外周血内毒素诱导产物在细菌性肺炎与肺结核鉴别中的意义

Significance of Endotoxin-triggered Products in the Peripheral Blood in Differentiating Bacterial Pneumonia from Pulmonary Tuberculosis

目的探讨外周血内毒素诱导产物包括细胞因子、降钙素原(PCT)在肺结核和细菌性肺炎鉴别中的临床应用价值。方法选择2015年1月-8月住院确诊的50例医院获得性肺炎患者作为肺炎组,同期随机采集确诊的50例肺结核患者作为肺结核组。采用内毒素刺激后用流式方法检测外周血CD 4+干扰素γ(IFN-γ)+、CD 4+肿瘤坏死因子-α(TNF-α)+、CD 4+白细胞介素(IL)-2+、CD 4+IL-10+、CD 8+IFN-γ+、CD 8+TNF-α+、CD 8+IL-2+、CD 8+IL-10+细胞群比例;采用免疫荧光定量法检测患者血清PCT、C反应蛋白(CRP)、IL-6等指标。结果肺炎组患者外周血CD 4+IFN-γ+、CD 4+TNF-α+、CD 4+IL-2+、CD 4+IL-10+、CD 8+IFN-γ+、CD 8+TNF-α+、CD 8+IL-2+、CD 8+IL-10+细胞群的数目明显高于肺结核组,差异有统计学意义(P<0.05)。肺炎组PCT、CRP、IL-6活性水平均较肺结核组显著增加,差异均有统计学意义(P<0.05)。肺炎组PCT、IL-6、CRP阳性率均较肺结核组高,差异均有统计学意义(P<0.05)。结论内毒素诱导产物的检测有助于肺结核与细菌性肺炎的鉴别诊断。

Objective To investigate the diagnostic value of products triggered by endotoxin including cytokines and procalcitonin for differentiating bacterial pneumonia from pulmonary tuberculosis.Methods Fifty patients diagnosed to have hospital-acquired pneumonia and another 50 patients diagnosed with tuberculosis admitted into West China Hospital between January and August 2015 were recruited in this study.The frequencies of CD 4＋ interferon（IFN）-γ-＋,CD 4-＋tumor necrosis factor（TNF）-α-＋,CD 4-＋ interleukin（IL）- 2-＋,CD 4-＋ IL- 10-＋ as well as CD 8-＋ IFN-γ-＋,CD 8-＋ TNF-α-＋,CD 8-＋ IL- 2-＋,CD 8-＋ IL- 10-＋ populations in peripheral blood were detected by flow cytometry after endotoxin stimulation.Meanwhile,the levels of procalcitonin,IL- 6 and C reactive protein were measured by immunofluorescence staining.Results The frequencies of CD 4-＋IFN-γ-＋,CD 4-＋TNF-α-＋,CD 4-＋IL- 2-＋,CD 4-＋IL- 10-＋ as well as CD 8-＋ IFN-γ-＋,CD 8-＋ TNF-α-＋,CD 8-＋IL- 2-＋,CD 8-＋IL- 10-＋ populations in the pneumonia group increased significantly compared with those in the tuberculosis group（P〈0.05）.The levels of procalcitonin,IL- 6 and C-reactive protein in the pneumonia group increased statistically compared with the counterparts in the tuberculosis group（P〈0.05）.The positive rates of procalcitonin,IL- 6 and C-reactive protein in the pneumonia group were significantly higher than those in the tuberculosis group（P〈0.05）.Conclusion Measurement of products triggered by endotoxin is beneficial for differential diagnosis of pneumonia from tuberculosis.