Th1/Th2细胞因子谱在恶性血液肿瘤患者化疗后中性粒细胞缺乏伴感染的应用价值  

Application of Th1/Th2 cytokine profile in patients with malignant hematologic tumors with agranulocytosis and infection after chemotherapy

作　　者：徐嘉愉 张复华 牛国敏[1] 梁家宝 潘焕玉 麦秀蕖 杨国雷 徐嘉良 黄佑勇 Jiayu Xu;Fuhua Zhang;Guomin Niu;Jiabao Liang;Huanyu Pan;Xiuqu Mai;Guolei Yang;Jialiang Xu;Youyong Huang(Department of Hematologic Lymphoma,Nanhai District People's Hospital,Foshan 528200,China)

机构地区：[1]广东省佛山市南海区人民医院血液淋巴瘤科,佛山528200

出　　处：《中华细胞与干细胞杂志（电子版）》2024年第3期143-150,共8页Chinese Journal of Cell and Stem Cell（Electronic Edition）

基　　金：广东省医学科学技术研究基金(B2022241)。

摘　　要：目的探讨Th1/Th2细胞因子谱在恶性血液肿瘤患者化疗后中性粒细胞缺乏(简称粒缺)伴感染的应用价值。方法选取2021年10月至2023年1月佛山市南海区人民医院血液淋巴瘤科住院治疗的66例中性粒细胞缺乏继发感染的血液系统恶性肿瘤患者,34例血液系统肿瘤化疗后粒缺无感染的患者与34例本院体检中心健康志愿者为研究对象,并采用流式细胞微球阵列(CBA)技术测定其外周血,同步进行血培养,探讨Th1/Th2细胞因子谱的临床意义。采用Kaplan-Meier法绘制粒缺伴感染组患者的生存曲线,使用log-rank检验比较生存情况差异的显著性。结果粒缺伴感染组患者粒缺后的Th1/Th2细胞因子谱水平高于粒缺前,差异有统计学意义(P<0.05),粒缺无感染组粒缺后与粒缺前Th1/Th2细胞因子谱水平对比差异无统计学意义(P>0.05);粒缺无感染组的Th1/Th2细胞因子谱水平与健康组患者相比差异无统计学意义(P>0.05),粒缺伴感染组的干扰素γ(IFN-γ)、肿瘤坏死因子(TNF)、白细胞介素-10(IL-10)、IL-6、IL-4和IL-2水平相较于粒缺无感染组升高(P<0.05);66例粒缺感染的患者中,占比最高的前三种感染菌类型为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌,其占比分别为36.36%、28.79%、12.12%,其中感染且病原菌未知的患者有3例(4.55%)。革兰阴性菌感染患者的TNF、IL-10和IL-6水平均较革兰阳性菌感染组升高(P<0.05);粒缺伴感染组中感染死亡例数为12例,感染无死亡的例数为51例,感染死亡的患者IL-10、IL-6水平均较感染无死亡组患者相比升高(P<0.05)。结论Th1/Th2细胞因子谱在化疗后中性粒细胞缺乏伴感染患者中的应用具有重要的临床意义,可指导临床早期用药,且IL-10、IL-6水平可作为患者病情严重程度的判断指标。Objective To investigate the application of the Th1/Th2 cytokine profile in neutrophil deficiency(agranulocytosis)associated with infection after chemotherapy in patients with hematologic malignancies.Methods A total of 66 patients with hematologic malignant tumor with neutrophilia and secondary infection,34 patients with hematologic tumor without infection after chemotherapy and 34 healthy volunteers from the physical examination center of Foshan Nanhai District People's Hospital from October 2021 to January 2023 were selected as the study objects.Flow cytometer microsphere array(CBA)technique was used to determine the peripheral blood and blood culture was performed simultaneously to explore the clinical significance of Th1/Th2 cytokine profile.Kaplan-Meier method was used to plot the survival curve of patients with particle deficiency and infection,and the log-rank test was used to compare the significance of the difference in survival.Results The Th1/Th2 cytokine profile levels after granulosis were higher than before granulosis in patients with granulosis combined with infection,and the difference was statistically significant(P<0.05).There was no significant difference in Th1/Th2 cytokine profile levels between patients without infection after neutropenia and before neutropenia(P>0.05).Th1/Th2 cytokine levels in patients without infection after neutropenia were not significantly different from those of healthy individuals(P>0.05).The levels of interferon-γ(IFN-γ),tumor necrosis factor(TNF),interleukin-10(IL-10),IL-6,IL-4 and IL-2 were higher in patients with neutropenia accompanied by infection compared to patients without infection after neutropenia(P<0.05).Among the 66 patients with neutropenia and infection,the three most common types of infecting bacteria were Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa,accounting for 36.36%,28.79%,and 12.12%respectively.There were 3 cases(4.55%)of infection with unknown pathogens.TNF,IL-10,and IL-6 levels were higher in patients with Gram-negati

关 键 词：TH1/TH2 细胞因子谱 恶性血液肿瘤 化疗 粒缺伴感染 

分 类 号：R73[医药卫生—肿瘤]