外周血调节性T细胞及表面共刺激分子对耐多药肺结核患者疗效的预测价值  

Predictive value of peripheral blood regulatory T cells and surface co-stimulatory molecules in the efficacy of patients with multidrug-resistant pulmonary tuberculosis

作　　者：王俊力 杨铭 欧利 谌香明 刘蔺 WANG Junli;YANG Ming;OU Li;CHEN Xiangming;LIU Lin(Department of Respiratory and Critical Care Medicine,366 Hospital,Chengdu,Sichuan 610041,China;Department of Respiratory Medicine,Chengdu Public Health Clinical Medical Center,Chengdu,Sichuan 610000,China;Department of Respiratory Medicine,363 Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]三六三医院呼吸与危重症医学科,四川成都610041 [2]成都市公共卫生临床医疗中心呼吸内科,四川成都610000 [3]三六三医院呼吸内科,四川成都610041

出　　处：《国际检验医学杂志》2024年第8期926-931,共6页International Journal of Laboratory Medicine

基　　金：四川省医学会(青年创新)科研课题项目(S20065)。

摘　　要：目的 观察耐多药肺结核(MDR-TB)患者机体外周血调节性T细胞(Treg)及表面共刺激分子,并基于Nomogram预测模型探讨其对疗效的预测价值。方法 选取2020年5月至2022年5月三六三医院收治的200例MDR-TB患者作为研究对象,给予标准化或个体化抗结核治疗,根据预后情况分为预后良好组、预后不良组。比较治疗前外周血Treg细胞(CD4^(+)CD25^(+)CD127^(-)、CD4^(+)CD25^(+)Foxp3^(+))、Treg表面共刺激分子(CTLA-4^(+)Treg、PD-1^(+)Treg、ICOS^(+)Treg)及血清白细胞介素-10(IL-10)、转化生长因子β1(TGF-β1)水平,分析Treg细胞与Treg表面共刺激分子、血清TGF-β1、IL-10水平的相关性,分析MDR-TB患者预后不良的影响因素,根据影响因素及实验室指标构建预后不良的Nomogram预测模型,并对Nomogram预测模型进行验证。结果 MDR-TB患者中,预后良好108例,预后不良92例。预后不良组年龄、治疗情况、吸烟、不规则治疗、治疗前空洞、二线抗结核治疗史与预后良好组比较差异有统计学意义(P<0.05);预后不良组外周血CD4^(+)CD25^(+)Foxp3^(+)、CTLA-4^(+)Treg、PD-1^(+)Treg、CD4^(+)CD25^(+)CD127^(-)、ICOS^(+)Treg细胞比例及血清TGF-β1、IL-10水平高于预后良好组(P<0.05)。相关性分析显示,MDR-TB患者外周血CD4^(+)CD25^(+)Foxp3^(+)、CD4^(+)CD25^(+)CD127^(-)与血清TGF-β1水平及CTLA-4^(+)Treg、PD-1^(+)Treg、ICOS^(+)Treg细胞比例呈正相关(均P<0.05);Logistic回归分析显示,年龄、治疗情况、吸烟、不规则治疗、治疗前空洞、二线抗结核治疗史均为MDR-TB患者预后不良的独立危险因素(OR=2.551、6.088、3.252、4.266、4.949、6.748,均P<0.05);根据Nomogram预测模型获得患者预后不良的风险概率,外部验证Nomogram预测模型受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.833,校准曲线显示该模型预测具有良好校准度。结论 MDR-TB患者预后转归受外周血CTLA-4^(+)Treg、PD-1^(+)Treg、CD4^(+)CD25^(+)Foxp3^(+)、ICOS^(+)TregObjective To observe the peripheral blood regulatory T cells(Treg)and surface co-stimulatory molecules in patients with multidrug-resistant pulmonary tuberculosis(MDR-TB),and to explore the predictive value for therapeutic efficacy based on the Nomogram prediction model.Methods A total of 200 MDR-TB patients from May 2020 to May 2022 admitted to 363 Hospital were selected as the study objects,and all of whom received standardized or individualized anti-tuberculosis treatment.The patients were divided into good prognosis group and poor prognosis group according to the prognosis.Before treatment,peripheral blood Treg(CD4^(+)CD25^(+)CD127^(-),CD4^(+)CD25^(+)Foxp3^(+)),Treg surface co-stimulatory molecules(CTLA-4^(+)Treg,PD-1^(+)Treg,ICOS^(+)Treg),serum interleukin-10(IL-10),transform growth factorβ1(TGF-β1)between the group with good prognosis and the group with poor prognosis were compared.In addition,the correlation between Treg and Treg surface co-stimulatory molecules,serum TGF-β1,and IL-10 levels were analyzed,as well as the influencing factors for poor prognosis in MDR-TB patients.Based on the influencing factors and laboratory indicators,a Nomogram prediction model for poor prognosis was constructed and verified.Results Among MDR-TB patients,108 had good prognosis and 92 had poor prognosis.There were significant differences in age,treatment status,smoking,irregular treatment,pre-treatment cavity and second-line anti-tuberculosis treatment history between the poor prognosis group and the good prognosis group(P<0.05).The proportion of peripheral blood CD4^(+)CD25^(+)Foxp3^(+),CTLA-4^(+)Treg,PD-1^(+)Treg,CD4^(+)CD25^(+)CD127^(-),and ICOS^(+)Treg and serum levels of TGF-β1 and IL-10 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Correlation analysis shows that peripheral blood CD4^(+)CD25^(+)Foxp3^(+),CD4^(+)CD25^(+)CD127^(-)in MDR-TB patients were positively correlated with serum TGF-β1 levels and the proportion of CTLA-4^(+)Treg,PD-1^(+)Treg,and ICOS^(+)Treg(all P<0.

关 键 词：调节性T细胞 NOMOGRAM 耐多药肺结核 预后 

分 类 号：R446.11[医药卫生—诊断学] R521[医药卫生—临床医学]