肿瘤坏死因子-α和转铁蛋白检测在肺结核诊治中的临床价值

The clinical value and mechanism of tumor necrosis factor-alpha and transferrin in pulmonary tuberculosis infection

目的:在肺结核患者诊治全过程中,跟踪测定肿瘤坏死因子-α(TNF-α)和转铁蛋白(TRF)的浓度,分析它们在肺结核诊治中的临床价值,帮助探讨结核杆菌与宿主细胞之间的相互作用机制。方法:于诊断后3d内和治疗后2、6、9个月分别测定TNF-α和TRF浓度,与同步进行的痰标本抗酸染色涂片和结核杆菌药敏试验检查结果进行综合分析。结果:TNF-α和TRF浓度与痰结核分枝杆菌数量呈正相关;痰菌阴转后TNF-α和TRF水平显著下降(P<0.01),2、6、9个月阴转患者TNF-α浓度分别为(58.6±18.4)、(51.6±17.1)、(48.3±17.4)ng/L;TRF浓度分别为(52.9±19.8)、(50.8±19.0)、(45.7±18.4)μmol/L;治疗后耐多药肺结核患者TNF-α和TRF水平无显著改变(P>0.05),2、6、9个月时TNF-α分别为(84.6±24.9)、(84.7±27.3)、(86.7±28.8)ng/L,TRF分别为(68.0±25.4)、(74.0±25.6)、(75.9±24.9)μmol/L。结论:TNF-α和TRF的全程跟踪测定不仅对了解机体抗结核感染的状况、抗结核治疗疗效及耐药性的产生具有重要的价值,而且有助于帮助探讨结核杆菌与宿主细胞之间相互作用的机制。

Objective To detect tumor necrosis factor-alpha （TNF-α and transferrin （TRF） concentration during the whole process in pulmonary tuberculosis diagnosis and treatment,analyze their clinical value and interaction mechanism between tuberculosis bacili and the host cell. Methods In three days after diagnosis, two months, six months and nine months after treatment, TNF-α and TRF were measured respectively. The data was comprehensively analyzed with sputum acid-fast staining examination and drug sensitive tests of mycobacterium tuberculosis. Results Serum levels of TNF-α and TRF were positively correlated with the number of the sputum mycobacterium tuberculosis;TNF-α and TRF level decreased significantly when negative sputum acid-fast staining examination was founded （P 〈 0.01）. At 2,6,9 months,the concentration of TNF-α reduced to （58.6 ± 18.4）, （51.6 ± 17.1）, （48.3 ± 17.4）ng/L respectively,and the concentration of TRF reduced to （52.9 ± 19.8）, （50.8 ± 19.0）, （45.7 ± 18.4）μmol/L separately. In patients diagnosed with multi-drug resistant tuberculosis infection, TNF-α and TRF level had no significant changes （P 〉 0.05）. At 2,6,9 months, the TNF-α concentration was （84.6 ± 24.9）, （84.7 ± 27.3）, （86.7 ± 28.8）ng/L respectively,and the TRF concentration was （68.0 ± 25.4）, （74.0 ± 25.6）, （75.9 ± 24.9）p, mol/Lseparately. Conclusion Detection of TNF-α and TRF not only is very important for us to understand anti-tuberculosis infection status, anti-tubercular treatment effect and resistance produces, but also help to research mechanism of interaction between tubercle bacillus and host cell.