目的 探讨血清糖类抗原125(CA125)和铁蛋白(SF)等检测结果与肺结核病变侵及胸膜的相关性研究.方法 收集2013年11月至2017年4月入住张家口市传染病医院的继发性肺结核患者296例,依据肺实质病灶是否侵及胸膜的关系将患者分为侵及胸膜组(207例)和未侵及胸膜组(89例).采用化学发光免疫分析检测血清CA125和SF水平,以中位数(四分位数:Q1,Q3)表示;并进行痰菌检查[包括抗酸杆菌染色涂片镜检(萋-尼染色法)、结核分枝杆菌培养(MGIT 960快速液体培养,简称“MGIT 960培养”)]、γ-干扰素释放试验(IGRA)、超敏C反应蛋白(hs-CRP)和各营养指标[包括血红蛋白(Hb)、白蛋白(ALB)、血清前白蛋白(PA)]的实验室相关检查.采用Mann-Whitney U检验、χ2检验、Spearman相关分析、logistic逐步回归分析并建立新变量[logit (P)](由 CA125、SF、痰菌检查三组指标数据计算得出)回归方程和受试者工作特征曲线(ROC)及最佳临界值,探索CA125、 SF、hs-CRP、痰结核分枝杆菌、IGRA和Hb、ALB、PA的变化原因及与肺结核浸润病变侵及胸膜间的关系.结果 侵及胸膜组与未侵及胸膜组患者的检查结果中,CA125[31.55 (18.45,71.80) kU/L; 16.15 (9.55, 23.15) kU/L]、SF[234. 68 (128.27, 504.12) μg/L; 127.39 (86.31, 201.76) μg/L]、 hs-CRP[47.50 (16.00,82.55) mg/L; 3.40(0.78,7.73) mg/L]和痰菌检查阳性率(32.85％,68/207;11.24％,10/89)差异均有统计学意义(Z值分别为-5.84、-4.87、-6.34,χ2= 296.00;P值均=0.000).两组患者的 CA125、SF、hs-CRP指标与是否侵及胸膜经Spearman相关性分析存在明显相关性(r值分别为0.38、0.32,0.64,P值均=0.000).logistic逐步回归分析, CA125、SF、痰菌检查结果与是否侵及胸膜具有相关性(OR=1.11,P=0.001;OR= 1.01, P= 0.005;OR= 5.89, P=0.025).新变量logit(P)的ROC曲线下面积(AUC,0.88)高于CA125和SF指标(均为0.78),具有明显预测概率(P值均=0.000).经Spearman相关性分析,CA125、SF指标与侵及胸膜面积(Y)存在明显相关性(r值分别为0.69、0.55,P值均=0.000);进一步经回归模型Anova分析,InCA125、InSF与侵及胸膜存在明显相关性(F值分别为68.65、29.45,P值均=0.000)].结论 肺结核痰结核分枝杆菌检查阳性及血清hs-CRP、CA125和SF指标升高与肺实质浸润病变侵及胸膜呈正相关,IGRA与肺实质浸润病变侵及胸膜无相关性.肺结核患者 CA125、SF指标升高与肺结核病变侵及胸膜面积呈正相关.“,”Objective To investigate the correlation between the results of serum carbohydrate antigen 125 (CA125), ferritin (SF) and other laboratory tests with the pleura invasion among the patients with pulmonary tuberculosis (TB). Methods From November 2013 to April 2017, a total of 296 patients with secondary pulmonary TB were admitted to Zhangjiakou Infectious Disease Hospital. The related data and information were collected from those patients. According to whether the pleura of the patients were invasive from their pulmonary lesions or not, the patients were divided into the pleura invasion group (207 cases) and the pleura non-invasion group (89 cases). Chemiluminescent immunoassay was used to exam the levels of serum CA125 and ferritin, and the examination results were showed with the median (quartile: Q1, Q3 ). The following examinations were performed to the patients, including sputum smear (Ziehl-Neelsen acid-fast staining method), Mycobacterium tuberculosis culture (MGIT 960 liquid culture), interferon gamma releasing assays (IGRA), highsensitive creactive protein (hsCRP) and other related laboratory tests such as hemoglobin (Hb),albumin (ALB) and pre-albumin (PA). The Mann-Whitney U test, chi-square test, spearman correlation analysis, logistic stepwise regression analysis were used, and the new variable regression equation (logit (P)), the receiver-operating characteristic curve (ROC) and the optimal cut-off value were also established to explore the causes of the changes of CA125,SF,hs CRP,sputum Mycobacterium tuberculosis, IGRA, Hb,ALB and PA, as well as the relationship between those indicators and the pleura invasion by pulmonary TB lesions. Results Among the examination results of the patients in two groups, CA125 (31.55(18.45,71.80) kU/L; 16.15 (9.55, 23.15) kU/L), SF (234.68 (128.27,504.12) μg/L; 127.39 (86.31, 201.76) μg/L),hs-CRP (47.50 (16.00,82.55) mg/L; 3.40 (0.78,7.73) mg/L) and the sputum bacteriological positive rate (32.85％, 68/207; 11.24％, 10/89) had the statistically significant differences 5.84, -4.87,-6.34 respectively, χ2 = 296.00; P = 0.000, respectively). The indicators of CA125,SF and hs-CRP in the patients of two groups were found to have significantly correlated with whether or not the pleura were invasive by pulmonary TB lesions through the spearman correlation analysis (r=0.38,0.32,0.64,respectively; P = 0.000, respectively). Logistic stepwise regression analysis showed that the results of CA125,SF, sputum Mycobacterium tuberculosis examination were correlated with whether or not the pleura were invasive by pulmonary TB lesions (OR=1.11,P=0.001; OR=1.01, P=0.005; OR=5.89, P=0.025). The area under the ROC curve of the new variable logit (P)(AUC, 0.88) was higher than that of the indicators of CA125 and SF (AUC, 0. 78 respectively), and had obvious prediction probability (P=0.000,respectively). Spearman correlation analysis showed a significant correlation between the indicators of CA125,SF and the area of the invasive pleura by pulmonary TB lesions (Y) (r=0.69,0.55, respectively; P=0.000, respectively). In linear regression analysis, Anova showed that InCA125 and InSF were significantly correlated with the pleura invasion (F=68.65,29.45, respectively; P=0.000,respectively). Conclusion Sputum TB bacteriological positive, the increased levels of hs-CRP,serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the pleura invasion by pulmonary TB lesions, there is no correlation between IGRA and the pleura invasion. The increased levels of serum CA125 and ferritin in the patients with pulmonary TB are positively correlated with the area of the pleura invasion by pulmonary TB lesions.