为肺结核组、肺炎组、肺癌组和对照组,对受试者血清MMP-9水平检测分析。结果:对照组、肺结核组、肺炎组、肺癌组研究对象的血清MMP-9水平分别为(1 976. 36±907. 44) ng/ml、(4 350. 45±2 574. 75) ng/ml、(2 135. 68±1 263. 56) ng/ml和(2 590. 38±1 532. 84) ng/ml,差异有统计学意义(F=25. 000,P<0. 001),其中,肺结核组患者的血清MMP-9水平显著高于其他三组(P<0. 001),肺癌组患者的血清MMP-9水平显著高于对照组,差异有统计学意义(P<0. 05)。血清MMP-9在肺结核与健康人+肺炎+肺癌、健康人、肺炎、肺癌、肺炎+肺癌鉴别诊断中的受试者工作特征曲线下面积(AUC)分别为0. 739、0. 769、0. 751、0. 699、0. 725(P均<0. 05)。结论:肺结核患者表现为血清MMP-9水平显著升高,且幅度高于肺癌或肺炎患者,血清MMP-9有助于肺结核鉴别诊断和筛查,但应注意适当提高诊断的灵敏度。
Objective: To analyze the value of serum matrix metalloproteinase-9(MMP-9) in differential diagnosis of pulmonary tuberculosis. Methods: 60 cases of patients with pulmonary tuberculosis,pneumonia or lung cancer patients respectively and 60 cases of healthy volunteers were selected as the tuberculosis group,the pneumonia group,the lung cancer group and the control group. The serum levels of MMP-9 of all the subjects were detected and compared. Results: The serum levels of MMP-9 of the subjects in the control group,the pulmonary tuberculosis group,the pneumonia group and the lung cancer group were(1 976. 36±907. 44) ng/ml,(4 350. 45±2 574. 75) ng/ml,(2 135. 68±1 263. 56) ng/ml and(2 590. 38±1 532. 84) ng/ml respectively,the difference was statistically significant(F = 25. 000,P< 0. 001),among them,the serum MMP-9 level of the patients in the pulmonary tuberculosis group was significantly higher than that of the other three groups(P<0. 001),the serum MMP-9 level of the patients in the lung cancer group were significantly higher than that of the control group,the difference was statistically significant(P<0. 05). The areas under the receiver operating characteristic curve(AUC) of the serum MMP-9 in differential diagnosis of pulmonary tuberculosis versus healthy people+pneumonia+lung cancer,healthy people,pneumonia,lung cancer,and pneumonia+lung cancer were0. 739,0. 769,0. 751,0. 699,0. 725 respectively(P< 0. 05). Conclusion: The patients with pulmonary tuberculosis show significantly higher serum MMP-9 level,which is significantly higher than that in the patients with pneumonia or lung cancer,can be used as a serum marker for the diagnosis and screening of pulmonary tuberculosis,but more attention should be paid to improve the sensitivity of the diagnosis properly.
Objective: To analyze the value of serum matrix metalloproteinase-9(MMP-9) in differential diagnosis of pulmonary tuberculosis. Methods: 60 cases of patients with pulmonary tuberculosis,pneumonia or lung cancer patients respectively and 60 cases of healthy volunteers were selected as the tuberculosis group,the pneumonia group,the lung cancer group and the control group. The serum levels of MMP-9 of all the subjects were detected and compared. Results: The serum levels of MMP-9 of the subjects in the control group,the pulmonary tuberculosis group,the pneumonia group and the lung cancer group were(1 976. 36±907. 44) ng/ml,(4 350. 45±2 574. 75) ng/ml,(2 135. 68±1 263. 56) ng/ml and(2 590. 38±1 532. 84) ng/ml respectively,the difference was statistically significant(F = 25. 000,P< 0. 001),among them,the serum MMP-9 level of the patients in the pulmonary tuberculosis group was significantly higher than that of the other three groups(P<0. 001),the serum MMP-9 level of the patients in the lung cancer group were significantly higher than that of the control group,the difference was statistically significant(P<0. 05). The areas under the receiver operating characteristic curve(AUC) of the serum MMP-9 in differential diagnosis of pulmonary tuberculosis versus healthy people+pneumonia+lung cancer,healthy people,pneumonia,lung cancer,and pneumonia+lung cancer were0. 739,0. 769,0. 751,0. 699,0. 725 respectively(P< 0. 05). Conclusion: The patients with pulmonary tuberculosis show significantly higher serum MMP-9 level,which is significantly higher than that in the patients with pneumonia or lung cancer,can be used as a serum marker for the diagnosis and screening of pulmonary tuberculosis,but more attention should be paid to improve the sensitivity of the diagnosis properly.
引文
[1]邹琳琳,黎友伦.干扰素释放试验在免疫受损合并肺结核患者中的应用[J].中国免疫学杂志,2016,32(6):878-881.Zou LL,Li YL.Application of interferon-release assay in immunocompromised patients with pulmonary tuberculosis[J].Chin J Immunol,2016,32(6):878-881.
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[12]陈健儿,吴文斌,郭健.MMP-9、TIMP-1的表达与糖尿病合并肺结核发病的关系探讨[J].中国医学创新,2015,12(24):5-7.Chen JE,Wu WB,Guo J.The expression levels and significance of MMP-9 and TIMP-1 in the lung lesions of tuberculosis patients with diabetes mellitus[J].Med Innovation China,2015,12(24):5-7.
[13]袁国平,陈俊杰,谢芳.INF-γ、MMP-9和ADA联合检测在结核性脑膜炎诊断中的应用价值[J].中国卫生检验杂志,2014,24(1):78-79.Yuan GP,Chen JJ,Xie F.Application value of INF-γ,MMP-9and ADA in diagnosis of tuberculous meningitis[J].Chin JHealth Laborat Technol,2014,24(1):78-79.
[14]徐小艳,徐宪伟,王慧,等.肺腺癌中CD147、MMP-9和VEGF的表达及临床意义[J].临床与实验病理学杂志,2017,33(4):384-387.Xu XY,Xu XW,Wang H,et al.Quantitative expression of CD147,MMP-9 and VEGF in lung adenocarcinoma and their clinical significance[J].J Clin Exp Pathol,2017,33(4):384-387.
[15]徐晓艳,裴陆田,李秀霞.非小细胞肺癌中MMP-9和MMP-13的表达及意义[J].临床与实验病理学杂志,2014,30(12):1358-1364.XU XY,Pei LT,LI XX.Expression of MMP-9 and MMP-13 in non-small cell lung cancer and their significance[J].J Clin Exp Pathol,2014,30(12):1358-1364.
[16]马小刚,杨晓光,赵峥.肺癌患者手术前后血清Lipocalin-2、MMP-9表达的临床意义[J].河北医药,2014,36(9):1288-1290.Ma XG,Yang XG,Zhao Zheng.Expression and clinical significance of serum Lipocalin-2 and MMP-9 before and after operation in patients with lung cancer[J].Hebei Med J,2014,36(9):1288-1290.
[17]于嘉琛,于菲,孙妍.ORMDL3和MMP-9在慢性支气管哮喘气道重塑中的作用机制及布地奈德的干预作用[J].中国儿童保健杂志,2017,25(2):139-142,150.Yu JC,Yu F,Sun Y.Effects of budesonide on airway remodeling through regulating the expression of ORMDL3 and MMP-9 in chronic asthma mouse model[J].CJCHC FEB,2017,25(2):139-142,150.
[18]安钟健,金燕,延光海,等.Pyrin重组蛋白对肺纤维化大鼠VEGF/VEGFR2/MMP-9信号通路的影响[J].中国药理学通报,2016,32(2):234-238.An ZJ,Jin Y,Yan GH,et al.Effects of pyrin recombinant protein on VEGF/VEGFR2/MMP-9 signaling pathway in pulmonary fibrosis of rats[J].Chin Pharmacolog Bulletin,2016,32(2):234-238.
[19]潘娜,陈乾华,辛丽云,等.痰上清液MMP-9、TIMP-1与慢性阻塞性肺疾病气道炎症的关系[J].中国老年学杂志,2017,37(9):2221-2223.Pan N,Chen QH,Xin LY,et al.The relationship between MMP-9and TIMP-1 of sputum supernatant and airway inflammation in chronic obstructive pulmonary disease[J].Chin J Gerontol,2017,37(9):2221-2223.
[20]康彩云,吴世满,刘晓君,等.慢性阻塞性肺疾病中MMP-9/TIMP-1与Th17/Treg作用与联系[J/CD].中华肺部疾病杂志(电子版),2014,7(3):67-71.Kang CY,Wu SM,Liu XJ,et al.Roles and correlations of Th17/Treg and MMP-9/TIMP-1 in chronic obstructive pulmonary disease[J/CD].Chin J Lung Dis(Electronic Edition),2014,7(3):67-71.
[21]Ong CW,Pabisiak PJ,Brilha S,et al.Complex regulation of neutrophil-derived MMP-9 secretion in central nervous system tuberculosis[J].J Neuroinflammation,2017,14(1):31.
[22]Chen WL,Sheu JR,Chen RJ,et al.Mycobacterium tuberculosis upregulates TNF-αexpression via TLR2/ERK signaling and induces MMP-1 and MMP-9 production in human pleural mesothelial cells[J].PLoS One,2015,10(9):e0137979.
[2]Goyal V,Kadam V,Narang P,et al.Prevalence of drug-resistant pulmonary tuberculosis in India:systematic review and metaanalysis[J].BMC Public Health,2017,17(1):817.
[3]徐向前,鹿振辉,陆城华,等.中医药治疗耐多药肺结核的研究近况[J].中华中医药杂志,2017,32(4):1653-1655.Xu XQ,Lu ZH,Lu CH,et al.Study on multidrug-resistant tuberculosis treated by traditional Chinese medicine[J].Chin J Tradit Chin Med Pharm,2017,32(4):1653-1655.
[4]Gupta A,Mrigpuri P,Faye A,et al.Pulmonary tuberculosis-An emerging risk factor for venous thromboembolism:A case series and review of literature[J].Lung India,2017,34(1):65-69.
[5]Nachiappan AC,Rahbar K,Shi X,et al.Pulmonary tuberculosis:role of radiology in diagnosis and management[J].Radiographics,2017,37(1):52-72.
[6]Pande T,Cohen C,Pai M,et al.Computer-aided detection of pulmonary tuberculosis on digital chest radiographs:a systematic review[J].Int J Tuberc Lung Dis,2016,20(9):1226-1230.
[7]林定文,林玫,崔哲哲.肺结核病原学诊断技术研究进展[J].中华医院感染学杂志,2016,26(21):5025-5028.Lin DW,Lin M,Cui ZZ.Advances in research of etiological diagnosis techniques of pulmonary tuberculosis[J].Chin JNosocomiol,2016,26(21):5025-5028.
[8]Nakao M,Sone K,Kagawa Y,et al.Diagnostic delay of pulmonary tuberculosis in patients with acute respiratory distress syndrome associated with aspiration pneumonia:Two case reports and a minireview from Japan[J].Exp Ther Med,2016,12(2):835-839.
[9]童尧,李泉.MMP-9、HIF-1和SIRT1在急性肺损伤中的研究进展[J].中华急诊医学杂志,2016,25(3):384-388.Tong Y,Li Q.MMP-9,HIF-1 and SIRT1 in acute lung injury:a review[J].Chin J Emergency Med,2016,25(3):384-388.
[10]高娟,王添印,韩茹,等.MMP-9、TIMP-1在肺纤维化中作用的研究进展[J].山东医药,2017,57(26):104-106.Gao J,Wang TY,Han R,et al.Research progress on the role of MMP-9 and TIMP-1 in pulmonary fibrosis[J].Shandong Med J,2017,57(26):104-106.
[11]张锦萍.细胞因子在初治肺结核患者血液中表达的研究[J].社区医学杂志,2014,12(6):24-26.Zhang JP.Expressions of IL-2,IL-4,IL-18,IFN-γand MMP-9 in untreated patients with pulmonary tuberculosis[J].J Commun Med,2014,12(6):24-26.
[12]陈健儿,吴文斌,郭健.MMP-9、TIMP-1的表达与糖尿病合并肺结核发病的关系探讨[J].中国医学创新,2015,12(24):5-7.Chen JE,Wu WB,Guo J.The expression levels and significance of MMP-9 and TIMP-1 in the lung lesions of tuberculosis patients with diabetes mellitus[J].Med Innovation China,2015,12(24):5-7.
[13]袁国平,陈俊杰,谢芳.INF-γ、MMP-9和ADA联合检测在结核性脑膜炎诊断中的应用价值[J].中国卫生检验杂志,2014,24(1):78-79.Yuan GP,Chen JJ,Xie F.Application value of INF-γ,MMP-9and ADA in diagnosis of tuberculous meningitis[J].Chin JHealth Laborat Technol,2014,24(1):78-79.
[14]徐小艳,徐宪伟,王慧,等.肺腺癌中CD147、MMP-9和VEGF的表达及临床意义[J].临床与实验病理学杂志,2017,33(4):384-387.Xu XY,Xu XW,Wang H,et al.Quantitative expression of CD147,MMP-9 and VEGF in lung adenocarcinoma and their clinical significance[J].J Clin Exp Pathol,2017,33(4):384-387.
[15]徐晓艳,裴陆田,李秀霞.非小细胞肺癌中MMP-9和MMP-13的表达及意义[J].临床与实验病理学杂志,2014,30(12):1358-1364.XU XY,Pei LT,LI XX.Expression of MMP-9 and MMP-13 in non-small cell lung cancer and their significance[J].J Clin Exp Pathol,2014,30(12):1358-1364.
[16]马小刚,杨晓光,赵峥.肺癌患者手术前后血清Lipocalin-2、MMP-9表达的临床意义[J].河北医药,2014,36(9):1288-1290.Ma XG,Yang XG,Zhao Zheng.Expression and clinical significance of serum Lipocalin-2 and MMP-9 before and after operation in patients with lung cancer[J].Hebei Med J,2014,36(9):1288-1290.
[17]于嘉琛,于菲,孙妍.ORMDL3和MMP-9在慢性支气管哮喘气道重塑中的作用机制及布地奈德的干预作用[J].中国儿童保健杂志,2017,25(2):139-142,150.Yu JC,Yu F,Sun Y.Effects of budesonide on airway remodeling through regulating the expression of ORMDL3 and MMP-9 in chronic asthma mouse model[J].CJCHC FEB,2017,25(2):139-142,150.
[18]安钟健,金燕,延光海,等.Pyrin重组蛋白对肺纤维化大鼠VEGF/VEGFR2/MMP-9信号通路的影响[J].中国药理学通报,2016,32(2):234-238.An ZJ,Jin Y,Yan GH,et al.Effects of pyrin recombinant protein on VEGF/VEGFR2/MMP-9 signaling pathway in pulmonary fibrosis of rats[J].Chin Pharmacolog Bulletin,2016,32(2):234-238.
[19]潘娜,陈乾华,辛丽云,等.痰上清液MMP-9、TIMP-1与慢性阻塞性肺疾病气道炎症的关系[J].中国老年学杂志,2017,37(9):2221-2223.Pan N,Chen QH,Xin LY,et al.The relationship between MMP-9and TIMP-1 of sputum supernatant and airway inflammation in chronic obstructive pulmonary disease[J].Chin J Gerontol,2017,37(9):2221-2223.
[20]康彩云,吴世满,刘晓君,等.慢性阻塞性肺疾病中MMP-9/TIMP-1与Th17/Treg作用与联系[J/CD].中华肺部疾病杂志(电子版),2014,7(3):67-71.Kang CY,Wu SM,Liu XJ,et al.Roles and correlations of Th17/Treg and MMP-9/TIMP-1 in chronic obstructive pulmonary disease[J/CD].Chin J Lung Dis(Electronic Edition),2014,7(3):67-71.
[21]Ong CW,Pabisiak PJ,Brilha S,et al.Complex regulation of neutrophil-derived MMP-9 secretion in central nervous system tuberculosis[J].J Neuroinflammation,2017,14(1):31.
[22]Chen WL,Sheu JR,Chen RJ,et al.Mycobacterium tuberculosis upregulates TNF-αexpression via TLR2/ERK signaling and induces MMP-1 and MMP-9 production in human pleural mesothelial cells[J].PLoS One,2015,10(9):e0137979.