脑脊液白介素8、干扰素γ水平在结核性脑膜炎病程中的动态变化及意义

Dynamic Changes in IL-8 and IFN-γ in Cerebrospinal Fluid of Patients with Tuberculous Meningitis

目的观察结核性脑膜炎(TBM)患者脑脊液白介素8(IL-8)、干扰素γ(IFN-γ)水平的动态变化情况,并探讨脑脊液IL-8、IFN-γ水平在TBM诊断和预后中的应用价值。方法选取2014年12月—2016年8月在兰州大学第二医院住院的符合纳入标准的TBM患者(作为TBM组)、病毒性脑膜炎患者(作为病毒性脑膜炎组)、非感染性神经系统疾病患者(作为非感染性神经系统疾病组),各30例。TBM组患者病情严重程度:Ⅰ期患者12例,Ⅱ期患者11例,Ⅲ期患者7例。分析TBM组患者抗结核治疗前及抗结核治疗后1、2周的脑脊液IL-8、IFN-γ水平变化,比较TBM组患者抗结核治疗前,病毒性脑膜炎组、非感染性神经系统疾病组患者治疗前脑脊液IL-8、IFN-γ水平,并分析TBM组患者脑脊液IL-8、IFN-γ水平与其病情严重程度的关系。结果 TBM组患者抗结核治疗后1周脑脊液IL-8、IFN-γ水平低于抗结核治疗前(t_(配对)=15.710,P<0.001;t_(配对)=10.793,P<0.001);TBM组患者抗结核治疗后2周脑脊液IL-8、IFN-γ水平低于抗结核治疗前(t_(配对)=21.268,P<0.001;t_(配对)=14.357,P<0.001);TBM组患者抗结核治疗后2周脑脊液IL-8、IFN-γ水平低于抗结核治疗后1周(t_(配对)=12.554,P<0.001;t_(配对)=17.979,P<0.001)。TBM组患者抗结核治疗前脑脊液IL-8、IFN-γ水平高于病毒性脑膜炎组、非感染性神经系统疾病组患者治疗前(P<0.05);病毒性脑膜炎组患者治疗前脑脊液IL-8、IFN-γ水平高于非感染性神经系统疾病组患者治疗前(P<0.05)。TBM组患者脑脊液IL-8、IFN-γ水平与其病情严重程度呈正相关(rs值分别为0.509、0.665,P值分别为0.004、<0.001)。结论抗结核治疗后TBM患者脑脊液IL-8、IFN-γ水平逐渐下降,且脑脊液IL-8、IFN-γ水平与病情严重程度呈正相关,说明脑脊液IL-8、IFN-γ水平对TBM有一定的诊断价值,可用于患者的治疗效果评估及预后判断。

Objective To observe the dynamic changes of IL- 8 and IFN-γ in cerebrospinal fluid （CSF） of tuberculous meningitis （TBM） , and to investigate their significance for the diagnosis and prognosis of TBM. Methods The subjects enrolled in this study were 30 inpatients with TBM （TBM group）, 30 inpatients with viral meningitis （viral meningitis group）, 30 inpatients with noninfectious neurologie diseases （noninfectious neurologie diseases group） treated in Lanzhou University Second Hospital from December 2014 to August 2016. There were 12 patients of stage Ⅰ , 11 patients of stage Ⅱ , 7 patients of stage Ⅲ in the TBM group. The changes of IL - 8, IFN - γ levels in CSF of TBM group before antitubereulosis treatment, 1 week and 2 weeks after antitubereulosis treatment were analyzed. The IL - 8 and IFN -γ levels in CSF of TBM group before antitubereulosis treatment, viral meningitis group and noninfectious neurologic diseases group before treatment were compared. The relation between the level of IL- 8 and IFN-γ in CSF and the severity of the disease in TBM group was analyzed. Results The levels of IL-8 in CSF 1 week after antituberculosis treatment （ t = 15. 710, P 〈 0. 001 ） and 2 weeks after antituberculosis treatment （t = 21. 268, P 〈0. 001 ） were significantly lower than those before antituberculosis treatment in TBM group ; the levels of IL - 8 in CSF 2 weeks after antitubereulosis treatment were significantly lower than those 1 week after antituberculosis treatment in TBM group （ t = 12. 554, P 〈 0. 001 ） . The levels of IFN-γ in CSF 1 week after antitubereulosis treatment （t = 10. 793, P 〈0. 001 ） and 2 weeks after antituberculosis treatment （ t = 14. 357, P 〈0. 001 ） were lower compared with those before antitubereulosis treatment in TBM group; the levels of IFN-γ in CSF 2 weeks after antitubereulosis treatment were lower compared with those 1 week after antituberculosis treatment in TBM group （ t = 17. 979, P 〈 0. 001 ） . The levels of IL - 8 and IFN-γ in CSF of TBM group before antituberculosis treatment were significantly higher than those of viral meningitis group and noninfectious neurologic diseases group before treatment （ P 〈 0. 05 ）, and the levels of IL - 8 and IFN - 7 in CSF of viral meningitis group before treatment were significantly higher than those of noninfectious neurologic diseases group before treatment （P〈0.05） .Thelevel ofIL-8 （rs =0.509, P=0.004） and that ofIFN-7 （rs =0-665, P〈0.001） in CSF were positively correlated with the severity of TBM in TBM group. Conclusion Both the levels of IL - 8 and IFN - γ in CSF of TBM group gradually decrease with the progress of treatment, and they are positively related to the TBM stage, so they may be used as the predictors for the assessment of the response rate and prognosis of the disease.