结核与肿瘤患者胸腔积液中TNF-α,IFN-γ,IL-2,IL-4的水平及临床意义  

TNF-α,IFN-γ,IL-2 and IL-4 in Tuberculous and Malignant Pleural Effusion

作　　者：武江海[1] 舒敬奎[1] 张剑青[1] 冯家钢[1] 贾曼 刘凌[1] WU Jiang-hai;SHU Jing-kui;ZHANG Jian-qing;FENG Jia-gang;JIA Man;LIU Ling(Dept.Ⅱof Respiratory and Critical Care Medicine,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院呼吸与危重症医学二科

出　　处：《昆明医科大学学报》2019年第12期103-107,共5页Journal of Kunming Medical University

基　　金：云南省卫计委卫生科技计划基金资助项目(2014NS166)

摘　　要：目的探讨肿瘤坏死因子(tumor necrosis factor,TNF)-α,γ干扰素(interferon-γ,IFN-γ),白细胞介素(interleukin,IL)-2,IL-4在结核性和肿瘤性胸腔积液中的水平及临床意义。方法收集2016年4月至2018年6月在昆明医科大学第一附属医院呼吸内科住院的确诊为结核性或肿瘤性胸腔积液患者的胸腔积液和血清标本,其中结核性30例,肿瘤性32例。采用酶联免疫吸附法(ELISA)测定胸腔积液和血清中TNF-α,IFN-γ,IL-2,IL-4浓度,并分析结果及其临床意义。结果 (1)结核组胸腔积液中TNF-α,IFN-γ,IL-2的浓度高于其血清浓度(P <0.05);肿瘤组胸腔积液中IL-2的浓度高于其血清浓度(P <0.05);(2)结核组胸腔积液中TNF-α,IFN-γ,IL-2及血清中IFN-γ浓度高于肿瘤组(P <0.01);(3) IL-4的胸腔积液和血清浓度,及血清中TNF-α,IL-2浓度在结核和肿瘤组间差异无统计学意义(P> 0.05)。(4) ROC曲线结果显示,胸腔积液中TNF-α,IFN-γ,IL-2及血清中IFN-γ的浓度均可作为鉴别结核和肿瘤性胸腔积液的指标。结论结核性胸腔积液由TH1细胞介导的局限于胸膜腔的免疫反应占主导;结核性胸腔积液患者胸腔积液中TNF-α,IFN-γ,IL-2的浓度及血清中IFN-γ的浓度升高,可有效鉴别结核和肿瘤性胸腔积液。Objective To investigate the concentrations and clinical significance of tumor necrosis factor(TNF)-α,interferon-γ (IFN-γ),interleukin(IL)-2,IL-4 in tuberculous pleural effusion(TPE) and malignant pleural effusion(MPE). Methods Pleural effusion(PE) and corresponding serum samples were obtained from 62 patients from Department Ⅱ of Respiratory and Critical Care Medicine of First Affiliated Hospital of Kunming Medical University from April 2016 to June2018. There were 30 cases with tuberculous pleural effusion(TPE) and 32 with malignant pleural effusion(MPE). The pleural and serum levels of TNF-α,IFN-γ,IL-2 and IL-4 were determined by sandwich enzyme-linked immunosorbent assays(ELISA). Results(1) The concentration of TNF-α,IFN-γ and IL-2 in TPE were higher than that of the corresponding serum concentration(P < 0.05);The concentration of IL-2 in MPE is higher than that in the corresponding serum concentration(P < 0.05);(2)The concentration of TNF-α,IFN-γ,IL-2 in PE and IFN-γin serum of TME group were higher than that of MPE(P < 0.01);(3) The concentration of IL-4 in PE and serum, and the concentration of TNF-α,IL-2 in serum showed no difference between tuberculous and malignant groups(P > 0.05).(3) The concentration of TNF-α, IFN-γ,IL-2 in PE and IFN-γin serum exhibited reliable diagnostic efficiency for distinguishing TPE from MPE according to ROC curve. Conclusion Our data reflected local Th1-mediatd immune response played a dominant role in TPE. The concentration of TNF-α,IFN-γ,IL-2 in PE and IFN-γin serum of patients with TPE were significantly higher than those of patients with MPE. These biomarkers may effectively differentiate TPE from MPE.

关 键 词：肿瘤坏死因子α 白细胞介素类 干扰素Γ 胸腔积液 结核 恶性肿瘤 

分 类 号：R561.3[医药卫生—呼吸系统]