PBMCs结核分枝杆菌特异性抗原反应性MIG和IFN-γ对活动期肺结核的鉴别诊断意义  

Evaluating the potential value of MIG and IFN-γ as biomarkers for the differential diagnosis of active pulmonary tuberculosis

作　　者：王心静[1] 曹志红[1] 刘宇 杨秉芬[1] 刘艳华[1] 蒋静[1] 程小星[1] 

机构地区：[1]解放军第三0九医院结核病研究室,北京100091 [2]解放军第三0九医院呼吸内科,北京100091

出　　处：《中国医师杂志》2011年第7期873-875,共3页Journal of Chinese Physician

基　　金：国家自然科学基金（81071318,81071319）

摘　　要：目的研究活动期肺结核和常见肺部鉴别诊断疾病肺炎及原发性肺癌患者的外周血单个核细胞（PBMCs）经结核分枝杆菌特异性抗原肽刺激后干扰素-γ诱导的单核因子（Monokine induced by interferon gamma，MIG）和干扰素-γ（IFN-1）的表达特点及诊断意义。方法90例初治活动期肺结核患者，31例细菌性肺炎和原发性支气管肺癌患者，分离外周血PBMCs，用结核分枝杆菌特异性抗原肽刺激，采用Flowcytomix流式技术检测细胞培养液上清上中MIG和IFN-γ的表达。用接受者工作特征曲线（ROCcurve）评价结核分枝杆菌特异性抗原反应性MIG和IFN-γ的诊断价值。结果PBMCs经结核分枝杆菌特异性抗原肽刺激后，培养液上清中MIG水平显著升高，初治活动期肺结核患者与其他肺病对照组差异有统计学意义（3023．0pg／mlvs112．5pg／ml，P〈0．0001），与IFN-γ的表达水平呈正相关（r=0．7168，P〈0．0001），单独应用MIG诊断肺结核的敏感性为94．4％，单独应用IFN-γ诊断肺结核的特异性为96．8％，二者并联应用诊断肺结核的敏感性为97．8％，特异性为87．1％。结论结核分枝杆菌特异性抗原肽刺激外周血单个核细胞产生的MIG和IFN-γ能够良好的鉴别初治活动期肺结核及常见的细菌性肺炎和原发性支气管肺癌，可能成为新的诊断指标。Objective To study the feature of MIG and IFN-γ obtained from PBMCs stimulated with Mtb specific antigens and the potential value in the differential diagnosis of active pulmonary tuberculo- sis from bacterial pneumonia and primary lung cancer. Methods 90 patients with active pulmonary tuberculosis and 31 patients with bacterial pneumonia and primary lung cancer were enrolled. MIG and IFN-γ in supernatants from PBMCs stimulated with Myeobacterium tuberculosis-specific antigens were analyzed with Bender Flowcytomix on flow cytometry. The diagnostic values were established based on receiver operating characteristic curve analysis. Results PBMCs stimulated with Mtb-specific antigens produced significantly higher levels of MIG compared with IFN-γThe level of MIG in active pulmonary TB patients was significandy higher than in controls （3023.0 pg/ml vs 112. 5 pg/ml, P 〈 0. 0001 ）. The MIG and IFN-γ tests were positive in 96. 8 and 86.7% of the TB patients, the specificity was up to 94.4 and 87. 1%. With com- bination of MIG and IFN-γ, tests, the positive rate increased among TB patients to 97.8% without a significant decrease in specificity. Conclusions The responses of the MIG and IFN-γ against to Mtb-specific antigens could be used to discriminate newly-treated active pulmonary tuberculosis from bacterial pneumonia and primary lung cancer. Combination of MIG and IFN-γ, might be a simple and quick approach to diagnosis newly-treated active pulmonary tuberculosis.

关 键 词：单核细胞/代谢 趋化因子CXCL9/生物合成 干扰素Ⅱ型/生物合成 结核 N/代谢 肺炎/代谢 肺肿瘤/代谢 诊断 鉴别 

分 类 号：R521[医药卫生—内科学]