血清中相关细胞因子表达水平变化对肺结核治疗效果的评估  

Efficacy in cytokine expression levels in serums in evaluating treatment effect of pulmonary tuberculosis

作　　者：李华 许婉华 龚兰 谢贝[1] 杨瑜[1] 刘志辉[1] 吴玲[1] 孟繁荣[1] 王楠[1] 王琪 张言斌 LI Hua;XU WanHua;GONG Lan;XIE Bei;YANG Yu;LIU Zhihui;WU Ling;MENG Fanrong;WANG Nan;WANG Qi;ZHANG Yanbing(Institute of Pulmonary Diseases,Guangzhou Chest Hospital,Guangzhou 510095,China;不详)

机构地区：[1]广州市胸科医院肺部疾病研究所,广州510095 [2]广州市结核病防治所二分所,广州510095 [3]广州市红十字会医院,广州510220

出　　处：《实用医学杂志》2022年第17期2203-2208,共6页The Journal of Practical Medicine

基　　金：广州市科技计划项目(编号:202102020910);广州市科技计划项目(编号:202002030152);广州市科技计划项目(编号:202206010134);广州市高水平临床重点专科和培育专科建设项目(编号:穗卫函[2019]1555号);广州市医学重点学科(结核病学)建设项目。

摘　　要：目的分析血清中相关细胞因子表达水平变化在肺结核治疗效果评估中的检验效能。方法分别收集肺结核患者治疗前和治疗2月时血清,通过流式细胞术测量其中白细胞介素(IL)-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12P70、IL-17、肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ和IFN-α的表达水平。同时影像学监测病灶变化情况,较治疗前,治疗2月时病灶无变化及增大为无效组,病灶吸收为有效组。受试者工作曲线分析血清中各细胞因子治疗2月与治疗前浓度的比值(Ratio值)区分肺结核治疗无效和有效的界值和检验效能。进一步将不同细胞因子串联或并联后,分析其组合后的检验效能。结果(1)无效组和有效组患者的年龄和性别差异无统计学意义。总体而言,肺结核患者治疗两月后血清中IL-6、IFN-γ表达水平较治疗前降低,差异具有统计学意义(P=0.020、0.023),IL-10表达水平较治疗前升高,差异具有统计学意义(P=0.011)。有效组治疗两月后肺结核患者血清中IL-6表达水平较治疗前降低,差异具有统计学意义(P=0.033)。(2)TNF、IL-17、IL-1β、IL-4、IL-6、IFN-γ、IL-12P70、IFN-α和IL-8的Ratio值在判断肺结核治疗无效时的敏感度>80%,但特异度较低;IL-5和IL-10的Ratio值在判断肺结核治疗无效时的特异度>80%,但敏感度较低。(3)IFN-γ、IL-17和IFN-α三种细胞因子串联组合后,在判断肺结核治疗无效时的灵敏度84.00%,特异度70.97%,准确度76.79%;IL-6和IFN-α两种细胞因子串联组合后,在判断肺结核治疗无效时的灵敏度80.00%,特异度67.74%,准确度73.21%。结论对比治疗前,肺结核患者治疗2月后血清中部分细胞因子表达水平的变化有用于抗结核治疗效果监测的潜力。Objective To analyze the efficacy of changes in serum cytokine expression levels in the evaluation of pulmonary tuberculosis treatment effects.Methods The serums of pulmonary tuberculosis patients were collected before treatment and after 2-month treatment.The expression levels of interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P70,IL-17,tumor necrosis factor(TNF)-α,interferon(IFN)-γand IFN-αwere measured by flow cytometry.At the same time,the changes of the lesions were monitored by imaging.The treatment was considered as ineffective if the lesions did not change or increased after 2-month treatment when compared with before treatment,and as effective when the lesions disappeared.Receiver operating curve analysis was done to analyze the cut-off value of ratio(ratio of the concentration of each cytokine in serum after 2-month treatment to that before treatment)and identify the boundary value and test power between the ineffective and effective treatment of pulmonary tuberculosis.After further connecting different cytokines in series or in parallel,the combined test performance was analyzed.Results(1)There was no significant difference in age and gender between the ineffective group and the effective group.Overall,the expression levels of IL-6 and IFN-γin the serums of tuberculosis patients after two-month treatment were significantly lower than those before treatment(P=0.020,P=0.023,respectively).The expression level of IL-10 in the serums after two-month treatment was significantly higher than that before treatment(P=0.011).After two-month treatment,the expression level of IL-6 in the serums in the effective group was significantly lower than that before treatment(P=0.033).(2)The sensitivity of the ratio of TNF,IL-17,IL-1β,IL-4,IL-6,IFN-γ,IL-12P70,IFN-αand IL-8 in judging the ineffectiveness of pulmonary tuberculosis treatment was>80%,but the specificity was low.The specificity of the ratio of IL-5 and IL-10 in judging the ineffectiveness of treatment was>80%,but the sensitivity was low.(3)After c

关 键 词：肺结核 细胞因子 表达水平变化 治疗效果 

分 类 号：R378.911[医药卫生—病原生物学]