Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, China.
School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou 310053, China.
J Immunol Res. 2023 Sep 27;2023:5309816. doi: 10.1155/2023/5309816. eCollection 2023.
Rapid and accurate methods for the diagnosis of tuberculous pleurisy (TP) are urgently needed. Activation markers of tuberculosis (TB)-reactive T cells are considered promising for the diagnosis of active TB (ATB). Different activation indexes may play different roles in the progression of TB, but there are few reports on T cell activation indicators, except for HLA-DR. Hence, we evaluated the expression of early (CD25 and CD69) and late (CD134) activation markers on TB antigen-stimulated CD4+ T cells in populations with different TB infection status and investigated their diagnostic value for ATB, particularly, for TP. Moreover, we compared the differences in the diagnostic efficacy among the indexes from peripheral blood (PB) and pleural fluid (PF) for TP. The expression of each activation marker was significantly increased in TB-infected populations (patients with ATB and latent TB infection vs. healthy individuals; patients with TP vs. non-TP) and was significantly higher in the PF than in the PB of patients with TP. The diagnostic performance of the coexpressed activation markers was superior to that of single expression markers in the differential diagnosis of ATB and non-TB, with CD25+CD134+ showing the best diagnostic efficiency (AUC: 0.93, 95% CI, 0.87-0.99; sensitivity: 86.7%, 95% CI, 72.5%-94.5%; and specificity: 94.0%, 95% CI, 82.5%-98.4%). Except for TB-IGRA, the activation indexes were more accurate than conventional laboratory methods for ATB diagnosis. In addition, the expression of CD25+CD134+ in PB and PF was the best values for differential diagnosis of TP and NTP, with AUCs of 0.87 (95% CI, 0.77-0.96) and 0.95 (95% CI, 0.90-1.00), respectively. Our study provides information on the diagnostic value of different activation markers for TB and shows that the expression of CD25+CD134+ on CD4+ T cells in PF can serve as a potential marker for TP diagnosis.
快速准确的结核性胸膜炎（TP）诊断方法是急需的。结核反应性 T 细胞的激活标志物被认为是诊断活动性结核（ATB）的有前途的方法。不同的激活指标可能在结核的进展中发挥不同的作用，但除了 HLA-DR 之外，关于 T 细胞激活指标的报道很少。因此，我们评估了不同结核感染状态人群中 TB 抗原刺激的 CD4+T 细胞上早期（CD25 和 CD69）和晚期（CD134）激活标志物的表达，并研究了它们对 ATB，特别是对 TP 的诊断价值。此外，我们比较了外周血（PB）和胸腔积液（PF）中不同指标在 TP 诊断中的差异。在结核感染人群（ATB 患者和潜伏性结核感染患者与健康个体；TP 患者与非 TP 患者）中，每个激活标志物的表达均显著增加，并且在 PF 中的表达明显高于 TP 患者的 PB。在 ATB 和非 TB 的鉴别诊断中，共表达激活标志物的诊断性能优于单一表达标志物，其中 CD25+CD134+显示出最佳的诊断效率（AUC：0.93，95%CI，0.87-0.99；敏感性：86.7%，95%CI，72.5%-94.5%；特异性：94.0%，95%CI，82.5%-98.4%）。除了 TB-IGRA 之外，这些激活指标对于 ATB 诊断的准确性都高于常规实验室方法。此外，在 PB 和 PF 中 CD25+CD134+的表达对于区分 TP 和 NTP 的诊断效果最佳，AUC 值分别为 0.87（95%CI，0.77-0.96）和 0.95（95%CI，0.90-1.00）。本研究提供了关于不同激活标志物对结核诊断价值的信息，并表明 PF 中 CD4+T 细胞上 CD25+CD134+的表达可以作为 TP 诊断的潜在标志物。
