肺结核患者血清Th1/Th2细胞因子浓度变化及影响因素研究

Study on serum Th1/Th2 cytokines levels and associated factors in pulmonary tuberculosis patients

目的探讨Th1型细胞因子γ-干扰素(IFN-γ)、白介素-2(IL-2)和Th2型细胞因子白介素-4(IL-4)、白介素-10(IL-10)在肺结核患者抗结核治疗前后血清浓度的变化及治疗前血清浓度的影响因素。方法以上海市5个结核病示范区的8家定点医院为研究现场,连续纳入2013年5月—2015年8月诊断的上海市户籍肺结核患者,使用自制问卷对患者进行问卷调查,并于抗结核治疗前、治疗2个月末留取血液样本,采用酶联免疫吸附法(ELISA)分别检测IFN-γ、IL-2、IL-4、IL-10的血清浓度。结果共纳入患者309例,其中痰涂片结核分枝杆菌阳性患者占80.6%,男女比例为2.64,平均年龄为(51.43±18.29)岁。治疗2个月末痰涂片转阴率为72.69%。IFN-γ(治疗前45.11 pg/mL,2个月末36.17 pg/mL)、IL-2(治疗前15.12 pg/mL,2个月末9.96 pg/mL)、IL-10(治疗前28.72 pg/mL,2个月末12.28 pg/mL)血清浓度治疗前后差异有统计学意义,治疗2个月末显著下降;IL-4浓度治疗前后差异无统计学意义。Th1/Th2比值(IFN-γ/IL-4)在治疗前后分别为3.59和2.17,差异有统计学意义(t=4.715,P<0.01)。结论肺结核患者体内存在明显的免疫紊乱,抗结核治疗后,IFN-γ、IL-2、IL-10血清浓度下降,Th1/Th2比值下降。监测Th1/Th2相关细胞因子血清浓度有助于判断肺结核的病程及治疗效果。

Objective To investigate the serum concentration levels and associated factors of T helper 1（ Th1）（ IFN- γ,interleukin（ IL）- 2）,and Th2（ IL- 4,IL- 10） cytokines in pulmonary TB patients before and after anti-TB treatment. Methods Permanent Shanghai residential pulmonary TB patients diagnosed in 8 designated hospitals from 5 tuberculosis control demonstration districts from May2013 to August 2015 were enrolled. Questionnaires survey was conducted covering geographic,demographic,social-economic information,clinical manifestation and past medical history. The blood samples were taken before and after 2 months of anti-TB treatment. Enzyme-linked immunosorbent assay（ ELISA） was used to assess the level of serum IFN- γ,IL- 2,IL- 4,and IL- 10. Results 309 TB patients were enrolled,among which 80. 6% were sputum smear positive（ SS ＋）. The male-to-female ratio was 2. 64 and the average age was 51. 43 ± 18. 29 years. The negative conversion rate of sputum smear at the end of 2 months of anti-TB treatment was 72. 69%. The serum levels of IFN- γ（45. 11 pg / mL to 36. 17 pg / mL）,IL-2（15. 12 pg / mL to 9. 96 pg / mL）,and IL- 10（28. 72 pg / mL to 12. 28 pg / mL） were significantly decreased after 2 months of anti-TB treatment. The differences were with statistical significance. The difference of serum IL- 4 before and after the treatment was without statistical significance. The cytokines rate of IFN- γ / IL- 4 before and after 2 months of anti-TB treatment was 3. 59,2. 17,respectively,and the difference was with statistical significance（ t = 4. 715,P 0. 01）. Conclusion The immune system of pulmonary TB patients was obviously disordered. After 2 months of anti-TB treatment,the level of serum IFN- γ,IL- 2,and IL- 10 decreased as well as the cytokines rate of IFN- γ / IL-4. Monitoring the serum levels of relative cytokines may be helpful to evaluate the course of pulmonary tuberculosis and the efficacy of the treatment.