摘要
目的探讨IFN-γ联合IL-6在菌阴性肺结核临床诊断中的应用及其临床意义。方法收集2021年10月21日至2023年4月27日期间在苏州大学附属传染病医院病例266例。依据肺结核诊断标准(WS288-2017),肺结核患者196例,其中男性130例,女性66例,平均年龄58.4±17.1岁;病灶双侧患者141例,病灶单侧患者55例;菌阳患者92例,菌阴患者104例。职业性尘肺病患者70例,其中男性69例,女性1例,平均年龄62.7±8.9岁。健康对照组20例,其中男性10例,女性10例,平均年龄58.6±6.3岁。采用流式细胞术检测血浆中细胞因子IFN-γ、IFN-α、IL-2、IL-4、IL-5、IL-6、IL-8、TNF-α、IL-10、IL-12P70、IL-1β、IL-17的表达水平,比较不同组别中这12项炎症细胞因子的差异。结果(1)活动性肺结核患者组血浆IFN-γ、IL-6水平显著高于健康对照组以及职业性尘肺病患者组(非结核性肺部疾病对照组)。(2)活动性肺结核患者中,双侧病灶肺结核患者组的血浆IL-6、IL-8水平显著高于单侧病灶肺结核患者组。(3)活动性肺结核患者中,菌阳性肺结核患者组血浆IL-6水平显著高于菌阴性肺结核患者组。(4)活动性肺结核患者中,γ-干扰素释放试验阴性患者组IFN-γ、IL-6水平显著高于健康对照组。(5)菌阴性肺结核患者中,γ-干扰素释放试验阴性患者组IFN-γ、IL-6水平显著高于健康对照组。结论IFN-γ、IL-6、IL-8可反映结核患者的炎症情况、疾病严重程度及细菌负荷,并且IFN-γ联合IL-6可以作为无病原学证据、免疫学检查结果为阴性且具有肺部影像学依据患者诊断的辅助指标,临床医师可以通过IFN-γ、IL-6的表达水平联合肺部影像学证据来为该类患者进行辅助诊断,并评估患者免疫状态,提高患者免疫力,为患者的个性化治疗提供依据。
Objective To investigate the application value of IFN-γcombined with IL-6 in the clinical diagnosis of mycobacterium-negative pulmonary tuberculosis and its clinical significance.Methods 266 cases were collected from October 21,2021 to April 27,2023 for the examination at the Infectious Diseases Hospital of Soochow University.According to the diagnostic criteria of pulmonary tuberculosis(WS288-2017),the following groups were identified:196 patients with pulmonary tuberculosis(130 males,66 females,mean age 58.4±17.1),141 patients with bilateral lesions,55 patients with unilateral lesions,92 patients with bacteriophage positive,104 patients with bacteriophage negative.There were 70 patients with occupational pneumoconiosis,including 69 male and 1 female with mean age of 62.7±8.9.There were 20 cases in the healthy control group,including 10 males and 10 females with mean age of 58.6±6.3.The expression levels of cytokines(IFN-γ,IFN-α,IL-2,IL-4,IL-5,IL-6,IL-8,TNF-α,IL-10,IL-12P70,IL-1β,IL-17)in plasma were detected by flow cytometry to evaluate the differences of these twelve inflammatory cytokines in different groups.Results(1)plasma IFN-γand IL-6 levels were significantly higher in the group of patients with active tuberculosis than in the group of healthy controls as well as in the group of patients with occupational pneumoconiosis(non-tuberculous lung disease controls);(2)In patients with active tuberculosis,plasma IL-6 and IL-8 levels were significantly higher in the group of patients with bilateral tuberculosis lesions than in the group of patients with unilateral tuberculosis lesions;(3)In patients with active tuberculosis,plasma IL-6 levels were significantly higher in the group of patients with bacillus-positive tuberculosis than in the group of patients with bacillus-negative tuberculosis;(4)In patients with active tuberculosis,the levels of IFN-γand IL-6 were significantly higher in the group of patients with negative gamma-interferon release assays than in the group of healthy controls;(5)In patients with mycobacterium-negative tuberculosis,IFN-γand IL-6 levels were significantly higher in the group of patients with negative gamma-interferon release assays than in the healthy control group.Conclusion IFN-γ,IL-6,IL-8 can reflect the inflammation status,disease severity and bacterial load of tuberculosis patients,and IFN-γcombined with IL-6 can be used as an auxiliary indicator for the diagnosis of patients with no evidence of pathogenicity,negative immunological examination results and a pulmonary imaging basis.Clinicians can utilize expression levels of IFN-γ,IL-6 combined with the evidence of pulmonary imaging to carry out auxiliary diagnosis of such patients,as well as to assess the immune status of the patient to improve patients’immunity and to provide the knowledge basis of personalized treatment.
作者
刘轩妙
徐俊驰
岳晓冬
胥萍
LIU Xuanmiao;XU Junchi;YUE Xiaodong;XU Ping(Suzhou Medical College of Soochow University,Suzhou 215131,China;Department of Clinical Laboratory,The Affiliated Infectious Diseases Hospital,Suzhou 215131,China;Suzhou Xiangcheng Second People’s Hospital,Suzhou 215131,China)
出处
《标记免疫分析与临床》
CAS
2024年第3期450-455,475,共7页
Labeled Immunoassays and Clinical Medicine
基金
苏州市科技计划(苏州市第五人民医院医学检验临床试验机构能力提升,编号:SLT2021012
苏州市不明病原体感染性疾病诊疗重点实验室,编号:SZS2020311)。
