血清腺苷脱氨酶和乳酸脱氢酶水平对艾滋病合并马尔尼菲篮状菌病预后的判断
|
摘要
目的寻找评价艾滋病合并马尔尼菲篮状菌病预后的生化检查标志物。方法选取某院2016年1月—2017年12月符合研究标准的艾滋病合并马尔尼菲篮状菌病患者,根据预后分为死亡组及存活组,采用单因素和多因素分析方法对两组患者入院时白细胞计数、血小板计数、血红蛋白、腺苷脱氨酶、肌酸激酶同工酶、乳酸脱氢酶、天门冬氨酸氨基转移酶、总胆红素、CD4~+T细胞计数等实验室生化检查指标进行统计学分析。结果共纳入艾滋病合并马尔尼菲篮状菌病患者140例,其中死亡组32例,存活组108例。单因素统计分析结果显示,白细胞计数、血小板计数、腺苷脱氨酶、肌酸激酶同工酶、乳酸脱氢酶、天门冬氨酸氨基转移酶、总胆红素死亡组患者与存活组患者比较,差异均有统计学意义(均P<0.01)。多因素logistic回归结果分析显示,腺苷脱氨酶[OR及95%CI为0.056(0.013～0.252)]、乳酸脱氢酶[OR及95%CI为0.135(0.032～0.566)]对艾滋病合并马尔尼菲篮状菌病的结局影响有统计学意义。结论血清腺苷脱氨酶和乳酸脱氢酶水平是评价艾滋病合并马尔尼菲篮状菌病预后的重要指标,二者升高提示预后不良。
Objective To search biochemical marks for evaluating the prognosis of acquired immunodeficiency syndrome(AIDS) complicated with Talaromyces marneffei(T.marneffei) infection.Methods AIDS patients with T.marneffei infection in a hospital from January 2016 to December 2017 were selected,they were divided into death group and survival group according to the prognosis,laboratory biochemical marks such as white blood cell count(WBC),platelet count(PLT),hemoglobin(HGB),adenosine deaminase(ADA),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),aspartate aminotransferase(AST),total bilirubin(TBIL),and CD4~+T cell count were performed univariate and multivariate analysis.Results A total of 140 AIDS patients with T.marneffei infection were included,32 were in death group and 108 in survival group.Univariate analysis showed that there were significant differences in WBC,PLT,ADA,CK-MB,LDH,AST,and TBIL between patients in death group and survival group(all P<0.01).Multivariate logistic regression analysis showed that ADA(OR,0.056[95%CI,0.013-0.252]) and LDH(OR,0.135 [95%CI,0.032-0.566]) had statistical significance on the outcome of AIDS complicated with T.marneffei infection.Conclusion Serum ADA and LDH levels are important markers for evaluating prognosis of AIDS patients with T.marneffei infection,and their elevation suggests poor prognosis.
Objective To search biochemical marks for evaluating the prognosis of acquired immunodeficiency syndrome(AIDS) complicated with Talaromyces marneffei(T.marneffei) infection.Methods AIDS patients with T.marneffei infection in a hospital from January 2016 to December 2017 were selected,they were divided into death group and survival group according to the prognosis,laboratory biochemical marks such as white blood cell count(WBC),platelet count(PLT),hemoglobin(HGB),adenosine deaminase(ADA),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),aspartate aminotransferase(AST),total bilirubin(TBIL),and CD4~+T cell count were performed univariate and multivariate analysis.Results A total of 140 AIDS patients with T.marneffei infection were included,32 were in death group and 108 in survival group.Univariate analysis showed that there were significant differences in WBC,PLT,ADA,CK-MB,LDH,AST,and TBIL between patients in death group and survival group(all P<0.01).Multivariate logistic regression analysis showed that ADA(OR,0.056[95%CI,0.013-0.252]) and LDH(OR,0.135 [95%CI,0.032-0.566]) had statistical significance on the outcome of AIDS complicated with T.marneffei infection.Conclusion Serum ADA and LDH levels are important markers for evaluating prognosis of AIDS patients with T.marneffei infection,and their elevation suggests poor prognosis.
引文
[1] Kawila R,Chaiwarith R,Supparatpinyo K.Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand:a retrospective study[J].BMC Infect Dis,2013,5(13):464.
[2]周国强,王敏,肖钢.血清腺苷脱氨酶对马尔尼菲青霉菌病的诊断价值[J].中国艾滋病性病,2015,21(8):720-722.
[3]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南[J].中华传染病杂志,2006,24(2):133-134.
[4] Vanittannkom N,Coopee CR Jr,Fisher MC,et al.Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects[J].Clin Microbiol Rev,2006,19(1):95-110.
[5] Wong SS,Wong KH,Hui WT,et al.Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immundoficiebcy virus(HIV)and non-HIV-infected patients[J].Clin Microbiol,2001,39(12):4535-4540.
[6] Heard DJ,Norby PL,Holloway J,et al.Human ERRgamma,a third member of the estrogen receptor-related receptor(ERR)subfamily of orphan nuclear receptors:Tissue-specific isoforms are expressed during development and in the adult[J].Mol Endocrinol,2000,14(3):382-392.
[7] Zavialov AV,Gracia E,Glaichenhaus N,et al.Human adenosine deaminase 2 induces differentiation of monocytes into macrophages and stimulates proliferation of T helper cells and macrophages[J].J Leukoc Biol,2010,88(2):279-290.
[8] Zavialov AV,Engstr9m A.Human ADA2 belongs to a new family of growth factors with adenosine deaminase activity[J].Biochem J,2005,391(Pt 1):51-57.
[9]曾静,程多智.腺苷脱氨酶在胸水性质鉴别的临床应用[J].临床肺科杂志,2013,18(12):2302-2303.
[10]Li H,Xiong W,Liu H,et al.Serum LDH level may predict outcome of chronic lymphocytic leukemia patients with a 17p deletion:a retrospective analysis of prognostic factors in China[J].Chin J Cancer Res,2017,29(2):156-165.
[11]Marmorino F,Salvatore L,Barbara C,et al.Serum LDH predicts benefit from bevacizumab beyond progression in metastatic colorectal cancer[J].Br J Cancer,2017,116(3):318-323.
[12]Terragni R,Morselli-Labate AM,Vignoli M,et al.Is serum total LDH evaluation able to differentiate between alimentary lymphoma and inflammatory bowel disease in a real world clinical setting?[J].PLoS One,2016,11(3):e0151641.
[13]Warburg O,Wind F,Negelein E.The metabolism of tumors in the body[J].J Gen Physiol,1927,8(6):519-530.
[14]Yang L,Xie M,Yang M,et al.PKM2 regulates the Warburg effect and promotes HMGB1 release in sepsis[J].Nat Commun,2014,5:4436.
[15]Kelly B,O’Neill LA.Metabolic reprogramming in macrophages and dendritic cells in innate immunity[J].Cell Res,2015,25(7):771-784.
[16]Corcoran SE,O’Neill LA.HIF1αand metabolic reprogramming in inflammation[J].J Clin Invest,2016,126(10):3699-3707.
[17]Arts RJ,Gresnigt MS,Joosten LA,et al.Cellular metabolism of myeloid cells in sepsis[J].J Leukoc Biol,2017,101(1):151-164.
[18]Tannahill GM,Curtis AM,Adamik J,et al.Succinate is an inflammatory signal that induces IL-1 through HIF-1[J].Nature,2013,496(7444):238-242.
[19]Rodríguez-Prados JC,Través PG,Cuenca J,et al.Substrate fate in activated macrophages:a comparison between innate,classic and alternative activation[J].J Immunol,2010,185(1):605-614.
[20]Mikkelsen ME,Miltiades AN,Gaieski DF,et al.Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock[J].Crit Care Med,2009,37(5):1670-1677.
[21]Lu J,Wei ZH,Jiang H,et al.Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis:a retrospective observational study[J].J Surg Res,2018,228:314-321.
[2]周国强,王敏,肖钢.血清腺苷脱氨酶对马尔尼菲青霉菌病的诊断价值[J].中国艾滋病性病,2015,21(8):720-722.
[3]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南[J].中华传染病杂志,2006,24(2):133-134.
[4] Vanittannkom N,Coopee CR Jr,Fisher MC,et al.Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects[J].Clin Microbiol Rev,2006,19(1):95-110.
[5] Wong SS,Wong KH,Hui WT,et al.Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immundoficiebcy virus(HIV)and non-HIV-infected patients[J].Clin Microbiol,2001,39(12):4535-4540.
[6] Heard DJ,Norby PL,Holloway J,et al.Human ERRgamma,a third member of the estrogen receptor-related receptor(ERR)subfamily of orphan nuclear receptors:Tissue-specific isoforms are expressed during development and in the adult[J].Mol Endocrinol,2000,14(3):382-392.
[7] Zavialov AV,Gracia E,Glaichenhaus N,et al.Human adenosine deaminase 2 induces differentiation of monocytes into macrophages and stimulates proliferation of T helper cells and macrophages[J].J Leukoc Biol,2010,88(2):279-290.
[8] Zavialov AV,Engstr9m A.Human ADA2 belongs to a new family of growth factors with adenosine deaminase activity[J].Biochem J,2005,391(Pt 1):51-57.
[9]曾静,程多智.腺苷脱氨酶在胸水性质鉴别的临床应用[J].临床肺科杂志,2013,18(12):2302-2303.
[10]Li H,Xiong W,Liu H,et al.Serum LDH level may predict outcome of chronic lymphocytic leukemia patients with a 17p deletion:a retrospective analysis of prognostic factors in China[J].Chin J Cancer Res,2017,29(2):156-165.
[11]Marmorino F,Salvatore L,Barbara C,et al.Serum LDH predicts benefit from bevacizumab beyond progression in metastatic colorectal cancer[J].Br J Cancer,2017,116(3):318-323.
[12]Terragni R,Morselli-Labate AM,Vignoli M,et al.Is serum total LDH evaluation able to differentiate between alimentary lymphoma and inflammatory bowel disease in a real world clinical setting?[J].PLoS One,2016,11(3):e0151641.
[13]Warburg O,Wind F,Negelein E.The metabolism of tumors in the body[J].J Gen Physiol,1927,8(6):519-530.
[14]Yang L,Xie M,Yang M,et al.PKM2 regulates the Warburg effect and promotes HMGB1 release in sepsis[J].Nat Commun,2014,5:4436.
[15]Kelly B,O’Neill LA.Metabolic reprogramming in macrophages and dendritic cells in innate immunity[J].Cell Res,2015,25(7):771-784.
[16]Corcoran SE,O’Neill LA.HIF1αand metabolic reprogramming in inflammation[J].J Clin Invest,2016,126(10):3699-3707.
[17]Arts RJ,Gresnigt MS,Joosten LA,et al.Cellular metabolism of myeloid cells in sepsis[J].J Leukoc Biol,2017,101(1):151-164.
[18]Tannahill GM,Curtis AM,Adamik J,et al.Succinate is an inflammatory signal that induces IL-1 through HIF-1[J].Nature,2013,496(7444):238-242.
[19]Rodríguez-Prados JC,Través PG,Cuenca J,et al.Substrate fate in activated macrophages:a comparison between innate,classic and alternative activation[J].J Immunol,2010,185(1):605-614.
[20]Mikkelsen ME,Miltiades AN,Gaieski DF,et al.Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock[J].Crit Care Med,2009,37(5):1670-1677.
[21]Lu J,Wei ZH,Jiang H,et al.Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis:a retrospective observational study[J].J Surg Res,2018,228:314-321.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |