结核特异性IL-2释放试验在结核感染中的诊断价值探讨  

A Study of the Diagnostic Value of Tuberculosis-specific IL-2 Release Assay in Tuberculosis Infection

作　　者：赵志鹏[1] 李润青 李晓晨 熊攀 赵秀英[1] ZHAO Zhipeng;LI Runqing;LI Xiaochen;XIONG Pan;ZHAO Xiuying(Laboratory Medicine Department,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghu University,Beijing 100044,China)

机构地区：[1]清华大学附属北京清华长庚医院,清华大学临床医学院检验医学科,北京102218

出　　处：《标记免疫分析与临床》2024年第2期214-217,313,共5页Labeled Immunoassays and Clinical Medicine

摘　　要：目的基于结核特异性白细胞介素2(IL-2)释放试验的结果,探讨IL-2在辅助诊断活动性结核(ATB)感染中的作用,以及用于监测治疗效果的价值。方法回顾性分析临床进行了结核感染排查的病例599例,其中确诊为活动性结核感染的病例128例,除外活动性结核感染的病例471例。(1)对与阴性对照共同孵育后上清中IL-2(N)检测值制作ROC工作曲线,分析失去抗原刺激后PBMCs持续释放IL-2的能力;(2)对抗原刺激后的响应值IL-2(T-N),制作ROC工作曲线,分析对活动性结核感染的诊断价值;(3)对比分析两组患者IL-2的阳性率;(4)观察响应值IL-2(T-N)阴性和阳性转化时间与疾病进程的依从性。结果IL-2(N)ROC曲线下面积为0.460,95%CI 0.402~0.516;IL-2(T-N)ROC曲线下面积为0.788,95%CI 0.745~0.832;在活动性结核感染组,IL-2(T-N)的阳性率显著高于非活动性结核感染组(χ^(2)=110.858,P<0.001);IL-2发生阴阳性转化的平均时间为3.1个月,时间区间为0.5~7个月。结论PBMCs失去抗原刺激后IL-2仅低水平分泌,对诊断ATB没有价值;结核分枝杆菌特异性抗原刺激后的响应值IL-2(T-N),用于诊断ATB具有一定准确性;IL-2(T-N)阴阳性转化的时间较短,在监测治疗效果方面存在一定价值,监测时间间隔建议为3个月。Objective This study aims to investigate the role of interleukin-2(IL-2)in the diagnosis of active tuberculosis(ATB)infection,as well as its clinical value for monitoring treatment effects,based on the results of tuberculosis-specific IL-2 release assay.Methods A total of 599 cases of tuberculosis infection were retrospectively analyzed.Among them,128 cases were diagnosed as active tuberculosis infection and 471 cases were excluded from active tuberculosis infection.(1)The study employed the receiver operating characteristic(ROC)curve to evaluate the ability of PBMCs to continuously release IL-2 after losing antigen stimulation;(2)The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of IL-2(T-N)in active tuberculosis infection;(3)The positive rate of IL-2 was compared between the two groups;(4)The compliance of IL-2(T-N)negative and positive transformation duration with the disease course was observed.Results The area under the ROC curve of IL-2(N)was 0.460,and 95%CI 0.402-0.516;The area under the ROC curve of IL-2(T-N)was 0.788,and 95%CI 0.745-0.832;The positive rate of IL-2(T-N)in active tuberculosis infection group was significantly higher than that in the non-active tuberculosis infection group(χ^(2)=110.858,P<0.001).The average duration of IL-2 negative and positive transformation was 3.1 months,and the interval was 0.5-7 months.Conclusion IL-2 secretion by PBMCs without antigen stimulation is low and not valuable for the diagnosis of ATB;IL-2(T-N)stimulated by Mycobacterium tuberculosis specific antigen demonstrates certain accuracy in the diagnosis of ATB;The duration of IL-2(T-N)negative and positive transformation is short,suggesting its value in monitoring the therapeutic effect,with a recommended monitoring interval of 3 months.

关 键 词：IL-2 活动性结核感染 IGRAs 结核特异性IL-2释放试验 治疗效果监测 

分 类 号：R52[医药卫生—内科学]