血清单核细胞趋化蛋白-1、γ干扰素、白细胞介素-18 表达情况及其在肺结核患者诊断和治疗评估中的价值

doi:10.19871/j.cnki.xfcrbzz.2023.06.010

摘要/Abstract

摘要： 目的分析肺结核患者血清单核细胞趋化蛋白-1（monocyte chemoattractant protein-1,MCP-1）、γ干扰素（interferon-γ,INF-γ）、白细胞介素-18（interleukin-18,IL-18）表达情况,探讨其在肺结核诊治中的临床价值。方法选择2019年1月至2021年6月期间在深圳市福田区慢性病防治院接受治疗的85例活动性肺结核患者,根据病情程度分为轻度组（51例）和重度组（34例）,比较不同临床特征患者血清INF-γ、IL-18、MCP-1水平,并比较轻度组、重度组治疗前后血清INF-γ、IL-18、MCP-1水平;病灶不同吸收程度患者血清INF-γ、IL-18、MCP-1水平。分析肺结核患者血清INF-γ、IL-18、MCP-1水平和急性生理与慢性健康状况评分系统（acute physiology and chronic health evaluation,APACHE）Ⅱ评分的相关性。85例患者均接受药物治疗,将治疗2个月时血清INF-γ、IL-18、MCP-1值与治疗前的浓度比值绘制受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）,分析血清INF-γ、IL-18、MCP-1的比值对肺结核疗效的评价效能。结果病灶累及≥2个肺野、有空洞病变、重度肺结核患者血清INF-γ、IL-18、MCP-1水平分别高于病灶累及1个肺野、无空洞病变和轻度肺结核患者（P<0.001）;轻度组、重度组治疗后空洞数量、痰检查转归及临床症状评分均显著降低,与本组治疗前比较差异有统计学意义（P<0.001）;轻度组、重度组治疗后血清INF-γ、IL-18、MCP-1水平均显著降低（P<0.001）;轻度组、重度组病灶明显吸收、吸收、不吸收患者血清INF-γ、IL-18、MCP-1水平依次逐渐升高（P<0.001）;Pearson相关分析显示活动性肺结核患者血清INF-γ、IL-18、MCP-1水平与APACHEⅡ均呈正相关（r=0.428、0.505、0.581,均P<0.001）;ROC曲线显示,血清INF-γ、IL-18、MCP-1的比值联合应用评价肺结核治疗效果的曲线下面积（area under the curve,AUC）达到0.808,敏感度和特异度分别为85.4%和72.9%。结论血清INF-γ、IL-18、MCP-1水平高低、浓度变化,可在一定程度反映肺结核患者病情严重程度及其抗结核治疗效果。

关键词: 肺结核, 单核细胞趋化蛋白-1, γ干扰素, 白细胞介素-18, 病情, 疗效

Abstract: Objective To analyze the expression of serum monocyte chemoattractant protein-1 (MCP-1), interferon-γ (INF-γ) and interleukin-18 (IL-18) in patients with pulmonary tuberculosis, and to explore their clinical value in the diagnosis and treatment of pulmonary tuberculosis. Method From January 2019 to June 2021, 85 patients with active pulmonary tuberculosis who were treated in Futian District Chronic Disease Prevention in Shenzhen were selected, and they were divided into mild group (51 cases) and severe group (34 cases). Serum INF-γ, IL-18 and MCP-1 levels of patients with different clinical characteristics were compared. And the serum INF-γ, IL-18 and MCP-1 levels before and after treatment between the mild and severe groups- were compared; The serum INF-γ, IL-18 and MCP-1 levels of patients with different absorption levels of lesions in the mild and severe groups. The correlation between serum INF-γ, IL-18, MCP-1 levels and acute physiology and chronic health evaluation (APACHE) Ⅱscore in patients with active pulmonary tuberculosis was analyzed. 85 patients of the active group received drug treatment. The serum INF-γ, IL-18 and MCP-1 levels in 2 months for treatment were compared with those before treatment, and the ratio values of their concentrations were obtained. The receiver operating characteristic curve (ROC curve) was drawn to analyze the efficiency of the ratio value of serum INF-γ, IL-18 and MCP-1 in evaluating the therapeutic effect of pulmonary tuberculosis. Result The levels of serum INF-γ, IL-18 and MCP-1 of patients with ≥ 2 lung fields, cavities, and severe pulmonary tuberculosis were higher than those of patients with one lung field, no cavities, and mild tuberculosis (P<0.001); The number of voids, sputum examination outcome and clinical symptom scores were significantly reduced in both mild and severe groups, with a statistically significant difference between before treatment in this group (P<0.001). The levels of Serum INF-γ,IL-18 and MCP-1 of patients after treatment in mild and severe groups were significantly reduced (P<0.001); The levels of serum INF-γ,IL-18 and MCP-1 of significantly absorb, absorb, and not absorb patient of mild and severe groups gradually increased (P<0.001);Pearson correlation analysis showed that the serum levels of INF-γ, IL-18 and MCP-1 of the active group were positively correlated with APACHEⅡ score (r=0.428, 0.505 and 0.581, P<0.001). The ROC curve showed that the area under the curve (AUC) of the ratio value of serum INF-γ, IL-18 and MCP-1 in evaluating the treatment effect of pulmonary tuberculosis was 0.808, and the sensitivity and specificity were 85.4% and 72.9%, respectively. Conclusion The serum levels of INF-γ, IL-18 and MCP-1 can reflect the severity of pulmonary tuberculosis and the effect of anti-tuberculosis treatment.

Key words: Tuberculosis, Monocyte chemoattractant protein-1, Interferon-γ, Interleukin-18, Disease condition, Efficacy

中图分类号:

陈洁, 叶海明, 张菊芳. 血清单核细胞趋化蛋白-1、γ干扰素、白细胞介素-18 表达情况及其在肺结核患者诊断和治疗评估中的价值[J]. 新发传染病电子杂志, 2023, 8(6): 52-57.

Chen Jie, Ye Haiming, Zhang Jufang. Expression of serum MCP-1, INF-γ and IL-18 in patients with pulmonary tuberculosis and its value in the diagnosis and treatment evaluation of the disease[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(6): 52-57.

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