可溶性Tim-3及Galectin-9在结核性脑膜炎患者脑脊液中的表达及意义

Expression and significance of soluble Tim-3 and Galectin-9 in cerebrospinal fluid of tuberculous meningitis patients

目的探讨可溶性T细胞免疫球蛋白黏蛋白分子-3(Tim-3)及半乳糖凝集素-9(Galectin-9)在结核性脑膜炎患者脑脊液中的表达及意义。方法选择该院收治的结核性脑膜炎患者86例为病例组,选择同期以头痛症状为主,但神经系统查体、脑脊液及相关辅助检查均正常的患者76例为对照组,测定两组研究对象脑脊液Tim-3、Galectin-9、白细胞介素(IL)-2、IL-4、IL-8、IL-10、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、早期分泌性靶抗原6(ESAT-6)水平,并进行比较,分析Tim-3、Galectin-9与其他指标的相关性。结果病例组Tim-3、Galectin-9、IL-2、IL-4、IL-8、IL-10、TNF-α、hs-CRP、ESAT-6水平高于对照组,IFN-γ水平低于对照组,差异均有统计学意义(P<0.05);Tim-3、Galectin-9与IL-2、IL-4、IL-8、IL-10、TNF-α、hs-CRP、ESAT-6呈正相关(P<0.05),与IFN-γ呈负相关(P<0.05);高水平的Tim-3、Galectin-9、ESAT-6均为结核性脑膜炎患者发生死亡事件的危险因素(P<0.05);Tim-3、Galectin-9单独检测诊断结核性脑膜炎的灵敏度、特异度相近,差异无统计学意义(P>0.05),均小于Tim-3联合Galectin-9,差异有统计学意义(P<0.05)。结论结核性脑膜炎患者脑脊液中Tim-3、Galectin-9水平升高,高水平的Tim-3、Galectin-9可能与核性脑膜炎病情严重程度关系密切;Tim-3与Galectin-9联合诊断结核性脑膜炎具有较高的灵敏度、特异度,值得在临床上推广应用。

Objective To investigate the expression and significance of soluble T cell immunoglobulin domain and mucin domain protein-3(Tim-3)and Galectin-9 in cerebrospinal fluid of tuberculous meningitis.Methods A total of 86 cases of tuberculous meningitis(case group)and 76 cases of headache patients with normal neurological signs and cerebrospinal fluid(control group)in Xiaogan Central Hospital during the same period were selected.The levels of Tim-3,Galectin-9,interleukin(IL)-2,IL-4,IL-8,IL-10,interferon(IFN)-γ,tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)and early secretory target antigen 6(ESAT-6)in the cerebrospinal fluid were measured.Results The levels of Tim-3,Galectin-9,IL-2,IL-4,IL-8,IL-10,TNF-α,hs-CRP,ESAT-6 in case group were higher than those in control group,meanwhile the IFN-γin case group was lower than that in control group,the differences were statistically significant(P<0.05).Tim-3,Galectin-9 had positive correlations with IL-2,IL-4,IL-8,IL-10,TNF-α,hs-CRP and ESAT-6,and had negative correlations with IFN-γ(P<0.05).High levels of Tim-3,Galectin-9 and ESAT-6 were risk factors for death of tuberculous meningitis(P<0.05).The sensitivity and specificity of Tim-3 and Galectin-9 in the diagnosis of tuberculous meningitis were similar(P>0.05),which were less than Tim-3 combined Galectin-9(P<0.05).Conclusion The high levels of Tim-3 and Galectin-9 in the cerebrospinal fluid of tuberculous meningitis patients might positively correlate with the severity of nuclear meningitis.The combined detection of Tim-3 and Galectin-9 has higher sensitivity and specificity in the diagnosis of tuberculous meningitis,which is worthy of clinical application.