肺结核患者BALF病原菌分布及mIL-2R、 sIL-2R、IL-4和TNF-α水平  

Distribution of pathogens isolated from BALF and levels of mIL-2R, sIL-2R, IL-4 and TNF-α of patients with pulmonary tuberculosis

作　　者：刘曦 罗晓松 孙涛 吴应梅 付星 LIU Xi;LUO Xiao-song;SUN Tao;WU Ying-mei;FU Xing(The People's Hospital of Qiannan,Qiannan,Guizhou 558000,China)

机构地区：[1]黔南州人民医院全科医学科,贵州黔南558000 [2]黔南州人民医院急诊内科,贵州黔南558000 [3]黔南州人民医院感染科,贵州黔南558000

出　　处：《中华医院感染学杂志》2023年第1期13-17,共5页Chinese Journal of Nosocomiology

基　　金：贵州省科研基金项目(2020L01002)。

摘　　要：目的 分析肺结核患者支气管肺泡灌洗液(BALF)的菌群分布及膜白细胞介素-2受体(mIL-2R)、可溶性白细胞介素-2受体(sIL-2R)、白细胞介素-4(IL-4)和肿瘤坏死因子α(TNF-α)的表达及意义。方法 选取2018年2月-2021年8月黔南州人民医院收治的肺结核患者476例,采集患者BALF标本进行病原菌培养,多因素Logistic回归筛选肺结核患者BALF中有致病菌生长的危险因素,检测BALF中mIL-2R、sIL-2R、IL-4及TNF-α水平。结果 476份BALF标本共有58份检出致病菌,检出病原菌69株,其中革兰阴性菌42株占60.87%,革兰阳性菌21株占30.43%,真菌6株占8.70%;年龄≥45岁、合并糖尿病、合并慢性肺病及吸烟史均为肺结核患者BALF中有致病菌生长的危险因素(P<0.05);相较于陈旧性肺结核患者,活动性肺结核患者BALF中sIL-2R和TNF-α水平升高,mIL-2R水平降低(P<0.05);相较于无空洞肺结核患者,有空洞肺结核患者BALF中IL-4和TNF-α水平升高(P<0.05)。结论 年龄≥45岁、合并糖尿病、合并慢性肺病及吸烟史肺结核患者更应警惕肺部感染的发生,同时BALF中mIL-2R、sIL-2R水平变化和肺结核的活动度有一定的关系,IL-4、TNF-α则与病灶的空洞形成密切相关。OBJECTIVE To explore the distribution of pathogens isolated from bronchoalveolar lavage fluid(BALF) of patients with pulmonary tuberculosis and observe the expression levels of membrane interleukin-2 receptor(mIL-2R), soluble interleukin-2 receptor(sIL-2R), interleukin-4(IL-4) and tumor necrosis factor alpha(TNF-α) as well as their significance. METHODS A total of 476 patients with pulmonary tuberculosis who were treated in the People′s Hospital of Qiannan from Feb 2018 to Aug 2021 were enrolled in the study, the BALF specimens were collected for culture of pathogens, the risk factors for growth of pathogenic bacteria in BALF were screened out by multivariate logistic regression, and the levels of mIL-2R, sIL-2R, IL-4 and TNF-α in BALF were detected. RESULTS Totally 58 of 476 BALF specimens were detected with pathogens;a total of 69 strains of pathogens were isolated, 42(60.87%) of which were gram-negative bacteria, 21(30.43%) were gram-positive bacteria, and 6(8.70%) were fungi. The no less than 45 years of age, complication with diabetes mellitus, complication with chronic pulmonary diseases and smoking history were the risk factors for the growth of pathogens in BALF(P<0.05). The levels of BALF sIL-2R and TNF-α of the patients with active tuberculosis were higher than those of the patients with obsolete tuberculosis, while the mIL-2R level of the patients with active tuberculosis was lower than that of the patients with obsolete tuberculosis(P<0.05);the levels of BALF IL-4 and TNF-α of the patients with cavity tuberculosis patients were higher than those of the patients without cavity tuberculosis(P<0.05). CONCLUSION The no less than 45 years of age, complication with diabetes mellitus, complication with chronic pulmonary diseases and smoking history are the risk factors for pulmonary infection in the patients with pulmonary tuberculosis. There is certain association between the levels of BALF mIL-2R and sIL-2R and the activity of pulmonary tuberculosis, and the IL-4 and TNF-α are closely assocviated wi

关 键 词：肺结核 支气管肺泡灌洗液 病原菌 膜白介素-2受体 可溶性白介素-2受体 白细胞介素-4 肿瘤坏死因子α 

分 类 号：R521[医药卫生—内科学]