论文部分内容阅读
目的:研究肺结核、肺结核合并细菌性肺炎患者血清脂类特征及与痰涂片结果的相关性。方法:研究对象来自山东省潍坊市第二人民医院,共3组:入院治疗的肺结核患者460例(单一结核组),肺结核合并细菌性肺炎患者315例(结核合并肺炎组),同期健康体检者434例(健康对照组)。抽取研究对象清晨空腹血,离心后检测血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、脂蛋白a(lipoprotein(a),Lp(a))、载脂蛋白A1(apoprotein A1,Apo A1)、载脂蛋白B(apoprotein B,Apo B)的含量。TC、TG采用酶法测定;HDL-C、LDL-C采用选择性遮蔽直接法测定;Lp(a)、Apo A1、Apo B采用免疫透射比浊法测定。收集患者即时、夜间、次日清晨9份痰液,做抗酸染色镜检,结果用--、1+、2+、3+、4+表示。结果:(1)与健康对照组相比,单一结核组TC、TG、HDL-C、LDL-C、Apo A1、Apo B降低(Z值分别为-5.941、-3.733、-4.170、-6.213、-4.557、-4.022,P值均小于0.001),Lp(a)升高(Z=-2.399,P=0.016);(2)与健康对照组相比,结核合并肺炎组TC、TG、HDL-C、LDL-C、Apo A1、Apo B降低(Z值分别为-6.894、-3.676、-5.796、-6.287、-5.799、-4.321,P值均小于0.001),Lp(a)升高(Z=-2.888,P=0.004);(3)与单一结核组相比,结核合并肺炎组TC、HDL-C、LDL-C、Apo A1降低(Z值分别为-5.624、-4.169、-2.237、-4.328,P值分别为0.000、0.000、0.025、0.000);(4)单一结核组痰涂片结果与Apo A1相关(rs=-0.319,P=0.000),结核合并肺炎组痰涂片结果与HDL-C、Apo A1相关(rs值分别为-0.175、-0.302,P值分别为0.002、0.000)。结论:(1)血清TC、TG、HDL-C、LDL-C、Lp(a)、Apo A1和Apo B可辅助诊断肺结核;(2)TC、HDL-C、LDL-C、Apo A1可区分肺结核、肺结核合并细菌性肺炎两种疾病;(3)Apo A1有望成为肺结核患者病情严重程度的诊断标准,HDL-C、Apo A1有望成为肺结核合并细菌性肺炎患者病情严重程度的诊断标准。
Objective: To study the relationship between serum lipids and sputum smear results in patients with pulmonary tuberculosis and pulmonary tuberculosis complicated with bacterial pneumonia. Methods: The subjects were from the Second People’s Hospital of Weifang City, Shandong Province. There were 3 groups of tuberculosis patients (single tuberculosis group), 315 tuberculosis combined bacterial pneumonia group (tuberculosis and pneumonia group) 434 cases (healthy control group). The fasting blood samples were collected from the subjects and the serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol low density lipoprotein cholesterol (LDL-C), lipoprotein (a), Lp (a), apoprotein A1 (Apo A1), apoprotein B content. TC and TG were determined by enzymatic method. HDL-C and LDL-C were determined by selective occlusion direct method. Lp (a), Apo A1 and Apo B were determined by immunoturbidimetry. Patients were collected immediately, at night, the next morning nine sputum, anti-acid staining microscopy, the results with -, 1 +, 2 +, 3 +, 4 + said. Results: (1) The levels of TC, TG, HDL-C, LDL-C, Apo A1 and Apo B in single tuberculosis group were significantly lower than those in healthy controls (Z values were -5.941, -3.733, -4.170, (P <0.05). (2) Compared with the healthy control group, the levels of TC, TG, HDL- C, LDL-C, Apo A1 and Apo B decreased (P values were less than 0.001 in Z value of -6.894, -3.676, -5.796, -6.287, -5.799 and -4.321, respectively) = -2.888, P = 0.004). (3) The levels of TC, HDL-C, LDL-C and Apo A1 in tuberculosis combined pneumonia group were lower than those in single tuberculosis group (Z values were -5.624, -4.169, -2.237, -4.328, P values were 0.000,0.000,0.025,0.000); (4) sputum smear results of a single tuberculosis group was associated with Apo A1 (rs = -0.319, P = 0.000), tuberculosis with pneumonia group sputum smear results and HDL-C, and Apo A1 (rs = -0.175, -0.302, P = 0.002,0.000, respectively). Conclusion: (1) TC, HDL-C, LDL-C, Lp (a), Apo A1 and Apo B can be used to diagnose pulmonary tuberculosis. (2) TC, HDL- Tuberculosis and bacterial pneumonia. (3) Apo A1 is expected to become the diagnostic criteria for the severity of pulmonary tuberculosis. HDL-C and Apo A1 are expected to become the diagnostic criteria for the severity of tuberculosis complicated with bacterial pneumonia.