| Objective:To detect the level of IL-33 from peripheral blood plasma in tuberculosis,pneumonia,latent tuberculosis patients and healthy controls.To explore its diagnostic value in pulmonary tuberculosis.T-SPOT.TB and Mycobacterium tuberculosis DNA were measured in patients with pulmonary tuberculosis,and whether combined detection could improve the diagnosis rate of pulmonary tuberculosis was discussed.Methods:Patients with tuberculosis and pneumonia in Wuxi Fifth People’s Hospital,latent tuberculosis patients screened by tuberculosis department of our hospital and health examination personnel in the physical examination center were selected as the subjects from June 2016 to June 2018.They were divided into tuberculosis group,pneumonia group,latent tuberculosis infection group and healthy control group.Peripheral venous blood was extracted from all participants.Detected plasma concentrations of IL-33 by ELISA(Enzyme-linked immunosorbent assay),ROC curve(receptive operation curve)was used to analyze the sensitivity and specificity of IL-33 level in the diagnosis of tuberculosis.At the same time,T-SPOT.TB was detected by ELISPOT in tuberculosis group,pneumonia group and latent infection group.Mycobacterium tuberculosis DNA was detected by PCR-fluorescence probe in tuberculosis group and pneumonia group.Results:(1)The average concentration of IL-33 in peripheral blood of the tuberculosis group was 284±73ng/l,the average concentration of IL-33 in the pneumonia group was 207±46ng/l,the average concentration of IL-33 in the latent tuberculosis group was 221±135ng/l,and the average concentration of IL-33 in the healthy control group was 116±42ng/1.There was statistically significant difference between tuberculosis group and the other three groups(P<0.001).The pneumonia group and the latent tuberculosis group were both higher than the healthy group,and the difference was statistically significant(P<0.001).The difference was not statistically significant between the pneumonia group and the latent tuberculosis group(P>0.05).(2)The area under the ROC curve of IL-33 in the diagnosis of pulmonary tuberculosis was 0.818,and its 95%confidence interval was[0.740-0.897];the optimal diagnostic cut-off point was 228.5ng/l;the corresponding sensitivity was 77.6%,specificity was 80.0%,Youden index was 0.576,positive predictive value was 88.1%,and negative predictive value was 65.3%.The positive likelihood ratio was 3.88,and the negative likelihood ratio was 0.28,with high sensitivity and specificity.The area under the ROC curve of IL-33 in the diagnosis of pneumonia was 0.423,its 95%confidence interval was[0.341-0.505],and the area under the ROC curve of IL-33 in the diagnosis of latent tuberculosis infectionwas 0.509,its 95%confidence interval was[0.431-0.588].For pneumonia and latent tuberculosis infection,the concentration of IL-33 in peripheral blood had no diagnostic value.(3)In this study,the sensitivity of diagnosis of tuberculosis through T-SPOT.TB was 96%,while that of IL-33 was 84.00%.When combine T-SPOT.TB with IL-33 level,its sensitivity was 100%,the diagnosis of pulmonary tuberculosis was improved compared with single index,so combine T-SPOT.TB with IL-33 is a better way to diagnose tuberculosis.(4)In the tuberculosis group,the sensitivity of Mycobacterium tuberculosis DNA detection was 62%,and the sensitivity of IL-33 was 86%,and the sensitivity of IL-33 was higher than that of Mycobacterium tuberculosis DNA detection,and the difference was statistically significant(P>0.05).(5)The level of IL-33 in the peripheral blood of sputum positive pulmonary tuberculosis was 280±79ng/l,the level of IL-33 sputum negative pulmonary tuberculosiswas 293±59ng/l,there was no statistical difference between the two groups(P>0.05).The level of IL-33 in peripheral blood of patients with initial treatment of tuberculosis was 294±65ng/l,and that in patients with retreatment of tuberculosis was 269±83ng/l,there was no statistical difference between the two groups(P>0.05).It is suggested that the level of IL-33 is not affected by the factors such as whether the tuberculosis patients are sterilized or not,the initial treatment or retreatment,and it has a good applicability for the diagnosis of tuberculosis.Conclusion:The detection of IL-33 in peripheral blood has high sensitivity and specificity in the diagnosis of tuberculosis,and it is highly expressed in sputum positive pulmonary tuberculosis,sputum negative pulmonary tuberculosis,initial treatment of tuberculosis and retreatment of tuberculosis.The detection of IL-33 content in peripheral blood by ELISA is a relatively simple and efficient diagnostic method for tuberculosis.At the same time,combined with T-SPOT.TB detection and Mycobacterium tuberculosis DNA detection,it can improve the diagnosis of tuberculosis. |
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