Clinical investigation: increased serum stromal derived factor 1 alpha levels in pulmonary tuberculosis 
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Pulmonary tuberculosis, a granulomatous disease, has few serological markers for its activity. Recently, an increased plasma level of stromal derived factor 1 alpha (SDF‐1α), which can induce strong chemotaxis of cells through its receptor CXCR4, was detected in patients with tuberculosis. In this study we investigated serum SDF‐1α levels and CXCR4 expression on peripheral blood mononuclear cells (PBMCs). Fifty‐five active tuberculosis patients, 30 resolved tuberculosis patients, 27 acute bronchitis patients and 8 healthy volunteers were examined. Histological expression of SDF‐1α in the tuberculosis lesion and CXCR4 expression of PBMCs were also analysed. Serum SDF‐1α levels in active tuberculosis patients were significantly higher than other groups. The sensitivity and specificity for the diagnosis of active tuberculosis was 88·5% and 85·3% (cutoff value = 650 pg/ml), respectively. CXCR4 expression levels on PBMCs showed a significant negative correlation with serum SDF‐1α levels. Inflammatory cells including multinuclear giant cells in the lesion expressed SDF‐1α. Measurement of serum SDF‐1α could be a useful screening marker for the identification of active pulmonary tuberuculosis. We propose that interaction of SDF‐1α and CXCR4 might be involved in the pathogenesis of pulmonary tuberculosis.

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