Abstract:

Objective　To explore the potential value of leukocyte cell-derived chemotaxin 2 (LECT2) and human cartilage glycoprotein-39 (YKL-40) in the diagnosis of tuberculosis in patients with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), assess the performance of these biomarkers in predicting tuberculosis, and provide more precise diagnostic tools for clinical use. Methods　From February 2021 to February 2023, 84 HIV/AIDS patients with tuberculosis admitted to No.215 Hospital of Shaanxi Nuclear Industry were selected as a study group, and 92 HIV/AIDS patients without tuberculosis during the same period were selected as a control group. There were 57 males and 27 females in the study group, aged (47.69±10.59) years. There were 64 males and 28 females in the control group, aged (48.22±9.46) years. Blood samples were collected to measure the levels of LECT2 and YKL-40. The diagnostic value of the two markers for tuberculosis in HIV/AIDS patients was verified by the receiver operating characteristic curve (ROC). Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis in HIV/AIDS patients with tuberculosis. Results　The level of LECT2 in the study group was lower than that in the control group [(20.65±3.38) μg/L vs. (22.67±3.34) μg/L], and the level of YKL-40 was higher than that in the control group [(159.54±17.56) μg/L vs. (148.74±18.74) μg/L], with statistically significant differences (t=3.995 and 3.935, both P<0.001). The area under the curve (AUC) of combined diagnosis of LECT2 and YKL-40 for tuberculosis in HIV/AIDS patients was 0.739 (95%CI 0.665-0.812), with a sensitivity of 79.8% and a specificity of 58.7%. Multivariate logistic regression analysis showed that anti-HIV treatment, duration of HIV infection, CD4+ T cells, and LECT2 level were important factors for judging the prognosis of HIV/AIDS patients with tuberculosis (all P<0.05). ROC was used to evaluate the prognostic value of LECT2, and the results showed that the AUC of LECT2 was 0.657, with a sensitivity of 64.5% and a specificity of 67.9%. Conclusion　The significant changes in the levels of LECT2 and YKL-40 are closely associated with the state of tuberculosis in HIV/AIDS patients, and can serve as effective biomarkers for auxiliary diagnosis.

Key words:

Human immunodeficiency virus, Acquired immunodeficiency syndrome, Tuberculosis, Leukocyte cell-derived chemotaxin 2, Human cartilage glycoprotein-39, Diagnostic value

摘要：

目的　本研究旨在探讨白细胞衍生趋化因子2（LECT2）和人类软骨糖蛋白39（YKL-40）在人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）患者诊断结核病中的潜在价值。评估这些生物标志物预测结核病的表现，为临床提供更为精确的诊断工具。方法　本研究为回顾性分析。选取2021年2月至2023年2月陕西省核工业二一五医院收治的84例HIV/AIDS合并结核病患者为研究组，另选取同期未合并结核病的HIV/AIDS患者92例为对照组。研究组男57例、女27例，年龄（47.69±10.59）岁；对照组男64例、女28例，年龄（48.22±9.46）岁。研究组84例患者持续抗结核治疗6个月后，分为预后不良组31例、预后良好组53例。比较患者的LECT2和YKL-40水平，通过受试者操作特征曲线（ROC）验证其对HIV/AIDS患者合并结核病的诊断价值。运用多因素logistic回归分析识别HIV/AIDS合并结核病患者预后不良的独立危险因素。结果　研究组LECT2水平低于对照组［（20.65±3.38）µg/L比（22.67±3.34）µg/L］、YKL-40水平高于对照组［（159.54±17.56）µg/L比（148.74±18.74）µg/L］，差异均有统计学意义（t=3.995、3.935，均P<0.001）。LECT2和YKL-40对HIV/AIDS患者合并结核病的联合诊断曲线下面积（AUC）为0.739（95%CI 0.665～0.812），灵敏度为79.8%，特异度为58.7%。多因素logistic回归分析结果表明，抗HIV治疗、HIV感染时间、CD4+T细胞和LECT2水平均是判断HIV/AIDS合并结核病患者预后的重要因素（均P<0.05）。采用ROC对LECT2的预后价值进行评估，结果表明，LECT2评估预后的AUC为0.657，灵敏度为64.5%，特异度为67.9%。结论　LECT2和YKL-40水平的显著升高与HIV/AIDS患者合并结核病密切相关，可作为一种有效的生物标志物用于辅助诊断。

关键词:

人类免疫缺陷病毒, 获得性免疫缺陷综合征, 结核病, 白细胞衍生趋化因子2, 人类软骨糖蛋白39, 诊断价值