摘要
目的探讨外周血辅助性T细胞(Th)1/Th2及部分细胞因子对活动性肺结核(APTB)患者治疗效果的评估价值。方法选取初诊APTB患者和健康体检者各100例作为研究组和对照组,收集2组研究对象的一般临床资料,研究组患者予以6个月标准化抗结核治疗,并于治疗开始后第2、6月随访评估治疗效果;抽取对照组体检者体检日和研究组患者治疗前及治疗后第2、6个月的清晨空腹静脉血,采用流式细胞仪检测外周血Th1、Th2细胞,采用酶联免疫法检测血清干扰素γ(IFN-γ)、白细胞介素2(IL-2)、IL-4及IL-10水平;采用受试者工作(ROC)曲线分析研究组患者Th1/Th2细胞及其细胞因子对APTB患者治疗有效的预测价值。结果治疗前研究组患者外周血Th1、Th1/Th2和血清IFN-γ、IL-2低于对照组(P<0.05),外周血Th2和血清IL-4、IL-10水平高于对照组(P<0.05);与治疗前相比,研究组患者治疗后第2、6月时外周血Th1、Th1/Th2和血清IFN-γ、IL-2升高(P<0.05),外周血Th2和血清IL-4、IL-10水平下降(P<0.05);与无效组比较,有效组APTB患者治疗前外周血Th1、Th1/Th2和血清IFN-γ、IL-2升高(P<0.05),Th2占比和血清IL-4、IL-10水平降低(P<0.05);ROC曲线显示,研究组患者外周血Th1/Th2评估APTB治疗价值的特异度最高(68.37%)、血清IL-4敏感度最高(78.53%),Th1、Th2、Th1/Th2、IFN-γ、IL-2、IL-4及IL-10联合检测预测APTB患者抗结核治疗有效曲线下面积(AUC)为0.913(95%CI为0.546~0.910),敏感度和特异度(86.23%、76.28%)较单项指标检测提高。结论APTB患者机体存在Th1/Th2细胞调节失衡,抗结核治疗有助于Th1/Th2平衡调节,监测外周血Th1/Th2细胞及部分细胞因子可评估APTB临床治疗效果。
Objective To explore the appraisal value of peripheral blood helper T cell(Th)1/Th2 and some cytokines in evaluating their therapeutic effect on patients with active pulmonary tuberculosis(APTB).Methods A total of 100 newly diagnosed APTB patients and 100 healthy subjects were selected as study and control groups,respectively.General clinical data of two groups were collected.The patients in study group were treated with standardized anti-tuberculosis therapy for 6 months,and the prognosis was evaluated at the second and sixth months after the start of treatment.Therapeutic effect was evaluated at the 2 nd and 6 th follow-up months after the start of treatment.Fasting venous blood in the morning was collected on the day of physical examination in control group,before treatment,at 2 nd and 6 th months after treatment in study group.Peripheral blood Th1 and Th2 cells were examined using flow cytometry.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the levels of serum interferon-γ(IFN-γ),interleukin-2(IL-2),IL-4,and IL-10.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of Th1/Th2 cells and their cytokines in therapeutic efficacy in study group.Results Before treatment,peripheral blood Th1,Th1/Th2,serum IFN-γ,and IL-2 were lower in study group than those in control group(P<0.05),while peripheral blood Th2,serum IL-4 and IL-10 were higher in study group than those in control group(P<0.05).When compared with before treatment,peripheral blood Th1,Th1/Th2,serum IFN-γand IL-2 were increased at 2 and 6 months after treatment in study group(P<0.05),while peripheral blood Th2,serum IL-4 and IL-10 were decreased(P<0.05).When compared with the ineffective group,the peripheral blood Th1,Th1/Th2,and serum IFN-γand IL-2 were increased after treatment in the effective group(P<0.05),and the proportion of Th2,serum IL-4,and IL-10 were decreased(P<0.05).ROC curve showed that the specificity of peripheral blood Th1/Th2 in evaluating the therapeutic value was the highest(68.37%),and the sensitivity of serum IL-4 was the highest(78.53%).The area under the curve(AUC)of the combination of Th1,Th2,Th1/Th2,IFN-γ,IL-2,IL-4,and IL-10 in predicting therapeutic efficacy of anti-tuberculosis treatment for APTB patients was 0.913(95%CI was 0.546-0.910),and the sensitivity and specificity were 86.23%and 76.28%,respectively,which were higher than a single indicator detection.Conclusion There is an imbalance in Th1/Th2 cell regulation in APTB patients.Anti-tuberculosis treatment can help regulate Th1/Th2 balance.Monitoring peripheral blood Th1/Th2 cells and some cytokines may evaluate the clinical treatment effect for APTB.
作者
李倩
李曼
杜月菊
孔祥龙
高艳军
LI Qian;LI Man;DU Yueji;KONG Xianglong;GAO Yanjun(Department of Clinical Laboratory,Hebei Chest Hospital,Shijiazhuang 050000,Hebei,China)
出处
《贵州医科大学学报》
CAS
2023年第6期728-732,738,共6页
Journal of Guizhou Medical University
基金
河北省2020年度医学科学研究课题计划(20200814)。
