不同期别矽肺患者诱导痰中细胞因子的变化

The discriminant analysis of the silicosis＇s induction on cytokines in phlegm and combined multi-markers

目的 探讨不同期别矽肺患者诱导痰中细胞因子的变化情况.方法 选取山东某金矿矽肺观察对象、Ⅰ期、Ⅱ期矽肺患者各40名分别作为观察对象组、矽肺Ⅰ期组、矽肺Ⅱ期组,80名接触矽尘但无矽肺临床症状的工人为矽尘接触组,另选择40名无粉尘接触史、无既往疾病史的后勤工作人员作为对照组,通过问卷调查其基本情况,进行雾化吸入诱导痰,应用酶联免疫吸附试验（ELISA）测定诱导痰中肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素-16（interleukin,IL-16）、巨噬细胞炎性蛋白-lα（macrophage inflammatory protein-1α,MIP-1α）、单核细胞趋化因子-1（monocyte chemotactic factor-1,MCP-1）、金属蛋白酶2（metalloproteinases2,MMP-2）、MMP-9、转化生长因子β（transforming growth factor-β,TGF-β）、血小板衍生因子（platelet derived growth factor,PDGF）含量.结果 矽肺Ⅰ期组患者诱导痰中TGF-β[（901.60±30.09）ng/L]含量低于观察对象组[（913.02±20.51） ng/L],矽肺Ⅰ期组MMP-9[（212.49±5.97） ng/L]、MCP-1[（129.91±4.30） ng/L]含量较对照组、矽尘接触组、观察对象组升高,差异均有统计学意义（P＜0.05）.矽肺Ⅰ期组患者诱导痰中TNF-α[（85.76±3.78） ng/L]含量达到最大值,明显高于对照组、矽尘接触组,差异有统计学意义（P＜0.05）.与对照组比较,矽肺Ⅰ期组诱导痰中MMP-2[（427.95±23.64） ng/L]含量升高,差异有统计学意义（P＜0.05）.与对照组、矽尘接触组、观察对象组比较,矽肺Ⅱ期组患者诱导痰中IL-16 [（21.40±9.24） ng/L]含量降低、PDGF [（5.96±0.51） ng/L]、MMP-2[（447.86±27.10） ng/L]、MMP-9[（223.91±12.28） ng/L]、MCP-1[（122.87±6.08） ng/L]含量升高,差异均有统计学意义（P＜0.05）.结论 TNF-α、TGF-β、IL-16、PDGF、MMP-2、MMP-9、MCP-1作为矽肺生物监测标志物有一定的意义,通过多指标联合判别方程可提高早期矽肺患者的检出率.

Objective To investigate the changes of cytokines in induced sputum at different stages of silicosis patients.Methods A total of 200 workers from one of the Shandong Province gold mine were chosen as object of observation.Among which 40 patients at silicosis stage Ⅰ and 40 patients at silicosis stage Ⅱ were divided into silicosis observed object group,silicosis stage Ⅰ group,silicosis stage Ⅱ group,and another 80 workers exposed to silica dust without suffering from silicotic Clinical symptoms,however,were chosen as group of dust exposed,and 40 logistical workers without being exposed and history of silicosis＇ s illness were chosen as control group.And ask their basic information by questionnaire.Then,spray-inhalation the induced sputum and apply the ELISA to assess the level of tumor necrosis factor （TNF）,interleukin （IL）,macrophage inflammatory protein-1 （MIP-1α）,monocyte chemotactic factor-1 （MCP-1）,metalloproteinases （MMP）,transforming growth factor-β（TGF-β）,platelet derived growth factor（PDGF）in induced sputum from subjects.Results The level of TGF-β [（901.60±30.09） ng/L] in the induced sputum of patients in silicosis stage Ⅰ group is lower than that in the observed object group [（913.02±20.51） ng/L],and the level of MMP-9[（212.49±5.97）ng/L],MCP-1 [（129.91 ± 4.30） ng/L] has various degrees of increase than that in control group,observed object group and dust exposed group.All the differences have statistical significances （P＜0.05）.The level of TNF-α [（85.76±3.78）ng/L] in the induced sputum of patients in silicosis stage Ⅰ group reaches the maximum,there are significant differences comparing with that level in the silica dust exposure group and the control group,whose differences are statistically significant （P＜0.05）.Compared with the control group,the level of MMP-2 （427.95±23.64） in the induced sputum of patients in silicosis stage Ⅰ group has increased,whose differences also have statically significant （P＜0.05）.Compared with the control group,silica dust exposed group,the observation group of objects,the pneumosilicosis patients of IL-16 in induced sputum IL-16 （21.40±9.24）decreased,the content of PDGF [（5.96±0.51） ng/L],MMP-2 [（447.86±27.10） ng/L],MMP-9 [（223.91±12.28） ng/L],MCP-1[（122.87± 6.08） ng/L] increased,the differences are statistically significant （P＜0.05）.Conclusion As silicosis biomarkers,TNF-alpha,TGF-beta,IL-16,PDGF,MMP-2,MMP-9 and MCP-1 have certain significance,further suggesting that early detection rate of patients with silicosis can be improved by employing the multiple indexes discriminate equation.