血清CXC趋化因子受体3配体检测在活动性肺结核诊断中的价值

The value of serum CXC chemokine receptor 3 ligands in the diagnosis of active pulmonary tuberculosis

目的评估CXC趋化因子受体3(CXCR3)配体在活动性肺结核诊断中的应用价值。方法搜集2018年3—12月就诊于河北省胸科医院的活动性肺结核(PTB组)患者106例(其中痰涂片抗酸染色阴性组31例,痰涂片抗酸染色+^++组39例,痰涂片抗酸染色+++^++++组36例),肺部恶性肿瘤(PMT组)患者89例(其中小细胞肺癌12例,腺癌37例,鳞癌35例,大细胞癌3例,神经内分泌癌2例),其他肺部良性疾病(PBD组)患者82例(支气管扩张继发感染36例,肺脓肿13例,真菌感染15例,支原体感染12例,错构瘤6例),健康对照(HC)组90例作为研究对象。采用酶联免疫吸附试验测定各组血清γ干扰素(interferon-γ,IFN-γ)和CXCR3配体[IFN-γ诱导的单核因子(CXCL9),γ干扰素诱导蛋白10(CXCL10),干扰素诱导的T细胞α趋化剂(CXCL11)]水平。结果PTB组CXCL9、CXCL10、CXCL11的含量[650.28(220.00,881.21)pg/ml;390.00(200.05,500.29)pg/ml;150.33(80.12,320.00)pg/ml]分别与PMT组[120.21(33.50,244.28)pg/ml;58.00(30.25,85.56)pg/ml;35.52(20.27,44.50)pg/ml]比较,差异均有统计学意义(χ^2值分别为124.21,155.03,118.68;P值均为0.000);与PBD组[45.52(15.25,86.55)pg/ml;55.56(26.75,86.28)pg/ml;31.53(20.50,45.25)pg/ml]比较,差异均有统计学意义(χ^2值分别为194.93,159.84,124.71;P值均为0.000);与HC组[50.11(28.32,81.22)pg/ml;50.28(32.27,70.62)pg/ml;11.46(5.28,30.39)pg/ml]比较,差异均有统计学意义(χ^2值分别为184.68,183.53,208.18;P值均为0.000)。PTB组IFN-γ[13.00(8.50,18.25)pg/ml]与PMT组[15.11(8.50,18.00)pg/ml]比较,差异无统计学意义(χ^2=10.05,P=0.509);与PBD组[13.02(9.90,18.28)pg/ml]相比,差异无统计学意义(χ^2=1.17,P=0.940);与HC组[10.86(7.01,12.00)pg/ml]相比,差异有统计学意义(χ^2=80.19,P=0.000)。PTB组血清CXCL9、CXCL10、CXCL11曲线下面积(AUC)分别为0.700,0.680,0.778。结论血清CXCR3配体可能有助于活动性肺结核的诊断,其中CXCL11和CXCL9较CXCL10评价作用更为突出。

Objective To evaluate the value of CXCR3 ligand in the diagnosis of active pulmonary tuberculosis.Methods 106 patients with active pulmonary tuberculosis(PTB)(including 31 patients with sputum smear acid-fast staining negative,39 patients with sputum smear acid-fast staining+^++,36 patients with sputum smear acid-fast staining+++^++++),89 patients with lung malignant tumors(PMT)(12 cases of small cell lung cancer,37 cases of adenocarcinoma,35 cases of squamous cell carcinoma,3 cases of large cell carcinoma and 2 cases of neuroendocrine carcinoma),82 patients with other pulmonary benign disease(PBD)(36 cases of secondary infection of bronchiectasis,13 cases of lung abscess,15 cases of fungal infection,12 cases of mycoplasma infection,6 cases of hamartoma),and 90 healthy controls(HC)were selected in Hebei Provincial Chest Hospital from March 2018 to December 2018.Serum interferon-γ(IFN-γ)and CXCR3 ligands(IFN-γinduced mononuclear factor(CXCL9),IFN-γ-inducible protein 10(CXCL10),and IFN-inducible T-cellαchemoattractant(CXCL11))were determined by ELISA.Results The contents of CXCL9,CXCL10 and CXCL11 in PTB group were(650.28(220.00,881.21)pg/ml,390.00(200.05,500.29)pg/ml,150.33(80.12,320.00)pg/ml)which had statistical significance when compared with those(120.21(33.50,244.28)pg/ml,58.00(30.25,85.56)pg/ml,35.52(20.27,44.50)pg/ml)in PMT group(χ^2 values were 124.21,155.03,118.68;P values were 0.000),and compared with those(45.52(15.25,86.55)pg/ml,55.56(26.75,86.28)pg/ml,31.53(20.50,45.25)pg/ml)in PBD group(χ^2 values were 194.93,159.84,124.71;P values were 0.000),and compared with those(50.11(28.32,81.22)pg/ml,50.28(32.27,70.62)pg/ml,11.46(5.28,30.39)pg/ml)in HC group(χ^2 values were 184.68,183.53,208.18;P values were 0.000).IFN-γin PTB group(13.00(8.50,18.25)pg/ml)had no statistical significance when compared with those(15.11(8.50,18.00)pg/ml)in PMT group(χ^2=10.05,P=0.509),and compared with those(13.02(9.90,18.28)pg/ml)in PBD group(χ^2=1.17,P=0.940).IFN-γin PTB group had statistical significance compared with those(10.86(7.01,12.00)pg/ml)in HC group(χ^2=80.19,P=0.000).The area under curves(AUC)of CXCL9,CXCL10 and CXCL11 were 0.700,0.680 and 0.778 in PTB group respectively.Conclusion Serum CXCR3 ligands may be helpful in the diagnosis of active pulmonary tuberculosis,especially CXCL11 and CXCL9 are more prominent than CXCL10.