Evaluate The Effects Of Four Antigens In The Diagnosis Of Atypical Spine Tuberculosis

Objective To detect the expression of Mycobacterium tuberculosis heat shock protein 60(MTB Hsp60),Mycobacterium tuberculosis heat shock protein 10(MTB Hsp10),heat shock protein 70(Hsp70)and heat shock protein 16.3(Hsp16.3)in the serum of patients with atypical spinal tuberculosis.To investigate the significance of serum MTB Hsp60,MTB Hsp10,Hsp70 and Hsp16.3 in diagnosis of atypical spinal tuberculosis.Methods 66 cases of suspected atypical spinal tuberculosis who were treated in People's Hospital of Xinjiang Uygur Autonomous Region from February 2016 to March 2017 and 30 healthy volunteers were selected,the optical density values(OD value)of MTB Hsp10,MTB Hsp60,Hsp16.3 and Hsp70 in serum of subjects were measured by enzyme-linked immunosorbent assay(ELISA),The OD values were further analyzed by operating characteristic curve receiver(ROC).The areas under the ROC curve(AUC)for the four antigens and the combined diagnosis were compared.While to select the maximum Youden index(sensitivity + specificity-1)as the diagnostic value and comparison.Results Out of 66 patients,3 were excluded from the study.37 subjects had culture-confirmed spinal tuberculosis,26 patients with other spinal diseases.There were 32 cases of atypical spinal tuberculosis patients received surgical treatment and 5 cases with conservative treatment.All atypical spinal tuberculosis patients received regular anti tuberculosis treatment for 10~12 months.The OD values of MTB Hsp60,MTB Hsp10,Hsp70 and Hsp16.3 in serum of atypical spinal tuberculosis were 1.75±0.32,0.35±0.24,0.39±0.22,0.27±0.18,respectively.The OD values of four antigens in the other spinal diseases group were 1.06±0.42,0.15±0.11,0.23±0.08,0.10±0.07,respectively.The OD values of four antigens in health control group were 1.17±0.41,0.13±0.11,0.23±0.12,0.08±0.04,respectively.Variance analysis results showed that the OD value was not equal to all four antigens of atypical spinal tuberculosis group,spinal diseases group and healthy group(p<0.001).SNK-q test showed that four kinds of serum antigen OD value of atypical spinal tuberculosis group is higher than that of other spinal diseases group and healthy control group(p<0.05).The diagnostic sensitivity and specificity of MTB Hsp60,MTB Hsp10,Hsp70 and Hsp16.3 were 89%,87%,51%,70% and 75%,73%,91%,84%,respectively.The sensitivity and specificity of the combined diagnosis of the four antigens were 89% and 98%.By plotting the ROC curve,the AUC of MTB Hsp60,MTB Hsp10,Hsp70 and Hsp16.3 were 0.878,0.847,0.726,0.818,respectively.The MTB Hsp10 and MTB Hsp60 in the four antigens was the highest(0.85 and 0.88,respectively),and the diagnostic efficiency of the four antigens was higher(AUC=0.97)(p<0.001).conclusion 1.The four antigens of MTB Hsp60,MTB Hsp10,Hsp70 and Hsp16.3 in the serum of atypical spinal tuberculosis patients were significantly higher than those in non-spinal tuberculosis group,these four antigens are associated with atypical spinal tuberculosis.2.These four antigens appears to be a rapid and accurate supplementary tool for early diagnosing atypical spinal tuberculosis,and the combined diagnosis is more valuable.