活动性结核病患者全血干扰素诱导蛋白10测定及免疫状态的研究

The analysis of IP-10 in human blood and the active tuberculosis patients' immune states

目的研究全血干扰素诱导蛋白10(interferon-inducible protein 10,IP-10)对活动性结核病的辅助诊断价值及活动性结核病患者免疫状态。方法分别应用植物血凝素、纯化的结核分枝杆菌CFP10/ESAT6融合蛋白刺激人全血产生IP-10,用化学发光免疫分析法检测105例活动性结核病患者、52例非结核肺部疾病患者、29例健康对照者全血中IP-10水平;绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)确定其诊断活动性结核病的临界值,并评价其诊断效能。结果活动性结核病组非特异性IP-10水平(868±513pg/ml)高于健康对照组(549±365pg/ml,P<0.05)与非结核呼吸疾病组(738±459pg/ml,但P>0.05)。活动性结核病患者组结核特异的IP-10的水平为(287.16±236.49pg/ml),显著高于非结核呼吸疾病组(56.35±20.54pg/ml,P<0.001)和健康对照组(52.20±28.28pg/ml,P<0.001)。活动性肺结核组全血中结核特异的IP-10水平(317±258pg/ml)显著高于活动性肺外结核组(232±167pg/ml,P<0.05);活动性结核涂片抗酸杆菌染色阳性组结核特异的IP-10水平(302±283pg/ml)高于活动性结核涂片阴性组(285±218pg/ml,但P>0.05);活动性结核PPD皮试阳性组结核特异的IP-10水平(338±222pg/ml)显著高于活动性结核PPD阴性组(241±105pg/ml,P<0.05)。结核特异的IP-10诊断结核病的临界值为89pg/ml,其灵敏度和特异性分别为85.7%和88.9%。结论活动性结核病患者免疫反应增强,全血结核特异的IP-10检测可能成为活动性结核病辅助诊断指标之一。

Objective To exploit the value of interferon-inducible protein 10（IP-10）in active tuberculosis＇s auxiliary diagnosis and immune status of the active tuberculosis patients.Methods There were 186 human whole blood samples,105 samples of active tuberculosis patients,52 samples of non-tuberculous pulmonary disease patients and 29 healthy controls,stimulated by PHA and purified fusion protein CFP10/ESAT6 of mycobacterium tuberculosis respectively to produce IP-10.The level of IP-10 was evaluated by chemiluminescence enzyme immunoassay.Then the receiver operating characteristic curve was drawn to determine the threshold of IP-10 for diagnosis of active tuberculosis and to evaluate its diagnostic performance.Results The non-specific IP-10 levels of the active tuberculosis group（868±513 pg/ml） was higher than that of the healthy control group（549±365 pg/ml,P〈0.05） and that of the non-tuberculous pulmonary disease group（738±459 pg/ml,but P〈0.05）.The specific IP-10 level of active tuberculosis group（287.16±236.49 pg/ml） was significantly higher than that of non-tuberculous pulmonary disease group（56.35±20.54 pg/ml,P〈0.001） and that of the healthy control group（52.20±28.28 pg/ml,P〈0.001）.The specific IP-10 level of active tuberculosis group（317±258 pg/ml） was significantly higher than that of the extra-pulmonary tuberculosis group（232±167 pg/ml,P〈0.05）.The tuberculosis-specific IP-10 level of the active tuberculosis acid-fast bacilli smear-positive group（302±283 pg/ml） was higher than that of the active tuberculosis smear-negative group（285±218 pg/ml,but P〈0.05）.The specific IP-10 level of PPD the active tuberculosis tuberculosis skin test positive group（338±222 pg/ml） was significantly higher than that of the active tuberculosis PPD-negative group（241±105 pg/ml,P〈0.05）.The threshold of IP-10 for diagnosis of tuberculosis was 89 pg/ml and its sensitivity and specificity were 85.7% and 88.9% respectively.Conclusion The immune response strengthens in tuberculosis patient and the whole blood tuberculosis special IP-10 examination may become one of the active tuberculosis auxiliary diagnostic targets.