基于外周血细胞和GBP1建立2型糖尿病合并结核性多浆膜腔积液患者预后预测模型的研究

Development of a prognostic prediction model based on peripheral blood cells and GBP1 in patients with type 2 diabetes mellitus complicated by tuberculous multi-pleural effusion

摘要:

目的 探讨外周血细胞和鸟苷酸结合蛋白1（GBP1）在2型糖尿病（T2DM）合并结核性多浆膜腔积液患者中的表达水平，评估生物标志物对患者预后的预测价值。方法 选取2020年6月—2023年1月赣州市第五人民医院结核科收治的115例T2DM合并结核性多浆膜腔积液患者为研究对象。采用多因素一般Logistic回归模型分析T2DM合并结核性多浆膜腔积液患者预后不良的危险因素，绘制受试者工作特征（ROC）曲线评估外周血清指标和GBP1在患者预后评估中的预测价值。结果 预后良好组WBC、hs-CRP、IL-6均低于预后不良组（P <0.05），TP、GBP1 mRNA均高于预后不良组（P <0.05）。多因素一般Logistic回归分析结果表明，WBC、hs-CRP、IL-6是T2DM合并结核性多浆膜腔积液患者发生预后不良的独立危险因素（P <0.05），高水平TP和高水平GBP1 mRNA是T2DM合并结核性多浆膜腔积液患者发生预后不良的保护因素（P <0.05）。建立预测模型为logit（P）=23.626+0.813×（WBC）+0.030×（hs-CRP）+0.091×（IL-6）-0.456×（TP）-1.122×（GBP1）。ROC曲线分析结果表明，外周血清指标和GBP1联合应用于预测T2DM合并结核性多浆膜腔积液患者预后不良的曲线下面积为0.987（95% CI：0.955，1.000），敏感性为96.4%（95% CI：0.896，1.000），特异性为90.8%（95% CI：0.847，0.969），约登指数为0.861。校正曲线具有良好的Hosmer-Lemeshow拟合优度（P =0.822）。结论 WBC、hs-CRP、IL-6、TP、GBP1与T2DM合并结核性多浆膜腔积液患者的预后密切相关，可作为有效的预后评估生物标志物。

Abstract:

Objective This study aimed to explore the expression levels of peripheral blood cell analysis and guanylate-binding protein 1 (GBP1) in patients with type 2 diabetes mellitus (T2DM) complicated by tuberculous pleural effusion, and to evaluate the predictive value of these biomarkers on patient prognosis.Methods A total of 115 patients with T2DM complicated by tuberculous pleural effusion, who were admitted to the Tuberculosis Department of the Fifth People's Hospital of Ganzhou City from June 2020 to January 2023, were selected as research subjects. Multifactorial regression analysis was utilized to identify the risk factors for poor prognosis in patients with T2DM complicated by tuberculous pleural effusion. The application value of peripheral serum indicators and GBP1 in the prognosis evaluation of patients was assessed through ROC curve analysis.Results Comparisons between the poor prognosis group and the good prognosis group for levels of WBC, hs-CRP, IL-6, TP, and GBP1 were made using the t-test, and statistically significant differences were observed (P < 0.05). It was found that levels of WBC, hs-CRP, and IL-6 were lower in the good prognosis group compared to the poor prognosis group, whereas levels of TP and GBP1 were higher in the good prognosis group than in the poor prognosis group. Multifactorial regression analysis indicated that high levels of WBC, hs-CRP, and IL-6 were independent risk factors for poor prognosis in patients with T2DM complicated by tuberculous pleural effusion (P < 0.05), whereas high levels of TP and GBP1 were protective factors for poor prognosis in these patients (P < 0.05). The established prediction model was logit(P) = 23.626 + 0.813 × (WBC) + 0.030 × (hs-CRP) + 0.091 × (IL-6) - 0.456 × (TP) - 1.122 × (GBP1). ROC curve analysis demonstrated that the combined use of peripheral serum indicators and GBP1 for predicting poor prognosis in patients with T2DM complicated by tuberculous pleural effusion had an AUC value of 0.987 (95% CI:0.955, 1.000), sensitivity of 96.4% (95% CI:0.896, 1.000), specificity of 90.8% (95% CI:0.847, 0.969), and Youden's index of 0.861. The calibration curve exhibited good Hosmer-Lemeshow goodness of fit (P = 0.822).Conclusion The expression levels of WBC, hs-CRP, IL-6, TP, and GBP1 are closely related to the prognosis of patients with T2DM complicated by tuberculous pleural effusion and can serve as effective prognostic assessment biomarkers.