血清细胞因子水平对儿童噬血细胞性淋巴组织细胞增生症的早期诊断价值  

Serum cytokine levels in early diagnosis of hemophagocytic lymphohistiocytosis in children

作　　者：杨红兰 杨小燕 金皎 黄璟 杨振中 张景荣[3] 何志旭 YANG Honglan;YANG Xiaoyan;JIN Jiao;HUANG Jing;YANG Zhengzhong;ZHANG Jingrong;HE Zhixu(Department of Pediatric Hematology,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Pediatrics,Guizhou Provincial People's Hospital,Guiyang 550004,Guizhou,China;Department of Pediatric Hematology,Guiyang Maternal and Child Health Hospital,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院儿童血液科,贵州贵阳550004 [2]贵州省人民医院儿科,贵州贵阳550004 [3]贵阳市妇幼保健院儿童血液科,贵州贵阳550004

出　　处：《贵州医科大学学报》2024年第12期1818-1823,共6页Journal of Guizhou Medical University

基　　金：贵州省科技计划项目(黔科合平台人才[2019]5406);贵阳市科技计划项目(筑科合同[2019]9-1-33);贵州省卫生健康委科学技术基金项目(gzwkj2024-424)。

摘　　要：目的探讨血清细胞因子白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)及γ-干扰素(IFN-γ)的水平对儿童噬血细胞性淋巴组织细胞增生症(HLH)的早期诊断价值。方法选取HLH患儿和传染性单核细胞增多症(IM)患儿分别为HLH组(n=12)和IM组(n=12),收集2组患儿的临床资料[性别、发热及脾肿大情况、中性粒细胞绝对值(NEU#)、血红蛋白含量(Hb)、血小板计数(PLT)、甘油三脂(TG)、纤维蛋白原(Fib)、血清铁蛋白(Fer)、可溶性白细胞介素-2受体(sIL-2r)、噬血现象及NK细胞活性];抽取2组患儿治疗前外周血,采用流式细胞术检测血清IL-2、IL-4、IL-6、IL-10、TNF-α及IFN-γ水平;采用受试者工作特征(ROC)曲线分析异常细胞因子临界值及其对儿童HLH早期诊断的敏感度和特异度,采用ROC曲线下面积(AUC)评估各细胞因子对儿童HLH的早期诊断价值。结果HLH患儿血清IL-4、IL-6、IL-10及IFN-γ水平高于IM组患儿(P<0.005);ROC曲线分析显示,IL-6、IL-10及IFN-γ诊断儿童HLH具有较高价值,AUC均>0.095;IFN-γ>14.4 ng/L诊断HLH特异度和敏感度几乎达100%,AUC为1.000,优于IL-6和IL-10(P<0.005)。结论HLH患儿血清IL-6、IL-10及IFN-γ水平对疾病诊断具有较高价值,其中IFN-γ早期诊断价值最高。Objective To investigate the diagnostic value of serum cytokines,including interleukin 2(IL-2),interleukin 4(IL-4),interleukin 6(IL-6),interleukin 10(IL-10),tumor necrosis factorα(TNF-α),andγinterferon(IFN-γ),for early detection of Hemophagocytic Lymphohistiocytosis(HLH)in children.Methods A total of 12 children with HLH and 12 children with Infectious Mononucleosis(IM)were enrolled in the HLH and IM groups,respectively.Clinical data,including gender,fever,splenomegaly,absolute neutrophil count(NEU#),hemoglobin(Hb),platelet count(PLT),triglycerides(TG),fibrinogen(Fib),ferritin(Fer),soluble IL-2 receptor(sIL-2r),hemophagocytosis,and NK cell activity,were collected.Peripheral blood samples were drawn prior to treatment for flow cytometric analysis of serum cytokine levels(IL-2,IL-4,IL-6,IL-10,TNF-α,and IFN-γ).Receiver operating characteristic(ROC)curves were used to determine the optimal cut-off values for abnormal cytokines and to evaluate their sensitivity and specificity for early HLH diagnosis.Area under the curve(AUC)was used to assess the diagnostic value of each cytokine for HLH.Results Serum levels of IL-4,IL-6,IL-10,and IFN-γwere significantly higher in the HLH group compared to the IM group(P<0.005).ROC curve analysis indicated that IL-6,IL-10,and IFN-γshowed high diagnostic value for HLH,with AUC>0.095.IFN-γlevels above 14.4 ng/L exhibited nearly 100%sensitivity and specificity for HLH diagnosis,with an AUC of 1.000,outperforming IL-6 and IL-10(P<0.005).Conclusion Serum levels of IL-6,IL-10,and IFN-γare of high diagnostic value in children with HLH,with IFN-γshowing the highest early diagnostic potential.

关 键 词：儿童 细胞因子类 早期诊断 噬血细胞综合征 敏感度 特异度 临界值 

分 类 号：R72[医药卫生—儿科]