The Expression And Clinical Significance Of SuPAR In Tuberculosis Patients

Objective 1.To investigate the expression and clinical significance of soluble urokinase-type plasminogen activator receptor(su PAR)in tuberculosis.2.To evaluate the diagnostic efficacy of su PAR as a new diagnostic marker for tuberculosis.3.To investigate the diagnostic efficacy of the combination of su PAR and other methods of tuberculosis diagnosis for active tuberculosis.Methods 1.Lithium heparin anticoagulant was used to collect 5m L of peripheral blood from the patients who came to the Shenzhen Third People's Hospital(the third clinical medical department of Shenzhen University)from June 2016 to June 2016.The serum of the blood was taken out for further detection.A total of 200 patients were collected.Of them,107 cases were diagnosed with tuberculosis(TB),44 cases were latent tuberculosis infection(LTBI)and 49 cases were healthy controls(HC).2.Detection of about 400 different markers(such as su PAR,IL-6,IL-1?)in peripheral blood by protein chip technology in 8 tuberculosis patients(TB),8 tuberculosis latent infection patients(LTBI)and 8 healthy controls(HC),on the basis of this,the su PAR,IL-6 and IL-1? which are significantly increased in tuberculosis patients were selected.Enzyme-Linked Immunosorbent Assay(ELISA)were used to verify the differences in expression of su PAR,IL-6,IL-1? in different populations.3.Used ELISA to detect the expression of su PAR in 107 tuberculosis patients,44 tuberculosis latent infection patients and 49 healthy controls.The expression levels of su PAR in the three groups were analyzed,and the ROC curve was plotted to evaluate the diagnostic effectiveness of su PAR as a diagnostic marker for tuberculosis.The positive threshold for the diagnosis of tuberculosis by su PAR was determined.4.Mycobacterium tuberculosis positive(TB-1)and Mycobacterium tuberculosis negative group(TB-2)based on mycobacterial culture,mycobacterial smears,TB DNA-PCR,etc.Analysis of the differences in the expression levels of su PAR in TB-1 and TB-2.To evaluate the diagnostic efficacy of su PAR in TB-1 and TB-2,and to explore the possible application of su PAR detection combined with other diagnostic methods in the diagnosis of active tuberculosis.5.Analyze the correlation between the expression of su PAR and leukocytes,C-reactive protein,procalcitonin,ESR,and albumin in patients with active tuberculosis(TB),and investigate whether the expression of su PAR is affected by leukocytes,C-reactive protein,procalcitonin,ESR,albumin expression levels in the body.Results 1.The protein chip detection revealed that IL-6,su PAR are highly expressed in TB patients.The su PAR expression in the TB group showed a significant difference with HC and LTBI group respectively(P = 0.002,P < 0.001).Further detection of ELISA showed that IL-6,su PAR were still highly expressed in tuberculosis,and su PAR was significant difference in comparison between TB group and the two groups of HC and LTBI groups(P=0.018 and P<0.001).2.Extensive samples found that su PAR was highly expressed in TB group,and the expression level of su PAR in serum of TB patients was significantly higher than that of HC.LTBI group(P<0.001).The ROC curve was drawn,and the AUC of su PAR in distinguishing TB and HC was 0.786,the sensitivity was 75.510% and the specificity was 70.370%.The AUC of resolution TB and LTBI was 0.743,the sensitivity was 86.360% and the specificity was 62.960%.The threshold of su PAR for the diagnosis of active TB was 5428pg/ml.3.Analysis the su PAR expression levels in the Mycobacterium tuberculosis positive group(TB-1)and Mycobacterium tuberculosis negative group(TB-2)showed that there was no significant difference,and they all showed high expression.The expression levels of su PAR in TB-1,TB-2 and HC and LTBI groups were highly expressed and all had significant differences.According to the ROC curve,the AUC of TB-1 and TB-2 in differentiating HC and LTBI was 0.716-0.805,and the specificity was over 90%,the sensitivity was 52%-61.11%.4.The results showed that su PAR joined with IGARs can enhance the sensitivity of diagnosis of TB to 87.850%;su PAR joined with mycobacterium tuberculosis microorganism detection can enhance the sensitivity of diagnosis of TB to 84.375%;su PAR joined with TB DNA-PCR can enhance the sensitivity of diagnosis of TB to 77.528%.5.The expression level of su PAR in active tuberculosis patients was not significantly associated with leukocyte,C-reactive protein,procalcitonin,erythrocyte sedimentation rate and albumin(all P>0.05).Conclusion This study found that su PAR was highly and steadily expressed in patients with active TB.The diagnosis efficacy of active TB can be improved by combining su PAR with IGRAs,sputum culture,sputum smear or TB DNA-PCR,which can help to detect active TB.As a new diagnostic marker,su PAR has a great clinical significance.