不同临床类型结核病患者血清白细胞介素-21水平及其临床意义  

Expression and clinical significance of serum interleukin-21 in patients with different types of tuberculosis

作　　者：杨智彬[1] 申恩瑞 潘丽[3] 赵丽惠 王聪[1] 杨艳霞 李阳 王巧凤 马世武[4] Yang Zhibin;Shen Enrui;Pan Li;Zhao Lihui;Wang Cong;Yang Yanxia;Li Yang;Wang Qiaofeng;Ma Shiwu(Department of Infectious Diseases,People’s Hospital of Yuxi City,The Sixth Affiliated Hospital of Kunming Medical University,Yuxi 653100,China;Department of Infectious Diseases,People’s Hospital of Jianshui County,Honghe Prefecture,Jianshui 654300,China;Department of Laboratory,People’s Hospital of Yuxi City,The Sixth Affiliated Hospital of Kunming Medical University,Yuxi 653100,China;Department of Infectious Diseases,the 920 Hospital of Joint Logistic Support Force of PLA (Kunming General Hospital of PLA),Kunming 650032,China)

机构地区：[1]昆明医学院第六附属医院(玉溪市人民医院)感染科,玉溪市653100 [2]云南红河州建水县人民医院感染科,建水县654300 [3]昆明医学院第六附属医院(玉溪市人民医院)检验科,玉溪市653100 [4]联勤保障部队第九二〇医院(原成都军区昆明总医院)感染科,昆明市650032

出　　处：《中华实验和临床感染病杂志（电子版）》2019年第1期48-53,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探讨不同临床类型结核病患者白细胞介素-21(IL-21)表达水平及其与结核抗体间的相关性。方法选取2014年10月至2018年6月昆明医学院第六附属医院感染科初治结核病患者共180例,根据患者结核发病部位分为肺结核组(99例,其中包括结核性胸膜炎患者37例)和肺外结核组(81例),选取同期体检的健康志愿者作为对照组(140例),运用酶联免疫吸附试验(ELISA)检测结核病患者抗结核分枝杆菌治疗前后血清IL-21水平和抗结核分枝杆菌抗体,以及结核性胸膜炎患者抗结核分枝杆菌治疗前胸水IL-21水平,分析血清IL-21水平与结核分枝杆菌抗体的相关性。结果在抗结核分枝杆菌治疗前,肺结核组[43.16(72.98)pg/ml]和肺外结核组[38.68(58.17)pg/ml]患者血清IL-21水平均低于健康对照组[59.49(42.41)pg/ml],差异均有统计学意义(Z=-2.788、P=0.005,Z=-2.788、P=0.005);但肺结核组和肺外结核组差异无统计学意义(Z=-0.052、P=0.961)。经过强化期抗结核分枝杆菌治疗,肺结核组和肺外结核组患者血清IL-21水平均显著回升[60.21(57.58)pg/ml vs. 43.16(72.98)pg/ml,Z=-2.681、P=0.007;66.16(42.21)pg/ml vs. 38.68(58.17)pg/ml,Z=-2.422、P=0.015]。肺结核组中结核性胸膜炎患者胸水IL-21水平显著高于其抗结核分枝杆菌治疗前血清IL-21水平[121.36(133.67)pg/ml vs. 49.09(80.67)pg/ml,Z=-3.477、P=0.001]。结论结核病患者血清IL-21水平降低,并于抗结核分枝杆菌治疗后回升,提示IL-21水平可作为观察结核病患者疗效及临床转归的指标。Objective To investigate the expression level of interleukin 21 (IL-21) and its correlation with tuberculosis antibody in patients with different clinical types of tuberculosis.Methods From October 2014 to June 2018,a total of 180 patients with primary tuberculosis in The Sixth Affiliated Hospital of Kunming Medical University were divided into two groups according to the lesion locations:pulmonary tuberculosis group (n = 99,including 37 cases with tuberculous pleurisy) and extrapulmonary tuberculosis group (n = 81);while 140 healthy volunteers were selected as control group.The levels of serum IL-21 and anti-Mycobacterium tuberculosis antibody in the patients with tuberculosis before and after anti-Mycobacterium tuberculosis treatment were detected by Enzyme linked immunosorbent assay (ELISA).IL-21 levels in pleural effusions were detected in patients with tuberculosis pleurisy before treatment.The correlation between serum IL-21 level and anti-Mycobacterium tuberculosis expression was analyzed.Results Before anti-Mycobacterium tuberculosis treatment,the serum IL-21 levels in both pulmonary tuberculosis patients [43.16 (72.98) pg/ml] and extrapulmonary tuberculosis patients [38.68 (58.17) pg/ml] were lower than those of healthy controls [59.49 (42.41) pg/ml],with significant differences (Z =-2.788,P = 0.005;Z =-2.788,P = 0.005);but there was no significant difference between pulmonary tuberculosis group and extrapulmonary tuberculosis group (Z =-0.052,P = 0.961).After intensive anti-Mycobacterium tuberculosis treatment,the serum IL-21 levels of both pulmonary tuberculosis and extrapulmonary tuberculosis patients were significantly increased [60.21 (57.58) pg/ml vs.43.16 (72.98) pg/ml;Z =-2.681,P = 0.007;66.16 (42.21) pg/ml vs.38.68 (58.17) pg/ml;Z =-2.422,P = 0.015].The average level of IL-21 in pleural effusion of patients with tuberculous pleurisy in pulmonary tuberculosis group was significantly higher than their serum IL-21 level before anti-Mycobacterium tuberculosis [121.36 (133.67) pg/ml vs.49.09 (80.67)

关 键 词：结核病 白细胞介素-21 细胞因子 结核分枝杆菌抗体 体液免疫 

分 类 号：R52[医药卫生—内科学]