新疆急慢性布鲁菌病患者炎性细胞因子免疫水平研究

Inflammatory cytokine immunity in patients with acute and chronic brucellosis in Xinjiang

目的探讨新疆急、慢性布鲁菌病患者细胞因子(IL-4、IL-6、IL-10、IL-17、TNF-α、INF-γ)、炎性因子(PCT、hs-CRP)及RF、ESR、ASO、血培养的临床诊断意义。方法对布鲁菌病住院患者(病例组)和正常对照人群(对照组)采用多重微球流式免疫荧光发光法和生化等技术检测多种细胞因子及炎性因子,并进行统计学分析。结果病例组和对照组IL-4、IL-6、IL-10、IL-17、TNF-α和IFN-γ分别为2.74(0.97~6.25)和0.56(0.53~0.64)、34.10(13.05~60.8)和0.78(0.41~2.52)、1.83(1.15~2.75)和0.89(0.77~1.13)、6.77(2.48~13.74)和1.03(0.68~1.20)、35.23(5.79~74.98)和1.33(0.80~2.17)、212.96(42.3~436.72)pg/mL和1.69(1.36~1.89)pg/mL,病例组明显高于对照组,差异均有统计学意义(P<0.05)。急性组和慢性组IL-6、IL-10、IL-17、TNF-α、IFN-γ分别为65.32(36.27~68.60)和29.38(11.30~53.09)、2.38(1.51~3.34)和0.89(0.77~1.13)、11.98(3.92~16.49)和5.27(2.24~12.49)、50.88(16.59~96.69)和28.24(5.30~64.40)、319.00(145.14~588.52)pg/mL和160.52(36.5~418.54)pg/mL,PCT和hs-CRP分别为0.08(0.06~0.12)pg/mL和0.04(0.03~0.06)pg/mL、12.60(5.0~30.8)mg/L和3.30(1.2~16.2)mg/L,差异均有统计学意义(P<0.05);低抗体滴度组和高抗体滴度组IL-6、PCT、hs-CRP、RF、ESR、血培养阳性率分别为30.46(11.30~50.02)pg/mL和46.20(17.72~79.69)pg/mL、0.04(0.03~0.06)pg/mL和0.07(0.04~0.11)pg/mL、3.03(0.85~9.70)mg/L和13.65(2.97~31.43)mg/L、3.0(0.8~9.7)IU/mL和13.6(3.0~31.4)IU/mL、15(7~31)mm/h和27(15~46)mm/h、15.3%和33.3%,差异均有统计学意义(P<0.05)。单因素分析显示6种细胞因子均为布鲁菌病患病程度的危险因素,多因素Logistic回归分析显示IL-6和INF-γ水平是布鲁菌病患病程度的独立危险因素。结论IL-4、IL-6、IL-10、IL-17、TNF-α、IFN-γ及PCT、hs-CRP等指标不仅能及时准确反映布鲁杆菌感染发病程度和临床分期的免疫状况,而且IL-6和INF-γ表达水平具有独立的临床诊断评估作用,血培养在急性期或高滴度组具有重要的临床诊断价值。

Objective To investigate the cytokines IL-4,IL-6,IL-10,IL-17,TNF-α,INF-γ,and inflammatory factors PCT,hs-CRP and related factors RF,ESR,ASO,and blood culture in patients with acute and chronic brucellosis in Xinjiang.Methods Blood culture,sputum red plate,and test tube agglutination test were used to diagnose patients with Brucellosis(case group)and normal controls(control group).Experimental tests were performed using multiple microsphere flow immunofluorescence and biochemical techniques.Various cytokine and inflammatory factor indicators were analyzed using Stata 15.0 software.Results IL-6,IL-4,IL-10,IL-17,TNF-αand IFN-γin the case group and the control group,were 2.74(0.97-6.25)vs 0.56(0.53-0.64),34.10(13.05-60.8)vs 0.78(0.41-2.52),1.83(1.15-2.75)vs 0.89(0.77-1.13),6.77(2.48-13.74)vs 1.03(0.68-1.20),35.23(5.79-74.98)vs 1.33(0.80-2.17),212.96(42.3-436.72)pg/mL vs 1.69(1.36-1.89)pg/mL,and these factors in the case group were significantly higher than in the control group(P<0.05).IL-6,IL-10,IL-17,TNF-αand IFN-γin the acute and chronic groups were 65.32(36.27-68.60)vs 29.38(11.30-53.09),2.38(1.51-3.34)vs 0.89(0.77-1.13),11.98(3.92-16.49)vs 5.27(2.24-12.49),50.88(16.59-96.69)vs 28.24(5.30-64.40),319.00(145.14-588.52)pg/mL vs 160.52(36.5-418.54)pg/mL,respectively,PCT and hs-CRP were 0.08(0.06-0.12)pg/mL vs 0.04(0.03-0.06)pg/mL,12.60(5.0-30.8)mg/L vs 3.30(1.2-16.2)mg/L,respectively,with statistically significant differences(P<0.05).IL-6,PCT,hs-CRP,RF,ESR and the positive rates of blood culture in the low antibody titer group and the high antibody titer group were 30.46(11.30-50.02)pg/mL vs 46.20(17.72-79.69)pg/mL,0.04(0.03-0.06)pg/mL vs 0.07(0.04-0.11)pg/mL,3.03(0.85-9.70)mg/L vs 13.65(2.97-31.43)mg/L,3.0(0.8-9.7)IU/mL vs 13.6(3.0-31.4)IU/mL,15(7-31)mm/h vs 27(15-46)mm/h,15.3%vs 33.3%,respectively,the differences were statistically significant(P<0.05).Univariate analysis showed that all 6 cytokines were risk factors for brucellosis,and multivariate Logistic regression analysis showed that IL-6 and INF-γlevels were independent risk factors for brucellosis.Conclusion IL-4,IL-6,IL-10,IL-17,TNF-α,IFN-γ,and PCT,hs-CRP and other indicators can not only accurately and timely reflect the incidence and clinical significance of Brucella infection.Staged immune status,and IL-6 and INF-γexpression levels have independent clinical diagnostic evaluation.Blood culture has important clinical diagnostic value in the acute phase or high titer group.