标题：血清Hsp10联合CT诊断脊柱结核的价值

      作者：王志永，王立，张志飞，陈晓辉    陕西省结核病防治院(陕西省第五人民医院)影像中心，陕西 西安 710100

      卷次： 2023年34卷22期

      【摘要】 目的 探讨血清热休克蛋白 10 (Hsp10)联合电子计算机断层扫描(CT)诊断脊柱结核的价值。方法 回顾性收集2019年4月至2022年4月陕西省第五人民医院收治的83例疑为脊柱结核患者的临床资料，按照最终确诊分为结核组(n=34)和非结核组(n=49)，并另选同期40例体检健康者作为健康组，三组受检者均检测血清Hsp10水平，并绘制受试者工作特征曲线(ROC)分析其对脊柱结核的诊断价值，对疑为脊柱结核患者行CT扫描，总结脊柱结核 CT特点，采用Kappa检验分析Hsp10联合 CT诊断脊柱结核与最终临床病理学诊断的一致性。结果 83例疑为脊柱结核患者，CT正确检出脊柱结核 26例，敏感度为 76.47%，特异性为 91.84%，准确率为85.54%；结核组患者的血清Hsp10水平为(131.14±17.81) pg/mL，明显高于非结核组的(100.13±11.14) pg/mL及健康组的(96.33±10.75) pg/mL，差异均有统计学意义(P<0.05)，而非结核组与健康组受检者的血清Hsp10水平比较差异无统计学意义(P>0.05)；经ROC分析结果显示，血清Hsp10诊断脊柱结核曲线下面积(AUC)为 0.732，约登指数(0.502)最大时对应截断值为115.09 pg/mL，诊断敏感度为70.59%，特异度为79.59%；以截断值为诊断界限，83例可疑脊柱结核患者中，血清Hsp10正确检出脊柱结核24例，准确率为81.93%；血清Hsp10联合CT正确检出脊柱结核31例，敏感度为93.94%，特异性为96.00%，准确率为95.18%，血清Hsp10与CT检查两者联合诊断效能优于两者单独诊断(P<0.05)。结论 血清Hsp10与CT诊断脊柱结核的敏感度、特异度及诊断符合率均较高，但两者联合诊断的敏感度、特异度及诊断符合率高于两者单独诊断，可降低漏诊率及误诊率。
      【关键词】 结核杆菌；热休克蛋白10；电子计算机断层扫描；联合诊断；脊柱结核
      【中图分类号】 R529.2 【文献标识码】 A 【文章编号】 1003—6350（2023）22—3301—04

Value of serum Hsp10 combined with CT in the diagnosis of spinal tuberculosis.
WANG Zhi-yong, WANG Li,ZHANG Zhi-fei, CHEN Xiao-hui. Imaging Center, Shaanxi Provincial Tuberculosis Control Hospital (The Fifth People'sHospital of Shaanxi Province), Xi'an 710100, Shaanxi, CHINA
【Abstract】 Objective To explore the value of serum heat shock protein 10 (Hsp10) combined with computedtomography (CT) in the diagnosis of spinal tuberculosis. Methods The clinical data of 83 patients with suspected spi-nal tuberculosis who were treated in the Fifth People's Hospital of Shaanxi Province were retrospectively collected be-tween April 2019 and April 2022. According to the final diagnosis, the patients were divided into tuberculosis group (n=34) and non-tuberculosis group (n=49). Forty healthy people undergoing physical examination during the same periodwere selected as healthy group. Serum Hsp10 level was detected among the three groups of subjects. Receiver operatingcharacteristic (ROC) curve was drawn to analyze the diagnostic value of Hsp10 on spinal tuberculosis. CT scan wasperformed on patients with suspected spinal tuberculosis, and the CT characteristics of spinal tuberculosis were summa-rized. Kappa test was used to analyze the consistency between Hsp10 combined with CT and final clinical pathologicaldiagnosis in the diagnosis of spinal tuberculosis. Results Among 83 patients with suspected spinal tuberculosis, CTcorrectly detected 26 cases of spinal tuberculosis, with a sensitivity of 76.47%, a specificity of 91.84%, and an accura-cy rate of 85.54%. Serum Hsp10 level in the tuberculosis group was (131.14±17.81) pg/mL, which was significantlyhigher than (100.13±11.14) pg/mL in non-tuberculosis group and (96.33±10.75) pg/mL in the healthy group (P<0.05).There was no statistically significant difference in serum Hsp10 level between non-tuberculosis group and healthy group(P>0.05). ROC analysis showed that the area under the curve (AUC) of serum Hsp10 in the diagnosis of spinal tuberculo-sis was 0.732, and the corresponding cut-off value, diagnostic sensitivity, and specificity were 115.09 pg/mL, 70.59%,and 79.59% when the Youden index was maximum (0.502). Taking the cut-off value as the diagnostic threshold, serumHsp10 correctly detected 24 cases of spinal tuberculosis among the 83 patients with suspected spinal tuberculosis, withan accuracy rate of 81.93%. Serum Hsp10 combined with CT correctly detected 31 cases of spinal tuberculosis, and thesensitivity, specificity, and accuracy rate were 93.94%, 96.00%, and 95.18%. The diagnostic efficiency of the combina-tion of serum Hsp10 and CT examination was better than that of Hsp10 or CT alone (P<0.05). Conclusion The sensi-tivity, specificity, and diagnostic coincidence rate of serum Hsp10 and CT in the diagnosis of spinal tuberculosis werehigh, but the sensitivity, specificity, and diagnostic coincidence rate of combined diagnosis were higher than those of sin-gle diagnosis, which could reduce the rate of missed diagnosis and misdiagnosis.
      【Key words】 Mycobacterium tuberculosis; Heat shock protein 10; Computed tomography; Combined diagnosis;Spinal tuberculosis