胸腔积液中白细胞介素-20与-22的水平及其临床意义

Interleukin-20 and interleukin-22 in pleural effusion

目的探讨各种病因所致的胸腔积液中IL-20与IL-22的水平及其临床意义。方法收集2011年6月至2013年6月在武汉市结核病防治所住院的88例胸腔积液患者的胸腔积液及相应外周血标本，其中恶性胸腔积液患者27例，结核性胸腔积液患者24例，细菌性胸腔积液患者17例，漏出液患者20例。采用酶联免疫吸附法（ELISA）测定胸腔积液上清液和血清中IL-20与IL-22浓度，并对结果及其临床意义进行分析。结果（1）除漏出液外，胸腔积液中IL-20浓度：恶性胸腔积液为（36.8±5.1） ng/L，结核性胸腔积液为（34.8±6.0） ng/L，细菌性胸腔积液为（41.7±20.2） ng/L，均显著高于其相应的血清浓度（29.7±5.97）、（27.3±6.7）和（25.6±4.7） ng/L（t值分别为5.044、3.804和3.452，均P〈0.05）；与漏出液的（34.1±7.3） ng/L比较，差异无统计学意义（P〉0.05）。胸腔积液中IL-22浓度（中位数，四分位间距）：结核性胸腔积液为146.1（397.5） ng/L，细菌性胸腔积液为59.6（484.3） ng/L，均明显高于其相应血清中的浓度18.7（9.8）和15.7（17.2） ng/L（Z值分别为－3.971、－3.290，均P〈0.05）；结核性胸腔积液、细菌性胸腔积液和漏出液中的IL-22浓度均明显高于恶性胸腔积液（P〈0.001）。（2）恶性胸腔积液中IL-22浓度与其相应血清浓度呈正相关（r＝0.729，P〈0.001）。（3）受试者工作特征曲线（ROC曲线）结果显示，胸腔积液中IL-22浓度鉴别感染性胸腔积液（含结核性或细菌性积液）和恶性胸腔积液的最佳阈值为19.7 ng/L，相应敏感度和特异度分别为95.1%（39例）和88.9%（24例），两者比较，差异有统计学意义（P〈0.001）; 胸腔积液中IL-20浓度、血清IL-22和IL-20浓度均不具备诊断价值（P〉0.05）。结论结核性胸腔积液和细菌性胸腔积液中IL-22浓度较血清显著增高，IL-22很可能参与感染性胸腔积液的免疫学发病过程。胸腔积液中IL-22浓度测定可有效鉴别感染性与恶性胸腔积液。

ObjectiveTo investigate the concentrations and clinical significance of interleukin （IL）-20 and IL-22 in pleural effusion with various etiologies. MethodsPleural effusion （PE） and corresponding serum samples were obtained from 88 patients from Wuhan Tuberculosis Prevention and Control Institute from June 2011 to June 2013. There were 27 cases with malignant pleural effusion, 24 with tuberculous pleural effusion, 17 with bacterial pleural effusion and 20 with transudativeeffusion. The pleural and serum levels of IL-20 and IL-22 were determined by sandwich enzyme-linked immunosorbent assays （ELISA）. Results（1） Except for transudativeeffusion, the concentration of IL-20 in malignant pleural effusion （36.8±5.1） ng/L, tuberculous pleural effusion （34.8±6） ng/L, bacterial pleural effusion （41.7±20.2） ng/L, were significantly higher than that of the corresponding serum concentration （29.7±5.97） ng/L, （27.3 ±6.7） ng/L, （25.6±4.7） ng/L （t=5.044, 3.804, 3.452, P〈0.05）. However, the concentration of IL-20 in pleural effusions of different causes showed no significant difference; malignant （36.8±5.1） ng/L, tuberculous（34.8±6.0） ng/L, bacterial （41.7±20.2） ng/L, transudate （34.1±7.3） ng/L （P〉0.05）. The concentration of IL-22 （median, quartiles） in tuberculouseffusion was 146.1 （39.8） ng/L and bacterial effusion 59.6 （484.3） ng/L was significantly higher than those in the corresponding serum concentrations 18.7 （9.8） ng/L, 15.7 （17.2） ng/L （Z value respectively -3.971, -3.290, P〈0.05）. The concentration of IL-22 in tuberculous pleural effusion, bacterial pleural effusion, transudative pleural effusion was significant higher than those in malignant pleural effusion respectively （all P〈0.001）. （2）The concentrations of IL-22 in malignant pleural effusion was correlated positively with those in serum （r=0.729, P〈0.001）. （3） With a cut-off value of 19.7 ng/L, pleural IL-22 exhibited a high sensitivity and specificity of 95.1% （39/41） and 88.9%（24/27） respectively, when used for distinguishing infectious pleural effusion （including tuberculous and bacterial effusion） from malignant pleural effusion （P〈0.001）. ConclusionsHigher levels of IL-22 in tuberculous and bacterial pleural effusion were found when compared with corresponding serum levels and might be involved in the pathogenesis of infectious pleural effusion. Pleural IL-22 measurement provided reliable diagnostic efficiency for distinguishing infectious from malignant pleural effusion.